http://www.capmh.com The latest research articles published by Child and Adolescent Psychiatry and Mental Health 2012-05-20T00:00:00Z Background: Clinical studies have shown that children of parents with mental health problems are most likely to develop psychiatric problems themselves when their parents have a Personality Disorder characterized by hostility. The Personality Disorders that appear most associated with hostility, with the potential to affect children, are Borderline Personality Disorder, Antisocial Personality Disorder and Narcissistic Personality Disorder. The question addressed in this study is whether the risk to children's mental health extends to the normal population of parents who have subclinical symptomlevels of these disorders. Methods: This inquiry used data from a Trondheim, Norway community sample of 922 preschoolers and one parent for each child. The mean age of the children was 53 months (SD 2.1). Parents reported symptoms of Borderline, Antisocial and Narcissistic Personality Disorders on the DSM-IV ICD-10 Personality Questionnaire, and the children's symptoms of DSM-IV behavioral and emotional diagnoses were measured with the Preschool Age Psychiatric Assessment, a comprehensive interview. Multigroup Structural Equation Modeling was used to assess the effect of parents' symptoms on their preschoolers' behavioral and emotional problems. Results: The analyses yielded strongly significant values for the effect of parents' Personality Disorder symptoms on child problems, explaining 13.2% of the variance of the children's behavioral symptoms and 2.9% of the variance of internalizing symptoms. Biological parents' cohabitation status, i.e., whether they were living together, emerged as a strong moderator on the associations between parental variables and child emotional symptoms; when parents were not cohabiting, the variance of the children's emotional problems explained by the parents' Personality Disorder symptoms increased from 2.9% to 19.1%. Conclusions: For the first time, it is documented that parents' self-reported symptoms of Borderline, Antisocial, and Narcissistic Personality Disorders at a predominantly subclinical level had a strong effect on their children's psychiatric symptoms, especially when the biological parents were not living together. Child service providers need to be aware of these specific symptoms of parental Personality Disorders, which may represent a possible risk to children. http://www.capmh.com/content/6/1/19 Turid Suzanne Berg-Nielsen Lars Wichstrom Child and Adolescent Psychiatry and Mental Health 2012, null:19 2012-05-20T00:00:00Z doi:10.1186/1753-2000-6-19 /content/figures/1753-2000-6-19-toc.gif Child and Adolescent Psychiatry and Mental Health 1753-2000 ${item.volume} 19 2012-05-20T00:00:00Z PDF Background: Although there has been some empirical research on ethics concerning the attitudes and approaches of staff in relation to adult patients, there is very little to be found on child and adolescent psychiatric care. In most cases researchers have defined which issues are important, for instance, coercive care. The aim of this study was to provide a qualitative description of situations and experiences that gave rise to ethical problems and considerations as reported by staff members on child and adolescent psychiatric wards, although they were not provided with a definition of the concept. Methods: The study took place in six child and adolescent psychiatric wards in Sweden. All staff members involved with patients on these wards were invited to participate. The staff members were asked to keep an ethical diary over the course of one week, and data collection comprised the diaries handed in by 68 persons. Qualitative content analysis was used in order to analyse the diaries. Results: In the analysis three themes emerged; 1) good care 2) loyalty and 3) powerlessness. The theme 'good care' contains statements about the ideal of commitment but also about problems living up to the ideal. Staff members emphasized the importance of involving patients and parents in the care, but also of the need for professional distance. Participants seldom perceived decisions about coercive measures as problematic, in contrast to those about pressure and restrictions, especially in the case of patients admitted for voluntary care. The theme 'loyalty' contains statements in which staff members perceived contradictory expectations from different interested parties, mainly parents but also their supervisor, doctors, colleagues and the social services. The theme 'powerlessness' contains statements about situations that create frustration, in which freedom of action is perceived as limited and can concern inadequacy in relation to patients and violations in the workplace. Conclusions: The ethical considerations described by child and adolescent psychiatric care staff are multifaceted and remarkably often concern problems of loyalty and organization. These problems frequently had a considerable influence on the care provided. It seems that staff members lack a language of ethics and require both an ethical education and a forum for discussion of ethical issues. http://www.capmh.com/content/6/1/18 Veikko Pelto-Piri Karin Engström Ingemar Engström Child and Adolescent Psychiatry and Mental Health 2012, null:18 2012-05-08T00:00:00Z doi:10.1186/1753-2000-6-18 /content/figures/1753-2000-6-18-toc.gif Child and Adolescent Psychiatry and Mental Health 1753-2000 ${item.volume} 18 2012-05-08T00:00:00Z PDF Background: Children living in socioeconomic disadvantage are at risk of poor mental health outcomes. In order to focus and evaluate population health programs to facilitate children's resilience, it is important to accurately assess baseline levels of functioning. With this end in mind, the aim of this study was to test the utility of 1) a voluntary random sampling method and 2) quantitative measures of adaptation (with national normative data) for assessing the resilience of children in an identified community. Methods: This cross-sectional study utilized a sample of participants (N = 309), including parents (n = 169), teachers (n = 20) and children (n = 170; age range = 5-16 years), recruited from the schools in Tenterfield; a socioeconomically disadvantaged community in New South Wales, Australia. The Strengths and Difficulties Questionnaire (SDQ; including parent, teacher and youth versions) was used to measure psychological well-being and pro-social functioning, and NAPLAN results (individual children's and whole school's performance in literacy and numeracy) were used to measure level of academic achievement. Results: The community's disadvantage was evident in the whole school NAPLAN performance but not in the sample's NAPLAN or SDQ results. The teacher SDQ ratings appeared to be more reliable than parent's ratings. The voluntary random sampling method (requiring parental consent) led to sampling bias. Conclusions: The key indicators of resilience - psychological well-being, pro-social functioning and academic achievement - can be measured in whole communities using the teacher version of the SDQ and whole school results on a national test of literacy and numeracy (e.g., Australia's NAPLAN). A voluntary random sample (dependent upon parental consent) appears to have limited value due to the likelihood of sampling bias. http://www.capmh.com/content/6/1/17 Debra Dunstan Anna Todd Child and Adolescent Psychiatry and Mental Health 2012, null:17 2012-05-04T00:00:00Z doi:10.1186/1753-2000-6-17 /content/figures/1753-2000-6-17-toc.gif Child and Adolescent Psychiatry and Mental Health 1753-2000 ${item.volume} 17 2012-05-04T00:00:00Z PDF Background: It is estimated that world-wide up to 20 % of children suffer from debilitating mental illness. Mental disorders that pose a significant concern include learning disorders, hyperkinetic disorders (ADHD), depression, psychosis, pervasive development disorders, attachment disorders, anxiety disorders, conduct disorder, substance abuse and eating disorders. Living with such children can be very stressful for caregivers in the family. Therefore, determination of challenges of living with these children is important in the process of finding ways to help or support caregivers to provide proper care for their children. The purpose of this study was to explore the psychological and emotional, social, and economic challenges that parents or guardians experience when caring for mentally ill children and what they do to address or deal with them.MethodologyA qualitative study design using in-depth interviews and focus group discussions was applied. The study was conducted at the psychiatric unit of Muhimbili National Hospital in Tanzania. Two focus groups discussions (FGDs) and 8 in-depth interviews were conducted with caregivers who attended the psychiatric clinic with their children. Data analysis was done using content analysis. Results: The study revealed psychological and emotional, social, and economic challenges caregivers endure while living with mentally ill children. Psychological and emotional challenges included being stressed by caring tasks and having worries about the present and future life of their children. They had feelings of sadness, and inner pain or bitterness due to the disturbing behaviour of the children. They also experienced some communication problems with their children due to their inability to talk. Social challenges were inadequate social services for their children, stigma, burden of caring task, lack of public awareness of mental illness, lack of social support, and problems with social life. The economic challenges were poverty, child care interfering with various income generating activities in the family, and extra expenses associated with the child's illness. Conclusion: Caregivers of mentally ill children experience various psychological and emotional, social, and economic challenges. Professional assistance, public awareness of mental illnesses in children, social support by the government, private sector, and non-governmental organizations (NGOs) are important in addressing these challenges. http://www.capmh.com/content/6/1/16 Joel Seme Ambikile Anne Outwater Child and Adolescent Psychiatry and Mental Health 2012, null:16 2012-05-04T00:00:00Z doi:10.1186/1753-2000-6-16 /content/figures/1753-2000-6-16-toc.gif Child and Adolescent Psychiatry and Mental Health 1753-2000 ${item.volume} 16 2012-05-04T00:00:00Z PDF Background: Post-traumatic stress disorder (PTSD) is diagnosed in 20% to 53% of sexually abused children and adolescents. Living with PTSD is associated with a loss of health-related quality of life. Based on the best available evidence, the NICE Guideline for PTSD in children and adolescents recommends cognitive behavioural therapy (TF-CBT) over non-directive counselling as a more efficacious treatment. Methods: A modelled economic evaluation conducted from the Australian mental health care system perspective estimates incremental costs and Quality Adjusted Life Years (QALYs) of TF-CBT, TF-CBT combined with selective serotonin reuptake inhibitor (SSRI), and non-directive counselling. The "no treatment" alternative is included as a comparator. The first part of the model consists of a decision tree corresponding to 12 month follow-up outcomes observed in clinical trials. The second part consists of a 30 year Markov model representing the slow process of recovery in non-respondents and the untreated population yielding estimates of long-term quality-adjusted survival and costs. Data from the 2007 Australian Mental Health Survey was used to populate the decision analytic model. Results: In the base-case and sensitivity analyses, incremental cost-effectiveness ratios (ICERs) for all three active treatment alternatives remained less than A$7,000 per QALY gained. The base-case results indicated that non-directive counselling is dominated by TF-CBT and TF-CBT + SSRI, and that efficiency gain can be achieved by allocating more resources toward these therapies. However, this result was sensitive to variation in the clinical effectiveness parameters with non-directive counselling dominating TF-CBT and TF-CBT + SSRI under certain assumptions. The base-case results also suggest that TF-CBT + SSRI is more cost-effective than TF-CBT. Conclusion: Even after accounting for uncertainty in parameter estimates, the results of the modelled economic evaluation demonstrated that all psychotherapy treatments for PTSD in sexually abused children have a favourable ICER relative to no treatment. The results also highlighted the loss of quality of life in children who do not receive any psychotherapy. Results of the base-case analysis suggest that TF-CBT + SSRI is more cost-effective than TF-CBT alone, however, considering the uncertainty associated with prescribing SSRIs to children and adolescents, clinicians and parents may exercise some caution in choosing this treatment alternative. http://www.capmh.com/content/6/1/15 Elena Gospodarevskaya Leonie Segal Child and Adolescent Psychiatry and Mental Health 2012, null:15 2012-04-10T00:00:00Z doi:10.1186/1753-2000-6-15 /content/figures/1753-2000-6-15-toc.gif Child and Adolescent Psychiatry and Mental Health 1753-2000 ${item.volume} 15 2012-04-10T00:00:00Z PDF Non-suicidal self-injury (NSSI) among adolescents is gaining increasing attention in both clinical and scientific arenas. The lifetime prevalence of NSSI is estimated to vary between 7.5% to 8% for preadolescents, and increasing to between 12% and 23% for adolescents. Despite the prevalence and the increasing interest in NSSI, few psychotherapeutic treatments have been designed specifically for NSSI, and no treatments have been evaluated specifically for the treatment of NSSI among adolescents. Consequently, child and adolescent clinicians are left with little evidence-based guidance for treating this challenging population. To provide some guidance, evaluations of treatments for adults with NSSI and for adolescents with related conditions, such as deliberate self-harm and borderline personality disorder, are reviewed. Clinical guidelines and resources are also discussed to assist with the gaps in the knowledge base for treatment of NSSI among adolescents. http://www.capmh.com/content/6/1/14 Jason Washburn Sarah Richardt Denise Styer Michelle Gebhardt K Juzwin Adrienne Yourek Delia Aldridge Child and Adolescent Psychiatry and Mental Health 2012, null:14 2012-03-30T00:00:00Z doi:10.1186/1753-2000-6-14 /content/figures/1753-2000-6-14-toc.gif Child and Adolescent Psychiatry and Mental Health 1753-2000 ${item.volume} 14 2012-03-30T00:00:00Z PDF Non-suicidal self-injury (NSSI) content and related e-communication have proliferated on the Internet in recent years. Research indicates that many youth who self-injure go online to connect with others who self-injure, view others' NSSI experiences, and share their own through text and videos platforms. Although there are benefits to these behaviours in terms of receiving peer support, these activities can introduce these young people to risks, including NSSI reinforcement through the sharing of stories and strategies as well as risks for triggering NSSI urges. Due to the nature of these risks, mental health professionals need to know about them and how to effectively assess adolescents' online activity in order to adequately monitor the effects of the purported benefits and risks associated with NSSI content. This article offers research informed clinical guidelines for the assessment, intervention, and monitoring of online NSSI activities. To help bridge the gap between youth culture and mental health culture, these essentials include descriptions of Community, Social Networking, and Video/Photo Sharing websites and the terms associated with these websites. Assessment of these behaviours can be facilitated by a basic Functional Assessment approach that is further informed using specific recommended online questions tailored to NSSI online and an assessment of the frequency, duration, and time of day of the online activities. Intervention in this area should initially assess readiness for change and use motivational interviewing to encourage substitution of healthier online activities for the activities that may currently foster harm. http://www.capmh.com/content/6/1/13 Stephen Lewis Nancy Heath Natalie Michal Jamie Duggan Child and Adolescent Psychiatry and Mental Health 2012, null:13 2012-03-30T00:00:00Z doi:10.1186/1753-2000-6-13 /content/figures/1753-2000-6-13-toc.gif Child and Adolescent Psychiatry and Mental Health 1753-2000 ${item.volume} 13 2012-03-30T00:00:00Z PDF Background: Non-suicidal self-injury (NSSI) is a common concern among hospitalized adolescents, and can have significant implications for short and long-term prognosis. Little research has been devoted on how personality features in severely ill adolescents interact with NSSI and "attitude toward life and death" as a dimension of suicidality. Developing more specific assessment methodologies for adolescents who engage in self-harm without suicidal intent is relevant given the recent proposal of a non-suicidal self-injury (NSSI) disorder and may be useful in predicting risk in psychiatrically impaired subjects. Methods: Consecutively hospitalized adolescents in a psychiatric unit (N = 52; 71% females; age 12-19 years), reporting at least one recent episode of self-harm according to the Deliberate Self-harm Inventory, were administered the Structured Clinical Interview for DSM Mental Disorders and Personality Disorders (SCID I and II), the Children's Depression Inventory and the Multi-Attitude Suicide Tendency Scale (MAST). Results: Mean age onset of NSSI in the sample was 12.3 years. All patients showed "repetitive" NSSI (high frequency of self-harm), covering different modalities. Results revealed that 63.5% of adolescents met criteria for Borderline Personality Disorder (BPD) and that the rest of the sample also met criteria for personality disorders with dysregulated traits. History of suicide attempts was present in 46.1% of cases. Elevated depressive traits were found in 53.8%. Results show a statistically significant negative correlation between the score on the "Attraction to Life" subscale of the MAST and the frequency and diversification of self-harming behaviors. Conclusions: Most adolescent inpatients with NSSI met criteria for emotionally dysregulated personality disorders, and showed a reduced "attraction to life" disposition and significant depressive symptoms. This peculiar psychopathological configuration must be addressed in the treatment of adolescent inpatients engaging in NSSI and taken into account for the prevention of suicidal behavior in self-injuring adolescents who do not exhibit an explicit intent to die. http://www.capmh.com/content/6/1/12 Mauro Ferrara Arianna Terrinoni Riccardo Williams Child and Adolescent Psychiatry and Mental Health 2012, null:12 2012-03-30T00:00:00Z doi:10.1186/1753-2000-6-12 Non-suicidal self-injury in adolescents Adolescent inpatients engaging in non-suicidal self-injury displayed criteria for emotionally dysregulated personality disorders, and showed a reduced 'attraction to life' disposition and significant depressive symptoms, suggesting clinicians also need to consider these additional variables. /content/figures/1753-2000-6-12-toc.gif Child and Adolescent Psychiatry and Mental Health 1753-2000 ${item.volume} 12 2012-03-30T00:00:00Z XML Although attempted suicide and non-suicidal self-injury (NSSI) are distinct behaviors differing in intent, form, and function, the behaviors co-occur at a high rate in both adults and adolescents. Researchers have begun to investigate the association between attempted suicide and NSSI among adolescents. The purpose of this paper is to present current research on this association. First, we discuss definitional issues associated with self-injurious behaviors. Next, we present research on the co-occurrence of attempted suicide and NSSI, including prevalence and associations with self-injury characteristics. We then discuss psychosocial variables associated with engaging in both NSSI and attempted suicide or one type of self-injury alone. Finally, we present the research to date on risk factors uniquely associated with either attempted suicide or NSSI. Implications for mental health professionals and future avenues of research are discussed. http://www.capmh.com/content/6/1/11 Margaret Andover Blair Morris Abigail Wren Margaux Bruzzese Child and Adolescent Psychiatry and Mental Health 2012, null:11 2012-03-30T00:00:00Z doi:10.1186/1753-2000-6-11 /content/figures/1753-2000-6-11-toc.gif Child and Adolescent Psychiatry and Mental Health 1753-2000 ${item.volume} 11 2012-03-30T00:00:00Z PDF Non-suicidal Self-Injury (NSSI) has received an increasing amount of attention over the last years. Although first papers on NSSI date back to the 1960s, it was not until 2002, that the first epidemiological study on adolescents was published, leading to a large body of research that has been growing ever since. Ten years after this seminal study, that showed a high prevalence of NSSI in a non-clinical population, we are discussing a new entity, which has been proposed to be included in the DSM V as Non-Suicidal Self-Injury Syndrome. This proposal was the result of seeing a growing number of adolescents, that did not fulfil the criteria for Borderline Personality disorder (the only diagnostic category in DSM IV and ICD-10 that listed NSSI as symptom), but were nevertheless distressed, in need of help and - as recent research showed - at risk for suicide. It has been discussed, whether a new diagnostic entity makes sense, especially with regards to suicide and the relationship between NSSI and suicidality. However, given the high prevalence of adolescents that "use" NSSI as emotional regulation "skill" and clearly distance themselves from suicidality, the inclusion in a classificatory systems seems to make sense in order to foster further treatment and research in an area, that causes a lot of distress in adolescents, research that within the next years will have to focus on trajectories and predictors, since the first promising longitudinal studies, reported specific risk factors and a strong decrease of prevalence in young adulthood, both of which needs to be understood more clearly in order to assist therapeutic approaches to treating NSSI. http://www.capmh.com/content/6/1/9 Paul Plener Joerg Fegert Child and Adolescent Psychiatry and Mental Health 2012, null:9 2012-03-30T00:00:00Z doi:10.1186/1753-2000-6-9 /content/figures/1753-2000-6-9-toc.gif Child and Adolescent Psychiatry and Mental Health 1753-2000 ${item.volume} 9 2012-03-30T00:00:00Z XML