Biomedical subjects

Panos Vostanis

Publications and source records attributed to Panos Vostanis.

At least 19 recordsLinked to original sources

PubMed2006

Relationship between parental psychopathology, parenting strategies and child mental health--findings from the GB national study.

BACKGROUND: Parental and child psychiatric disorders have been found to be associated, and this association can be mediated by other psychosocial variables, including parenting attitudes and strategies. As most previous studies included clinical samples, the purpose of this study was to establish the relationship between parental psychopathology and parenting strategies with child psychiatric disorders in a national survey population. METHODS: The sample included 10,438 children of 5-15 years and their parents, from representative UK households. Families were assessed on child psychiatric diagnosis, parental psychopathology, family functioning, and socioeconomic status. Parenting strategies included using rewards, physical and non-physical punishments towards their child. FINDINGS: Parental psychopathology scores (OR 3.99, 95% CI 3.13-5.09) and non-physical punishment (OR 1.50, 95% CI 1.27-1.76) were associated with child psychiatric disorders. This association was particularly prominent among children with conduct disorders: parental psychopathology scores (OR 3.13, 95% CI 2.28-4.30) and non-physical punishment (OR 3.19, 95% CI 2.55-3.97). Absence of child psychopathology was associated with a combination of rewarding and non-punitive parenting strategies. CONCLUSIONS: Although parents in the general population may be using less physical strategies than in the past, non-physical punishment is strongly related to mental health problems in children. Enhancement of positive parenting through universal and targeted interventions is an important preventive strategy.

Adolescent↗

PubMed2006

Strengths and Difficulties Questionnaire: research and clinical applications.

PURPOSE OF REVIEW: To critically discuss recent findings from studies using the Strengths and Difficulties Questionnaire, in relation to different research designs and clinical purposes. RECENT FINDINGS: A substantive body of research exists on the psychometric properties of the Strengths and Difficulties Questionnaire in different cultures. This body supports the validity and reliability of its versions for the parent, teacher and self-reporting purpose, despite some variation in cut-off scores. The Strengths and Difficulties Questionnaire is increasingly being used as a measure of child psychopathology in other types of research, that is, aetiological, longitudinal and service evaluation studies. Future studies need to address in more detail the Strengths and Difficulties Questionnaire diagnostic algorithms, added value score, impact and burden items and a preschool version. SUMMARY: The Strengths and Difficulties Questionnaire has been established as the most widely used instrument in child mental health research. It is easy to complete, is user friendly because of its positive attributes items, allows comparisons to be made between different populations and is sensitive to change.

Adolescent↗

PubMed2006

Parenting programmes for behavioural problems: where do tertiary units fit in a comprehensive service?

Children with behavioural problems are often referred to child mental health services without rationalization of criteria or referral routes. The aims of the present study were to establish the psychosocial characteristics of children with behavioural problems referred to a tertiary Day Resource, and to compare these with children referred for similar problems to a specialist outpatient child mental health service and a family support community service. Demographic data, the Strengths and Difficulties Questionnaire and the Health of the Nations Outcome scales for Children and Adolescents were used. Families attending the Day Resource were found to have more involvement with other agencies, and children showed higher levels of clinical severity and complexity. Most of this difference was accounted for by attentional difficulties, as well as communication and physical health problems. These findings confirmed the hypothesis that families seen at tertiary service level presented with more complex psychosocial needs and frequent child comorbidity, thereby justifying the multimodal treatment package developed at that service level. It is concluded that there is a need for this level of parenting interventions, but only for complex cases that have not responded to community interventions.

Adolescent↗

PubMed2006

Evaluation of a family support service: short-term outcome.

The aim of this study was to evaluate the short-term impact of two types of family support services (FSS) for children with behavioural problems (N = 51 and 49 respectively). These were compared with children (N = 40) matched for presenting problems and referred to specialist CAMHS in a locality without FSS. Pre and postintervention measures were the Health of the Nation Outcome Scales (HoNOSCA), the Strengths and Difficulties Questionnaire (SDQ), and a service utilization checklist. Although all three groups were associated with decrease of child behavioural scores, the two family support services provided an earlier response and resulted in significantly higher reduction of HoNOSCA and SDQ scores. The two FSS types implemented different 'levels' of interventions, as FSS-B resulted in a more favourable short-term outcome and appeared to operate more closely to specialist services, while FSS-A appeared to adopt a more preventive role. Family support services have an important role within a comprehensive child mental health service, but the specificity of their interventions for different target client groups requires further investigation.

Child↗

PubMed2006

Caring for children with learning disabilities who present problem behaviours: a maternal perspective.

The theoretical cognitive model of stress and coping provides a structure to obtain and analyse maternal perceptions of caring for children with learning disabilities who present severe problem behaviours. The Family Fund database identified 18 families who met the sample criteria of children aged five years to 15 years with severe to moderate learning disability presenting severe problem behaviour. Physical aggression was reported to be the primary behavioural problem for 13 of the children. Interviews undertaken with the main carer of the child at their home were taped and transcribed. The data were analysed using grounded theory techniques which identified 'secondary stressors' for the parent. These were social isolation, conflict, limitation of lifestyle and self-blame. It is proposed that the amalgamated impact of these can weaken parents' coping resources and, therefore, may prove to be as significant to the negative association with maternal wellbeing as the problem behaviour.

Adaptation, Psychological↗

PubMed2006

Trauma exposure in pre-school children in a war zone.

BACKGROUND: There has been little reported research into the effect of war on the behaviour and emotional well-being of pre-school children. AIMS: To investigate the relationship between exposure to war trauma and behavioural and emotional problems among pre-school children. METHOD: A total of 309 children aged 3-6 years were selected from kindergartens in the Gaza Strip, and were assessed by parental reports in regard to their exposure to war trauma, using the Gaza Traumatic Checklist, and their behavioural and emotional problems, using the Behaviour Checklist (BCL) and the Strengths and Difficulties Questionnaire (SDQ). RESULTS: Pre-school children were exposed to a wide range of traumatic events. The total number of traumatic events independently predicted total BCL and SDQ scores. Exposure to day raids and shelling of the children's houses by tanks were significantly associated with total behavioural and emotional problems scores. CONCLUSIONS: Direct and non-direct exposure to war trauma increases the risk of behavioural and emotional problems among pre-school children, which may present as non-specific psychopathology.

Child Behavior Disorders↗

PubMed2006

Palestinian mothers' perceptions of child mental health problems and services.

The aim of this study was to explore Palestinian mothers' perceptions of child mental health problems and their understanding of their causes; to determine Palestinian mothers' awareness of existing services and sources of help and support; to identify professionals in the community whom Palestinian mothers would consult if their child had mental health problems; and to establish their views on ways of increasing awareness of child mental health issues and services. Checklists exploring the above issues were completed by 249 Palestinian mothers living in refugee camps in the Gaza Strip. Palestinian mothers equally perceived emotional, behavioural and psychotic symptoms as suggestive of mental ill health in childhood. Mothers perceived multiple causes of child mental health problems, including family problems, parental psychiatric illness and social adversity. A substantial proportion (42.6%) had knowledge of local child mental health care services. Overall, mothers preferred Western over traditional types of treatment, and were keen to increase mental health awareness within their society. Despite a different cultural tradition, Palestinian mothers appear open to a range of services and interventions for child mental health problems. As in other non-Western societies, child mental health service provision should be integrated with existing primary health care, schools, and community structures.

Journal Article↗

PubMed2005

Group crisis intervention for children during ongoing war conflict.

The aim of this study was to evaluate the short-term impact of a group crisis intervention for children aged 9-15 years from five refugee camps in the Gaza Strip during ongoing war conflict. Children were selected if they reported moderate to severe posttraumatic stress reactions, and were allocated to group intervention (N=47) encouraging expression of experiences and emotions through storytelling, drawing, free play and role-play; education about symptoms (N=22); or no intervention (N=42). Children completed the CPTSD-RI and the CDI pre- and post-intervention. No significant impact of the group intervention was established on children's posttraumatic or depressive symptoms. Possible explanations of the findings are discussed, including the continuing exposure to trauma and the non-active nature of the intervention.

Adolescent↗

PubMed2005

Psychiatric comorbidity in children and adolescents.

PURPOSE OF REVIEW: This review critically discusses recent research findings on psychiatry comorbidity in children and adolescent persons. RECENT FINDINGS: Several epidemiological studies have confirmed previous findings in relation to the high rates of psychiatric comorbidity in children and adolescents. In particular, psychiatric comorbidity has been detected in children with substance abuse, and with conduct and oppositional defiant, anxiety and attention deficit-hyperactivity disorders. These studies have also investigated the impact comorbidity has on symptom presentation, outcome and service utilization. Although the presence of concurrent psychiatric disorders in children and adolescents is well established, there has been limited research on the need for different treatment modalities in children suffering from more than one disorder. SUMMARY: It is widely accepted that children and adolescents frequently present with more than one psychiatric diagnosis. The substantial variation in psychiatric comorbidity found in the literature may be due to the different methods of data collection as well as to the classification system used. Whether children and adolescents fulfil diagnostic criteria for a mixed condition (International Classification of Diseases-10) or multiple disorders (Diagnostic and Statistical Manual of Mental Disorders-IV), it is important that the concurrent psychopathology be recognized and treated.

Journal Article↗

PubMed2005

Patients as parents and young people approaching adulthood: how should we manage the interface between mental health services for young people and adults?

PURPOSE OF REVIEW: The present review discusses critically recent research findings (published during the period 2003-2004) on the mental health needs of young people in transition (old adolescents and young adults), including those of young parents. Also, the evidence on effective interventions and service models is considered. RECENT FINDINGS: Emerging evidence indicates that young people have high rates of mental health needs (in addition to high prevalence of psychiatric disorders) that may be related to life transitions. These needs often fall between the remit of adolescent/adult and mental health/social care services, and therefore are not adequately met. With the exception of mental health interventions for early psychosis and psychosocial programmes for teenage parents, there is very limited knowledge on how best to meet the mental health needs of young people in transition. SUMMARY: It is widely recognized that young people in transition require services and interventions tailored to their characteristics, rather than a mere extension to either child/adolescent or adult services. Recent policies and research findings have led to the development of early psychosis interventions, with initial encouraging messages. Similar initiatives are required for young people with nonpsychotic disorders.

Journal Article↗

PubMed2005

Child mental health problems in the Gaza Strip.

This study describes the mental health characteristics of 150 children of 6-13 years of age, who had been referred to different types of services in the Gaza Strip: a community mental health center, five primary health centers and a pediatric hospital. There was a high rate of somatising disorders among children referred to the mental health center (42%). Parent-reported rates of significant mental health problems were high for all groups, i.e., 70% in the mental health center group, 30% in the pediatric group, and 18% among children referred to primary health centers.

Adolescent↗

PubMed2004

Maltreatment and coping strategies among male adolescents living in the Gaza Strip.

OBJECTIVE: To establish the nature and extent of maltreatment experiences, coping strategies, and behavioral/emotional problems, and their relationships, in a sample of Palestinian adolescents. METHOD: A study of 97 male adolescents aged 15-19 years, and attending a vocational training center based in the Gaza Strip. Adolescents completed the Child Maltreatment Schedule and the Ways of Coping Scale (WAYS). The Strengths and Difficulties Questionnaire (SDQ) was completed by adolescents and by their teachers. RESULTS: Findings revealed high rates of emotional and physical maltreatment. Reliance on emotion-focused or avoidant coping strategies was associated with exposure to maltreatment. Use of maladaptive coping also predicted emotional difficulties in the respondents. CONCLUSIONS: Coping strategies are an important indicator of psychosocial functioning in adolescents who have experienced maltreatment. Identification of coping styles can augment the assessment of at-risk adolescents. Emotion-focused strategies, in particular, appear to be widely used by young people from non-Western cultural backgrounds.

Adaptation, Psychological↗

PubMed2004

Interprofessional perspectives on transitional mental health services for young people aged 16-19 years.

This qualitative study investigated the need for transitional mental health services for young people aged 16-19 years in a health district, as perceived by professionals from mental health, social, education and non-statutory services. Semi-structured interviews with 39 managers and practitioners who planned or provided services for this age range, from a wide range of agencies, explored issues related to older adolescents' needs, service communication, transfer arrangements, current gaps, and recommendations. Interviews were transcribed verbatim and themes emerged according to grounded theory. The four identified themes, with 21 categories, were: (i) older adolescents have multi-faceted needs, (ii) statutory mental health services are not geared towards this age group, (iii) communication between services is variable, and (iv) there are no formal transfer arrangements from child to adult services. The findings support the need for specialist transitional services, and the adoption of an interprofessional service model incorporating education, social services and non-statutory agencies.

Adolescent↗

PubMed2004

A family support service for homeless children and parents: users' perspectives and characteristics.

The objective of the present study was to establish the psychosocial characteristics and perspectives of 49 consecutive homeless families who received input from a new designated family support worker (FSW) post at a large statutory hostel for homeless parents and children. The FSW provided: assessment of social, educational and health needs; support and parent training; and liaison with and referral to specialist services. Measures included quantitative questionnaires (i.e. the Hospital Anxiety and Depression Scale, the Parenting Daily Hassles Scale, the Eyberg Child Behaviour Inventory, and the Health of the Nation Outcome Scales for Children and Adolescents), and a qualitative (semistructured) interview on service experiences and satisfaction. The psychosocial measures indicated high rates of parenting difficulties, mental health and related needs among children and their parents. Parenting difficulties were associated with child behaviour problems. Parents expressed satisfaction with the service whilst they were residents at the hostel, but they were often not clear about the objectives of agencies and interventions. Family support interventions have a key role in service provision for homeless and other vulnerable families by providing direct parenting interventions and ensuring that specialist agencies are appropriately involved. Family support worker involvement needs to continue when families are re-housed in the community.

Adult↗

PubMed2004

Comorbidity of PTSD and depression among refugee children during war conflict.

BACKGROUND: We examined the prevalence and nature of comorbid post-traumatic stress reactions and depressive symptoms, and the impact of exposure to traumatic events on both types of psychopathology, among Palestinian children during war conflict in the region. METHODS: The 403 children aged 9-15 years, who lived in four refugee camps, were assessed by completing the Gaza Traumatic Events Checklist, the Child Post Traumatic Stress Reaction Index (CPTSD-RI), and the Short Mood and Feelings Questionnaire (MFQ). RESULTS: Children reported experiencing a wide range of traumatic events, both direct experience of violence and through the media. CPTSD-RI and MFQ scores were significantly correlated. Both CPTSD-RI and MFQ scores were independently predicted by the number of experienced traumatic events, and this association remained after adjusting for socioeconomic variables. Exposure to traumatic events strongly predicted MFQ scores while controlling for CPTSD-RI scores. In contrast, the association between traumatic events and CPTSD-RI scores, while controlling for MFQ scores, was weak. The CPTSD-RI items whose frequency was significantly associated with total MFQ scores were: sleep disturbance, somatic complaints, constricted affect, impulse control, and difficulties in concentration. However, not all remaining CPTSD-RI items were significantly associated with exposure to traumatic events, thus raising the possibility that the association between depression and PTSD was due in part to symptom overlap. CONCLUSIONS: Children living in war zones are at high risk of suffering from PTSD and depressive disorders. Exposure to trauma was not found to have a unique association with PTSD. The relationship between PTSD and depressive symptomatology requires further investigation.

Adolescent↗

PubMed2004

Health needs of young offenders.

Health services' input to the Youth Offending Teams (YOTs) is an integral component of the YOTs' philosophy. Fifty young people aged 14-18 years, who attended two representative YOTs consecutively, completed a health checklist and a strengths and difficulties questionnaire. They were interviewed on the health of the nation outcome scales for children and adolescents and their perceptions of health needs and services. The young people reported high rates of accidents and injuries, admissions to hospital, emotional and peer relationships difficulties. Their perceptions of what mental illness means varied between stigma, aggression, lack of coping, previous experiences and physical ill-health. Only five young people expressed a wish to receive mental health help. The findings are discussed in relation to health services provision to the YOTs.

Adolescent↗

PubMed2003

Service utilisation by children with conduct disorders--findings from the GB National Study.

BACKGROUND: Children with conduct disorders and their families come into contact with a range of community and specialist agencies. METHODS: The aim of this study was to establish the lifetime service utilisation rates among children with conduct disorders from the Great Britain National Study (N = 10,438), and to examine the association between comorbid disorders, family and social factors, and service utilisation. The Development and Well-Being Assessment, a service checklist, and a battery of family and social functioning measures were used. RESULTS: The weighted prevalence of oppositional and conduct disorders was 5.4%. Within this group (N = 403), 241 (59.8%) had conduct disorder only, 79 (19.6%) comorbid emotional, 72 (17.9%) comorbid hyperkinetic, and 11 (2.7%) comorbid emotional and hyperkinetic disorders. These subgroups were compared on service utilisation with children with other psychiatric disorders (N = 351). Children with conduct disorders had significantly higher lifetime rates of utilisation of social and educational services than children with other psychiatric disorders. Contact with primary health, specialist health, and educational services was significantly associated with comorbid physical and psychiatric disorders. In contrast, contact with social services was associated with family discord and social sector tenancy. CONCLUSIONS: The findings are discussed in the context of organisation and co-ordination of health, other statutory, and non-statutory services, also taking into account previous research on interventions for children with conduct disorders and their families.

Adolescent↗

PubMed2003

Primary Mental Health Workers within Youth Offending Teams: a new service model.

Primary Mental Health Workers (PMHWs) have been deployed to address the mental health needs of young offenders referred to Youth Offending Teams (YOTs) in two UK areas. The mental health characteristics of 60 young people consecutively referred to these PMHWs, the assessment outcome and interventions offered, are described. In addition to the anticipated concerns about oppositional/aggressive behaviour, young people were referred for a range of mental health problems. There were high levels of emotional problems, self-harm, peer and family relationships difficulties, and school non-attendance. PMHWs offered a range of direct interventions, as well as consultation to YOT staff. The service findings indicate the usefulness of such an inter-agency model in strengthening the links between specialist CAMHS and YOTs, and providing an accessible, responsive and effective service to a needy group of young people.

Adolescent↗