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<b>Introduction</b>: Maternal antenatal depression has been associated with an increased risk of offspring psychopathology and more recently with disturbed infant sleep; in particular, shorter sleep duration, more awakenings and sleep problems. The exact mechanisms through which risk may be transmitted remain unknown, as does the question of whether all infants are equally susceptible to the effects of antenatal depression. The primary objectives of this thesis were to examine: i) The role of two potential moderators on the association between antenatal depression and infant sleep: infant reactive temperament and the serotonin transporter polymorphism 5-HTTLPR ii) The association between antenatal depression and infant sleep using objective behavioural and physiological measures. iii) Infant sleep and temperament in a pilot randomised controlled trial (RCT) following treatment of antenatal depression <b>Methods</b> i) The role of infant reactivity and 5-HTTLPR as potential moderators was examined in two large longitudinal cohorts: the Avon Longitudinal Study of Parents And Children (ALSPAC) and the Generation R study, based in the UK and The Netherlands respectively (n=8,991 and n=2,441). ii) An Oxford based pilot longitudinal family study (n=16) iii) A pilot randomised controlled trial of women with antenatal depression who received Cognitive Behavioural Therapy (CBT) or Care as Usual (n=25). <b>Results</b> i) There was evidence that reactive temperament moderated the association between antenatal depression and infant sleep; boys seemed to be most affected exhibiting more awakenings, sleep problems and shorter sleep duration. 5-HTTLPR did not moderate this association. ii) Antenatal depression was associated with shorter infant sleep duration 5 months postpartum iii) Improvement in depression was associated with shorter infant sleep duration and easier temperament 2 months postpartum <b>Conclusion</b>: This thesis suggests that not all infants are equally susceptible to environmental influences and this may prove important in targeting interventions. The role of genetic factors in conferring any susceptibility remains unclear. Actigraphy offering accurate representation of activity levels and timing during the day and night was a significant methodological advantage, but recruitment to a study incorporating these proved challenging. Finally, psychological interventions during pregnancy appear to have beneficial effects for child development.

This thesis investigated (1) social status and shaming experiences in relation to aggressive behaviour and depression, and (2) gene-environment interactions between two genetic polymorphisms related to the serotonergic system – MAOA-VNTR and 5HTTLPR – and experiences of maltreatment in relation to delinquent behaviour and depression among adolescents. The four included studies are based on questionnaire data from the Survey of Adolescent Life in Vestmanland 2006 (SALVe-2006). A total of 5396 students in 9th (15-16 years old) grade of elementary school and 2nd (17-18 years old) grade of high school comprised the target population. The students in 2nd grade of high school also provided a saliva sample for gene extraction. There were strong associations between shaming experiences and both aggressive behaviour and depression. In addition, individuals who reported many shaming experiences and had either low or high social status had increased risks of physical aggression or depression, whereas medium social status seemed to have a protective effect. Gene-environment interactions were found between experiences of maltreatment and the MAOA-VNTR in relation to delinquent behaviour. Moreover, the direction of the gene-environment interaction differed depending on sex: boys with the short (S) variant of the MAOA-VNTR, in contrast to girls with the long (LL) variant, had the highest risk of delinquency in combination with maltreatment. Gene-environment interactions were also found between experiences of maltreatment and the 5HTTLPR in relation to depression among girls. The girls that were homozygous for the S allele (SS) had the highest risk of depression in combination with maltreatment. Among boys however, no gene-environment interaction was found between the 5HTTLPR and maltreatment in relation to depression. In conclusion, it is important to consider both genetic effects, and psychosocial factors such as social status, shaming experiences, and experiences of maltreatment when investigating different aspects of health and behaviour among adolescents.

Background: In a rapidly changing and increasingly interconnected world, the issue of mental health and well-being among adolescents is one of the important research topics. However, there have been few studies amongst Japanese adolescents that have been published in international journals. Objectives: (I) to make a comparison in selfconcept between healthy adolescents in Japan and Sweden, (II) to address the influence of perceived parental rearing on self-concept and mental health problems among Japanese adolescents, (III) to investigate contributions of attachment and self-concept to mental health problems reported by Japanese adolescents, (IV) to address a comparison of mental health problems and self reported competence in adolescents from Greece, Japan, Russia, and Sweden. Methods: The following self-report instruments were used: Self- Description Questionnaire II (Marsh, 1992), Actual-Ideal Questionnaire (Nishikawa, 2003), Self-Description Questionnaire IIShort (Marsh, Ellis, Parada, Richards, &amp; Heubeck, 2005), Youth Self- Report (Achenbach, 1991), Attachment Questionnaire- for Children (Sharpe et al., 1998), and Egna Minnen Beträffande Uppfostran (my memories of child upbringing) for Children (Muris, Meesters, &amp; van Brakel, 2003). The participants for Paper I were adolescents aged 14 and 15 from Japan (n=144) and Sweden (n=96). One hundred ninety three Japanese students between the ages of 15-19 participated in Paper II and 228 students for Paper III. The participants for Paper IV were 812 healthy adolescents between 15 and 17 years of age from Greece (n=152), Japan (n=219), Russia (n=159), and Sweden (n=282).  Results: Paper I showed that Japanese students reported less positive self-concept compared to the Swedish counterparts. The results were discussed in terms of different response style and modesty in Japanese culture. Paper II showed that dysfunctional parental rearing and insecure peer attachment were associated with negative self-concept and more mental health problems. A unique influence on mental health problems from parent-adolescent relationships depending on the gender of parents and adolescents was also found. Paper III showed a mediating role of self-concept in influencing the relationships between attachment style and Internalizing Problems. Paper IV indicated rather small differences across countries in the syndrome scales. Japanese and Swedish adolescents tended to score lower than Russian and Greek counterparts. Some cultural specific syndromes were found. Conclusion: These results reported in this thesis present a general view of Japanese adolescents’ self-concept and the influence of interpersonal relationships in mental health problems assessed by Western self-report instruments. When being compared with other countries, cultural background and response style must be taken into account.

Anorexia Nervosa is a psychiatric illness with peak onset in ages 14-17. Most cases recover within a few years, but the illness can have a fatal outcome or long duration. Multifactor causes of anorexia nervosa include genetics, personality, family, and socio-cultural factors. This study measures mortality, recovery from anorexia nervosa, and psychosocial outcome of patients with adolescent onset anorexia nervosa that were treated in Child and Adolescent Psychiatry in northern Sweden from 1980 to 1985. In addition, this study assesses the predictive value of background variables and studies perfectionism in relation to recovery. Finally, this study looks at how patients understand the causes of their anorexia nervosa and how they view their recovery process. Follow ups were made 8 and 16 years after initial assessment at CAP. Quantitative and qualitative methods were used. These included a semistructured interview, DSM diagnostics of eating disorders (including GAF), and the self-assessment questionnaires EDI and SCL-90. The interview also contained questions about causes and recovery. Recovery increased from 68% to 85% from first to second follow-up and the mortality rate was 1%. Somatic problems and paediatric inpatient care during the first treatment period could predict long-term outcome of eating disorders. Most former patients had a satisfying family and work situation. At both follow-ups, individuals with long-term recovery had a lower level of perfectionism than those that recovered later. On individual levels, eating disorder symptoms and psychiatric symptoms decreased during recovery, whereas the levels of perfectionism stayed the same. Causes were attributed to self, family, and socio-cultural stressors outside of the family. The most common self-reported causes were high own demands and perfectionism. All recovered subjects could remember and describe a special turning point when the recovery started and 62% saw themselves as an active agent in the recovery process. Supportive friends, treatment, activities, family of origin, boyfriend, husband, and children were also helpful in the recovery process. Compared to other outcome studies, the results were good. In spite of the good outcome, some individuals had a long duration of illness and were not yet fully recovered after 16 years of follow-up. Predictors of non-recovery were related to initial somatic problems. Levels of perfectionism were associated to recovery and patients with initial high levels of perfectionism may need more complex treatment strategies. Results from the study also implied that one should stimulate the patients’ social contacts and their sense of self-efficacy in their recovery- process.

Syftet med denna studie är att utifrån ett föräldraperspektiv undersöka behov av och önskemål om stödsom föräldrar med diagnos inom autismspektrum beskriver i sin föräldraroll. Ett annat syfte är att bidra med ökad kunskaptill en diskussion kring utformandet av stödinsatser för dessa familjer. Studien är kvalitativ med intervjuer som gjorts ihalvstrukturerad form. Åtta föräldrar har intervjuats. Föräldrarna beskriver att deras svårigheter gör det svårt för dem isamspelet med barn och partner. De försöker själva och tillsammans med partnern finna lösningar i samspelet. Till hjälp attfinna lösningar har varit insikt om de egna svårigheterna, stöd riktat till AST-problematiken och att få hjälp i parrelationen.Avlastning framför allt genom utökad tid i förskola beskrivs som väsentlig. Önskemål framförs om att stödet ges med enhelhetssyn på familjen, att stödet anpassas och möjlighet att få samtala med föräldrar med liknande problematik. Studienvisar att föräldrarna efterfrågar stöd i sitt föräldraskap och att ytterligare studier behövs för att kunna möta dessa föräldrarsoch deras barns och partners behov. / The purpose of this study is to examine the needs and wishes of support in the parental role described by parents with diagnosis within the autism spectrum from a parental perspective. Another purpose is to contribute to increased knowledge to a discussion of the design of support for these families. The study is qualitative with interviews carried out in a semistructured format. Eight parents were interviewed. The parents describe their own difficulties, the difficulties in the interaction with the children and with their partner. They try to find solutions in the interaction both by themselves and with their partner. Helpful for finding solutions has been insight into their own difficulties, aid directed at problems related to their diagnosis and to get help in relationship. Relief, particularly through extended time in preschool described as essential. Wishes were expressed that the support is given with a holistic view of the family, that the support is adapted to the parental diagnosis and that opportunity to talk with parents with similar problems is provided. The study shows that the parents desire support in their parenting, and that further studies are needed to meet these needs of these parents, their children andtheir partner.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2005. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 4 uppsatser.

Introdução: Os transtornos de ansiedade na infância e adolescência são prevalentes e geralmente se mantêm até a vida adulta. Podem também ser considerados como fator de risco para o desenvolvimento de outros transtornos psiquiátricos. Portanto, a avaliação, o diagnóstico e o tratamento da ansiedade nesta faixa etária, assim como a detecção de comorbidades associadas, têm uma importância significativa para o alívio do sofrimento e para a prevenção de transtornos mentais em futuras etapas do ciclo vital. Objetivos: Avaliar, em uma amostra comunitária de crianças e adolescentes, a presença de comorbidades nos distintos transtornos de ansiedade em comparação ao grupo controle. Métodos: Em um delineamento de caso-controle, entre agosto de 2008 e dezembro de 2009 foram avaliadas, sucessivamente, 242 crianças e adolescentes pertencentes a escolas estaduais que estão dentro da área de abrangência da Unidade Básica de Saúde do Hospital de Clínicas de Porto Alegre (HCPA). A triagem realizada nas escolas faz parte de um projeto de pesquisa no qual foram aplicados instrumentos de avaliação de ansiedade e outros sintomas psiquiátricos com o objetivo de averiguar possíveis casos (ansiosos) e controles, para um amplo estudo sobre transtornos de ansiedade na infância e adolescência. Os indivíduos selecionados, através da triagem escolar, foram posteriormente avaliados através do K-SADS-PL (Schedule for Affective Disorders and Schizophrenia for School-Age Children – Present and Lifetime Version Diagnostic Interview), aplicado aos participantes da pesquisa, juntamente com seus pais, por psiquiatras treinados. Resultados: A amostra final foi composta por 138 casos e 104 controles. Entre os casos, 95 (68,8%) preencheram critérios para diagnóstico de ansiedade generalizada (TAG), 57 (41,3%) para transtorno de ansiedade social (TAS), 49 (35,5%) para transtorno de ansiedade de separação (TASep) e nove (6,5%) preencheram os critérios diagnósticos para transtorno de pânico (TP). Os ansiosos apresentaram alta taxa de comorbidade, ao longo da vida, estatisticamente significativa em comparação ao grupo controle, entre os transtornos de ansiedade: transtorno de ansiedade de separação com fobia específica - FE (51%) e TAG (59,2%); transtorno de ansiedade generalizada com TAS (36,8%), FE (52,6%) e transtorno do estresse pós-traumático - TEPT (8,5%); transtorno de ansiedade social com FE (59,6%) e TAG (61,4%). Também apresentaram mais comorbidade com depressão: com TAG (29,3%) e com TAS (30,9%), e enurese com TASep (22,4%). Conclusão: Houve, na amostra comunitária, uma alta prevalência de transtornos de ansiedade, principalmente transtorno de ansiedade generalizada, transtorno de ansiedade social e transtorno de ansiedade de separação. Evidenciou-se maior comorbidade com os demais transtornos de ansiedade, depressão e enurese entre os ansiosos em comparação ao grupo controle. Observou-se que possuir a comorbidade aumenta o risco de ter o desfecho (transtorno de ansiedade). É importante a realização de pesquisas similares com um maior número amostral, e de estudos caso-controle em amostras clínicas, para confirmação dos nossos resultados. / Introduction: Anxiety disorders in childhood and adolescence are prevalent, often remain until adulthood and may also be considered as a risk factor for developing other psychiatric disorders. Therefore, assessment, diagnosis and treatment of anxiety in this age group as well as the detection of comorbidities have a significant importance for the relief of suffering and the prevention of mental disorders in future stages of the lifecycle. Objectives: To evaluate the presence of comorbidities in the different anxiety disorders compared to controls in a community sample of children and adolescents. Methods: 242 children and adolescents were evaluated successively in the state schools which are within the area covered by the primary care unit of Hospital de Clinicas de Porto Alegre (HCPA) in a randomized case-control study, between August 2008 and December 2009. The screening conducted in schools is part of a research project in which instruments were used to evaluate anxiety and other psychiatric symptoms in order to investigate possible cases (anxious) and controls for an extensive study of anxiety disorders in childhood and adolescence. Those selected through the school screening, were subsequently evaluated using the K-SADS-PL (Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime Version Diagnostic Interview), applied to the research participants, along with their parents by trained psychiatrists. Results: The final sample included 138 cases and 104 controls. Among cases, 95 (68.8%) met diagnostic criteria for generalized anxiety disorder (GAD), 57 (41.3%) for social anxiety disorder (SAD), 49 (35.5%) for separation anxiety disorder (SepAD) and nine (6.5%) met the diagnostic criteria for panic disorder (PD). The forward had a high rate of comorbidity in lifetime, statistically significant compared to the control group, among the anxiety disorders: separation anxiety disorder with specific phobia - SP (51%) and GAD (59.2%); generalized anxiety disorder with SAD (36.8%), SP (52.6%) disorder and posttraumatic stress disorder - PTSD (8.5%), social anxiety disorder with PS (59.6%) and GAD (61.4%). There was also more comorbidity between depression with GAD (29.3%) and SAD (30.9%) and enuresis with SepAD (22.4%). Conclusion: There was a high prevalence of anxiety disorders, particularly generalized anxiety disorder, social anxiety disorder and separation anxiety disorder in the community sample. There has been a higher comorbidity with other anxiety disorders, depression and enuresis among anxious compared to control group and it has been observed that having the comorbidity increases the risk of the outcome (anxiety disorder). It is extremely relevant and important to conduct similar research with a larger sample and case-control studies in clinical samples to confirm the results.