Dr. Alexander Hassett | Canterbury Christ Church University | United Kingdom
Dr. Alicia Colbridge | Primary Behaviour Service: Ealing Primary Centre | United Kingdom
Objectives: Identity formation may be more complex for those who have been in foster care in the face of childhood abuse and trauma, difficult relationships, unstable environments and multiple care contexts but this does not imply there is anything pathological about it. Given the higher levels of mental health difficulties in looked after children and the known role identity has in mental health, whether as a risk or a protective factor, it seems clinically significant to investigate what factors help construct or hinder the formation of identity for those who have been in care. The aim of this research was to explore how female care leavers make sense of their identity development.
Method: Interpretative Phenomenological Analysis was used to analyse semi-structured interviews of eight female care-leavers about the understanding of their identity development.
Results: Whilst the journey for each participant was unique, three superordinate themes emerged from the data which reflected the process and outcome of identity development. The outcome of identity development highlighted two dimensions; 1) how individuals saw themselves and 2) how their identity played out practically day-to-day. Three superordinate themes emerged which encapsulated participants’ identity development. These included Construction of identity – How I became me, Understanding of identity – Who am I and Experience of identity – How my identity plays out. A model highlighting the interactional nature of the superordinate themes on identity was developed.
Conclusions: Participants’ construction of identity can be understood in the context of early adverse environments and developmental trauma. This construction of self, in turn mediates how participants understand and experience their identity. Findings were discussed in relation to previous research and limitations were outlined. Implications for future research included giving fuller consideration to the role of developmental trauma in identity formation. Clinical implications encourage understanding of looked after children and care-leavers in the context of developmental trauma, rather than focusing on symptoms of various diagnoses.
PhD Sabine Loos | Klinik für Psychiatrie und Psychotherapie II Universität Ulm am Bezirkskrankenhaus Günzburg | Germany
PD Dr. Bernd Puschner
Objectives: Young people with mental health problems facing transition from child and adolescent to adult health care are less likely to utilise care after reaching the age of 18. The aims of the study are to investigate perceptions and evaluations of health care during the period of transition from the young patients’ view, with a special focus on identifying health care needs and determinants of health behaviour.
Methods: 29 young people, aged 16 to 25 years, participated in seven group discussions and three interviews based on interview guides. Data were transcribed verbatim and analysed following a sequenced, reconstructive approach of the documentary method by Bohnsack.
Results: Lack of perceived humanity in care was the main theme reported by young people. Further predominant subthemes were being dependent on the health care system, being treated as an object rather than a person, and a role conflict as a patient (ideal of care vs. reality). Participants expressed a number of needs in relation to care provision: closeness, increased participation and involvement in treatment, and a greater variety of care offers. Stigma and passive coping were identified as hindering effective treatment.
Discussion: Implications for clinical health care provision and interventions in this age group in conjunction with care providers’ experiences are considered. Needs-oriented care and strengthening health literacy in this age group are possible approaches.
2638 - Transition psychiatry into practice: Mental health care trajectories of young patients (12-26 years)
Dr. Evelien van der Schee | Brijder Addiction Care | Netherlands
Leontien Los | Brijder Addiction Care | Netherlands
Dr. Renske Spijkerman | Brijder Addiction Care
Prof. Dr. Vincent Hendriks | Brijder Addiction Care
One of the challenges of treating adolescents and young adults in mental health care involves the transition of patients from adolescent to adult care. In this present study, we examine mental health care trajectories of young patients in a large mental health care organisation, which provides a wide range of mental health care for children, adolescents and adults. Trajectories of patients from adolescent to young adulthood were studied. Additionally, we analysed how these trajectories are related to patient characteristics, such as gender, age, clinical diagnoses.
We studied a cohort of patients (aged 12 to 26 years) who entered a mental health care in the Netherlands between 2011 and 2015. We studied patient trajectories by inspecting the number of admissions, type of mental health care facilities visited and days in treatment. We particularly focussed on how patients went from adolescent to adult mental health care within the organisation.
Between 2011 and 2015 69968 patients, aged 12 and 26 years, entered a treatment facility in the organisation. Their mean age at entrance was 20 (SD 4.1) and 53.4% of them were female. In total, they were admitted 84840 times, of which 82.8% once, 14.0% two and 3.2% three to nine times. During their admission, patients received treatment at one to eleven treatment facilities, with the majority receiving treatment in one facility (67.5%). Mean number of treatment days was 414.9 days (SD=411.3), with younger patients being treated significantly longer compared to the older ones. About 34% of the patients turned 18 years or older and made the transition to adult care.
We studied mental health care trajectories of young patients to provide insight in potential weaknesses of our mental health care system with regard to continuity of care. Our preliminary findings indicate that one third of the patients entering our large mental health care organisation had multiple treatment episodes during the period of 2011-2015 and older patients showed shorter treatment duration. About 34% of the study population should have made the transition from adolescent to adult care. In further analyses, we will examine these transitions in further detail to determine which patients show elevated number of treatment visits and how this might be related to age and transitions from adolescent to adults care.
2775 - Psychometric properties of an internet-based version of the Youth Self-Report and differences to paper-pencil assessment
Michael Zeiler | Medizinische Universität Wien | Austria
Dr. Julia Philipp | Medizinische Universität Wien | Austria
Dr. Gudrun Wagner | Medizinische Universität Wien | Austria
Stefanie Truttmann | Medizinische Universität Wien | Austria
Prof. Dr. Andreas Karwautz | Medizinische Universität Wien | Austria
Prof. Dr. Karin Waldherr | Ferdinand-Porsche FernFH | Austria
Objectives: Internet-based assessments become increasingly popular due to obvious advantages. Achenbach’s Youth Self-Report (YSR) is a world-wide used instrument for assessing general psychopathology in children and adolescents aged 11 to 18 years, both in the general population and in clinical samples. Although already used online, the interformat reliability of the YSR has not been investigated so far. Thus, this study aims at examining the psychometric properties of an internet-based (IB) version of the YSR and differences to the original paper-pencil (PP) version.
Methods: Data from a large (N > 3600 students aged 10-18 years) epidemiological study in Austria were used. About 80% completed IB version of the YSR, about 20% completed the original PP version. Interformat differences were analyzed regarding psychometric properties (internal consistencies), further indicators of data quality (e.g. number of missing items, completed open-ended questions) and outcomes (mean total problem score, % in clinically-relevant range). Sociodemographic and school characteristics were included as covariates to account for potential differences between the IB and PP group. Additionally, we explored associations between meta-data (time for completing the IB questionnaire) and the degree of mental health outcomes.
Results: Cronbach Alphas of the IB version ranged between .84 and .94 for the broad-band scales and between .62 and .86 for the syndrome scales. A slightly higher proportion of YSR datasets were analyzable for the IB version (97.7%) compared to the PP version (93.7%). Information provided for open-ended questions were about twice as high in the IB version (M = 35.8 characters, SD = 29.8) compared to the PP version (M = 18.7 characters, SD = 10.6). Mean problem scores did not significantly differ between the versions while there was a slightly higher proportion of students scoring in the deviant range in the PP version (19.6% vs. 15.3%). A low but significant correlation was observed regarding the time needed for completing the IB questionnaire and the YSR total problem score (r = .24).
Conclusion: The used IB version of the YSR was comparable to the original PP version with regard to the psychometric properties and indicators of data quality. The minor differences in the proportion of students scoring in the deviant range might need further investigations. Especially the use of meta-data available in IB assessment might foster future research.
3687 - Transition in case of child abuse and neglect: can childpsychiatrists make a difference?
Dr. Marie-José van Hoof | iMindU/YOEP Global Transitions/LUMC | Netherlands
1 To demonstrate the importance of collaboration in the advocacy against child abuse and neglect.
2 To demonstrate the role of child and adolescent psychiatrists in the prevention and treatment of abuse and neglect.
3 To give examples of different ways of successfully raising awareness by child psychiatrists for the prevention and treatment of abuse and neglect.
Childpsychiatrists and the Dutch Knowledge Center advocated against child abuse and neglect through research, a website for patients and professionals, presentations for professionals, and through advocacy at the political and legal arena. The experts gathered all scientific, legal and practical information about prevention, diagnostic procedures, treatment, and the policies on child abuse and neglect, and made this knowledge base available to the general public worldwide as well as to their professional colleagues (www.kenniscentrum-kjp.nl/ ).
Advocacy addressed the following fields which will be discussed in the oral presentation:
• The Dutch Knowledge Center provides unique opportunities for the dissemination of information and the advocacy of child and adolescent psychiatry by engaging a broad network. Examples will be given about the collaboration with Dutch experts, about the opportunities for advocacy, and about the policies the Center uses to bring together the psychiatric professionals.
• The experts increased professional and societal awareness by informing professionals in the legal, administrative and political field about consequences of legal procedures, and made a plea for finances for the prevention and treatment of abuse and neglect, etc.
• The experts presented as a group on national and international psychiatric conferences about relevant topics concerning e.g. the primary prevention of abuse, screening for safety in families, attachment and trauma, etc.
With the influx of a large number of traumatized refugee children in recent years the importance of trauma-focused approach in the organization of mental health care for this specific population was advocated.
Childpsychiatrists can and should proactively advocate against child abuse and neglect using all means possible to reach professionals in politics, ministeries, boroughs and other state-based institutions, insurance companies, schools, youth care and (mental) health care, as well as the wider public.
About the author
Marie-José van Hoof, M.D., M.Sc., Ph.D. candidate, is a consulting child and adolescent psychiatrist, specialised in attachment, trauma and child abuse and –neglect on which topics she is finishing her PhD at Curium-LUMC. She is working at her own practice iMindU and at mental health institute YOEP, specialized in mental health service at (international) schools, combining care and schoolissues, empowering teachers and parents in daily life. She also initiated and since chairs the expert group on trauma & childabuse and –neglect of the Dutch Knowledge Centre Child and Adolescent Psychiatry.
3114 - Associations between Psychotic Like Experiences (PLE) and psychiatric disorders, lack of functionality and history of abuse in the Offspring of Bipolar and Community Families.
Dr. Iria Mendez | Institut Clinic de Neurociències, Hospital Clínic i Provincial | Spain
Prof. Dr. David Axelson | Nationwide Children’s Hospital
Prof. Dr. Josefina Castro | Institut Clinic de Neurociències, Hospital Clínic i Provincial | Spain
Prof. Dr. Boris Birmaher | University of Pittsburgh Medical Center (UPMC) | United States
Roger Borras | Institut Clinic de Neurociències, Hospital Clínic i Provincial
INTRODUCTION: The prevalence of psychotic-like experiences (PLE) is higher than expected in younger populations. Recent studies have highlighted their link with psychiatric disorders and the transition to full-blown psychotic disorders.
OBJECTIVE: To study the association between psychiatric disorders and other predictors of PLE in two non-psychotic populations, one at genetic high risk for bipolar disorders (BP) and one from a community sample.
METHOD: PLE were evaluated at intake and during follow-up in a longitudinal cohort study of 390 offspring of BP parents and 247 from the community, ages 6 to 18 years old. PLE were examined using standard psychiatry interviews and questionnaires blind to parental psychiatric status. The sample was followed on an average of 8.3 years, with a 91.7% retention rate. All the analyses were modeled using GLMM.
RESULTS: 95 offspring reported PLE symptoms at some point of the study. There were no significant associations between PLE and family loading for Bipolar or any perinatal risk factors. The presence of any psychiatric disorders increased 10-fold the risk for PLE (OR=9.63, P=0.0001). With the exception of substance abuse disorder, almost all disorders were significant associated with PLE. In the multivariate analyses 3 factors were significant related with the onset of PLE: low psychosocial functioning (OR=6.42; P<0.0001), presence of any major psychiatric disorder (OR=3.46; P<0.01), and history of physical or sexual abuse (OR=2.99; P=0.04).
CONCLUSIONS: The presence of any PLE should be conceptualized as a marker for a major psychiatric disorder, and clearly related with poor functioning and history of abuse.