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BackgroundChildhood maltreatment is an important risk factor for mental and physical health problems. Adolescents living in residential youth care (RYC) have experienced a high rate of childhood maltreatment and are a high-risk group for psychiatric disorders. Quality of life (QoL) is a subjective, multidimensional concept that goes beyond medical diagnoses. There is a lack of research regarding the associations between childhood maltreatment and QoL. In the present study, we compare self-reported QoL between adolescents in RYC in Norway with and without maltreatment histories, and adolescents from the general population. We also study the impact of number of types of adversities on QoL.MethodsAdolescents aged 12–23 years living in RYC in Norway were invited to participate in the study; 400 participated, yielding a response rate of 67 %. Maltreatment histories were assessed through interviews with trained research assistants, and completed by 335 adolescents. Previous exposure to maltreatment was reported by 237 adolescents. The Questionnaire for Measuring Health-Related Quality of Life in Children and Adolescents (KINDL-R) was used. Nonexposed peers in RYC (n = 98) and a sample of adolescents from the general population (n = 1017) were used for comparison. General linear model analyses (ANCOVA) were conducted with five KINDL-R life domains as dependent variables. Linear regression was used to study the effect of number of types of adversities.ResultsExposed adolescents in RYC reported poorer QoL than peers in control groups. Compared with nonexposed peers in RYC, the 95 % confidence intervals for mean score differences on the KINDL-R subdomains (0–100 scale) were 1.9–11.4 (Physical Well-being), 2.2–11.1 (Emotional Well-being), −0.7–10.0 (Self-esteem), and 1.8–10.9 (Friends). Compared with the general population sample, the 95 % confidence intervals for mean score differences were 9.7–17.6 (Physical Well-being), 7.9–15.3 (Emotional Well-being), 3.6–12.5 (Self-esteem), and 5.3–12.8 (Friends). Number of types of adversities was associated with a poorer QoL score on all subdomains (Physical- and Emotional Well-being, Self-esteem, Friends, and School).ConclusionsChildhood maltreatment was associated with a poorer QoL score. We suggest the use of QoL and maltreatment measures for all children and adolescents in RYC.

Printed by NTNU Grafisk senter 1 NORSK SAMMENDRAG Ungdom i risiko: Overgrepserfaringer, psykopatologi og livskvalitet blant ungdom i barnevernsinstitusjonerOvergrep og omsorgssvikt i barndommen er assosiert med en rekke fysiske og psykiske helseplager senere i livet. Å kunne identifisere risikoutsatte befolkningsgrupper er svaert verdifullt med tanke på å kunne forebygge helseplager. Barn og unge i fosterhjem og på barnevernsinstitusjoner har opplevd mer overgrep og omsorgssvikt enn barn og unge i normalbefolkningen, og kan derfor vaere i en høy-risikogruppe for helseproblemer.Hovedmålet med denne studien var å studere om overgrepserfaringer var assosiert med psykiske lidelser og redusert livskvalitet også i en høy-risikogruppe av ungdom bosatt i barnevernsinstitusjoner. Et sekundaert mål var å forsøke å identifisere medierende faktorer som kunne øke kunnskapen om disse assosiasjonene ytterligere.Prosjektet er en del av studien «Psykisk helse hos barn og unge i barnevernsinstitusjoner» som ble gjennomført mellom 2010 og 2015. 400 ungdommer mellom 12 og 20 år bosatt i barnevernsinstitusjoner i Norge ble inkludert, og av disse gjennomførte 335 et semi-strukturert diagnostisk intervju som i tillegg til informasjon om psykiske lidelser også ga informasjon om overgrepserfaringer.En stor andel av ungdommene (71 %) oppga å ha overgrepserfaringer (å ha vaert vitne til vold, å ha vaert utsatt for fysiske eller seksuelle overgrep). I denne gruppa var det høyere forekomst av en rekke psykiske sykdommer sammenlignet med de andre ungdommene i barnevernsinstitusjonene. Det var statistisk signifikant forskjell i forekomst av alvorlig depresjon, dystymi, generalisert angstlidelse, alvorlig atferdsforstyrrelse og autismespekterforstyrrelse mellom de to ungdomsgruppene. I tillegg var det signifikant økt forekomst av tidligere selvmordsforsøk blant ungdommene med overgrepserfaringer. Denne gruppen ungdommer hadde også dårligere livskvalitet enn ungdom i normalbefolkningen i forhold til fysisk og emosjonelt velvaere, selvtillit og i forholdet til venner. Økende antall ulike typer overgrepserfaringer inkludert dysfunksjonelle familieforhold, var assosiert med økt odds for flere av de psykiatriske diagnosene, og for dårligere livskvalitet på alle undersøkte livsområder. Tre potensielle medierende faktorer ble undersøkt: globalt selvbilde, tilknytningsproblemer og bruk av tobakk/rusmidler. Av disse ble det funnet at kun globalt selvbilde hadde medierende effekt både på assosiasjonen mellom overgrepserfaringer og psykopatologi, og overgrepserfaringer og livskvalitet.Unge i barnevernsinstitusjoner hadde opplevd en rekke overgrepserfaringer. Resultatene fra denne studien indikerer at overgrepserfaringer spiller en nøkkelrolle i utviklingen av psykiske lidelser og utviklingen av dårlig livskvalitet blant ungdom i barnevernsinstitusjoner. Global selvfølelse ble identifisert som en mediator, og kan derfor vaere et velegnet angrepspunkt for intervensjon innenfor denne ungdomsgruppa. Studien åpner for muligheten av at tiltak som øker selvbild...

PurposeAdverse childhood experiences in sensitive periods of the developing brain render the individual at a life-long risk for a broad spectrum of aberrant health outcomes. However, there is a lack of scales for the comprehensive assessment of adverse childhood experiences providing information of various types and the age of occurrence. Based on the complete, experimental version of the Maltreatment and abuse chronology of exposure (MACE-X) scale, the present study aimed to develop and psychometrically test a Norwegian version of MACE. MethodsThe 75-item MACE-X was translated from German to Norwegian and administered as a self-report measure to 90 outpatients and 145 employees at a Division of specialized mental health care in South-Eastern Norway. The outpatients also completed the Childhood trauma questionnaire (CTQ) and the Symptom checklist 90 (SCL-90) to investigate convergent and predictive validity. To investigate test-retest reliability, outpatients completed MACE once more two weeks later. OPEN ACCESS Citation: Fosse R, Skjelstad DV, Schalinski I, Thekkumthala D, Elbert T, Aanondsen CM, et al. (2020) Measuring childhood maltreatment: Psychometric properties of the Norwegian version of the Maltreatment and Abuse Chronology of Exposure (MACE) scale. PLoS ONE 15(2): e0229661. https://doi.org/10.good to excellent for 10 subscale scores (ICC � 0.82). Convergent validity with the CTQ was moderate to high for both total scores (0.63 � r � 0.86) and subscale scores (0.56 � r � 0.82). As compared to CTQ total scores, a MACE total score that combined severity and duration of exposure was numerically more strongly associated with overall psychiatric symptoms and each of nine symptom domains on the SCL-90. ConclusionsThe newly developed Norwegian MACE comprehensively assesses past exposure to adverse childhood experiences with high psychometric properties. This scale is a useful tool for research questions addressing sensitive periods for childhood adversities and associated health phenotypes.Norwegian MACE PLOS ONE | https://doi.� MACE SxD = combined Sum and Duration score, see Methods. The MACE score was significantly (p�0.05) higher than the concomitant CTQ score in a 1 two-sided Z-test (Z �1.96) or in a 2 one-sided Z-test (Z �1.65). The associations with SCL-90 variables were compared for (i) each of MACE SxD and MACE sum with CTQ sum, and (ii) MACE multi with CTQ multi. GSI = Global severity index. PST = Positive symptom total. & Mean of participant average item scores for each SCL-90 subscale ("subscale GSI scores").

Background: Metformin is widely used in pregnancy to treat gestational diabetes mellitus and polycystic ovary syndrome (PCOS). Association between PCOS and developmental delay in offspring, and larger head circumference of metformin-exposed newborns has been reported. The objective of this study was to explore whether metformin exposure in utero had any effect on offspring cognitive function. Method:The current study is a follow-up of two randomized, placebo-controlled studies which were conducted at 11 public hospitals in Norway In the baseline studies (conducted in 2000-2003, and 2005-2009), participants were randomized to metformin 1700 and 2000 mg/d or placebo from first trimester to delivery. There was no intervention in the current study. We invited parents of 292 children to give permission for their children to participate; 93 children were included (mean age 7.7 years). The follow-up study was conducted in 2014-2016. The Wechsler Preschool and Primary Scale of Intelligence version III and the Wechsler Intelligence Scale for Children version IV were applied for cognitive assessment. Androstenedione and testosterone were measured in maternal blood samples at four time-points in pregnancy. Results:We found no difference in mean, full scale IQ in metformin (100.0 (SD 13.2)) vs. placebo-exposed (100.9 (SD 10.1)) children. There was an association between metformin exposure in utero and borderline intellectual function of children (full scale IQ between 70 and 85). Free testosterone index in gestational week 19, and androstenedione in gestational week 36 correlated positively to full scale IQ. Conclusions:We found no evidence of long-term effect of metformin on average child cognitive function. The increase of borderline intellectual functioning in metformin-exposed children must be interpreted with caution due to small sample size.

Background Residential youth care (RYC) institutions aim to provide care and stability for vulnerable adolescents with several previous and present challenges, such as disrupted attachments, wide-ranging adverse childhood experiences, mental health problems, and poor quality of life (QoL). To the best of our knowledge, the present study is the first to provide knowledge of the associations between perceived social support and QoL and to explore the potential moderating effect of perceived social support on QoL for adolescents who have experienced maltreatment and polyvictimization. Methods All RYC institutions with adolescents between the ages 12–23 in Norway were asked to participate in the study. A total of 86 institutions housing 601 adolescents accepted the invitation, from which 400 adolescents volunteered to participate. The Child and Adolescent Psychiatric Interview was used to gather information on maltreatment histories and degree of victimization; the Kinder Lebensqualität Fragebogen was used to measure QoL through several domains (overall QoL, physical well-being, emotional well-being, and self-esteem); and the Social Support Questionnaire was used to measure perceived social support. Linear regression and independent samples t-test were used to study the associations between perceived social support and QoL as well as the potential moderating effect of perceived social support in the association between maltreatment history and QoL. Results Perceived social support was positively associated with QoL for both girls and boys, with domain-specific findings. A higher number of different types of support persons was associated with overall QoL, emotional well-being, and self-esteem for boys, but only with self-esteem for girls. Individual social support from RYC staff and friends was associated with higher QoL for girls. However, perceived social support did not moderate the association between maltreatment history and reduced QoL for either sex. Conclusions This study emphasizes the importance of maintaining social support networks for adolescents living in RYC, the crucial contribution of RYC staff in facilitating social support, and the potential value of social skills training for these vulnerable adolescents. Furthermore, a wider range of initiatives beyond social support must be carried out to increase QoL among adolescents with major maltreatment and polyvictimization experiences.

Purpose To investigate, in adolescents referred for psychiatric services, the associations of initial self-esteem and family functioning with level and change of quality of life (QoL) over a 3-year period, over and above the effect of their emotional problems. Methods Of 1648 eligible 13-18 years old patients attending the child and adolescent psychiatric clinic (CAP) at least once, 717 (54.8% females) were enrolled at baseline (a response rate of 43.5%). Self-and parent reports on the McMaster Family Assessment Device were obtained. Adolescents reported self-esteem on the Rosenberg Scale, and emotional problems on the Symptom Check List-5. Adolescents completed the Inventory of Life Quality in Children and Adolescents (ILC). After 3 years, 570 adolescents again completed the ILC, and for 418 adolescents parent information was available. The longitudinal analysis sample of 418 adolescents was representative of the baseline sample for age, gender, emotional problems, and QoL. We used modified growth-model analysis, adjusted for SES, age, gender and time of contact with CAP, where residual variances for ILC at baseline and follow-up were fixed to 0. Results A poorer family functioning at baseline, reported by parents, was significantly associated with worsening QoL during the 3 years follow-up period (p = 0.001). Conclusions Parents have important knowledge about their families that may reflect long-term influences on QoL development in adolescent psychiatric patients. Health care providers and policy makers should optimize treatment outcomes by addressing family functioning in adolescents with emotional problems.

Purpose Many adolescents living in residential youth care (RYC) institutions perceive their quality of life (QoL) to be low. Enhancing QoL is thus important, but little is known about the potential contributors to their QoL. Early interpersonal trauma and subsequent removal from home and repeated relocations to new placements are expected to affect mental health and self-esteem. We therefore investigated if domain-specific self-esteem contributed to QoL among adolescents living in RYC institutions over and beyond their levels of psychopathology. Methods All youth in Norwegian RYC institutions between the ages 12-23 years were invited to participate. Of a total of 98 RYC institutions, 86 participated, and 400 of 601 eligible youths were examined. The participants' primary contact completed the Child Behavior Checklist to assess psychopathology. The adolescents completed a revised version of the Self-Perception Profile for Adolescents and the questionnaire for measuring health-related quality of life in children and adolescents (KINDL-R). Results After adjusting for psychopathology, age, and gender, self-esteem domains uniquely explained 42% of the variance in Qol, where social acceptance (b = 0.57) and physical appearance (b = 0.25) domains significantly predicted concurrent QoL. Conclusions The self-esteem domains, social acceptance and physical appearance, add substantially to the explained variance in QoL among adolescents living in RYC institutions, over and beyond the levels of psychopathology. These self-esteem domains may be targets of intervention to improve QoL, in addition to treating their psychopathology.