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.

The main aim of this thesis has been to investigate trauma and dissociation among Swedish adolescents and to evaluate the psychometric properties such as reliability and various kinds of validity of three screening instruments for assessment of dissociation and other symptoms of post traumatic stress. The three instruments in question have been Dis-Q-Sweden, A-DES and TSCC, the symptoms measured by these instruments are neither easy to capture nor easy for the adolescent to talk about. Therefore these self report scales are essential. A second aim has been to compare the results with results from other countries and to develop preliminary Swedish norms for the clinician to use. Age and gender differences have been looked upon as well as assessed symptoms connected to known experienced trauma/sexual and/or physical abuse and self-reported trauma in normal and clinical populations. The populations, in this thesis have been children and adolescents age 10 -19 years old from the general population; the clinical groups have had the same age range. All children and adolescents in the clinical groups have been sexually and/or physically abused. Participants have answered the questionnaires Dis-Q-Sweden, A-DES and/or TSCC and their answers have been statistically analysed. All three instruments have been shown to have good reliability, such as internal consistency and test-retest. Validity has been established through factor analyses, concurrent, and criterion related validity. Clinical groups with known experienced trauma/sexual abuse and/or physical abuse gave significantly higher scores on all the instruments compared to normative groups. Also self-reported trauma in a normative group gave significantly higher scores even if the significances are not as high as between the normative and clinical groups. Girls scored significantly higher than boys in both the clinical and normative groups. Girls in the age range 14-15 years old gave the significantly highest scores on both Dis-Q-Sweden and ADES. Swedish adolescents gave lower mean scores on all three instruments than have been reported from other studies in other countries. The scores from the clinical groups gave about the same mean as have been reported elsewhere. The conclusion from this thesis is that all the three questionnaires Dis-Q-Sweden, A-DES and TSCC have shown satisfactory psychometrics properties and can very well be used by Swedish clinicians in Child and Adolescents Psychiatry.

Child protection is the process that aims to find, investigate and help maltreated children. In many countries this process is initiated by professionals who compile mandated reports that are then submitted to a designated agency that in many cases is part of a separate child protection system. In Sweden there is no separate child protection system. In Sweden, the child protection process is part of the family-service organization system. The system has two main objectives, one is voluntary (provide family service), the other coercive (provide child protection). This system is administered by the municipal social services agencies (referred to throughout as Social Services). Aim: The overall purpose of this study was to gain knowledge of the child protection process in Sweden. The aim was two fold, one to carry out an in-depth study of a population of reports, the other to analyse the results of the findings in relation to the child protection system. The child protection system consists of elements outlined in the macro system: the underlying ideology and the framing of the problem, and the legislation, administration and the demands placed on professionals. Method: A total population of reports made to one municipality during 1998 was followed to a final decision. The reports were collected in 2000.´There were 1 570 reports made regarding 1 051 children, which composed 4 % of children age 0-18. This initial study was used in four papers where data were analysed covering four different issues. In 2003 a follow-up study was conducted in order to determine the extent to which the child appeared in the database of Social Services. In the first paper the children’s age, gender and contacts with Social Services were described as were the content of the reports and the outcome of reporting. The objective of the second paper was a description of the reporter, and the measurement of the extent to which the reports indicated child maltreatment. The third paper aimed at analysing how the first decision, the decision not to investigate reports, was made in the child protection process. Then a re-evaluation of these decisions was made to see how well the decision was justified. The contacts taken were described. In the fourth paper the influence of the socio-economic load on the child protection process was measured. Findings: Few reports (16 %) led to an intervention being provided, and 41% of the reports were not investigated further. In the follow-up study 61% of all 1 051 children appeared in the files of Social Services. As Sweden lacks a juvenile delinquency system these cases are automatically passed from the police to Social Services and are there registered as mandated reports. Hence the police became the largest report group of reporters, followed by professionals. Of the professionals’ reports 22 % were not investigated. In the follow-up study 53 % of these re-occurred at the Social Service and were then investigated. Seventy six percent of the reports not investigated were when re-evaluated found to indicate child maltreatment. The social worker used the parents as the main source for information in 74 % of the cases. The social worker did not contact the child at all in 53 % of the cases and only nine of the reporters were contacted. In the follow-up study 45 % of the children investigation re-appeared in the files of Social Services. Children from high socio-economic load districts were more often reported than those from middle or low (4.3%, 3.1% 2.3%). The socio economic load when measured in logistic regression was not found to correlate with the decision to investigate. A main finding in this study was that the child protection process was difficult to separate from other systems within the family service. This makes it much more difficult to evaluate the child protection process. The reports filed by professionals were not investigated adequately, and the lack of criteria of specifying how reports are to be evaluated creates a risk that maltreated children will not be found. The professional reports were handled in a way that increased the risk that professionals will have negative experiences with Social Services that consequently can lead them to refrain from filing eports. Conclusion: These findings suggest the following: Pass new legislation that makes it easier to separate each of the three systems from the other. Create a national database in which data on the handling of child-protection cases is systematically recorded. Develop a national reporting form that is to be used by all who file mandated reports of suspected maltreatment. Create clear criteria that specify how a report is to be handled to ensure that the reporting professionals are met with appropriate respect and that the quality of the decisions is guaranteed all over the country.

The comprehensive purpose of the thesis was to study the health and experiences, with a main focus on mental health, of a group of grown-up children of divorced parents in comparison to a group of persons without this experience. Mental health, experienced life events, narratives of divorce related experiences and personal resources were therefore examined in a group of young adults (age 22-33 years) whose parents divorced 15 years before the start of the first three studies. In addition to this, the presence of a child/adolescent and/or an adult psychiatric record and ten years of diagnosed physical health visits in the same but extended group (age 21-38 years) was examined 20 years after parental divorce. The outcomes of these examinations were compared with the outcomes of a group with married parents still living together, matched with the divorce group on age gender and living area. The results showed no major differences in mental health between the divorce and the non-divorce group, with the exception of women age 22-27 showing poorer mental health than the others in the study. Personal resources in this case SOC (Sense of Coherence) followed the same pattern, with no significant differences between the divorce and the non-divorce group, but with women age 22-27 showing lower SOC. The experiences/narratives told by the divorce group fell into one of two categories: one disappointment, the other contentment, with the first indicating non-optimal chances for adjustment to parental divorce and the other good. The run-through of psychiatric records showed no significant differences between the number of persons in need of adult psychiatric care in the divorce and the non-divorce group. A significant difference was present, however, in child- and adolescent psychiatric care pointing to a larger need for psychiatric care in the divorce group, a need most pronounced among girls. As concerned the number of diagnosed physical health care visits, only small differences between the groups were found. The main conclusion of the study was that experience of parental divorce in childhood is not found for a majority to be an experience determining poorer mental or somatic health in young adulthood.

Diagnosen Asperger syndrom är ett relativt nytt begrepp inom autismspektrumet. För bara 20 år sedan var syndromet relativt okänt världen över. År 1988 hölls den första internationella kongressen i London och där presenterades de första diagnoskriterierna av makarna Gillberg. Efter kongressen har ytterliggare tre kriterier uppkommit. Vi vill undersöka hur elever med Asperger syndrom uppfattar sin skolgång. Vi vill även undersöka hur lärare och föräldrar till barn med diagnosen upplever barnets skolsituation. Vi har utfört en kvalitativ studie, där vi med hjälp av sju ungdomar med diagnosen Asperger syndrom, fyra lärare som arbetar med barn i behov av särskilt stöd och två föräldrar som har barn med diagnosen Asperger syndrom. Resultatet av intervjuerna visar att eleverna är väl medvetna om vad som krävs av skola och lärarna för att de ska känna delaktighet i undervisningen. Vår studie visar att regelbunden kontakt med hemmet är mycket viktigt för både barnet, föräldern och läraren. Denna studie ger tänkvärd information för pedagoger och föräldrar som antingen arbetar eller kommer i kontakt med barn med diagnosen Asperger syndrom.

Lås in pedofilerna och kasta bort nyckeln. Tvångskastrera våldtäktsmännen. Samhällets dom mot sexualbrottslingarna är hård och vägen tillbaka för många omöjlig. Möt sexualbrottslingen och de som arbetar med män vars handlingar väcker avsky.

The aim of the study was to examine individual staff experience and management of threats and violence in the acute psychiatric department for children and teenagers in Uppsala. Previous research shows that the experience of threats and/or violence is individual, and that it is difficult to distinguish between these concepts. Research shows that it is particularly vulnerable to work in psychiatry when mental illness is a cause when threats and violence occurs. Threats and violence can result in different consequences for the individual. The study is based on qualitative interviews and the material was collected in the autumn of 2012 at Akademiska sjukhuset. The qualitative interviews was transcribed and carefully analyzed. The result had an outcome in four different themes: The diffuse definition between threats and violence that showed how difficult it is to define threats and violence. Causes and staff reaction showed that mental illness, how you treat someone and compulsive cares are contributing factors to threats and violence occurs. This theme also shows ambivalence within the staff, that the behavior is unacceptable meanwhile he or she is mentally ill. Management and reporting showed that the staff has different coping strategies when they deal with threats and violence and that it is different how functional the reporting is. The theme working environment showed that it is a vulnerable environment to work in. Therefore, it is important to get support from colleagues and managers but the staff has different opinions whether they feel supported from managers. There is a need to develop routines for incidents when threats and/or violence have occurred. / Syftet med studien var att undersöka personalens enskilda upplevelse och hantering av hot och våld på Barn- och ungdomspsykiatrins (BUP) akutmottagning i Uppsala. Tidigare forskning visar att det är individuellt hur man upplever hot och våld samt att det är svårt att hålla isär dessa begrepp. Forskning visar även att det innebär en särskilt utsatthet att arbeta inom psykiatrin, då psykiska sjukdomar är en bakomliggande faktor till att hot och våld uppstår. Att bli utsatt för hot och våld kan resultera i olika konsekvenser för den enskilde. Studien baseras på kvalitativa intervjuer och materialet samlades in hösten 2012 på BUP på Akademiska sjukhuset. De kvalitativa intervjuerna transkriberades och analyserades noggrant. Resultatet utmynnade i fyra teman: Den diffusa gränsen mellan hot och våld som visade hur svårdefinierat hot och våld är samt var gränsen mellan dessa går. Orsaker och personalens reaktion tog upp att psykiska sjukdomar, bemötande och tvångsvård är bidragande faktorer till att hot och våld uppstår. I en hot- och/eller våldshändelse uppstår en reaktion hos personal, en ambivalens mellan att personen är psykiskt labil och att beteendet är oacceptabelt.  BUP akutens hantering och rapportering visade att personalen har olika copingstrategier när de ska hantera en hot och/eller våldssituation samt att det är olika hur rapporteringen av dessa situationer fungerar. Det sista temat Arbetsmiljön visade att det är en utsatt miljö att arbeta i och att det är viktigt att få stöd i arbetet, men huruvida personalen upplever att de får stöd ser olika ut. Det finns ett behov för att utveckla rutiner kring samtal efter en hot- och/eller våldshändelse.

Syftet med denna studie var att belysa hur sjuksköterskor kan upptäcka och identifiera signaler hos barn som växer upp i en destruktiv miljö av alkoholmissbruk. Metod som användes för att belysa syftet var beskrivande litteraturstudie. Databaser som användes vid sökningen av valda källor var Medline(PubMed) och Cinahl. Andra sökstrategier var manuellsökning i valda källor. Huvudresultatet visade att barn till föräldrar med tungt alkoholmissbruk framförallt mådde psykiskt dåligt, det tog sig uttryck som depression och utåtagerande beteende. Barns ohälsa i samband med att växa upp i dysfunktionella miljöer relaterat till alkoholmissbruk tog även sig uttryck i återkommande psykosomatiska symtom samt kognitiva brister. Risken för att barn skulle fara illa kopplades även till den känslomässiga miljön som rådde i hemmet. Tecken på ohälsa behövde dock inte vara en följd av en ogynnsam uppväxtmiljö utan kunde härledas till genetiska faktorer. Slutsatsen är, för att kunna identifiera barn som befaras fara illa i sitt hem krävs goda kunskaper om problemets komplexitet. För att utgöra en viktig länk i detta arbete som sjuksköterska krävs förutom kunskap även utarbetade riktlinjer. Virginia Hendersons omvårdnadsteori kan enligt författarna utgöra ett gott stöd i att bedöma varje enskild situation, utifrån dess orsak och verkan baserade tänkande.

Manualized, evidence-based treatments (EBTs) for children are being increasingly incorporated in community mental health clinics. Yet, providers hold concerns about the appropriateness of manuals for community populations, as suggested by the research of Jensen-Doss, Hawley, Lopez and Osterberg. Such concerns could lead them to adapt EBTs in the field, potentially diminishing or increasing their effectiveness. Therefore, it is striking how little is known about provider-level manual adaptation in community settings. The present study investigated the extent to which therapists mandated to use a manualized EBT adapt the treatment in the field, including patterns, predictors and outcomes of adaptation. A typology of provider-level manual adaptation was created to describe sessions double-dipped (i.e., repeated), skipped, or flipped (i.e., delivered in reverse order). Patterns of manual adaptation used by a sample of 38 community therapists treating 288 depressed youths with Lewinsohn and colleagues? Adolescent Coping with Depression course (CWD-A) were described. Hierarchical Linear Modeling was used to identify which client and therapist characteristics predict manual adaptation, and whether adaptation is associated with greater improvement or worsening in youths? therapy outcomes. Adaptation was widespread and largely unsystematic, with no significant client predictors of repeats or flips. Sessions were skipped more often for youths belonging to families with higher income and youths with greater pre-treatment symptom severity, but less often for Hispanic and Asian youths relative to Caucasians. A significant portion of variability in adaptation was attributable to therapists, who showed habits in manual adaptation: therapists with more years of experience working at the clinics double-dipped sessions more often, and Hispanic therapists flipped sessions much less often than Caucasian therapists did. Finally, adaptation was significantly related with outcomes, such that doubledips were associated with worsened symptom severity, skips were associated with improved symptom severity, and flips were associated with worsened functioning. Given that these data suggest manualized EBTs are likely to undergo vast adaptation in community settings, and that such adaptation is related to client outcomes, further research is necessary to better inform practitioners about when each type of manual adaptation may be appropriate. Practical implications for implementation efforts are discussed.

Thesis (Ph. D.)--University of Texas at Austin, 1998. / Vita. Includes bibliographical references (leaves 281-292).