title: Changes in Mental Health, Bullying Behavior, and Service Use Among Eight-Year-Old Children Over 24 Years.
abstract: The aim of this study was to examine changes in the mental health problems, bullying, and service use of 8-year-old children at 4 different time points (1989, 1999, 2005, and 2013) using population-based, time-trend data.
  
  
  
  Information from 4 cross-sectional samples was compared over a 24-year period. The target population was Finnish-speaking children born in 1981 (n = 1,038), 1991 (n = 1,035), 1997 (n = 1,030), and 2004 (n = 1,114) and living in selected school districts in the Turku University Hospital area in southwestern Finland. The participation rates varied from 84% (2005) to 95% (1989). Information about the children's psychiatric symptoms, bullying experience, and service use was obtained from parents and teachers using Rutter questionnaires. Child depression was measured using the Children's Depression Inventory (CDI).
  
  
  
  Parental reports showed that emotional (p < .001) and conduct (p = .001) problems among boys and emotional (p = .002) problems among girls decreased over the 24-year period. In teacher reports, there were no significant changes in hyperactivity, emotional, and conduct problems between 1989 and 2013. Girls' self-reported depression scores increased between 1989 and 2005, but leveled off in 2013. There were no significant decreases in bullying behavior between 2005 and 2013 despite the introduction of a nationwide school-based anti-bullying program in 2009. Mental health service use increased constantly during the study period: in 1989, 4.2% of boys and 0.9% of girls were in contact with services, and by 2013 this had risen to 15.1% and 6.1% (p < .001).
  
  
  
  No substantial increases in children's mental health problems were seen between 1989 and 2013. Service use increased constantly, indicating lower thresholds for seeking help. Bullying behavior is strongly related to mental health problems, and that is why school-based bullying interventions, including mental health perspectives, are needed.
authors.affiliation: University of Turku and Turku University Hospital, Turku, Finland. Electronic address: andre.sourander@utu.fi.
authors.forename: André
authors.initials: A
authors.lastname: Sourander
authors.affiliation: University of Turku and Turku University Hospital, Turku, Finland.
authors.forename: Lotta
authors.initials: L
authors.lastname: Lempinen
authors.affiliation: School of Psychology, Interdisciplinary Center Herzliya, Herzliya, Israel and Psychological Medicine, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.
authors.forename: Anat
authors.initials: A
authors.lastname: Brunstein Klomek
mesh_terms: D058445:Bullying / Q000706:statistics & numerical data*; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D008297:Male; D008603:Mental Health / Q000706:statistics & numerical data* / Q000639:trends; D008605:Mental Health Services / Q000706:statistics & numerical data*
keywords: bullying; mental health; psychiatric problems; service use; time-trend