Cross-national differences in questionnaires do not necessarily reflect comparable differences in disorder prevalence

Purpose

To examine whether the widely used Strengths and Difficulties Questionnaire (SDQ) can validly be used to compare the prevalence of child mental health problems cross nationally.

Methods

We used data on 29,225 5- to 16-year olds in eight population-based studies from seven countries: Bangladesh, Brazil, Britain, India, Norway, Russia and Yemen. Parents completed the SDQ in all eight studies, teachers in seven studies and youth in five studies. We used these SDQ data to calculate three different sorts of “caseness indicators” based on (1) SDQ symptoms, (2) SDQ symptoms plus impact and (3) an overall respondent judgement of ‘definite’ or ‘severe’ difficulties. Respondents also completed structured diagnostic interviews including extensive open-ended questions (the Development and Well-Being Assessment, DAWBA). Diagnostic ratings were all carried out or supervised by the DAWBA’s creator, working in conjunction with experienced local professionals.

Results

As judged by the DAWBA, the prevalence of any mental disorder ranged from 2.2% in India to 17.1% in Russia. The nine SDQ caseness indicators (three indicators times three informants) explained 8–56% of the cross-national variation in disorder prevalence. This was insufficient to make meaningful prevalence estimates since populations with a similar measured prevalence of disorder on the DAWBA showed large variations across the various SDQ caseness indicators.

Conclusions

The relationship between SDQ caseness indicators and disorder rates varies substantially between populations: cross-national differences in SDQ indicators do not necessarily reflect comparable differences in disorder rates. More generally, considerable caution is required when interpreting cross-cultural comparisons of mental health, particularly when these rely on brief questionnaires.     

Atomoxetine for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in children with ADHD and dyslexia

Background

There are conflicting results on whether immigrant children are at a heightened risk of mental health problems compared with native youth in the resettlement country.

The objective of the study

To compare the mental health of 94 Norwegian-born children from a community cohort of Vietnamese refugees, aged 4 - 18 years, with that of a Norwegian community sample.

Methods

The SDQ was completed by two types of informants; the children's self-reports, and the parents' reports, for comparison with Norwegian data from the Health Profiles for Children and Youth in the Akershus study.

Results

The self-perceived mental health of second-generation Vietnamese in Norway was better than that of their Norwegian compatriots, as assessed by the SDQ. In the Norwegian-Vietnamese group, both children and parents reported a higher level of functioning.

Conclusion

This surprising finding may result from the lower prevalence of mental distress in Norwegian-Vietnamese children compared with their Norwegian peers, or from biased reports and cultural differences in reporting emotional and behavioural problems. These findings may represent the positive results of the children's bi-cultural competencies.     

Socioeconomic status and children’s mental health: results from the Bergen Child Study

Purpose

It is generally accepted that mental health problems are unequally distributed across population strata defined by socioeconomic status (SES), with more problems for those with lower SES. However, studies of this association in children and adolescents are often restricted by the use of global measures of mental health problems and aggregation of SES-indicators. We aim to further elucidate the relationship between childhood mental health problems and SES by including more detailed information about mental health and individual SES-indicators.

Methods

The participants (N?=?5,781, age 11–13) were part of the Bergen Child Study (BCS). Mental health was assessed using the teacher, parent and self-report versions of the Strengths and Difficulties Questionnaire (SDQ), including an impact section, used to measure symptom dimensions and probability of psychiatric disorders. Parent reports of family economy and parental education were used as SES measures.

Results

For each SES indicator we confirmed an inverse relationship across all the symptom dimensions. Poor family economy consistently predicted mental health problems, while parental education level predicted externalizing disorders stronger than internalizing disorders.

Conclusion

In this Norwegian sample of children, family economy was a significant predictor of mental health problems as measured across a wide range of symptom dimensions and poor economy predicted a high probability of a psychiatric disorder. Longitudinal studies of the impact of low family income as well as other SES factors on externalizing and internalizing symptom dimensions and disorders are called for.     

Diet quality and mental health problems in adolescents from East London: a prospective study

Purpose

In this study, we aimed to examine the relationship between diet quality and depression in a prospective study of adolescents from varied ethnic and cultural backgrounds.

Design

In this prospective cohort study, data were collected at two time points (2001 and 2003) from nearly 3,000 adolescents, aged either 11–12 years or 13–14 years, participating in RELACHS, a study of ethnically diverse and socially deprived young people from East London in the UK. Diet quality was measured from dietary questionnaires, and mental health assessed using the Strengths and Difficulties Questionnaire (SDQ) and the Short Mood and Feelings Questionnaire (SMFQ).

Results

In cross-sectional analyses, we found evidence for an association between an unhealthy diet and mental health problems. Compared to those in the lowest quintile of Unhealthy diet score, those in the highest quintile were more than twice as likely to be symptomatic on the SDQ (OR 2.10, 95 %CI 1.38–3.20) after taking all identified confounders into account. There was also some evidence for a cross-sectional inverse association between a measure of healthy diet and mental health problems. A prospective relationship between the highest quintiles of both Healthy (OR 0.63, 95 %CI 0.38–1.05) and Unhealthy (OR 1.75, 95 %CI 1.00–3.06) diet scores and SDQ scores at follow-up was also evident, but was attenuated by final adjustments for confounders.

Conclusion

This study is concordant with previous observational studies in describing relationships between measures of diet quality and mental health problems in adolescents.     

Diet and Exercise Intervention Adherence and Health-Related Outcomes among Older Long-Term Breast,Prostate, and Colorectal Cancer Survivors

Background

Diet and exercise interventions for cancer survivors result in health benefits; however, few studies have examined health outcomes in relation to adherence.

Purpose

We examined associations between adherence to components of a diet–exercise intervention and survivors’ physical and mental health.

Methods

A randomized controlled trial tested a telephone and mailed print intervention among 641 older, overweight, long-term survivors of breast, prostate, and colorectal cancer. Dietary and exercise behaviors were assessed at 14 time points throughout the year-long intervention; health outcomes were examined postintervention.

Results

Telephone session attendance had significant indirect relationships with health outcomes through intervention-period exercise and dietary behavior. Attendance showed positive indirect relationships with physical function (β?=?0.11, p?p?p?p?p?Conclusions Session attendance is vital in facilitating improvement in health behaviors and attendant outcomes (Clinicaltrials.gov number NCT00303875).     

Ethnicity,socioeconomic position and severity of problems as predictors of mental health care use in 5- to 8-year-old children with problem behaviour

Background

Empirical research on mental health care use and its determinants in young school-aged children is still scarce. In this study, we investigated the role of ethnicity, socioeconomic position (SEP) and perceived severity by both parents and teachers on mental health care use in 5- to 8-year-old children with emotional and/or behavioural problems.

Methods

Data from 1,269 children with a high score (>P90) on the Strengths and Difficulties Questionnaire (SDQ) in the school year 2008–2009 were linked to psychiatric case register data over the years 2010–2011. Cox proportional hazards models were used to predict mental health care use from ethnicity, SEP and perceived severity of the child’s problems.

Results

During the follow-up period, 117 children with high SDQ scores (9.2 %) had used mental health care for the first time. Ethnic minority children were less likely to receive care than Dutch children (HR Moroccan/Turkish: 0.26; 95 % CI 0.13–0.54, HR other ethnicity: 0.26; 95 % CI 0.12–0.58). No socioeconomic differences were found. After correction for previous care use, ethnicity and parental perceived severity, impact score as reported by teachers was significantly associated with mental health care use (HR 1.58; 95 % CI 1.01–2.46).

Conclusions

Ethnicity is an important predictor of mental health care use in young children. Already in the youngest school-aged children, ethnic differences in the use of mental health care are present. A distinct predictor of care use in this age group is severity of emotional and behavioural problems as perceived by teachers. Therefore, teachers may be especially helpful in the process of identifying young children who need specialist mental health care.     

Adolescents’ multiple,recurrent subjective health complaints: investigating associations with emotional/behavioural difficulties in a cross-sectional,school-based study

Background

Adolescence has been documented as the peak age of onset for mental health perturbations, clinical disorders and unsubstantiated health complaints. The present study attempted to investigate associations between multiple, recurrent subjective health complaints (SHC) with emotional/behavioural difficulties, as measured by the Strengths and Difficulties Questionnaire scale (SDQ), among Greek adolescents.

Methods

Questionnaires were administered in a large, nation-wide, random, school-based sample of Greek adolescents, aged 12–18 years. Data from 1170 participants were analyzed. Adolescents with multiple, recurrent SHC were compared in terms of their emotional/behavioural difficulties to their peers with lower levels of health complaints. SDQ scales were separately investigated for their associations with multiple, recurrent SHC, after adjustment for gender, age and socioeconomic status (ses). Further analysis included multiple logistic regression models with multiple, recurrent SHC as the dependent variable and gender, age, ses and SDQ Total difficulties score as independent factors. Potential gender and age interactions were also explored.

Results

Almost half of the study participants reported multiple, recurrent SHC. Adolescents with multiple, recurrent SHC had higher scores on all SDQ scales, except from the Prosocial behavior scale, compared to their peers with lower levels of health complaints. Emotional Symptoms, Conduct Problems, Hyperactivity/Inattention and Peer Problems were associated with greater likelihood of having multiple, recurrent SHC, after adjustment for gender, age and ses. The multiple logistic regression models revealed that older adolescents and girls, as well as those with increased Total difficulties score had an increased risk for multiple, recurrent SHC reporting. No significant interaction between SDQ scales and gender or age was found.

Conclusions

Our study highlights the magnitude of psychological burden among adolescents experiencing multiple, recurrent SHC. Professionals in school and clinical settings should be cautious for impaired emotional/behavioural functioning when assessing adolescents with multiple, recurrent SHC, so as early identification of at-risk individuals and timely, appropriate referrals are facilitated.     

Socio-economic,trafficking exposures and mental health symptoms of human trafficking returnees in Ethiopia: using a generalized structural equation modelling

Background

Mental health problems among trafficked persons could be the result of concomitantly interwoven effects of various factors. Analyzing the networked relationships concurrently could be a more substantive approach to better understand the role of risk factors in this population. This study aimed to assess the magnitude of mental health symptoms as well as the association among socio-demographic, trafficking related exposure variables, and mental health problems of Ethiopian returnees from trafficking.

Methods

A sample of 1387 returnees who were trafficked via three major human trafficking corridors of Ethiopia were selected consecutively. Data related to socio-economic, trafficking exposure variables, and symptoms of mental illness were collected in personal interviews. Anxiety was measured with a brief measure for generalized anxiety disorder (GAD-7), depression with a patient health questionnaire (PHQ-9), and PTSD with post-traumatic checklist (PCL-C). Generalized structural equation modeling was employed to estimate the relationships among exogenous, mediating, and endogenous variables simultaneously.

Results

The prevalence of symptoms of anxiety was estimated at 51.9% (95% CI 49.3–54.6%); PTSD was estimated at 34.5% (95% CI 32.1–37.1%) and depression at 58.3% (95% CI 55.6–60.9%). Restricted freedom of movement had a direct positive effect on anxiety (β?=?1.24, 95% CI 0.97–1.51), depression (β?=?0.94, 95% CI 0.71–1.17) and PTSD (13.00, 95% CI 11.23–14.77). Violence experienced during the trafficking period was a mediator variable and significantly associated with anxiety (β?=?0.46; 95% CI 0.26–0.66) and PTSD (β?=?4.00; 95% CI 2.06–5.94). History of detention had a positive total effect on GAD (total β?=?1.380, 95% CI 1.074–1.687) and PTSD (total β?=?15.63, 95% CI 13.708–17.545), and direct positive effect on depression (β?=?0.89, 95% CI 0.65–1.13).

Conclusion

Ethiopian trafficked persons were highly likely to return with increased levels of mental health symptoms, namely anxiety, depression, and PTSD. Socio-economic and trafficking related exposures mediated by violence were factors affecting mental health symptoms. Thus, in addition to economic re-integrations of victims, strategies should be designed and implemented to address the prevalent mental health problems.

     

Normative data and psychometric properties of the strengths and difficulties questionnaire among Japanese school-aged children

Background

Although child mental health problems are among the most important worldwide issues, development of culturally acceptable mental health services to serve the clinical needs of children and their families is especially lacking in regions outside Europe and North America. The Strengths and Difficulties Questionnaire (SDQ), which was developed in the United Kingdom and is now one of the most widely used measurement tools for screening child psychiatric symptoms, has been translated into Japanese, but culturally calibrated norms for Japanese schoolchildren have yet to be established. To this end, we examined the applicability of the Japanese versions of the parent and teacher SDQs by establishing norms and extending validation of its psychometric properties to a large nationwide sample, as well as to a smaller clinical sample.

Methods

The Japanese versions of the SDQ were completed by parents and teachers of schoolchildren aged 7 to 15 years attending mainstream classes in primary or secondary schools in Japan. Data were analyzed to describe the population distribution and gender/age effects by informant, cut-off scores according to banding, factor structure, cross-scale correlations, and internal consistency for 24,519 parent ratings and 7,977 teacher ratings from a large nationwide sample. Inter-rater and test-retest reliabilities and convergent and divergent validities were confirmed for a smaller validation sample (total n?=?128) consisting of a clinical sample with any mental disorder and community children without any diagnoses.

Results

Means, standard deviations, and banding of normative data for this Japanese child population were obtained. Gender/age effects were significant for both parent and teacher ratings. The original five-factor structure was replicated, and strong cross-scale correlations and internal reliability were shown across all SDQ subscales for this population. Inter-rater agreement was satisfactory, test-retest reliability was excellent, and convergent and divergent validities were satisfactory for the validation sample, with some differences between informants.

Conclusions

This study provides evidence that the Japanese version of the SDQ is a useful instrument for parents and teachers as well as for research purposes. Our findings also emphasize the importance of establishing culturally calibrated norms and boundaries for the instrument’s use.     

Health care seeking behavior for depression in Northeast Ethiopia: depression is not considered as illness by more than half of the participants

Background

Depression is one of the most disabling and chronic mental illnesses. Despite its high burden, many people suffering from depression did not perceive that they had a treatable illness and consequently most of them did not seek professional help. The aim of this study was to assess the level of professional help-seeking behavior and associated factors among individuals with depression.

Methods and materials

The community-based cross-sectional study was conducted among residents of Dessie, Northeast Ethiopia. First, 1165 residents were screened for depression using patient health questionnaire and then 226 individuals who were screened positive for probable depression were interviewed with General Help-Seeking Questionnaire to assess the professional help-seeking behavior of participants with depression. Major associated variables were identified using logistic regression with 95% confidence interval (CI), and variables with a p value less than 0.05 were considered statistically significant.

Results

Among the total participants with depressive symptoms, only 25.66% of them did seek professional help. Being female [adjusted odds ratio (AOR)?=?2.769, 95% CI (1.280, 5.99)], current alcohol drinking [AOR?=?2.74, 95% CI (1.265, 5.940)], co-morbid medical-surgical illness [AOR?=?4.49, 95% CI (1.823, 11.071)], perceiving depression as illness [AOR?=?2.44, 95% CI (1.264, 4.928)], having moderate depressive symptoms [AOR?=?2.54, 95% CI (1.086, 5.928)] and moderately severe depressive symptoms [AOR?=?7.67, 95% CI (2.699, 21.814)] were significantly associated with help seeking behavior of participants.

Conclusions

Level of professional help-seeking behavior is as low as previous studies in different countries. The severity of depressive symptoms, co-morbidity of medical–surgical illness, current drinking of alcohol, being female, and perceiving depression as illness were significantly associated with professional help-seeking behavior for depressive symptoms. Working on mental health literacy in the community is important to increase help-seeking behavior.

     

Dropout from outpatient mental health care: results from the Israel National Health Survey

Objectives

To examine the dropout rates from outpatient mental health treatment in the general medical and mental health sectors and to identify the predictors of dropout.

Method

The study population was extracted from the Israel National Health Survey. The analysis was related to 12-month service utilization for mental health reasons.

Results

The total dropout rate from mental health treatment was 24%, but differed between sectors. The dropout rate from general medical care was 32, and 22% from mental health care. In the general medical care sector, 30% ended treatment within two visits, while only 10% did so in the mental health-care sector. Chronic health condition, but not severity of psychiatric disorder, predicted dropout in the mental health sector.

Discussion

The higher rate of early dropout in general medical care may be related to the brevity of general medical visits and/or the inexperience of primary care physicians, which limits the opportunity to develop patient–physician rapport. Providers of services will have to promote education programs for GPs and allocate proper time to psychiatric patients.

Limitation

The sample, although based on a national representative cohort, was small and limited the number of independent variables that could be examined.     

Evaluating the impact of direct and indirect contact on the mental health stigma of pharmacy students

Purpose

Contact with mental health consumers has shown to be a promising strategy to address mental health stigma, particularly in the context of pharmacy education. This research aimed to compare the effectiveness of a direct (face-to-face) contact intervention with an indirect (film based) contact intervention in reducing the mental health stigma of pharmacy students.

Method

A two-group, non-randomized, comparative study was conducted with third year pharmacy students (n?=?198) allocated to the direct contact arm and fourth year pharmacy students (n?=?278) allocated to the indirect contact arm. Baseline and immediate post-intervention data were collected using a validated 39 item survey instrument to assess the impact of the interventions on mental health stigma as well as attitudes towards providing mental health pharmaceutical services.

Results

Participants in the direct contact group showed a significant improvement in 37 out of 39 survey items and participants in the indirect contact group showed a significant improvement in 27 out of 39 items (P?<?0.05). While direct contact had a stronger impact than indirect contact for 22 items (P?<?0.05), for numerous key measures of mental health stigma the impact of the two contact interventions was equivalent.

Conclusion

Both indirect and direct contact may positively impact mental health stigma. While the strength of the stigma-change process may be heightened by face-to-face interactions, the largely positive impact of indirect contact suggests that stigma reduction may depend less on the medium of contact but more on the transcendent messages contributed by the consumers facilitating the contact experience.     

Starting from scratch: prevalence,methods, and functions of non-suicidal self-injury among refugee minors in Belgium

Background

As many refugee minors have gone/go through stressful life experiences and uncertainty, one might expect mental health issues, including self-injury. However, literature on non-suicidal self-injury (NSSI) in refugee minors is scarce. This study explores the prevalence, methods, and functions of NSSI in refugee minors in Belgium, and compares research results to the existing literature on NSSI in Western adolescents.

Methods

Data were obtained from 121 refugee minors (mean age?=?16.12, SD?=?1.23; range 14–18 years) through schools located in the Flemish and Brussels-Capital regions of Belgium. The sample consists of 39.7% girls and 60.3% boys. Self-report questionnaires were used to explore socio-economic data, NSSI behaviour (e.g. The Brief Non-Suicidal Self-injury Assessment Tool; BNNSI-AT) and emotional and behavioural difficulties (The Strengths and Difficulties Questionnaire; SDQ). Non-parametric Chi square tests were used for statistical comparisons of the obtained data as well as independent-sample t-tests and Fisher’s exact tests.

Results

Results show a lifetime NSSI prevalence rate of 17.4%. Being accompanied or not, having both parents around, or living in an asylum centre did not influence NSSI prevalence. An average of 2.65 methods of NSSI was applied (SD?=?2.50; range 1–9). The mean number of functions per person was six (SD?=?4.97, range 0–16), with automatic functions reported the most. The data do point towards a greater psychological strain, with 68.4% reporting more than five acts of NSSI. Results of the SDQ’s Total Difficulties Scale and, more specifically, of the Emotional Problems, Conduct Problems, Peer Problems and Impact Scales indicate a substantial risk of clinically significant problems within the NSSI group. The Peer Problems and Impact Scales also point towards a high risk for suicidality amongst self-injuring refugees.

Conclusions

Prevalence rates, methods and functions are comparable to Western samples. However, the higher incidence of the NSSI and the results on the SDQ also emphasise the vulnerability of refugee minors.

     

Association between annual earnings and mental disorders in Spain: individual and societal-level estimates

Purpose

Indirect costs of mental disorders are considerable and include loss of work productivity. We aimed to study the association between personal annual earnings and common mental disorders in Spain.

Methods

A cross-sectional population study of a representative sample of noninstitutionalized adults from Spain was performed (ESEMeD-Spain). CIDI 3.0 was administered to assess DSM IV mental disorders, and the Sheehan Disability Scales were used for severity appraisal. Four categories of mental disorders were defined: 12-month serious, 12-month moderate, 12-month mild, and lifetime. Personal annual earnings were assessed. Three models were fitted to estimate differences in annual earnings associated with mental disorders, controlling for sociodemographic variables.

Results

Prevalence rates of 12-month mental disorders were: mild 4.6%, moderate 3.8%, and serious 1.6%. Respondents with 12-month serious mental disorder (SMD) were less likely to report any earnings compared to those with no mental disorders (OR?=?0.16; 95% CI?=?0.07–0.34, p?Conclusion This is the first study in Spain that describes the earnings gap between individuals with and without mental disorders. Despite the low prevalence of SMD, they represent considerable societal-level productivity loss. Prevention and treatment of SMD should improve work productivity.     

Validation of the WHO self-reporting questionnaire-20 (SRQ-20) item in primary health care settings in Eritrea

Background

In Eritrea, highly centralized mental health care services and lack of trained psychiatric personnel at primary health care units remain a challenge to the mental health care system. These problems can be minimized by introducing screening programs with a simple screening tool for mental disorders in the primary health care settings. Thus, this study aimed to assess the validity of the WHO self-reporting questionnaire 20 (SRQ-20) in Tigrigna version for use in Eritrean primary health care setting.

Methods

The SRQ-20 was translated into a local language (Tigrinya) in a process of forward and backward translation. SRQ-20 data were collected in a primary health care setting on 266 respondents. Internal reliability was tested using Cronbach’s alpha. Factorial validity was done using principal component analysis with varimax rotation to investigate whether SRQ-20 items properly measure the underlying dimensions of mental illness. Criterion validity was analyzed by looking at the relationship between the SRQ-20 and Brief Psychiatric Rating Scale using Pearson’s correlation coefficient. Sensitivity, specificity and the predictive values of the screening instrument were used to assess how well the results of SRQ-20 correspond with the criterion instrument.

Results

The SRQ-20 had good internal reliability (α?=?0.78). Factor analysis yielded two factors, explaining 31.2% of the total variance. The instrument performed well in detecting common mental disorders, with an area under the curve (AUC) of 0.879 (SE?=?0.23, 95% CI 0.83–0.92) to the overall sample and with optimal cut-off score at 5/6 with sensitivity 78.6% and specificity 81.5%. Cut-off scores were different for women (5/6) and men (4/5). For male participants, the AUC statistic was 0.877 (SE?=?0.04, 95% CI 0.79–0.96) and 0.871 (SE?=?0.02 95% CI 0.81–0.92) for female participants.

Conclusion

The Tigrinya version of the SRQ-20 can be used for screening probable common mental disorders in Eritrean primary health care setting, but cut-off scores need to be adjusted for men and women separately.

     

Socio-cultural factors surrounding mental distress during the perinatal period in Zambia: a qualitative investigation

Background

The presence of mental distress during pregnancy and after childbirth imposes detrimental developmental and health consequences for families in all nations. In Zambia, the Ministry of Health (MoH) has proposed a more comprehensive approach towards mental health care, recognizing the importance of the mental health of women during the perinatal period.

Aim

The study explores factors contributing to mental distress during the perinatal period of motherhood in Zambia.

Methods

A qualitative study was conducted in Lusaka, Zambia with nineteen focus groups comprising 149 women and men from primary health facilities and schools respectively.

Findings

There are high levels of mental distress in four domains: worry about HIV status and testing; uncertainty about survival from childbirth; lack of social support; and vulnerability/oppression.

Conclusion

Identifying mental distress and prompt referral for interventions is critical to improving the mental health of the mother and prevent the effects of mental distress on the baby.

Recommendation

Strategies should be put in place to ensure pregnant women are screened for possible perinatal mental health problems during their visit to antenatal clinic and referral made to qualified mental health professionals. In addition further research is recommended in order to facilitate evidence based mental health policy formulation and implementation in Zambia.     

Health care access and treatment for children with co-morbid autism and psychiatric conditions

Purpose

To characterize the rate of comorbid psychiatric conditions (CPC) among children with autism spectrum disorders (ASD), to examine their treatment utilization, and to investigate treatment delay or non-delivery.

Methods

Lifetime ASD and CPC in children, aged 2–17, were investigated using data from the 2007–2008 National Survey of Children’s Health (NSCH). The NSCH surveyed parents and guardians regarding the health and well being, including treatment, of their child(ren) under age 18 (n?=?91,642). Children with health conditions were defined by parent report that a doctor or other health professional had ever said their child had that condition. Factors related to overall health, treatment utilization, and barriers to access variables were investigated among this group.

Results

Children with ASD/CPC had poorer overall health outcomes than children with ASD alone. They more often were dissatisfied with their between-provider communication and less often had insurance cover needed services. Nonetheless, they did tend to use care coordination and mental health services to a greater degree. Families were more likely to report the delay or non-receipt of needed services when they perceived a lack of communication and partnership with providers, when they lacked insurance coverage, and when they felt that health care costs were unreasonable.

Conclusions

The presence of a CPC seems to shape the treatment utilization and health outcomes of children with ASD. Because of this, health professionals working with children with autism should give special attention to treatment of those with comorbid diagnoses.     

Early Adolescent Relationship Predictors of Emerging Adult Outcomes: Youth With and Without Type 1 Diabetes

Background

Emerging adulthood is a high-risk period for mental health problems and risk behaviors for youth generally and for physical health problems among those with type 1 diabetes.

Purpose

The purpose of this study was to examine whether adolescents’ relationships with parents and friends predict health and risk behaviors during emerging adulthood.

Method

Youth with and without diabetes were enrolled at average age 12 and followed for 7 years. Parent and friend relationship variables, measured during adolescence, were used to predict emerging adulthood outcomes: depression, risk behavior, and, for those with diabetes, diabetes outcomes.

Results

Parent relationship quality predicted decreased depressive symptoms and, for those with diabetes, decreased alcohol use. Parent control predicted increased smoking, reduced college attendance, and, for control participants, increased depressive symptoms. For those with diabetes, parent control predicted decreased depressive symptoms and better self-care. Friend relationship variables predicted few outcomes.

Conclusions

Adolescent parent relationships remain an important influence on emerging adults’ lives.