Finnish Sample Research Articles

Validity and reliability of the Finnish version of the Functioning Assessment Short Test (FAST) in bipolar disorder.

BackgroundThe Functioning Assessment Short Test (FAST) was developed for the clinical evaluation of functional impairment of patients suffering from bipolar disorder. The aim of this study was to validate the Finnish version of FAST.MethodsTranslation and back-translation of FAST were performed. Fifty patients with the Diagnostic and Statistical Manual of Mental Disorders-Fourth edition (DSM-IV) bipolar type I and II were interviewed at the Bipolar Disorder Research and Treatment Centre, City of Helsinki, Finland. Participants completed the FAST, the Social and Occupational Functioning Assessment Scale (SOFAS) of DSM-IV, and the Sheehan Disability Scale (SDS) as part of the assessment. Internal consistency and correlations between FAST and SOFAS and SDS were analysed. Twenty-five patients participated in a reliability assessment carried out 1 week apart by a different rater.Results and discussionThe internal consistency coefficient obtained was very good, with a Cronbach alpha of 0.870. Reliability of FAST was also found excellent (correlation between two measures r = 0.896, p < 0.001). A highly significant negative correlation between FAST and SOFAS scores was found (r = −0.723, p < 0.001). FAST and SDS were also highly significantly correlated (r = 0.742, p < 0.001).ConclusionsThe psychometric validity and reliability of FAST in the Finnish sample of patients with bipolar disorder types I and II were good.

Polymorphisms in DCDC2 and S100B associate with developmental dyslexia.

Genetic studies of complex traits have become increasingly successful as progress is made in next-generation sequencing. We aimed at discovering single nucleotide variation present in known and new candidate genes for developmental dyslexia: CYP19A1, DCDC2, DIP2A, DYX1C1, GCFC2 (also known as C2orf3), KIAA0319, MRPL19, PCNT, PRMT2, ROBO1 and S100B. We used next-generation sequencing to identify single-nucleotide polymorphisms in the exons of these 11 genes in pools of 100 DNA samples of Finnish individuals with developmental dyslexia. Subsequent individual genotyping of those 100 individuals, and additional cases and controls from the Finnish and German populations, validated 92 out of 111 different single-nucleotide variants. A nonsynonymous polymorphism in DCDC2 (corrected P=0.002) and a noncoding variant in S100B (corrected P=0.016) showed a significant association with spelling performance in families of German origin. No significant association was found for the variants neither in the Finnish case-control sample set nor in the Finnish family sample set. Our findings further strengthen the role of DCDC2 and implicate S100B, in the biology of reading and spelling.

Treatment received and treatment adequacy of depressive disorders among young adults in Finland.

BackgroundUnder-treated depression may be especially harmful in early adulthood. The aims of this study are to describe treatments received for depressive disorders, to define factors associated with treatment adequacy and dropouts from treatment in a Finnish general population sample of young adults.MethodsA nationally representative two-stage cluster sample of 1894 Finns aged 19 to 34 years was sent a questionnaire containing several mental health screens. All screen positives and a random sample of screen negatives were invited to participate in a mental health assessment including a SCID interview. Case records from mental health treatments for the same sample were obtained for the final diagnostic assessment. Based on all available information, receiving antidepressant pharmacotherapy for at least two months with at least four visits with any type of physician or at least eight sessions of psychotherapy within 12 months or at least four days of hospitalization were regarded as minimally adequate treatment. Treatment dropout was rated if the treatment strategy was assessed to be adequate according to the case records but the patient discontinued the visits.ResultsOf participants with depressive disorders (n = 142), 40.9% received minimally adequate treatment. In multiple logistic regression models, substance use disorder and female gender were associated with at least one visit with a physician, while having major depressive disorder was associated with visits with a physician at least 4 times a year. Women had higher odds of having received any psychotherapy and psychotherapy lasting for at least 8 sessions in a year. Low education and a history of suicide attempt were associated with increased odds of treatment dropout. None of the factors explained the final outcome of minimally adequate treatment.ConclusionsTreatment adequacy in the present study was better than previously seen, but more efforts are needed to provide adequate treatment for young adults, especially those with low education and suicidality.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-015-0427-8) contains supplementary material, which is available to authorized users.

Sex Differences in Mental Health among 13-15 Year Old Adolescents in Iran and Finland: A Comparative Study

Objectives: To investigate sex differences in mental health in 13-15 year-old adolescents in Iran and Finland, in order to explore potential cultural influence on sex differences in mental health during early adolescence. Methods: Six hundred adolescents from Iran and 2205 adolescents from Finland (age range 13-15 yrs.) filled in a questionnaire consisting of scales from the Brief Symptom Inventory (anxiety, hostility and depression), the Ostrobothnian Youth Survey (body satisfaction and somatic symptoms), the Rosenberg Self-Esteem Scale and the SCOFF index for eating disorders. Results: In the Iranian sample, no sex difference was found on any of the seven measures. In the Finnish sample, sex differences were found on all seven, indicating better mental health among boys than among girls, in this age group. Conclusion: Studies conducted in Western nations usually find better mental health among adolescent boys than among adolescent girls. In the present study, it was true for the Finnish sample but not for the Iranian sample. The results suggest that the commonly found sex difference in mental health among adolescents may be a culturally based phenomenon. More study on the subject is needed.

Bayesian Estimation of the True Prevalence and of the Diagnostic Test Sensitivity and Specificity of Enteropathogenic Yersinia in Finnish Pig Serum Samples.

Bayesian analysis was used to estimate the pig's and herd's true prevalence of enteropathogenic Yersinia in serum samples collected from Finnish pig farms. The sensitivity and specificity of the diagnostic test were also estimated for the commercially available ELISA which is used for antibody detection against enteropathogenic Yersinia. The Bayesian analysis was performed in two steps; the first step estimated the prior true prevalence of enteropathogenic Yersinia with data obtained from a systematic review of the literature. In the second step, data of the apparent prevalence (cross-sectional study data), prior true prevalence (first step), and estimated sensitivity and specificity of the diagnostic methods were used for building the Bayesian model. The true prevalence of Yersinia in slaughter-age pigs was 67.5% (95% PI 63.2–70.9). The true prevalence of Yersinia in sows was 74.0% (95% PI 57.3–82.4). The estimates of sensitivity and specificity values of the ELISA were 79.5% and 96.9%.

Patient experiences at diagnosis and psychological well-being in prostate cancer: A Finnish national survey

PurposeMost cases of prostate cancer are diagnosed at an early stage, and men live for many years after diagnosis. Thus, their well-being and quality of life are of great importance. This study investigated patient experiences and psychological well-being in a Finnish national sample of prostate cancer patients who received various types of treatment. MethodIn a national sample (50%) of prostate cancer patients diagnosed in Finland in 2004, information was collected on the patients' experiences at diagnosis and choice of treatment (e.g. treatment selection, patient satisfaction with care and information, psychological reactions). In 2009, participants were asked about their experiences, and psychological well-being (psychological symptoms, satisfaction with life) was measured. In total, 1239 completed questionnaires (73%) were accepted for the study. Differences between treatments and predictors of psychological well-being were investigated using descriptive statistics and regression analysis. ResultsHalf of the respondents were satisfied with the care and information they received about the cancer and side effects of treatment. Experiences and psychological well-being were most positive among patients who received brachytherapy and poorest among patients who received hormonal therapy. Patients who underwent prostatectomy or brachytherapy were most likely to have been involved in treatment selection. Negative experiences, such as learning of the diagnosis in an impersonal way and dissatisfaction with the information and care received, were predictive of poorer well-being. ConclusionsUnmet supportive care and informational needs were common. Experiences and well-being varied between treatments. Patients tended to prefer prostatectomy and brachytherapy. Unmet needs, which would probably be reduced by improvements in care, appear to have a long-lasting impact on patients' psychological well-being.

Cross-national and longitudinal investigation of a short measure of workaholism.

: The present study investigated the factor structure of the 10-item version of the Dutch Work Addiction Scale (DUWAS). The DUWAS-10 is intended to measure workaholism with two correlated factors: working excessively (WE) and working compulsively (WC). The factor structure of the DUWAS-10 was examined among multi-occupational samples from the Netherlands (n=9,010) and Finland (n=4,567) using confirmatory factor analysis (CFA). CFAs revealed that the expected correlated two-factor solution showed satisfactory fit to the data. However, a second-order factor solution, where WE comprised the first-order factors “working frantically” and “working long hours”, and WC the first-order factors “obsessive work drive” and “unease if not working”, showed significantly better fit to the data. The expectation of factorial group invariance of the second-order factor structure between the Dutch and Finnish samples was also supported. Moreover, factorial time invariance was observed across a two-year time lag in a sub-sample of Finnish managers (n=459). In conclusion, the DUWAS-10 was found to be a comprehensive measure of workaholism, meeting the criteria of factorial validity in multiple settings, and can thus be recommended for use in both research and practice.

No association between vitamin D and β‐cell autoimmunity in Finnish and Estonian children

Vitamin D has immunomodulatory properties, such as regulation of FOXP3 expression and regulatory T-cell activity. Our aim was to investigate whether plasma 25-hydroxyvitamin D [25(OH)D] concentrations associate with the development of β-cell autoimmunity and the transcriptional activity of FOXP3 or vitamin D3 convertase gene (CYP27B1) in CD4+ memory T cells. We studied 83 Finnish and 32 Estonian children participating in the DIABIMMUNE and DIPP studies. Twenty-nine Finnish and six Estonian children tested positive for at least one diabetes-associated autoantibody. The plasma concentrations of 25(OH)D and 1,25(OH)₂D were analysed with an enzyme immunoassay. Gene expression of FOXP3 and CYP27B1 in the isolated CD4+ memory T cells was studied with reverse transcription quantitative polymerase chain reaction. Vitamin D status did not differ between subjects positive and negative for β-cell autoantibodies. Finnish children had higher vitamin D status than Estonian children (p < 0.001). FOXP3 expression was higher in Estonian CD4+ memory T-cell samples than in Finnish samples (p < 0.01) even when including in both groups only children with serum 25(OH)D concentrations in the range of 50-80 nmol/L (p < 0.001). These findings do not support a crucial role of circulating 25(OH)D as a regulator of β-cell autoimmunity or FOXP3 expression.

Organization of nursing care in three Nordic countries: relationships between nurses' workload, level of involvement in direct patient care, job satisfaction, and intention to leave.

BackgroundHealth care systems in Finland, Norway and Sweden share many similarities, e.g. full-coverage and tax-financed, with predominately public sector hospitals. Despite similarities, there are differences in the working situations for RNs within these Nordic countries. The aim of this study was to analyze associations between RNs’ patient workload and level of involvement in direct patient care, their job satisfaction and intention to leave in these countries.MethodsA workforce survey was conducted through RN4CAST, an EU 7th framework project. The survey included 118 items derived from validated instruments or tested in prior research. Responses from 1133 RNs at 32 Finnish hospitals, 3752 RNs at 35 Norwegian hospitals, and 11 015 RNs at 71 Swedish hospitals comprise the database, which was analyzed using logistic and odds ratio regressions analyses.ResultsWe found statistically significant differences in RNs’ level of involvement in direct patient care (p < 0.001, Sweden compared to Norway and Finland), in patient workload and in number of patients needing ADL assistance and surveillance. A U-formed relationship was found between level of involvement in direct patient care and intention to leave in Sweden, and more satisfaction among RNs in roles with more direct patient care (OR = 1.16, 1.02 ≤ CI95% ≤ 1.32). Nearly half the Finnish sample report intention to leave, with significantly lower levels in Norway and Sweden (p < 0.001). Patient workload is associated with job satisfaction and intention to leave to some degree in all countries, i.e. greater patient workload, less job satisfaction and greater intention to leave.ConclusionsThis study suggests that more attention paid to patient mix, workload and role of RNs in patient care might potentially diminish intention to leave and increase job satisfaction in these Nordic countries.

Y-SNP L1034: limited genetic link between Mansi and Hungarian-speaking populations.

Genetic studies noted that the Hungarian Y-chromosomal gene pool significantly differs from other Uralic-speaking populations. Hungarians show very limited or no presence of haplogroup N-Tat, which is frequent among other Uralic-speaking populations. We proposed that some genetic links need to be observed between the linguistically related Hungarian and Mansi populations.This is the first attempt to divide haplogroup N-Tat into subhaplogroups by testing new downstream SNP markers L708 and L1034. Sixty Northern Mansi samples were collected in Western Siberia and genotyped for Y-chromosomal haplotypes and haplogroups. We found 14 Mansi and 92 N-Tat samples from 7 populations. Comparative results showed that all N-Tat samples carried the N-L708 mutation. Some Hungarian, Sekler, and Uzbek samples were L1034 SNP positive, while all Mongolians, Buryats, Khanty, Finnish, and Roma samples yielded a negative result for this marker. Based on the above, L1034 marker seems to be a subgroup of N-Tat, which is typical for Mansi and Hungarian-speaking ethnic groups so far. Based on our time to most recent common ancestor data, the L1034 marker arose 2,500 years before present. The overall frequency of the L1034 is very low among the analyzed populations, thus it does not necessarily mean that proto-Hungarians and Mansi descend from common ancestors. It does provide, however, a limited genetic link supporting language contact. Both Hungarians and Mansi have much more complex genetic population history than the traditional tree-based linguistic model would suggest.

Genome-wide association study of intracranial aneurysm identifies a new association on chromosome 7.

Common variants have been identified using genome-wide association studies which contribute to intracranial aneurysms (IA) susceptibility. However, it is clear that the variants identified to date do not account for the estimated genetic contribution to disease risk. Initial analysis was performed in a discovery sample of 2617 IA cases and 2548 controls of white ancestry. Novel chromosomal regions meeting genome-wide significance were further tested for association in 2 independent replication samples: Dutch (717 cases; 3004 controls) and Finnish (799 cases; 2317 controls). A meta-analysis was performed to combine the results from the 3 studies for key chromosomal regions of interest. Genome-wide evidence of association was detected in the discovery sample on chromosome 9 (CDKN2BAS; rs10733376: P<1.0×10(-11)), in a gene previously associated with IA. A novel region on chromosome 7, near HDAC9, was associated with IA (rs10230207; P=4.14×10(-8)). This association replicated in the Dutch sample (P=0.01) but failed to show association in the Finnish sample (P=0.25). Meta-analysis results of the 3 cohorts reached statistical significant (P=9.91×10(-10)). We detected a novel region associated with IA susceptibility that was replicated in an independent Dutch sample. This region on chromosome 7 has been previously associated with ischemic stroke and the large vessel stroke occlusive subtype (including HDAC9), suggesting a possible genetic link between this stroke subtype and IA.

Perceived outcomes of public libraries in Finland, Norway and the Netherlands

Purpose – The purpose of this paper is to compare the perceived benefits of public libraries and their structure in the major areas of life between Finland, Norway and the Netherlands. Design/methodology/approach – The data were based on representative samples of Finnish, Norwegian and Dutch adult library users. In Finland a mail survey was used and in Norway and the Netherlands web surveys were used for data collection. The distribution of the proportion of those benefiting from the library in various areas of life at least sometimes was compared across countries. The structure of benefits was compared across countries by factor analysis. Findings – The results showed that the level of the nineteen benefits observed was considerably higher, and the range of benefits remarkably broader in Finland compared to Norway and the Netherlands. It is likely that the greater supply of library services in Finland compared to the other two countries explains the differences in benefits derived from the public library. The study validated the measurement instrument for the perceived overall outcomes of public libraries. Research limitations/implications – Comparing only three countries is too limited for producing valid results on the relations between the supply of library services and their use and the benefits derived from that use. Analyzing these associations in a larger sample of countries would create reliable results also for policy making. Practical implications – The policy implications of these findings are discussed. Originality/value – This is the first across-country comparison observing perceived benefits of public libraries across major areas of life.

Genome-wide association study of sleep duration in the Finnish population.

Sleep duration is genetically regulated, but the genetic variants are largely unknown. We aimed to identify such genes using a genome-wide association study (GWAS) combined with RNA expression at the population level, and with experimental verification. A GWAS was performed in a Finnish sample (n=1941), and variants with suggestive association (P<5×10(-5) ) were tested in a follow-up sample from the same population with sleep duration (n=6834) and time in bed (n=1720). Variants with pointwise association of P<0.05 in the follow-up sample were analysed further. First, we correlated genotypes with transcript expression levels with sleep duration (n=207). The expression levels of significant transcripts were further studied in experimental sleep restriction. Of the 31 variants with P<5×10(-5) in the discovery sample, three variants showed nominal allelic association (P<0.05) in the follow-up sample: rs10914351, near PTPRU (P= 0.049), rs1037079 in PCDH7-CENTD1 (P=0.011) and rs2031573 near KLF6 (P=0.044). The risk alleles for shorter sleep (rs2031573 and rs1037079) were also associated with higher KLF6 and PCDH7 expression levels (P<0.05). Experimental sleep restriction increased the expression of KLF6 (P<0.01). These data suggest that rs2031573 near KLF6 or related loci and rs1037079 between PCDH7-CENTD1 or related loci may contribute to the regulation of sleep duration via gene expression. These results illustrate the utility of combining different analytical approaches to identify genetic determinants for traits related to sleep physiology. However, additional studies are needed in order to understand the roles of KLF6 and PCDH7 in sleep regulation.

Culinary-gastronomic tourism – a search for local food experiences

Purpose – The purpose of this article is to focus on travellers’ perceptions of culinary-gastronomic sensations as experiences and how these relate to the locality. The aim of the study is to explore the factors that contribute to travellers’ culinary-gastronomic dining experiences with an emphasis on the local food markets. Design/methodology/approach – One-hundred and fifty-eight prospective travelers at an annual fair in Helsinki completed a self-administered survey questionnaire. On the questionnaire, the respondents were asked to rate the importance of 17 items related to eating and food experiences when deciding on a destination for their next leisure trip. Findings – The findings reveal a frequency distribution of the sample characteristics and travel behavior, the respondents’ use of food and eating experiences as evaluative criteria when choosing travel destinations and latent factors of food and eating experiences. Based on an explorative factor analysis using a varimax abstraction method, the study concludes that eating and food experiences are influenced by the overall service (i.e. the food and where it is served and the dining setting and how it is served). The factors show that culinary-gastronomic food experiences are founded on local, original and authentic food that represents the local food culture. Practical implications – The study attempts to provide insights into aspects to consider for promotional activities related to local food and, ultimately, as a means for destination branding. The Finnish sample has a casual attitude to food, where new but also rather mundane experiences are sought. Accordingly, slow food preparation and atmospherics contribute to local food experiences that may lure travelers to revisit certain locations. Originality/value – Local food as a means of culinary-gastronomic sensations deserves scholarly attention, as many questions related to its consumption by tourists remain unanswered. Accordingly, the topic of the current study is truly timely and this research contributes by studying a rather unchartered issue.

Judges' views of child sexual abuse: evaluating beliefs against research findings in a Finnish sample.

Beliefs impact our decision-making and different professionals have been shown to have beliefs about child sexual abuse (CSA) that do not coincide with scientific findings. In the present study, judges' beliefs regarding CSA were explored. Finnish judges (N=104) answered a questionnaire about CSA related issues as well as questions regarding their professional experience of CSA cases. The judges held both correct and incorrect beliefs; while their CSA prevalence estimates were rather well in line with research findings, half of the participants estimated that no professionals use suggestive methods when interviewing children and more than 40% thought suggestive methods can be useful when trying to get a child to tell about real events. Judges correctly assumed symptoms cannot be used to assess a CSA case, however, the majority thought play observations were appropriate means for evaluating such suspicions. Experience seemed to lead to more confidence in their own expertise but not in an actual increase in knowledge, namely, judges thought themselves more expert when more experienced although their expertise as measured by the questionnaire did not improve. Overall, the judges had both correct and erroneous beliefs but while experience did not improve the situation, gaining information about CSA did. More research about the beliefs of judges and how such beliefs impact legal decision-making is needed.

Country, sex, and parent occupational status: moderators of the continuity of aggression from childhood to adulthood.

Using data from two American and one Finnish long-term longitudinal studies, we examined continuity of general aggression from age 8 to physical aggression in early adulthood (age 21-30) and whether continuity of aggression differed by country, sex, and parent occupational status. In all samples, childhood aggression was assessed via peer nominations and early adulthood aggression via self-reports. Multi-group structural equation models revealed significant continuity in aggression in the American samples but not in the Finnish sample. These relations did not differ by sex but did differ by parent occupational status: whereas there was no significant continuity among American children from professional family-of-origin backgrounds, there was significant continuity among American children from non-professional backgrounds.

Simulation of Finnish Population History, Guided by Empirical Genetic Data, to Assess Power of Rare-Variant Tests in Finland

Finnish samples have been extensively utilized in studying single-gene disorders, where the founder effect has clearly aided in discovery, and more recently in genome-wide association studies of complex traits, where the founder effect has had less obvious impacts. As the field starts to explore rare variants' contribution to polygenic traits, it is of great importance to characterize and confirm the Finnish founder effect in sequencing data and to assess its implications for rare-variant association studies. Here, we employ forward simulation, guided by empirical deep resequencing data, to model the genetic architecture of quantitative polygenic traits in both the general European and the Finnish populations simultaneously. We demonstrate that power of rare-variant association tests is higher in the Finnish population, especially when variants' phenotypic effects are tightly coupled with fitness effects and therefore reflect a greater contribution of rarer variants. SKAT-O, variable-threshold tests, and single-variant tests are more powerful than other rare-variant methods in the Finnish population across a range of genetic models. We also compare the relative power and efficiency of exome array genotyping to those of high-coverage exome sequencing. At a fixed cost, less expensive genotyping strategies have far greater power than sequencing; in a fixed number of samples, however, genotyping arrays miss a substantial portion of genetic signals detected in sequencing, even in the Finnish founder population. As genetic studies probe sequence variation at greater depth in more diverse populations, our simulation approach provides a framework for evaluating various study designs for gene discovery.

Chromosome 7 Linked to Intracranial Aneurysm in Novel Genetic Finding

This article discusses a region on Chromosome 7 was associated with intracranial aneurysm (IA) in a Dutch discovery sample used in a genomewide association study (GWAS). This new finding was replicated in another Dutch sample (but not in a Finnish sample), and in a meta-analysis of previous samples.

Living on the edge: reconstructing the genetic history of the Finnish wolf population

BackgroundMany western European carnivore populations became almost or completely eradicated during the last ~200 years, but are now recovering. Extirpation of wolves started in Finland in the 19th century, and for more than 150 years the population size of wolves has remained small. To investigate historical patterns of genetic variation, we extracted DNA from 114 wolf samples collected in zoological museums over the last ~150 years. Fifteen microsatellite loci were used to look at genotypic variation in this historical sample. Additionally, we amplified a 430 bp sequence of mtDNA control region from the same samples. Contemporary wolf samples (N = 298) obtained after the population recovery in the mid-1990s, were used as a reference.ResultsOur analyses of mtDNA revealed reduced variation in the mtDNA control region through the loss of historical haplotypes observed prior to wolf declines. Heterozygosity at autosomal microsatellite loci did not decrease significantly. However, almost 20% of microsatellite alleles were unique to wolves collected before the 1960s. The genetic composition of the population changed gradually with the largest changes occurring prior to 1920. Half of the oldest historical samples formed a distinguishable genetic cluster not detected in the modern-day Finnish or Russian samples, and might therefore represent northern genetic variation lost from today’s gene pool. Point estimates of Ne were small (13.2 and 20.5) suggesting population fragmentation. Evidence of a genetic population bottleneck was also detected.ConclusionsOur genetic analyses confirm changes in the genetic composition of the Finnish wolf population through time, despite the geographic interconnectivity to a much larger population in Russia. Our results emphasize the need for restoration of the historical connectivity between the present wolf populations to secure long-term viability. This might be challenging, however, because the management policies between Western and Eastern Europe often differ greatly. Additionally, wolf conservation is still a rather controversial issue, and anthropogenic pressure towards wolves remains strong.

The trajectories of child’s internalizing and externalizing problems, social competence and adolescent self-reported problems in a Finnish normal population sample

Group-based modeling techniques are increasingly used in developmental studies to explore the patterns and co-occurrence of internalizing and externalizing problems. Social competence has been found to reciprocally influence internalizing and externalizing problems, but studies on its associations with different patterns of these problems are scarce. Using data from a Finnish longitudinal normal population sample, trajectories of internalizing and externalizing problems were formed using the Child Behavior Checklist completed by the mother at the child’s age of 4- to 5-years-old, 8- to 9-years-old, and 16- to 17-years-old ( N = 261). The results indicate that adolescent’s self-reported internalizing and externalizing problems based on the Youth Self Report were associated with the trajectories of internalizing and externalizing problems. Social competence both in early childhood and in adolescence was poorer among children with chronic internalizing problems and among those with adolescent-onset externalizing problems. One-third of the children who had a chronically high level of internalizing problems had an initially high but decreasing level of externalizing problems, while 33% of the adolescents with adolescent-onset externalizing problems had a chronically high level of internalizing problems. School psychologists are encouraged to screen for internalizing problems from children with behavioral, academic or social problems.