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  • 1.
    Berglund, Staffan K.
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Chmielewska, Anna
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Starnberg, Josefine
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Westrup, Björn
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Norman, Mikael
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Effects of iron supplementation of low-birth-weight infants on cognition and behavior at 7 years: a randomized controlled trial2018In: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447, Vol. 83, p. 111-118Article in journal (Refereed)
    Abstract [en]

    Background Low-birth-weight infants (LBW) are at an increased risk of iron deficiency that has been associated with impaired neurodevelopment. We hypothesized that iron supplementation of LBW infants improves cognitive scores and reduces behavioral problems until school age.

    Methods We randomized 285 marginally LBW (2,000-2,500 g) infants to receive 0, 1, or 2 mg/kg/day of iron supplements from 6 weeks to 6 months of age. At 7 years of age, 205 participants were assessed regarding cognition using Wechsler Intelligence Scale for Children (WISC-IV) and behavior using the parental questionnaires Child Behavior Checklist (CBCL) and Five to Fifteen (FTF).

    Results There were no significant differences between the intervention groups in WISC-IV or FTF. However, the CBCL scores for externalizing problems were significantly different, in favor of supplemented children (P=0.045). When combining the supplemented groups, they had significantly lower scores for externalizing behavior compared with placebo (median (interquartile range): 44 [34;51] vs. 48.5 [41;56] P=0.013), and their risk ratio (95% confidence interval) for a total behavioral score above the cutoff for clinical problems was 0.31 (0.09-1.0), P=0.054.

    Conclusion Lower scores of externalizing behavior in supplemented children support our previous findings at 3 years, and suggest that iron supplementation may have long-lasting effects on behavioral functions.

  • 2.
    Berglund, Staffan
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Westrup, Björn
    Division of Neonatology, Department of Women and Child Health, Karolinska Institute, Stockholm, Sweden.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Hernell, Olle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Effects of iron supplementation of LBW infants on cognition and behavior at 3 years2013In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 131, p. 47-55Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Low birth weight (LBW) infants are at increased risk of cognitive and behavioral problems and at risk for iron deficiency, which is associated with impaired neurodevelopment. We hypothesized that iron supplementation of LBW infants would improve cognitive scores and reduce behavioral problems. METHODS: In a randomized controlled trial, 285 marginally LBW (2000-2500 g) infants received 0, 1, or 2 mg/kg/day of iron supplements from 6 weeks to 6 months of age. At 3.5 years of age, these infants and 95 normal birth weight controls were assessed with a psychometric test (Wechsler Preschool and Primary Scale of Intelligence) and a questionnaire of behavioral problems (Child Behavior Checklist; CBCL). RESULTS: There were no significant differences in IQ between the LBW groups or LBW infants versus controls. Mean (SD) full-scale IQ was 105.2 (14.5), 104.2 (14.7), and 104.5 (12.7) in the placebo, 1 mg, and 2 mg groups, respectively (P = .924). However, for behavioral problems, there was a significant effect of intervention. The prevalence of children with CBCL scores above the US subclinical cutoff was 12.7%, 2.9%, and 2.7% in the placebo, 1-mg, and 2-mg groups, respectively (P = .027), compared with 3.2% in controls. Relative risk (95% confidence interval) for CBCL score above cutoff in placebo-treated children versus supplemented was 4.5 (1.4-14.2). CONCLUSIONS: Early iron supplementation of marginally LBW infants does not affect cognitive functions at 3.5 years of age but significantly reduces the prevalence of behavioral problems. The study suggests a causal relation between infant iron deficiency and later behavioral problems.

  • 3. Bielawska-Batorowicz, Eleonora
    et al.
    Siddiqui, Anver
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry. University of Växjö , Sweden .
    A study of prenatal attachment with Swedish and Polish expectant mothers2008In: Journal of Reproductive and Infant Psychology, ISSN 0264-6838, E-ISSN 1469-672X, Vol. 26, no 4, p. 373-384Article in journal (Refereed)
    Abstract [en]

    The main purpose of the study was to investigate maternal prenatal attachment in Sweden and Poland, to analyse its diverse aspects, links to age, parity, planning and complications of pregnancy. Women in the third trimester of gestation filled in the Prenatal Attachment Inventory (PAI) and provided some demographic and medical data. Factor analyses were performed on PAI items for both samples and scores for samples' factors were compared using ANCOVA and two-way ANOVA. Correlates of attachment were examined with Pearson r and multiple regression analysis. Five factors were extracted which explained 53.9% (Swedish data) and 51.9% (Polish data) of variance. Items with the highest loading were similar in both samples. Total PAI scores given by Polish women were higher. Polish mothers gave scores that indicated more intense interactions with unborn children, they also more often shared their opinions about the baby with others. Swedish mothers more often attributed traits and showed affection. Swedish and Polish mothers showed evidence of fantasising about their unborn babies to a similar degree. Total PAI scores and factor scores were similar in planned and unplanned pregnancies. Polish mothers had lower total scores in complicated pregnancies and Swedish mothers in uncomplicated pregnancies. When both samples were analysed together the best predictors of attachment intensity were age and nationality, but they explained only 5.2% of variance in total scores. Despite several differences the findings indicate similarities in the way relationships with an unborn child are conceptualised by Swedish and Polish mothers.

  • 4.
    Birkeland, Anna-Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Dahlgren, Lars
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Rydberg, Annika
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Breaking bad news: an interview study of paediatric cardiologists2011In: Cardiology in the Young, ISSN 1047-9511, E-ISSN 1467-1107, Vol. 21, no 3, p. 286-291Article in journal (Refereed)
    Abstract [en]

    Technical developments in paediatric cardiology over the last few decades have increased expectations on professionals, demanding of them more emotional competence and communicative ability. The aim of this study was to examine the approach of paediatric cardiologists in informing and communicating with the family of the patient.

    Method: A qualitative interview method was first tested in a pilot study with two paediatric cardiologists. There were nine subsequent semi-structured interviews that were carried out with paediatric cardiologists. A researcher performed all the interviews, which were taped, transcribed, decoded, and analysed.

    Results: Among paediatric cardiologists, how to break bad news to the family is an important concern, evident in findings regarding the significance of trust and confidence, the use of different emotional positions, and a common ambition to achieve skills to handle the situation. There is a need for reflection, education, and sharing of experiences. The cardiologists desire further development of teamwork and of skills in medical students and residents for delivering bad news.

    Conclusions: Doctors are expected to cope with the complexities of diagnoses and decisions, while simultaneously being sensitive to the feelings of the parents, aware of their own emotions, and able to keep it all under control in the context of breaking the bad news to the parents and keeping them informed. These conflicting demands create a need to expand the professional role of the doctor by including more training in emotional competence and communicative ability, beginning in medical school and continuing through consultancy.

  • 5.
    Birkeland, Anna-Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hagglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Dahlgren, Lars
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Rydberg, Annika
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Interprofessional teamwork in Swedish pediatric cardiology: a national exploratory study2013In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 27, no 4, p. 320-325Article in journal (Refereed)
    Abstract [en]

    This paper aims to describe the nature of pediatric cardiology teams (PCTs) based in Sweden through the use of a mixed methods approach. Questionnaires examining issues about the organization/ways of working, functions/tasks and attitudes were answered by 30 PCTs. Focus group interviews were conducted with six PCTs, selected purposefully by size and location, and information on experiences and attitudes on interprofessional teamwork was explored in depth. Results from the quantitative indicated that in 17 of the teams, where the nurse acted as the central coordinator, there was a positive attitude to the value of teamwork. In the interviews, different problems and needs of improvements were mentioned regarding structure, leadership, presence of physicians in the team as well as the team's mandate. All of the participants, however, agreed that interprofessional teams were required to manage the complexity of the children's care. In conclusion, this study suggests that PCTs need further support to develop structure, leadership and coordination of resources to function in a more effective manner. National plans or recommendations that mandate the organization and working methods of PCTs would be helpful for the ongoing development of PCTs in Sweden.

  • 6.
    Birkeland, Anna-Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hällgren Graneheim, Ulla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Rydberg, Annika
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Dahlgren, Lars
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Facing bad news: a case study focusing on families having a child with congenital heart diseaseManuscript (preprint) (Other academic)
  • 7.
    Birkeland, Anna-Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Rydberg, Annika
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Dahlgren, Lars
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Teamwork in Swedish paediatric cardiology: a national exploratory study examining function and dynamicsManuscript (preprint) (Other academic)
  • 8.
    Birkeland, Anna-Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Rydberg, Annika
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    The complexity of the psychosocial situation in children and adolescents with heart disease2005In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 94, no 10, p. 1495-1501Article in journal (Refereed)
    Abstract [en]

    Aim: To describe the psychosocial situation of children/adolescents with heart disease and their families, an inventory method was worked out.

    Methods: Ninety-seven children/adolescents with congenital heart disease (CHD) were graded into three categories with respect to complexity of CHD. Group I included 42 patients with malformations requiring standardized operations. Group II included 20 patients with more complicated malformations, and group III included 35 patients with very complex malformations. The patients were compared with controls without heart disease, matched for age and gender. The psychosocial impact of CHD was measured by the inventory.

    Results: The most frequent problems in the patient group were healthcare and treatment-related needs (71/97) in the external sphere, family symptoms (68/97) in the interpersonal sphere, and somatic symptoms (19/97) in the personal sphere. Corresponding numbers in the controls were treatment-related needs (15/97), family (9/97) and somatic symptoms (25/97). Fifty per cent of the symptoms in the patient groups were mild, 30% moderate and 20% severe. The most severe symptoms were found in the interpersonal sphere, where family symptoms constituted the most severe variable. The frequency of severe problems in the personal sphere was 11% in the patients and 1% in the controls. This inventory method differentiates the grades of medical complexity both regarding number and severity of psychosocial symptoms. It indicates severe personal problems in the most complex group and shows that they have severe personal problems independent of family problems.

    Conclusion: This study elucidates the psychosocial complexity in children/adolescents with CHD, which has clinical implications in developing a psychosocial care programme.

  • 9.
    Björklund Olofsson, Lena
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Kidscreen: Självskattad livskvalitethos tolvåringar i fem svenska regioner2009Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 10.
    Blom, Eva Henje
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Psychiatry, Division of Child and Adolescent Psychiatry, UCSF Weill Institute for Neurosciences, University of California San Francisco (UCSF), San Francisco, CA, USA.
    Tymofiyeva, Olga
    Chesney, Margaret A.
    Ho, Tiffany C.
    Moran, Patricia
    Connolly, Colm G.
    Duncan, Larissa G.
    Baldini, Lisa
    Weng, Helen Y.
    Acree, Michael
    Goldman, Veronica
    Hecht, Frederick M.
    Yang, Tony T.
    Feasibility and Preliminary Efficacy of a Novel RDoC-Based Treatment Program for Adolescent Depression: "Training for Awareness Resilience and Action" (TARA)-A Pilot Study2017In: Frontiers in Psychiatry, ISSN 1664-0640, E-ISSN 1664-0640, Vol. 7, article id 208Article in journal (Refereed)
    Abstract [en]

    Background: The novel group treatment program Training for Awareness, Resilience, and Action (TARA) was developed to target specific mechanisms based on neuroscience findings in adolescent depression and framed within the National Institute of Mental Health Research Domain Criteria. TARA contains training of autonomic and emotional self-regulation, interoceptive awareness, relational skills, and value-based committed action.

    Methods: We performed a single-arm trial to test the feasibility and preliminary efficacy of TARA in reducing depression and anxiety levels and assessed whether the specific targeted domains of function reflected the hypothesized symptom change. Twenty-six adolescents (14–18 years old, 7 males and 19 females) participated in the 12-week group program. Assessment was performed before (T0), immediately after (T1), and 3 months after the end of TARA (T2).

    Results: Significant improvement was seen in depression symptoms (Reynolds Adolescent Depression Scale Second Edition) between T0–T1 (t-value = −3.56, p = 0.002, CI = −6.64, −1.77) and T0–T2 (t-value = −4.17, p < 0.001, CI = −11.20, −3.75) and anxiety symptoms (Multidimensional Anxiety Scale for Children) between T0–T1 (t-value = −2.26, p = 0.033, CI = −4.61, −0.21) and T0–T2 (t-value = −3.06, p = 0.006, 95% confidence interval = −9.02, −1.73). Significant improvements in psychological flexibility, sleep, and mindfulness skills were also found between T0 and T2.

    Limitations: The sample size was small without a control condition. The pilot design did not allow for testing the hypothesized brain changes and effect of TARA on relevant systemic biomarkers.

    Conclusion: TARA is feasible in a sample of clinically depressed and/or anxious adolescents and preliminary efficacy was demonstrated by reduced depression and anxiety symptoms. The specific symptom and behavioral outcomes corresponded well with the hypothesized mechanisms of change.

  • 11.
    Boström, Deborah
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Mom, why must ADHD exist?: Conceptions, experiences and concerns among children with ADHD and their parents2012Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 12.
    Carballeira Suarez, Nivia
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Nilsson, Karin
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Mitt barn svälter sig – hjälp!: Fallstudie med fokus på familjeterapi som behandling av ätstörning2012In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 109, no 42, p. 1889-1891Article in journal (Other academic)
    Abstract [sv]

    Maudsley-modellen är en familjebaserad behandlingsmetod vid ätstörning.

    Behandlingen lägger tonvikt på ätande och viktuppgång med stöd av föräldrarna, förhandling om nya relationsmönster och hantering av vanliga tonårsfrågor för återgång till ett åldersadekvat liv.

    Denna studie summerar elva samtal med en familj, där samtalen enligt mätningar och observationer under behandlingsförloppet gav god effekt på såväl ätstörningsproblematiken som familjens kommunikation.

  • 13.
    Cederin, Hanna
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Lekterapi - Vad fungerar och för vem?: En översikt över forskningsstudier om psykoterapeutiska lekterapier med positiva effekter under 2000-talet.2011Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 14. Chaplin, John Eric
    et al.
    Kriström, Berit
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Jonsson, Björn
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Tuvemo, Torsten
    Aronson, A Stefan
    Dahlgren, Jovanna
    Albertsson-Wikland, Kerstin
    Improvements in behaviour and self-esteem following growth hormone treatment in short prepubertal children2011In: Hormone research in paediatrics, ISSN 1663-2826, Vol. 75, no 4, p. 291-303Article in journal (Refereed)
    Abstract [en]

    Background/Aims: To evaluate effects of growth hormone (GH) treatment on behaviour and psychosocial characteristics in short-stature children.

    Methods: 99 referred prepubertal non-familiar short-stature children (32 GH deficiency; 67 idiopathic short stature) aged 3-11 years, randomized to fixed or individual GH doses and their parents completed questionnaires (Child Behaviour Checklist, Birleson Depression Self-Report Scale, Abbreviated Parent-Teacher Questionnaire, I Think I Am, Well-Being Visual-Analogue Scales for Short-Stature Children) at baseline (BL) and after 3, 12, and 24 months.

    Results: At BL, children showed higher levels of internalizing behaviour (p < 0.001), lower levels of externalizing behaviour (p < 0.006) and self-esteem (p < 0.001) compared to reference values. During GH treatment, behavioural measures (p < 0.001) and depression (p < 0.01) changed towards the mean of the population within the first 3 months and remained improved to 24 months. Self-esteem improved at all time points (p < 0.001), and in all subgroups, as did well-being dimensions stability and mood (p < 0.05). Multiple regression analysis showed that greater improvements were related to lower BL value, height gain, higher maximal GH value, being older, and being male.

    Conclusion: On GH treatment, prepubertal short children significantly improved on behavioural, depression, and psychosocial evaluations over a 2-year period of GH treatment. Most change occurred within the first 3 months, which highlights this short period as important not only for growth and metabolic changes but also for behaviour and psychosocial improvements following GH treatment.

  • 15.
    Chotai, Jayanti
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Jonasson, Mattias
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Adolfsson, Rolf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Adolescent attachment styles and their relation to the temperament and character traits of personality in a general population.2005In: Eur Psychiatry, ISSN 0924-9338, Vol. 20, no 3, p. 251-9Article in journal (Refereed)
  • 16.
    Chotai, Jayanti
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Jonasson, Mattias
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Adolfsson, Rolf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    The Temperament Scale of Novelty Seeking in adolescents shows an association with season of birth opposite to that in adults.2002In: Psychiatry Research, ISSN 0165-1781, E-ISSN 1872-7123, Vol. 111, no 1, p. 45-54Article in journal (Refereed)
    Abstract [en]

    We investigated the relationship between season of birth and the Junior Temperament and Character Inventory of Personality (Junior TCI, JTCI) in adolescents. The Temperament Scale of Novelty Seeking (NS) is significantly higher for females born during October-January as compared to females born otherwise. This association is opposite to that obtained earlier for adults. For both genders pooled, NS is significantly higher for those born during October-March compared to April-September. This association is also found when examining the data for those of age up to 18 years in a third independent study on the age range 11-81 years with the adult TCI. There is a greater tendency for exploration and risk-taking behavior as the child individuates from the family. Our study suggests that the effects of such environmental and developmental changes on personality are different in those born during October-March as compared to those born during April-September. The former show a higher rise in NS during adolescence and a steeper fall in NS during the years of adulthood, compared to the latter. Dopamine turnover is likely associated with NS, and the mutually inhibitory systems of dopamine and melatonin are the paracrine signals of day and night, respectively. Thus, the maternal entrainment of these systems during the prenatal period, or the postnatal environmental influence on these systems, may be different for those born during the short photoperiod of October-March as compared to those born during the long photoperiod part of the year.

  • 17.
    Desta, Menelik
    Umeå University, Faculty of Medicine, Clinical Sciences, Child and Adolescence Psychiatry.
    Epidemiology of child psychiatric disorders in Addis Ababa, Ethiopia2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Although mental disorders are common among children all over the world, information on the extent and types of child psychiatric disorders in Ethiopia is extremely limited. A study was conducted in an urban setting of Ethiopia to look at the prevalence of child psychiatric disorders and their correlates. A two-phase survey was performed. In the first phase, parents of 5000 children in Addis Ababa, the capital city of Ethiopia, were interviewed using the Reporting Questionnaire for Children (RQC). In the second phase, parents of all screen-positive children (n=864) and parents of 1537 screen-negative children were interviewed using the revised parent version of the Diagnostic Interview for Children and Adolescents (DICA-R), a semi-structured diagnostic instrument that is based on the third revised edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-III-R). This thesis discusses the results of that study in comparison with other child mental health studies in Ethiopia and elsewhere.

    At the recommended cut-off score of 1, the sensitivity, specificity, predictive values and likelihood ratios of the RQC to DICA-R diagnoses were acceptable. The RQC had high accuracy with a misclassification rate of 17%.

    The weighted prevalence for any DSM-III-R diagnosis was 17%. The most prevalent condition was enuresis (12.1%) followed by simple phobia (5.5%). The prevalence rates of all other identified conditions were below 1%. Children's age, severe economic problems, and single parenthood were found to be risk factors for any DSM-III-R diagnosis in children. Male sex, younger age, and lower achieved educational grade of the child were all independently associated with childhood enuresis. The odds of having enuresis were significantly higher for children in families with extreme poverty and in children from single-parent homes. The risk of having enuresis was significantly higher in children who had anxiety disorders (AD) and disruptive behaviour disorders (DBD). Sex was significantly associated with disruptive behaviour disorders while grade level, age, family size, ethnicity, poverty, and single parenthood were not. Anxiety disorders were significantly associated with sex, ethnicity, and extreme poverty but not with the other socio-demographic variables. The absence of mood disorders and somatoform disorders, of which symptoms are often encountered in both children and adults at clinical settings and the low prevalence rates of most identified conditions, were probably related to the lack of awareness or alternative explanations at the community level regarding the understanding of behaviour changes. Campaigns of public mental health education with the aim of providing scientific information to society are highly recommended. While Ethiopia works towards mainstreaming mental health into its health care system, training health care workers in applying simple screening tools like the RQC is recommended.

  • 18.
    Desta, Menelik
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Kebede, Derege
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Psychiatric disorders in urban children in Ethiopia: a population based cross sectional surveyIn: Social psychiatry and psychiatric epidemiologyArticle in journal (Refereed)
  • 19.
    Desta, Menelik
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Kebede, Derege
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Socio-demographic and psychopathologic correlates of enuresis in urban Ethiopian children.2007In: Acta Paediatr, ISSN 0803-5253, Vol. 96, no 4, p. 556-560Article in journal (Refereed)
  • 20.
    Desta, Menelik
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Kebede, Derege
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Stenlund, Hans
    Demographic and social factors associated with disruptive behaviour disorders and anxiety disorders in children in an urban community in EthiopiaIn: Nordic journal of psychiatryArticle in journal (Refereed)
  • 21.
    Desta, Menelik
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Kebede, Derege
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    The Reporting Questionnaire for Children (RQC) as a valid and simple child mental health screening instrument in EthiopiaManuscript (preprint) (Other academic)
  • 22.
    Engman Bredvik, Sofie
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Carballeira Suarez, Nivia
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry. Umeå University Hospital.
    Levi, Richard
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Nilsson, Karin
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry. Umeå University Hospital.
    Multi-family therapy in anorexia nervosa: a qualitative study of parental experiences2016In: Innovations in family therapy for eating disorders: novel treatment developments, patient insights, and the role of carers / [ed] Stuart Murray, Leslie Anderson, and Leigh Cohn, New York: Routledge, 2016, p. 236-248Chapter in book (Refereed)
  • 23.
    Engman-Bredvik, Sofie
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Carballeira Suarez, Nivia
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Levi, Richard
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Rehabilitation Medicine.
    Nilsson, Karin
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Multi-family therapy in anorexia nervosa: a qualitative study of parental experiences2016In: Eating Disorders, ISSN 1064-0266, E-ISSN 1532-530X, Vol. 24, no 2, p. 186-197Article in journal (Refereed)
    Abstract [en]

    This qualitative study from northern Sweden investigated experiences of multi-family therapy (MFT) in 12 parents of children with anorexia nervosa (AN). The main reported benefit was the opportunity to talk to others in a similar situation, thereby sharing experiences and struggles. MFT resulted in new perspectives and insights that improved family dynamics and enabled new constructive behaviors. In conclusion, MFT seems to be a useful therapeutic modality in the treatment of AN in a northern European setting.

  • 24. Eriksson, Charli
    et al.
    Kimber, Birgitta
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Skoog, Therése
    Design and implementation of RESCUR in Sweden for promoting resilience in children: a study protocol.2018In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 18, no 1, article id 1250Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: This research program aims to investigate the implementation and effects of a theoretically promising prevention method. It is being developed in a European research collaboration within a Comenius project (2012-2015) between 6 European universities (in Malta, Italy, Greece, Croatia, Portugal and Sweden) with the purpose of enhancing European children's resilience.

    METHODS/DESIGN: RESCUR in Sweden consists in a RCT study of the Resilience Curriculum (RESCUR) that is taking place in Sweden 2017-2019. The study is being performed by Junis, IOGT-NTO's Junior Association, part of IOGT International, in conjunction with researchers at Göteborg, Umeå and Stockholm universities, and is being funded by the Public Health Agency of Sweden. Around 1000 children of the ages 7-12 will, through their schools and associations, or via groups in social services, be acquainted with the material. Children will learn and practice mindfulness, storytelling, group discussions and much more, all designed to strengthen protective factors and increase their resilience. The program also involves parents, who are taking part in the work to reinforce children's protective factors. Based on the work with groups of children, an effectiveness study including children aged 7-12 in school classes, with randomized and controlled pre- and post-measurements, self-rating questionnaires and group observations is being performed. The program will also be implemented in a non-governmental organization and in groups in social services. The study also investigates forms of implementation.

    DISCUSSION: The design of the study will enable the researchers to answer five research questions by using a mixed-methods approach. Implementation will be studied, which is a necessary prerequisite for an effect study. Moreover, the research procedure has been tailored to the target group, with age-appropriate measures as well as multiple informants, which will produce high-quality data for analysis. A special ethical challenge is the study of young children, and efforts to give children a voice have been included in the program. This project is regarded as having good potential to benefit children in general, and particularly children in vulnerable positions.

    TRIAL REGISTRATION: National Institute of Health, ClinicalTrials.gov identifier NCT03655418. Registered August 31, 2018.

  • 25.
    Farooqi, Aijaz
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    School-age outcomes of children born at the limit of viability: a Swedish national prospective follow-up study at 10 to 12 years2007Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background/Aim: During the past two decades, major advances in maternal-fetal medicine, neonatology, and the development of regionalized perinatal care have resulted in dramatic increases in survival rates, by more than 60%, of extremely immature (EI) infants born at less than 26 completed weeks of gestation, creating a new infant population. Studies of school-age outcomes in children with an extremely low birth weight of < 1000 g, born in the1980s, indicated that these children had a substantially high prevalence of low-severity neuropsychological deficits, behavioral problems, and difficulties at school. Information on school-age outcomes of extremely preterm children born in the 1990s is sparse, and mainly restricted to the neurobehavioral and developmental outcome. The aim of this research was to investigate the comprehensive neurological, developmental, functional, and mental health status and health care needs of children born at 23-25 weeks of gestation in the 1990s, allowing a total view of the child in the context of the family, his peers, school, and the health care system. The ultimate aim was to obtain a clearer understanding of the functional capacities of these vulnerable children and the possibilities of ameliorative interventions, as a basis for planning and provision of services for this growing population.

    Methods: We studied 11-year-old children born from 1990 through 1992 before 26 completed weeks of gestation in all of Sweden. All had been evaluated at a corrected age of 36 months. Of 89 eligible children, 86 (97%) were studied at a mean age of 11 years. An equal number of children born at term served as controls. The following methods were used: 1) well validated, mailed questionnaires filled out by the parents, class teachers and the children themselves; 2) structured interviews were conducted with a parent or a primary caregiver; 3) review of pediatric case records and records from other specialist health care services; and 4) anthropometric measurements (length, weight, head circumference and body mass index) from birth to 11 years of age. The following domains were explored: current health status, growth attainment, mental health assessment, emotional well-being, adaptive functioning and social competencies, school performance, executive functions, and learning and language skills. Relations of socioeconomic background and of environmental and perinatal risk factors to the long-term outcome were evaluated.

    Results: EI children compared with the controls had significantly higher rates of specific diagnoses or disabilities including neurosensory impairment (15% vs 2%, respectively), asthma (20% vs 6%), poor motor skills (26% vs 3%), poor visual perception (21% vs 4%), poor learning skills (27% vs 3%),poor adaptive functioning (42% vs 9%), and poor academic performance (49% vs 7%). As a consequence of these disabilities, significantly more EI children than controls had chronic conditions, which included functional limitations (64% vs 11%), compensatory dependency needs (59% vs 25%), and services above those routinely required by children in general (67% vs 22%).

    Regarding growth attainment, EI children had significantly lower values for all three growth parameters (length, weight and head circumference) than the controls at 11 years. They showed a sharp decline in weight and height z scores up to 3 months’ corrected age, followed by good catch-up growth in both weight and height up to 11 years. EI children did not exhibit catch-up growth in head circumference after the first 6 months of life. Preterm birth and parental height were significant predictors of 11-year height, and group status (prematurity) correlated strongly with head circumference.

    Our results also suggest that the EI children had a significantly greater risk for poorer mental health and poorer emotional well-being than the control participants, including internalizing (anxiety/depression, withdrawn behavior and somatic complaints), and attention, social, and thought problems. No differences in externalizing problems were found between the EI cohort and controls. Multivariable analyses disclosed a number of significant predictors of behavioral adjustment: group status (EI vs control), family function, social risk, male gender, and presence of a chronic medical condition.

    Concerning school performance, more than half (59%) of our EI cohort were experiencing school difficulties and 15%, compared with 5% of the control children were attending special schools or having full-time special education. Despite fewer adaptive skills in the EI cohort these children were not different from the controls in respect to being happy and being positively adjusted in their day-to-day life.

    Compared with controls, EI children had a significantly increased risk for executive dysfunctions in most of the areas assessed (Attention control and Attention switching, Hypoactivity, Planning/organizing, and Working memory). EI children were also at increased risk for deficient skills in language tasks (comprehension, communication, and expression) and in the four standard measures of learning skills (reading/writing, math, general learning, and coping in learning). However, only a relatively small number of EI children exhibited severe impairments in executive or non-executive skills. Multivariate analyses revealed that prematurity, executive dysfunction and male gender were associated with poor learning skills.

    Conclusions and implications: Children born extremely immature have significantly greater health problems and special health care needs that require ongoing services through the school years. However, it is notable that very few children have severe impairments that curtail major activities of daily living. The overall results of this study are reassuring. Despite having an increased risk for mental health problems, executive dysfunctions and school difficulties, 85% of the EI children were in the mainstream schools and a majority were not having major adjustment difficulties. In terms of growth, most of our EI children showed good catch-up in late childhood and were within 2SD of their mean midparental height at 11 years of age.

    Although biological immaturity is associated with an increased risk for a substantial number of behavioral/emotional problems, improvement of the modifiable environmental factors will benefit the outcome in EI children. We also believe that knowledge of the course of development of psychopathological conditions from early childhood to adolescence and beyond is crucial for identifying the need for intervention and prevention strategies. Thus when there is evidence to suggest neuropsychological and behavioral or emotional problems, early identification and preventive measures might help families to manage these from an early stage. Our findings further suggest that current preterm follow-up programs might benefit from the addition of psychological and family services to traditional neurodevelopmental assessments, especially in the neonatal period and first years of life.

  • 26.
    Farooqi, Aijaz
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Adamsson, M
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Serenius, F.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Executive Functioning and Learning Skills of Adolescent Children Born at Fewer than 26 Weeks of Gestation2016In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 3, article id e0151819Article in journal (Refereed)
    Abstract [en]

    Aims To assess the cognitive and behavioral aspects of executive functioning (EF) and learning skills in extremely preterm (EPT) children compared with term control children aged 10 to 15 years. Methods A total of 132 of 134 (98% of all eligible survivors) EPT children born at the 2 Swedish regional tertiary care centers from 1992 to 1998 (mean age = 12 years, mean birth weight = 718 g, and mean gestational age = 24.4 weeks) and 103 matched term controls were assessed. General intelligence was assessed using the Wechsler Intelligence Scale for Children (WISC-III-R), and cognitive aspects of EF were analyzed using EF-sensitive sub-scales of the WISC-III-R and Tower test of the Delis-Kaplan Executive Function Scale (D-KEFS). Behaviors related to EF and learning skills were assessed using the Five to Fifteen questionnaire, which is a validated parent and teacher instrument. Academic performance in school was assessed by teachers' responses on Achenbach's Teachers Report Form. Analyses performed included multivariate analyses of covariance (ANCOVA and MANCOVA) and logistic regression analyses. Results The EPT children displayed significant deficits in cognitive aspects of EF compared with the controls, exhibiting decreases on the order of 0.9 SD to 1.2 SD for tasks of verbal conceptual reasoning, verbal and non-verbal working memory, processing speed and planning ability (P < 0.001 for all). After excluding the children with major neurosensory impairment (NSI) or a Full Scale intelligence quotient (FSIQ) of < 70, significant differences were observed on all tests. Compared with controls, parents and teachers of EPT children reported significantly more EF-related behavioral problems. MANCOVA of teacher-reported learning skills in children with FSIQ > 70 and without major NSI revealed no interactions, but significant main effects were observed for the behavioral composite executive function score, group status (EPT vs control) and FSIQ, for which all effect sizes were medium to large. The corresponding findings of MANCOVA of the parent-reported learning skills were very similar. According to the teachers' ratings, the EPT children were less well adjusted to the school environment. Conclusion EPT children born in the 1990s who received active perinatal care are at an increased risk of executive dysfunction, even after excluding children with significant neurodevelopmental disabilities. Even mild to moderate executive dysfunctions has a significant impact on learning skills. These findings suggest the need for timely interventions that address specific cognitive vulnerabilities and executive dysfunctions.

  • 27.
    Farooqi, Aijaz
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Sedin, G
    Gothefors, L
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Serenius, F
    Executive functions, language and learning skills in children born at 23-25 weeks' gestation in the 1990s: a Swedish national prospective follow-up studyArticle in journal (Refereed)
  • 28.
    Farooqi, Aijaz
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Sedin, Gunnar
    Gothefors, Leif
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Serenius, Fredrik
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Chronic conditions, functional limitations, and special health care needs in 10- to 12-year-old children born at 23 to 25 weeks' gestation in the 1990s: a Swedish national prospective follow-up study.2006In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 118, no 5, p. e1466-e1477Article in journal (Refereed)
  • 29.
    Farooqi, Aijaz
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics. Pediatrik.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry. Barn- och ungdomspsykiatri.
    Sedin, Gunnar
    Gothefors, Leif
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics. Pediatrik.
    Serenius, Fredrik
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics. Pediatrik.
    Growth in 10- to 12-year-old children born at 23 to 25 weeks' gestation in the 1990s: a Swedish national prospective follow-up study.2006In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Pediatrics, ISSN 1098-4275, Vol. 118, no 5, p. e1452-e1465Article in journal (Refereed)
  • 30.
    Farooqi, Aijaz
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Sedin, Gunnar
    Gothefors, Leif
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Serenius, Fredrik
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Mental health and social competencies of 10- to 12-year-old children born at 23 to 25 weeks of gestation in the 1990s: a Swedish national prospective follow-up study.2007In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 120, no 1, p. 118-133Article in journal (Refereed)
    Abstract [en]

    Abstract

    OBJECTIVE: We investigated a national cohort of extremely immature children with respect to behavioral and emotional problems and social competencies, from the perspectives of parents, teachers, and children themselves.

    METHODS: We examined 11-year-old children who were born before 26 completed weeks of gestation in Sweden between 1990 and 1992. All had been evaluated at a corrected age of 36 months. At 11 years of age, 86 of 89 survivors were studied and compared with an equal number of control subjects, matched with respect to age and gender. Behavioral and emotional problems, social competencies, and adaptive functioning at school were evaluated with standardized, well-validated instruments, including parent and teacher report questionnaires and a child self-report, administered by mail.

    RESULTS: Compared with control subjects, parents of extremely immature children reported significantly more problems with internalizing behaviors (anxiety/depression, withdrawn, and somatic problems) and attention, thought, and social problems. Teachers reported a similar pattern. Reports from children showed a trend toward increased depression symptoms compared with control subjects. Multivariate analysis of covariance of parent-reported behavioral problems revealed no interactions, but significant main effects emerged for group status (extremely immature versus control), family function, social risk, and presence of a chronic medical condition, with all effect sizes being medium and accounting for 8% to 12% of the variance. Multivariate analysis of covariance of teacher-reported behavioral problems showed significant effects for group status and gender but not for the covariates mentioned above. According to the teachers' ratings, extremely immature children were less well adjusted to the school environment than were control subjects. However, a majority of extremely immature children (85%) were functioning in mainstream schools without major adjustment problems.

    CONCLUSIONS: Despite favorable outcomes for many children born at the limit of viability, these children are at risk for mental health problems, with poorer school results.

  • 31.
    Farooqi, Aijaz
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Sedin, Gunnar
    Serenius, Fredrik
    Impact at age 11 years of major neonatal morbidities in children born extremely preterm2011In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 127, no 5, p. e1247-e1257Article in journal (Refereed)
    Abstract [en]

    Background: Uncertainty continues regarding the extent to which neonatal morbidities predict poor long-term outcome and functional abilities in extremely preterm infants.

    Objective: The goal of this study was to determine the impact of bronchopulmonary dysplasia (BPD), ultrasonographic signs of brain injury, and severe retinopathy of prematurity (ROP) on 11-year outcomes in infants born at <26 weeks' gestation.

    Methods: A total of 247 infants were born alive before 26 completed weeks of gestation from 1990 through 1992 in all of Sweden, and 98 (40%) survived to a postmenstrual age of 36 weeks. Main outcome measures were (1) poor outcome, defined as combined end point of death after 36 weeks' postmenstrual age or survival with at least 1 major disability at 11 years, and (2) consequences of chronic conditions in the survivors according to a validated instrument administered to parents.

    Results: Brain injury and severe ROP but not BPD correlated independently with poor outcome at 11 years of age. Among children who were free from BPD, brain injury, and severe ROP, 10% had a poor outcome. Corresponding rates with any 1, any 2, and all 3 neonatal morbidities were 19%, 58%, and 80%, respectively. Multivariate analysis revealed that brain injury and severe ROP were associated with high rates of consequences of chronic conditions.

    Conclusions: In infants born extremely preterm who survive to a postmenstrual age of 36 weeks, severe ROP and brain injury separately predict the risk of death or major disability at 11 years of age. Thus, continued research to determine how to prevent these complications of prematurity is critical.

  • 32.
    Farooqi, Aijaz
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Serenius, Fredrik
    Uppsala Univ, Sect Pediat, Dept Womens & Childrens Hlth, Uppsala, Sweden.
    Behaviours related to executive functions and learning skills at 11years of age after extremely preterm birth: a Swedish national prospective follow-up study2013In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 102, no 6, p. 625-634Article in journal (Refereed)
    Abstract [en]

    Aim We investigated a national cohort of children born extremely immature (<26weeks gestation, EI) regarding the nature, frequency and severity of the behavioural problems related to the executive functions (EF) and concerning learning skills, from the perspectives of parents and teachers. Methods At 11years of age 86 of 89 survivors of this cohort were studied and compared with an equal number of controls. Behaviours related to EF, and learning skills were assessed by a validated instrument, namely the Five to Fifteen questionnaire sent by mail to parents and teachers. Results Compared with controls, parents of EI children reported significantly more problems in behaviours related to EF in all areas assessed (Attention, Hyperactivity/Impulsivity, Hypoactivity, Planning/Organizing, and Working Memory). Teachers ratings showed a similar pattern. EI children also displayed deficient skills in the 4 standard measures of learning skills. Multivariate analysis revealed that prematurity, gender and behavioural composite score was associated with learning skills. Only a relatively small proportion of EI children (1030%) exhibited clinically significant impairments. Conclusion Despite a favourable outcome in many school-age children born at the threshold of viability, these are at increased risk of developing behavioural problems related to EF.

  • 33. Feder, Gene
    et al.
    Rohde, Jon E
    San Sebastian, Miguel
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Janlert, Urban
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Jimba, Masamine
    Materia, Enrico
    Hurtig, Anna-Karin
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Goldin, Stephen
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Stafford, Tom
    Edvardsson, Berit
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Hilt, Bjorn
    Parkinson, Stuart
    Birch, Marion
    Jones, Anna
    Archibald, Kathy
    Pastore, John O
    Reed Elsevier and the international arms trade.2005In: Lancet, ISSN 1474-547X, Vol. 366, no 9489, p. 889; discussion 889-90Article in journal (Refereed)
  • 34.
    Fekadu, Daniel
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Child labour and emotional disorders in an urban district, Ethiopia: a rapid assessment on community perception of child labour2001In: Ethiopian journal of health development, ISSN 1021-6790, Vol. 15, no 3, p. 197-202Article in journal (Refereed)
  • 35.
    Fekadu, Daniel
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Child abuse in child labor in urban district, EthiopiaManuscript (preprint) (Other academic)
  • 36.
    Fekadu, Daniel
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    The prevalence of mental health problems in Ethiopian child laborers.2006In: Journal of child psychology and psychiatry, ISSN 0021-9630, Vol. 47, no 9, p. 954-959Article in journal (Refereed)
  • 37.
    Fekadu, Daniel
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Review of child labor with emphasis on mental healthManuscript (Other academic)
  • 38.
    Fekadu Wolde-Giorgis, Daniel
    Umeå University, Faculty of Medicine, Clinical Sciences, Child and Adolescence Psychiatry.
    Child labour in Addis Ketema, Ethiopia: a study in mental health2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Child labour is a very common global problem. There are an estimated over 250 million in the world, and about 7.5 million child labourers in Ethiopia. Most of the studies available to date focus on the social, political, and economical issues, but very little on mental health or psychosocial problems of child labourers. There is no study describing the epidemiology of psychiatric disorders among this group of children.

    Aims: 1. to assess the level of awareness and attitude of an urban community on child labour. 2. to describe the patterns of child labour and the experiences of child labourers in the informal sector with emphasis to child domestic labour. 3. to determine the risk factors contributing to child abuse and psychiatric disorders in child labourers.

    Method: An initial qualitative survey, using key informants in a Rapid Assessment Procedure, was conducted in a central urban area of Addis Ababa, to determine the knowledge, attitude, and intervention priorities of the people on child labour. A cross-sectional quantitative study informed by this initial survey was conducted in a sampled population of 5-15 year old child labourers and non-economically active controls. Information about possible risk factors, socio-demography and child abuse were gathered using a questionnaire different from that used for mental health assessment. An Amharic translation of the Diagnostic Interview for Children and Adolescents (DICA) was used to collect data for symptoms of mental disorders and diagnosis was made according to the American Psychiatric Association (APA) Diagnostic and Statistical Manual, 3rd edition (DSM-III-R) criteria. Data analysis was done using Statistical Package for Social Sciences (SPSS) software.

    Results: Domestic labour, working in the streets, and in private enterprises were the three main types of child labour identified. These types of child labour were identified by 82% (n=158) key informants, who thought child labour was a social problem, mainly resulting from poverty, and associated with abuse. In the quantitative study (5-15 year old sample) 528 child labourers and 472 non-labourers were included in the study. Of the child labourers, 34% were engaged in domestic labour, 57% working in the streets, and 9% in private enterprises. Over half of the child labourers worked for more than 9 hours daily. The prevalence of child abuse was 43.9% and 17.2% among child labourers and controls, respectively (OR=3.7, 95% CI: 2.74, 5.09; p<0.001). Emotional abuse was the commonly encountered abuse compared to other types (OR=3.06, 95% CI: 2.23-4.20; p< 0.001). Child domestics and street labourers were the most vulnerable group. The prevalence of any DSM-III-R psychiatric disorder was 20.1% and 12.5% among child labourers and controls, respectively and the difference was statistically significant (OR=1.89, 95% CI: 1.34-2.67, p<0.01). Controlling for all socio-demographic factors, child labour status was the only significant factor in determining DSM-III-R diagnosis.

    Discussion: In a comparable group of child labourers and controls, child labourers were found to be a high-risk group for different types of abuse and psychiatric disorders. Although parental unemployment and low maternal education were associated with child labour, the only factor that was associated with psychiatric morbidity was being a child labourer. It seems that poverty is not the only reason for child labour; hence its mere alleviation alone is unlikely to dramatically improve the risk for child labour and mental health of the children. There are many motivating reasons to be a child labourer, and likewise various positive and negative maintaining factors. Therefore, not all child labourers are prepared to stop their paid job altogether in order to become a full time student.

    Recommendation: Education of all children and parents is a keystone to prevent child labour and the associated consequences. In enforcing legislations on child labour, the government, non-governmental organisation (NGO), and the public should view child labour as a menace in children’s development, with risk of psychiatric disorders. Policy design should accommodate the interests of children. It is recommended to do a cohort and a larger size study, in order to further examine the association of various risk factors, and psychiatric disorders in a comparative and similar vulnerable group of children.

  • 39.
    Fransson, Per
    Umeå University, Faculty of Social Sciences, Department of Psychology. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Defense mechanism test och ungdomar1998Doctoral thesis, comprehensive summary (Other academic)
  • 40.
    Fransson, Per
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    A comparative study of adolescents in psychiatric care assessed by means of the Defense Mechanism Test and the DSM-IV classification system1998In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 52, no 6, p. 527-536Article in journal (Refereed)
    Abstract [en]

    Twenty-seven adolescents in psychiatric care, assessed by means of DSM-IV, and 33 healthy controls were tested using the projective percept-genetic Defense Mechanism Test (DMT). Three diagnostic subgroups were created: psychotic (Axis 1), borderline personality disorder (Axis 2), and a non-patient group. The test protocols were scored with regard to 130 DMT variables and analyzed by means of partial least squares (PLS) discriminant analysis and by means of a pattern analysis of the DMT variables. The results showed that it was possible to distinguish significantly among the three groups. Specific perceptual distortions were identified among the three groups. It was concluded that DMT is a promising instrument in the assessment of adolescents in psychiatric care.

  • 41.
    Garcia, Danilo
    et al.
    Department of Psychology, Karlstad University, Karlstad, Sweden .
    Siddiqui, Anver
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry. Växjö University, Växjö, Sweden.
    Adolescents’ psychological well-being and memory for life events: Influences on life satisfaction with respect to temperamental dispositions2009In: Journal of Happiness Studies, ISSN 1389-4978, E-ISSN 1573-7780, Vol. 10, no 4, p. 407-419Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to explore how the number of recalled life events (positive and negative) predicts psychological well-being (PWB) and how PWB predicts life satisfaction (LS). In addition, participants were categorized into one of four different affective temperaments (self-actualizing, high affective, low affective, and self-destructive). One hundred and thirty-five high school students participated in completing the SWLS (LS), PWB (short-version), PANAS (to create affective temperaments), and the life events recollection task. Results indicated that adolescents with high positive affect also had high PWB; adolescents with low affective profiles also had high PWB. Positive and negative life events predicted PWB for self-destructive temperaments, whereas positive life events predicted PWB for low affective temperaments. PWB predicted LS for all temperaments except the self-actualizing group. In conclusion, the temperament combinations may allow the individual to achieve PWB and LS. Even more importantly, self-acceptance may foster LS regardless of temperament and may have more impact on LS than life events.

  • 42.
    Goldin, Stephen
    Umeå University, Faculty of Medicine, Clinical Sciences, Child and Adolescence Psychiatry.
    Living in the present with the past: mental health of Bosnian refugee children in Sweden2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The negative impact of war on child mental health has been repeatedly documented. Still, the majority of children exposed to ethnic and political violence show no signs of clinical disorder. In Western countries of exile, these findings have prompted a variety of attempts to evaluate refugee children, in the hope of identifying and offering support to those children “at risk”. This study critically examines one such attempt. The aims are fourfold: 1. to describe the range and pattern of child trauma-stress exposure and mental health reactions as captured on clinician semi-structured interview; 2. to critically compare clinician assessment with independent parent, child and teacher reports; 3. to identify factors of potential risk or protective import for child mental health; 4. to draw clinical implications: from whom and by what means can children at risk be reasonably identified?

    The target of our study was the entire population of Bosnian-Serbian-Croatian speaking child refugee families assigned to Umeå and surrounding municipalities during 1994-95. Fifty families, containing 90 children aged one month to 20 years, were included in the study. Assessment occurred in two phases. First, a semi-structured interview was conducted that inquired broadly as to the child’s family background, trauma-stress exposure, emotional-behavioral problems, patterns of family functioning, and future hopes. Second, standardized self-report questionnaires were administered, separately to parent and child, to provide alternative appraisal of the child’s war exposure, mental health symptoms, coping strategies, and social network. Teacher evaluation of child cognitive-social functioning as well as emotional-behavioral problems was also obtained.

    Clinician semi-structured interview revealed the child’s pre-war period as preponderantly good, and provided richly detailed narratives of child exposure during war and resettlement that clustered into a limited number of type-stories. Independent parent assessment captured the same broad strokes of child war exposure; but both approaches – fixed questionnaire and semi-structured interview – showed specific areas of blindness. Teenage self-report offered a disparate but equally rich account of war exposure, while that of primary school child was significantly less detailed.

    Nearly half of the study children (48%) were identified on clinician interview with one or more mental health problem “demanding further attention”. Depressiveness was the single most prevalent symptom (31%), followed by posttraumatic reactions (23%) and anxiety-regressiveness (15%). Independent symptom appraisal by parent and primary school child was largely concordant with that of clinician, while teenagers made similar assessment as to who was in distress, but defined the nature of that distress differently. Teacher report stood apart, identifying fewer inward emotional problems and asserting the cognitive-social competence of the vast majority of study children.

    Trauma-stress exposure during both war and resettlement presented as an unequivocal risk to mental health, but accounted for only part of outcome variance. Additional factors of strong import related broadly to “living in the present”. Parent impairment of daily routines, child dissatisfaction with school and an ongoing quarrelsome relationship presented as risk factors. Protection was associated with parent maintenance of a warm family climate and of concrete physical-emotional caring, child social ties to physically present others, including teacher; and above all, a family sense of hope for the future.

    Results support the general robustness of our semi-structured approach. Exploring the child’s present well-being in narrative relation to past and future, our assessment captured and gave meaning to the complexity of child exposure and behavior. At the same time, independent parent and child appraisals provided an additional richness to the retelling and evaluation of child experience. Particularly the apartness of teacher report underscores the need to incorporate an outside-world vantage point in the process of risk assessment.

  • 43.
    Goldin, Stephen
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Levin, Lilian
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Persson, Lars Åke
    International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Sweden.
    Mental health of Bosnian refugee children: a comparison of clinician appraisal with parent, child and teacher reports2008In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 62, no 3, p. 204-216Article in journal (Refereed)
    Abstract [en]

    This study compares clinician appraisal of Bosnian refugee children with independent parent, child and teacher reports. From whom and by what means can children “at risk” be reasonably identified? Forty-eight Bosnian refugee children (aged 7–20), resettled in Sweden 1994–95, were assessed clinically by means of a semi-structured interview. Thereafter, standardized mental health questionnaires were administered to parents (Achenbach's Child Behavior Checklist), children (Achenbach's Youth Self-Report and Macksoud's Posttraumatic Stress Reaction Checklist) and teachers (clinician designed School Competence Scale and Achenbach's Teacher's Report Form). On clinician interview, nearly half of the children (48%) were identified with one or more mental health problem “demanding further attention”. Depressiveness was the single most prevalent symptom (31%); followed by post-traumatic stress (23%), and anxiety-regressiveness (15%). At the same time, 75% of the children were rated by teachers as “quite competent” in school. Parent, child and clinician appraisals of primary school children showed broad similarities. Teachers reported a similar prevalence of child distress, but identified different symptoms and different children demanding attention. Evaluation of teenage youths showed greater disparity: teenagers labeled their own symptoms more often as post-traumatic stress reactions and teachers identified few youths in need of attention. Inter-relatedness among parent, child and clinician appraisals supports the robustness of our semi-structured interview. At the same time, apartness of teacher report underscores the need to incorporate an outside-world vantage point in the process of risk assessment. Also, a more concrete presentation of post-traumatic stress reactions and a higher “further attention” threshold for inward emotional problems seem called for.

  • 44.
    Goldin, Stephen
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Persson, Lars Åke
    Risk and protective factors for mental health in Bosnian refugee childrenManuscript (Other academic)
  • 45.
    Goldin, Stephen
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Levin, Lilian
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Persson, Lars Åke
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Child war trauma: a comparison of clinician, parent and child assessments2003In: Nordic journal of psychiatry, ISSN 0803-9488, Vol. 57, no 3, p. 173-183Article in journal (Refereed)
  • 46.
    Goldin, Stephen
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Levin, Lilian
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Persson, Lars Åke
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Stories of pre-war, war and exile: Bosnian refugee children in Sweden2001In: Medicine, conflict and survival, ISSN 1362-3699, Vol. 17, no 1, p. 25-47Article in journal (Refereed)
  • 47.
    Goris, Janny M
    et al.
    School of Population Health, MPH Program (partially funded by Queensland Health), The University of Queensland, Herston, QLD, Australia.
    Petersen, Solveig
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Stamatakis, Emmanuel
    Department of Epidemiology and Public Health, National Institute for Health Research, University College London, London, UK.
    Veerman, J Lennert
    School of Population Health, The University of Queensland, Herston, QLD, Australia.
    Television food advertising and the prevalence of childhood overweight and obesity: a multicountry comparison2010In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 13, no 7, p. 1003-1012Article in journal (Refereed)
    Abstract [en]

    Objective To estimate the contribution of television (TV) food advertising to the prevalence of obesity among 6–11-year-old children in Australia, Great Britain (England and Scotland only), Italy, The Netherlands, Sweden and the United States.

    Design Data from contemporary representative studies on the prevalence of childhood obesity and on TV food advertising exposure in the above countries were entered into a mathematical simulation model. Two different effect estimators were used to calculate the reduction in prevalence of overweight and obesity in the absence of TV food advertising in each country; one based on literature and one based on experts’ estimates.

    Setting Six- to eleven-year-old children in six Western countries.

    Results Estimates of the average exposure of children to TV food advertising range from 1·8 min/d in The Netherlands to 11·5 min/d in the United States. Its contribution to the prevalence of childhood obesity is estimated at 16 %–40 % in the United States, 10 %–28 % in Australia and Italy and 4 %–18 % in Great Britain, Sweden and The Netherlands.

    Conclusions The contribution of TV advertising of foods and drinks to the prevalence of childhood obesity differs distinctly by country and is likely to be significant in some countries.

  • 48. Hammarström, A.
    et al.
    Korhonen, J.
    Blomqvist, I.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Increase of internalised mental health symptoms over the last 33 years among adolescents2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no suppl_3, p. 271-272Article in journal (Other academic)
    Abstract [en]

    Background: Mental health among young people is of increasing public health importance. Several studies comparing the 1990ies with today suggest an increase of internalised mental health problems among adolescent girls. The development among adolescent boys is less clear. The aim of this study was to analyse the development of mental health among adolescence from the early 1980ies until today with regard to internalised and externalised symptoms among both boys and girls.

    Methods: Two cohorts were compared consisting of all pupils in the last year of compulsory school in Luleå (Sweden) in 1981 (n = 1083, response rate 99.7%) and in 2014 (n = 682, response rate 98.3%). The same questionnaire was used with validated questions about symptoms of mental health. Confirmatory factor analysis were performed in order to validate the proposed a priori factor structure of the mental health measures; anxiety symptoms, depression symptoms, functional somatic symptoms and externalised symptoms.

    Results: Symptoms of anxiety, depression and functional somatic symptoms increased among both boys and girls from 1981 until 2014 (p < 0.001 for all symptoms and for both boys and girls). Externalised symptoms decreased, especially among boys (p < 0.001 for both boys and girls). These changes between the cohorts were confirmed using multivariate regression techniques (controlling for parental socioeconomic status and parental country of origin) for each measure of mental health. among boys and girls.

    Conclusions: Symptoms of internalised mental health have increased among 16-year old boys and girls over the last 33 years while externalised symptoms have decreased, especially among boys. Public health actions need to be initiated in order to stop the increase and prevent internalised mental health problems among teenagers.

    Key messages:

    • A longer period than 20 years is needed in order to detect an increase in internalised mental health symptoms among adolescent boys.
    • Adolescent girls have the highest level and the highest increase in these symptoms during a period of 33 years, while externalised mental health symptoms have decreased mostly among adolescent boys.
  • 49.
    Hammarström, Anne
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Socialmedicin.
    Westerlund, Hugo
    Kirves, Kaisa
    Nygren, Karina
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Socialmedicin.
    Virtanen, Pekka
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Socialmedicin. School of Health Sciences, University of Tampere, Tampere, Finland.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Addressing challenges of validity and internal consistency of mental health measures in a 27- year longitudinal cohort study–the Northern Swedish Cohort study2016In: BMC Medical Research Methodology, ISSN 1471-2288, E-ISSN 1471-2288, Vol. 16, article id 4Article in journal (Refereed)
    Abstract [en]

    Background:There are inherent methodological challenges in the measurement of mental health problems in longitudinal research. There is constant development in definitions, taxonomies and demands concerning the properties of mental health measurements. The aim of this paper was to construct composite measures of mental health problems (according to today’s standard) from single questionnaire items devised in the early 1980s, and to evaluate their internal consistency and factorial invariance across the life course using the Northern Swedish Cohort.Methods:All pupils in the last year of compulsory school in Luleå in 1981 (n= 1083) form a prospective cohort study where the participants have been followed with questionnaires from the age of 16 (in 1981) until the age of43 (in 2008). We created and tested the following composite measures from self-reports at each follow-up:depressive symptoms, anxiety symptoms, functional somatic symptoms, modified GHQ and positive health. Validity and internal consistency were tested by confirmatory factor analysis, including tests of factorial invariance over time.Results:As an overall assessment, the results showed that the composite measures (based on more than 30-year-old single item questions) are likely to have acceptable factorial invariance as well as internal consistency over time.Conclusions:Testing the properties of the mental health measures used in older studies according to the standards of today is of great importance in longitudinal research. Our study demonstrates that composite measures of mental health problems can be constructed from single items which are more than 30 years old and that these measures seem to have the same factorial structure and internal consistency across a significant part of the life course. Thus, it can be possible to overcome some specific inherent methodological challenges in using historical data in longitudinal research.

  • 50. Hayward, J.
    et al.
    Millar, L.
    Petersen, Solveig
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Swinburn, B.
    Lewis, A. J.
    When ignorance is bliss: weight perception, body mass index and quality of life in adolescents2014In: International Journal of Obesity, ISSN 0307-0565, E-ISSN 1476-5497, Vol. 38, no 10, p. 1328-1334Article in journal (Refereed)
    Abstract [en]

    BACKGROUND/OBJECTIVES: Body weight is negatively associated with adolescent Health-Related Quality of Life (HRQoL). Despite this well-established relationship, some adolescents with obesity do not display the expected HRQoL decreases. This study hypothesised weight perception as a moderator of the association between weight status and adolescent HRQoL.

    SUBJECTS/METHODS: Subjects were secondary school students from an obesity prevention project in the Barwon South-West region of Victoria, Australia, entitled It's Your Move (N = 3040). Measures included standardised body mass index (BMI-z; World Health Organization growth standards), weight perception and HRQoL, measured by the Paediatric Quality of Life Inventory. Linear regression and average marginal effect analyses were conducted on cross-sectional baseline data to determine the significance of any interaction between weight perception and measured weight status in shaping adolescent HRQoL.

    RESULTS: The BMI-z/perceived weight status interaction was significantly associated with adolescent HRQoL outcomes. Adolescents with BMI z-scores in the overweight/obesity range who perceived themselves as overweight had lower HRQoL than those who perceived themselves as 'about right.' Conversely, adolescents with BMI scores in the lower end of the normal range or in the thinness range who perceived themselves as underweight had lower HRQoL than those with 'about right' perceptions.

    CONCLUSIONS: This was the first study to report third-variable impacts of a body-perception variable on the relationship between adolescent weight status and HRQoL. Adolescents' weight perceptions significantly moderated the relationship between overweight/obesity and reduced HRQoL. Adolescents who were outside the normal weight range and misperceived their objectively measured weight status enjoyed a higher HRQoL than adolescents whose weight perception was concordant with their actual weight status. These findings suggest that practitioners may need to exercise caution when educating adolescents about their weight status, as such 'reality checks' may negatively impact on adolescent HRQoL. It is suggested that more research be conducted to examine this potential effect.

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