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The underlying structure of obsessive-compulsive disorder (OCD) remains to be confirmed in child and adolescent populations. In this paper we report the first factor analytic study of individual OCD items from Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). OCD symptoms were assessed using the CY-BOCS symptom checklist in a sample of 854 patients with OCD (7-18 years of age) recruited from clinics in five countries. Pooled data were subjected to exploratory and confirmatory factor analysis (CFA) to identify the optimal factor structure. Various models were tested for age and gender subgroups. Also, the invariance of the solution across age and gender was tested and associations with demographic and clinical factors were explored. A three-factor model provided the best-fit solution. It consisted of the following factors: (1) harm/sexual, (2) symmetry/hoarding, (3) contamination/cleaning. The factor structure was invariant for age and gender across subgroups. Factor one was significantly correlated with anxiety, and factor two with depression and anxiety. Factor three was negatively correlated with tic disorder and attention-deficit/hyperactivity disorder (ADHD). Females had higher scores on factor two than males. The OCD symptom structure in children and adolescents is consistent across age and gender and similar to results from recent child and adolescents although hoarding may not be a separate factor. Our three-factor structure is almost identical to that seen in early studies on adults. Common mental disorders had specific patterns of associations with the different factors. [ABSTRACT FROM AUTHOR]

Focuses on a study which employed the Youth Self-Report (YSR) and the Depression Self-Rating Scale (DSRS) as measures of depression and suicidality among adolescents in Sweden. Reasons for the attractiveness of taxonomic approaches to the diagnosis of psychiatric problems in children and adolescents; Gender difference on DSRS and YSR scores; Correlations between the DSRS and YSR scales with emotional symptoms.

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

The Child Behavior Checklist (CBCL) and Youth Self-Report (YSR) are widely used measures of psychiatric symptoms and lately also adapted to the DSM. The incremental validity of adding the scales to each other has not been studied. We validated the DSM subscales for affective, anxiety, attention deficit/hyperactivity (ADHD), oppositional defiant (ODD), conduct problems (CD), and obsessive-compulsive disorder (OCD) in consecutively referred child and adolescent psychiatric outpatients (n = 267) against LEAD DSM-IV diagnoses based on the K-SADS-PL and subsequent clinical work-up. Receiver operating characteristic analyses showed that the diagnostic efficiency for most scales were moderate with an area under the curve (AUC) between 0.70 and 0.90 except for CBCL CD, which had high accuracy (AUC>0.90) in line with previous studies showing the acceptable utility of the CBCL DSM scales and the YSR affective, anxiety, and CD scales, while YSR ODD and OCD had low accuracy (AUC<0.70). The findings mostly reveal incremental validity (using logistic regression analyses) for adding the adolescent to the parent version (or vice versa). Youth and parent ratings contributed equally to predict depression and anxiety disorders, while parent ratings were a stronger predictor for ADHD. However, the youth ADHD rating also contributed. Adding young people as informants for ODD and OCD or adding the parent for CD did not improve accuracy. The findings for depression, anxiety disorders, and ADHD support using more than one informant when conducting screening in a clinical context., Competing Interests: The authors have declared that no competing interests exist.

Background: To evaluate screening efficiency and suggest cut-offs for parent and child Mood and Feelings Questionnaire (MFQ) and the short version (SMFQ) in unselected help seeking child- and adolescent psychiatric outpatients for subgroups of 6-12 versus 13-17 year olds and boys versus girls., Method: Eligible for inclusion were newly admitted outpatients age 6-17 years (n = 5908) in four Swedish child- and adolescent psychiatry clinics. They were prompted consecutively and n = 307 accepted a specific day for assessment until time slots randomly were filled. We prospectively validated the MFQ (33 items) and SMFQ (13 items) in patients (n = 186) using receiver operating characteristics against a reference test of Longitudinal Expert All Data DSM-IV depression based on a Kiddie-Schedule for Affective Disorders and Schizophrenia and 1.2 (sd .6) years of follow-up., Results: A depressive disorder was confirmed in 59 (31.7%) patients ranging from 14.0% for girls 6-12 years to 53.3% for girls 13-17 years. SMFQ performed roughly equivalent to MFQ. Adolescent score on SMFQ discriminated fairly for boys with Area Under Curve .77 (95% confidence interval .59-.81) and good (.82, .69-.91) for girls and parent ratings for adolescent girls (.85, .73-.93), but not for boys. Depression in children below age 13 could not be discriminated by MFQ or SMFQ whether filled in by child and mostly also when filled in by parent. Favouring maximum kappa value, the optimal cut-off was for MFQ self-report girls ≥32 versus boys ≥11 and for SMFQ self-report girls ≥17 versus boys ≥ 6. Suggested clinical SMFQ cut-offs for girls were ≥12 and for boys ≥ 6., Conclusions: MFQ and SMFQ can, with gender-based cut-offs, be used for screening in clinical populations of adolescents but not in children. Parent MFQ and SMFQ can be used for adolescent girls but not boys. SMFQ is sufficient for screening., Competing Interests: The authors have declared that no competing interests exist.

We evaluated the clinical utility of the Swedish SCARED-R in child- and adolescent psychiatric outpatients (n = 239) and validated it against Longitudinal Expert All Data (LEAD) DSM IV diagnoses based on the Children's Schedule for Affective Disorders and Schizophrenia (KSADS) and subsequent clinical work-up and treatment outcome. The SCARED-R total score and subscales had acceptable sensitivity/specificity for child and parent reports for cut-offs based on Receiver Operating Characteristics (ROC) curves, with mostly moderate area under the curve. Sensitivity ranged from 75% (parent rated social anxiety) to 79% [child rated Generalized Anxiety Disorder (GAD)]. Specificity, ranged from 60% for child-rated GAD to 88% for parent rated social anxiety. Parent-child agreement was moderate, and each informant provided unique information contributing to most diagnoses. In conclusion, the SCARED-R is useful for screening anxiety symptoms in clinical populations. However, it cannot replace interview based diagnoses, nor is it adequate to use just one informant.

Objective: To examine prevalence of sleep problems among children and adolescents with obsessive-compulsive disorder (OCD) as rated by their parents and the role of comorbidity., Methods: Children and adolescents with OCD (n=185) referred to specialized OCD unit were compared with children from child and adolescent psychiatry (CAP) outpatient units (n=177) and a school sample (GP) (n=317). All were assessed by parents on the Child Behaviour Checklist (CBCL)., Results: Sleep problems were common in both the OCD (28.8 %) and CAP (20.3%) groups compared with the GP group (5.4%). While the OCD group significantly more often had less sleep than the CAP group (11.7% vs. 6.8%), small differences were found between these two groups for nightmares (5.9%, vs. 6.8% n.s.). Comparing the OCD and CAP groups on total sleep problem scores, OCD was a weak while the CBCL syndrome scales Thought problems (which includes OCD symptoms), Anxiety/Depressed, Somatic problems and Aggressive behaviour were strong predictors indicating that comorbidity rather than OCD might be especially important., Conclusion: Sleep problems are common among children and adolescents with OCD as well as among regular CAP outpatients. In OCD patients, the total comorbid symptom burden predicts sleep problems to a greater extent than the OCD itself. A thorough assessment of sleep problems and their causes are needed for all outpatients referred to child and adolescent psychiatric service.

Objective: Assess the prevalence of autistic traits (AST) in pediatric obsessive-compulsive disorder (OCD) and relate them to OCD co-morbidity and compare them with published normative data., Methods: Pediatric patients with obsessive-compulsive disorder (n=109) according to the DSM-IV were studied using parent ratings of the Autistic Symptom/Syndrome Questionnaire to assess AST symptoms as a continuous rather than categorical trait. The KSADS, a semi-structured psychiatric interview, was used for the psychiatric diagnostic evaluation. Also, the Children's Yale-Brown Obsessive-Compulsive Scale was used to assess OCD severity and other clinical features., Results: AST was common among our patients. Symptom scores were highest in cases with co-morbid Autistic Spectrum Disorders, but cases with other co-morbidities as tics/Tourette and attention/behavioral disorders also scored higher. All sub-groups, including OCD without these co-morbidities scored higher than the Swedish normative group. Using ANOVA, co-morbid ASD and tics/Tourette (plus a term for gender by tic interaction indicating that girls with tics scored high, otherwise low) and pathological doubt contributed (R2=.41) to the AST-traits, while OCD severity and co-morbid anxiety- and depressive disorders did not., Conclusion: AST traits are prevalent in OCD and seem to be intricately associated with the co-morbidities as well as the OCD syndrome itself. The findings might have implication for our nosological understanding of OCD which currently is discussed.

Objective: Obsessive-compulsive disorder (OCD) defined at the diagnostic level encompasses divergent symptoms and is often associated with other psychiatric problems. The present study examines OCD versus co-morbid symptom patterns in OCD in children and adolescents in order to investigate the presence of diagnostic heterogeneity., Subjects and Methods: A total of 113 outpatients with primary OCD participated. The patients' and primary caretakers' responses on semi-structured interviews (child version of Schedule for Affective Disorders and Schizophrenia and the Children's Yale-Brown Obsessive Compulsive Scale) and parents' responses on the Child Behaviour Checklist were used in the study. Psychiatric diagnoses were related to CBCL syndrome scores and CBCL scores were compared with the Swedish normative data., Results: Co-morbid diagnoses were very common and only one out of five patients had only OCD. The most common group was the neuropsychiatric disorders (47%) where tic disorders were most common (27%), especially among boys (40.8%; P = .006, Fisher's exact test). Also anxiety disorders were common (39.8%) as were affective disorders (24.8%) neither with any gender differences. Diagnoses of disruptive disorders were less common (8.8%), almost exclusively of the oppositional kind (ODD) (8.8%). From the dimensional point of view using the CBCL, patients with OCD scored higher than Swedish youngster generally do, and some gender differences were seen in that girls scored higher on anxiety and depression while both girls and boys had high scores on thought problems, attention problems and especially aggressive behaviour. Comorbidities explained from 25 to 50% scores of the CBCL sub-syndrome scales, often with both main effects and through complex patterns of interaction with gender, OCD-severity and other co-morbid problems., Conclusions: While co-morbid problems is an important facet of OCD, sub-syndromal levels of symptoms that can be assessed using a dimensional approach, is a large part of the total symptom burden in these youngsters. Our data indicate contributions of different pathways for girls and for boys for several comorbid problems together with OCD-severity.

Objectives: Impaired arterial baroreflex sensitivity (BRS) has been associated with cardiac mortality and non-fatal cardiac arrests after a myocardial infarction. Patients with chronic renal failure (CRF) have a poor prognosis because of cardiovascular diseases, and sudden death is common. The aim of this study was to assess whether BRS or the baroreflex effectiveness index (BEI), a novel index reflecting the number of times the baroreflex is active in controlling the heart rate in response to blood pressure fluctuations, is associated with prognosis in CRF., Methods: Hypertensive patients with CRF who were treated conservatively, by haemodialysis or peritoneal dialysis were studied. Electrocardiogram and beat-to-beat blood pressures were recorded continuously and BRS and BEI were calculated. Patients were then followed prospectively for 41 +/- 15 months (range 1-64)., Results: During follow-up 69 patients died. Cardiovascular diseases and uraemia accounted for the majority of deaths (60 and 20%, respectively), whereas sudden death occurred in 15 patients. In adjunct with established risk factors such as age, diabetes, congestive heart failure and diastolic blood pressure, reduced BEI was an independent predictor of all-cause mortality among CRF patients [relative risk (RR) 0.50, 95% confidence interval (CI) 0.33-0.71 for an increase of one standard deviation in BEI, P < 0.001]. Diabetes and reduced BRS were independent predictors of sudden death (RR 0.29, 95% CI 0.09-0.86 for an increase of one standard deviation in BRS, P=0.022)., Conclusions: Both BEI and BRS convey prognostic information that may have clinical implications for patients with cardiovascular diseases in general.

Objectives: To assess weight problems and correlates in respect of body image, depression, anxiety and demographic background factors., Method: 405 Swedish adolescents were assessed in respect of Body Mass Index (BMI), biographical data, the Body Esteem Scale for Adolescents and Adults (BESAA), the Multidimensional Anxiety Scale for Children (MASC) and the Children's Depression Inventory (CDI)., Results: Boys were in the positive and girls in the negative direction from ideal BMI for age and gender. Girls and boys differed in respect of CDI, MASC and of BESAA where girls generally were shifted in the "pathological" direction., Discussion: The adolescents' own positive attitude to slimness, negative mood (girls), and anxiety symptoms that reflect social fears (boys) and physical aspects of anxiety (girls and boys) were important correlates of lower BMI than ideal. Adolescent cultural norms need to be addressed in preventive work. However, in girls' separation anxiety might be a protective factor against underweight. In girls, overweight seems to be associated with negative self-esteem.

The Swedish translation of a new scale developed for childhood and adolescent anxiety, the Multidimensional Anxiety Scale for Children (MASC), was studied regarding reliability and convergent validity and to obtain norms in a general population. Four hundred and five adolescents, reasonably representative of Swedish adolescents, were asked to rate their anxiety symptoms on the MASC. In order to study the convergent validity, they also rated their depressive symptoms on the Children's Depression Inventory (CDI), their attitude to their body on the Body Esteem Scale for Adolescents and Adults (BESAA) and filled in demographical data on themselves. The MASC showed adequate internal consistency both for the whole scale (alpha = 0.87) and for subscales (range 0.64-0.84). The scale showed convergent validity through a moderate correlation with the CDI (r=0.400, P=0.0001) and the BESAA (r= - 0.29, P=0001). Girls scored higher (mean = 38.9) than boys (mean = 31.9) on the MASC total score (t(385) = 5.14, P=0.0001) and on the subscales, except Harm avoidance. Using the MASC as a general screen for anxiety, scores of 48 for boys and 56 for girls using MASC total scores, or scores of 15 for boys and 17 for girls using the Anxiety Disorders Index could be employed (both representing the 90th percentiles). The MASC appears to be a reliable and valid scale both on the global and on the subscale level.

Self-rating scales are an economical and practical aid in the diagnostic work-up. However, normative data from the general population are needed to interpret scores. Four hundred and five adolescents selected to be fairly representative of the general population (both ethnical Swedes and born abroad) filled in a questionnaire containing the Children's Depression Inventory (CDI), the Multidimensional Anxiety Scale for Children (MASC) and background data (including socio-economic status (SES). The CDI was reliable in terms of internal consistency (0.86) with a mean inter-item correlation of 0.18 and item-total score correlations ranging from 0.26 to 0.57. The CDI sub-scales (Negative Mood, Ineffectiveness, Anhedonia and Negative Self-esteem had good internal consistency values slightly above 0.60, except for sub-scale Interpersonal Problems with poor internal consistency (0.36). The 90th and 95th percentiles respectively were defined by scores 15 and 18 and above for boys and by scores 20 and 23 and above for girls. Common correlates of high scores were female gender, broken family but not SES, nor ethnicity. Also, some estimates of the convergent validity of the CDI were found in a Pearson correlation of 0.40 with the MASC total score and in the capacity of the CDI (predictive validity); OR = 1.1 in predicting suicidal ideation. The CDI has some, but as of yet not sufficient indications of being a valid and reliable measure of depression in adolescence and scores can be used to indicate, though not prove the absence or presence of, depression.

Unlabelled: The aims of the present study were to examine OCD-related impairments in clinical cases of childhood OCD and to replicate and extend previous research on OCD-related impairments., Method: Sixty-eight patients aged 8-17 years recruited from four child psychiatric outpatient clinics in Norway and Sweden with a confirmed DSM-IV diagnosis of OCD were included in the study. All patients and their parents were interviewed for diagnosis and comorbidity (KSADS),OCD symptoms and severity (CY-BOCS), and global impairment (CGAS). OCD-specific impairments were assessed by means of the Child OCD Impact Scale (COIS), a 58 item questionnaire with parallel parent and child versions., Results: Overall, the majority of patients suffered from substantial impairments. The impact of OCD symptoms was found to be most severe at home, but impairments were also prominent in situations related to school and social settings., Conclusions: Our study supports findings of previous research suggesting multiple impacts of OCD symptoms on children's psychosocial functioning. We conclude that impairment issues should be further addressed in future research to establish a better empirical basis for the understanding of different aspects of OCD-related impairment.

Objective: To assess exercise habits and their relation to smoking habits and social and medical factors in postmenopausal women., Methods: A cross-sectional study with a questionnaire to all 1324 55-56 year old women in Linköping, Sweden., Results: Response rate was 85%. About a third of the women took part in some kind of quite strenuous exercise for at least one hour a week. After a quarter worked out once a week; fewer did swimming and jogging. One in four women smoked. Women who used hormone replacement therapy, who were not smoking and who had a physically light occupation more often took part in strenuous sports. Women who had been treated for malignancies or with back problems exercised to the same extent as women in the general population., Conclusion: About a third of the post-menopausal women exercised on a regular basis, if exercise involved in getting to and from work was not counted. Since regular physical exercise has many health benefits, more women should be encouraged to take part in regular physical exercise. Factors probably associated with level of education and general awareness of the importance of a healthy lifestyle positively influenced the likelihood of these women to be physically active on a regular basis. A previous malignant disease or current back problems did not prevent women from taking part in exercise on a regular basis.

This study examined the prevalence of self-reported depressive symptoms in a Swedish urban school sample (n = 524) aged 13-18 years using the Birleson Depression Self-Rating Scale (DSRS). Normative data are presented. The DSRS had high internal consistency. Factor analysis showed one single factor comprising almost exactly the same items that had been found to best reflect depressive phenomena in a previous clinical study. Items particularly endorsed by high scoring adolescents (above the 95th percentile) indicated a symptom constellation with 'endogenous' features. The frequencies of reported suicidal ideation and suicide attempts were 4% and 5%, respectively. Female gender and suicide attempt, but not age were associated with higher scores on the DSRS. Our results-indicate that, despite its shortcomings, the DSRS is a reliable and valid measure of depression in adolescence.