The role of stress in the onset of depressive disorders

Background: We conducted the present study to evaluate the impact of stressful events on the onset of depressive disorders in a Spanish clinical sample, compared to a control group matched for age, sex, civil status and social class. We compared our results with those of other studies carried out with samples that were both clinically and culturally similar to ours. Method: Fifty depressed patients that were diagnosed with a depressive episode in the 6 months prior to the interview and 50 healthy controls were included in the study. Both groups were compared on the “Life Events and Difficulties Schedule” (LEDS). Results: Of the depressive patients, 68 % compared to only 18 % of the control individuals experienced at least one provoking agent in the 12 months prior to the onset of the symptoms. The risk of developing a depressive disorder was 9.7 % greater in subjects exposed to such provoking agents. Chronic difficulties are equally important to the genesis of depressive disorders as severe life events. No significant differences were seen between the two diagnostic subgroups of depressed patients in the accumulation of severe events, major difficulties or provoking agents. Conclusion: The results support the view that stress is a major factor in the aetiology of depressive disorders. The amount of stress suffered by the patients, however, was less than that found in our healthy sample. Important issues about the model of interaction between stress and depression are discussed. Accepted: 29 July 2002 Correspondence to L. Rojo     

Exploring ADHD age-of-onset criterion in Brazilian adolescents

 Objective: To explore age-of-onset criterion for the diagnosis of attention–deficit hyperactivity disorder (ADHD) in a school sample of young Brazilian adolescents. Methods: 191 students aged 12 to 14 years were evaluated using DSM-IV ADHD criteria, measures of ADHD symptoms and global impairment. Results: Both adolescents with ADHD (n=30) and adolescents who fulfilled all DSM-IV ADHD criteria, except age of onset of impairment criterion (ADHD w/o age-of-onset, n=27) had significantly higher scores on Attention Problems, Delinquent and Aggressive Behavior scales of the Child Behavior Checklist (CBCL) and lower scores on the Child Global Assessment scale (CGAS) than non-ADHD adolescents (n=134). Adolescents with ADHD and youths with ADHD w/o age-of-onset did not differ significantly in any measure assessed. Conclusion: These results concur with recent literature proposing revision of the age-of-onset criterion for the diagnosis of ADHD. Accepted: 22 February 2000     

Cross-cultural differences in the conceptualisation of patients' satisfaction with psychiatric services

Background: The VSSS is a multi-dimensional questionnaire developed to address methodological concerns about measurement of satisfaction with services on the part of psychiatric patients. The acceptability, sensitivity, content validity and test-retest reliability of the original version of the VSSS, in Italian, have already been demonstrated [1, 2]. The internal consistency [3] and test-retest reliability [4] of the English translation have been shown to be within acceptable ranges. The content validity of the original 82-item and the 54-item English version has not yet been assessed. Aims: The aims of this study were to assess the content validity of the English translation of the VSSS and to compare it with that of the original version in Italian. Method: We used data collected as part of the first wave (T1) of the PRiSM Psychosis Study [5] and repeated the methods used to assess the content validity of the original Italian version of the VSSS [1, 2]. Content elements derived from answers to four open questions were rated independently by CH and HH in terms of their equivalence to VSSS items or dimensions. Results: were compared to those from the content validity study of the Italian version. Results Inter-rater agreement was very high. The largest proportion of the content elements of the answers were rated as equivalent or related to a questionnaire item or a dimension of the VSSS. The dimension ‘Professionals' Skills and Behaviour’ appears the most significant contributor to satisfaction, as it was most often related to content elements in answers to all four key questions (39.1 %). The second most frequently mentioned dimension was that of ‘Types of Intervention’ for three out of four open questions, while ‘Access’ was second most frequent for the fourth. Of the content elements, 17.2 % did not include items or dimensions covered by the VSSS; the three most frequently mentioned were other patients, food and security. Conclusions: The 82-item English version of the VSSS captures sharply most contents relevant to patients' satisfaction. Consideration of contributors to satisfaction so far neglected may refine the conceptualisation of satisfaction. Accepted: 2 September 2002 Correspondence to Claire Henderson     

Coping by Redefinition: Cognitive Appraisals in Mothers of Children with Autism and Children Without Autism

To test a model of how mothers cope with the stresses of raising a child with autism (Tunali & Power, 1993), mothers of children with and without autism were interviewed. As predicted, mothers of autistic children: (1) placed less emphasis on career success and were more likely to believe that mothers of young children should not work outside of the home; (2) spent more leisure time with their extended family; (3) placed less emphasis on others' opinions of their child's behavior; (4) placed more emphasis on spousal support and parental roles in their discussions of marriage; (5) had more difficulty understanding their child's behavior; and (6) showed a marginally significant difference in their tolerance of ambiguity. Moreover, mothers of children with autism who showed these characteristics had the greatest life satisfaction overall.     

Behavioural and emotional problems in children of alcoholic mothers and fathers

 The Child Behavior Check List (CBCL) was used to compare a sample of 103 Danish children of alcoholics (CoA) to a Danish population-based sample (N = 780). The CoA had a significantly greater incidence of symptoms on 17 of the 118 CBCL items. Compared to the reference population, daughters of alcoholics were more impaired than sons of alcoholics on most CBCL measures. In families with maternal alcoholism daughters had higher internalising and depression scores than sons, and in families with paternal alcoholism, sons had higher internalising and depression scores than daughters. The CoA also had a significantly greater risk of scoring above the 95th percentile on internalising behaviour, depression symptoms and socially deviant behaviour. On all CBCL dimensions, almost half of the CoA samples functioned as well as the average of the reference population. The results from this study suggest that CoA should be regarded as a risk group but with very heterogeneous consequences in response to parental alcoholism. Accepted: 29 November 1999     

Self-reported competencies and problems among Swedish adolescents: a normative study of the YSR. Youth Self Report

The aim of the study was to provide a standardisation of self-reported competencies and emotional/behavioural problems among Swedish adolescents, using the Youth Self-Report (YSR). The YSR was completed by 2522 adolescents aged 13–18 years, recruited from secondary and upper secondary schools in different regions in Sweden. The results showed that effects of gender and age were small but significant with girls scoring higher than boys on most problem scales, and 15- to 16-year-olds scoring higher than younger and older adolescents on the problem scales. Small effects were also found for residence as well as for parental SES. The correlations between internalising and externalising problems were 0.51 for boys and 0.49 for girls, whereas the correlation between competence and problem scores was low. We conclude that the individual variation in YSR-scores is much greater than can be attributed to factors such as gender, age, SES, or residential area. Consequently, the YSR has the potential to serve as an instrument for assessing individual adolescents' self-reported competencies and problems in Sweden. Given the almost orthogonal relation between self-reported competencies and problems, the competence scale is surprisingly little used in psychopathology research. Accepted: 10 January 2001     

Posttraumatic stress disorder in children after the military operation "Anfal" in Iraqi Kurdistan

 Five years after the military operation “Anfal” in Iraqi Kurdistan, 45 families were randomly selected among the survivors in two displacement camps. The Posttraumatic Stress Symptoms for Children (PTSS-C) and the Harvard Trauma Questionnaire (HTQ) were administered to the oldest child and the caregiver in each family, respectively. Posttraumatic stress disorder (PTSD) was reported in 87% of children and 60% of their caregivers. While childhood PTSD was only significantly predicted by child trauma score and the duration of captivity, it was neither predicted by maternal PTSD nor did it disappear after the reunion with the PTSD-free father. However, the small sample size makes the results hypotheses rather than conclusive. Accepted: 17 April 2000     

Reliability and validity of a child-specific cross-cultural instrument for assessing posttraumatic stress disorder

 The Posttraumatic Stress Symptoms in Children (PTSS-C) was developed as a cross-cultural semi-structured interview to diagnose posttraumatic stress disorder (PTSD) and to identify PTSD-non-related posttraumatic stress symptoms in children after various traumatic experiences. The psychometric properties were studied in two different child populations in Iraqi Kurdistan (the survivors of the military operation “Anfal”, and the orphans), in a sample of Kurdistanian refugee children in Sweden, and in a comparison sample of Swedish children. The instrument yielded satisfactory internal consistency, high interrater agreement, and excellent validity on cross-validation with the Child Posttraumatic Stress Disorder Reaction Index (CPTSD-RI) and the Diagnostic Interview for Children and Adolescents (DICA) according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Accepted: 14 March 2000     

Undertreatment of Motor Problems in Children with ADHD

Background: Motor problems occur in 30% to 50% of children with ADHD, and have a severe impact on daily life. In clinical practice there seems to be little attention for this comorbidity with the possible consequence that these motor problems go undertreated. Method: Clinical interview and questionnaire survey of treatment by physiotherapy and factors predicting treatment of motor problems in 235 children with ADHD and 108 controls. Results: Half of motor‐affected children had received physiotherapy. Treated children had more severe motor problems, and less frequently presented with comorbid anxiety and conduct disorder. Treated and untreated children were similar in age, and rated similarly on ADHD inattentive and hyperactive‐impulsive scales and parental socio‐economic status. Conclusion: Currently, undertreatment of motor problems in ADHD occurs. Behavioural factors play a role in referral and intervention.