Publications by authors named "Mauri Marttunen"

168 Publications

Life course associations between smoking and depressive symptoms. A 30-year Finnish follow-up study.

Nord J Psychiatry 2022 Mar 22. Epub 2022 Mar 22.

Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland.

Background: While the association between smoking and depressive symptoms has been studied quite extensively, only little is known whether the association changes and how the trajectories of smoking and depressive symptoms are intertwined during the life course. In this population-based study, we examined these associations from young adulthood to middle age.

Methods: Participants of a Finnish cohort study ( = 1955) were addressed at ages 22, 32, 42 and 52 using postal questionnaires including questions of daily smoking and depressive symptoms (the short 13-item Beck Depression Inventory). Linear and logistic regression analyses and longitudinal latent class and profile analyses were used.

Results: The percentages of daily smokers decreased, while levels of depressive symptoms increased among both women and men from age 22 to 52 years. Daily smoking was associated with higher levels of depressive symptoms between ages 22 and 42, while not at age 52. Associations among men prevailed also in the adjusted models. Four life course trajectories of daily smoking (non-smokers, quitters, persistent smokers, and late starters) and four depressive symptoms (low, increasing/moderate, decreasing/moderate, and high) were identified. In the adjusted models, persistent daily smokers and late starters had significantly higher risk of belonging to the high depressive symptoms profile in men, but not in women.

Conclusions: Compared to women the associations between daily smoking and depressive symptoms seem more robust among men during adulthood. Especially those men smoking persistently from young adulthood to middle age have an increased risk of high depressive symptoms trajectory during the life course.
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http://dx.doi.org/10.1080/08039488.2021.2019912DOI Listing
March 2022

Stress, development and mental health study, the follow-up study of Finnish TAM cohort from adolescence to midlife: cohort profile.

BMJ Open 2021 12 2;11(12):e046654. Epub 2021 Dec 2.

Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland.

Purpose: This cohort profile describes the Stress, development and mental health study (TAM), which is a cohort study investigating risk and protective factors as well as longitudinal associations regarding mental health and well-being from adolescence to midlife. This interdisciplinary cohort study operates, for example, in the fields of public health, social medicine, psychiatry and the life course perspective.

Participants: In 1981 (n=2242, 98.0% of the target population), 1982 (n=2191, 95.6%) and 1983 (n=2194, 96.7%) during school classes, surveys were conducted to all Finnish-speaking pupils (mostly born 1967) in the Tampere region in Finland. Participants of the school study at age 16 in 1983 (n=2194) comprised the base population for the longitudinal data and were followed-up using postal questionnaires in the years 1989, 1999, 2009 and 2019 at ages 22 (n=1656, 75.5% of the age 16 participants), 32 (n=1471, 67.0%), 42 (n=1334, 60.8%) and 52 (n=1160, 52.9%).

Findings To Date: The self-reported questionnaires include information on physical and mental health (eg, depression and mood disorders, anxiety disorders), health behaviour and substance misuse (eg, alcohol, tobacco and exercise), socioeconomic conditions, psychosocial resources (eg, self-esteem), social relationships and support, life events, etc. The numerous studies published to date have examined mental health and various factors from several perspectives such as risk and protective factors, individual developmental paths (eg, trajectories) and pathway models (mediation and moderation).

Future Plans: Current and future research areas include, for example, longitudinal associations between mental health (eg, depressive symptoms, self-esteem) and (1) substance use (alcohol and tobacco), (2) family transitions (eg, parenthood, relationship status) and (3) retirement. Next follow-up is planned to be conducted at the latest at age 62 in 2029. Before that it is possible to link the data with cause-of-death register.
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http://dx.doi.org/10.1136/bmjopen-2020-046654DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8640638PMC
December 2021

Adolescent psychiatric outpatient care rapidly switched to remote visits during the COVID-19 pandemic.

BMC Psychiatry 2021 11 20;21(1):586. Epub 2021 Nov 20.

Adolescent Psychiatry, University of Helsinki and Helsinki University Hospital, PO BOX 660, 00029 HUS, Helsinki, Finland.

Background: The COVID-19-pandemic and especially the physical distancing measures drastically changed the conditions for providing outpatient care in adolescent psychiatry.

Methods: We investigated the outpatient services of adolescent psychiatry in the Helsinki University Hospital (HUH) from 1/1/2015 until 12/31/2020. We retrieved data from the in-house data software on the number of visits in total and categorized as in-person or remote visits, and analysed the data on a weekly basis. We further analysed these variables grouped according to the psychiatric diagnoses coded for visits. Data on the number of patients and on referrals from other health care providers were available on a monthly basis. We investigated the data descriptively and with a time-series analysis comparing the pre-pandemic period to the period of the COVID-19 pandemic.

Results: The total number of visits decreased slightly at the early stage of the COVID-19 pandemic in Spring 2020. Remote visits sharply increased starting in 3/2020 and remained at a high level compared with previous years. In-person visits decreased in Spring 2020, but gradually increased afterwards. The number of patients transiently fell in Spring 2020.

Conclusions: Rapid switch to remote visits in outpatient care of adolescent psychiatry made it possible to avoid a drastic drop in the number of visits despite the physical distancing measures during the COVID-19 pandemic.
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http://dx.doi.org/10.1186/s12888-021-03580-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8605888PMC
November 2021

Therapeutic Alliance: A Comparison Study between Adolescent Patients and Their Therapists.

Int J Environ Res Public Health 2021 10 26;18(21). Epub 2021 Oct 26.

Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, 00290 Helsinki, Finland.

The aim of this study was to examine the congruence of adolescent- and therapist-rated therapeutic alliance, and to explore which rating or combination of ratings would predict treatment outcome or premature termination. We also studied whether the alliance changes over the course of treatment and if the change is related to the outcome or dropout. This study comprised 58 adolescents clinically referred for psychotherapeutic interventions. The alliance (Working Alliance Inventory, patient/therapist ratings) and treatment outcomes (Beck Depression Inventory, Clinical Outcomes in Routine Evaluation-Outcome Measure) were measured at baseline and at 3-, 6-, and 12-month follow-ups. The alliance did not change significantly over the course of therapy, but adolescent and therapist ratings did not correlate. Low values in the early assessment of adolescent-rated alliance and discrepancy between the ratings were significant predictors of undesirable treatment outcome. Weak adolescent- or therapist-rated alliance later in treatment and change for the worse in adolescent-rated alliance was associated with treatment dropout. As adolescent-rated alliance predicts treatment outcome better than therapist-rated alliance, therapists should frequently use assessments of therapeutic relationship within the therapy and pay attention if the adolescent feels the alliance is weakening or his/her evaluation is contrary to the therapist's.
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http://dx.doi.org/10.3390/ijerph182111238DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8583560PMC
October 2021

Changes over time in mental health symptoms among adolescents in Tampere, Finland.

Scand J Child Adolesc Psychiatr Psychol 2021 15;9:96-104. Epub 2021 May 15.

Tampere University, Tampere University Hospital, Vanha Vaasa Hospital, Vaasa, Finland.

Background: Mental health problems are common in adolescence and seeking help for them is becoming more common. Referrals to adolescent mental healthcare have recently increased in Finland.

Objective: To examine time trends in internalizing and externalizing mental health symptoms among Finnish adolescents.

Method: A time-trend school survey was conducted among 9 graders (15-year-olds) in Tampere, Finland, in three time periods: 2002-03, 2012-13 and 2018-19 (N = 4,162).

Results: Compared to the period 2002-03, prevalence of externalizing symptoms decreased in the period 2012-13 and further in 2018-19. The prevalence of internalizing symptoms did not change significantly between 2002-03 and 2012-13; however, in 2018-19, depression, social anxiety, general anxiety, poor subjective health, stress symptoms among boys, and poor self-esteem increased compared to earlier time periods. The increases were more marked among girls. However, suicidal ideation did not increase in 2018-19 compared to earlier time periods.

Conclusion: Whereas the prevalence of externalizing symptoms decreased among Finnish adolescents between 2002-03 and 2018-19, the prevalence of internalizing symptoms increased between 2012-13 and 2018-19. To help to understand the causes of these increases and to prevent internalizing problems, further research on the underlying causes is needed.
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http://dx.doi.org/10.21307/sjcapp-2021-011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8132727PMC
May 2021

Detection, treatment, and course of eating disorders in Finland: A population-based study of adolescent and young adult females and males.

Eur Eat Disord Rev 2021 09 18;29(5):720-732. Epub 2021 May 18.

Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland.

Objective: We assessed the detection, treatment and outcomes of DSM-5 eating disorders in a nationwide community setting.

Method: The FinnTwin12 cohort comprises twins born in 1983-1987 in Finland (n = 5,600), with follow-up starting at age 12. We outline treatment and outcomes of the 127 females and 15 males diagnosed with a lifetime DSM-5 eating disorder in interviews conducted for a subsample (n = 1,347) in their early 20s.

Results: Only 45 (32%) of those diagnosed with eating disorder in the interviews had their condition detected in healthcare, and even fewer received treatment (30% of females, 13% of males). Anorexia nervosa (AN), bulimia nervosa, and atypical AN were detected and treated more often than other eating disorders. Five years after disease onset, 41% of those diagnosed had recovered. There were no statistically significant differences in the course of different eating disorders (log-rank p = 0.66) but the outcome was more favourable among males (log-rank p = 0.008). The likelihood of 5-year recovery did not differ between those who had and who had not received treatment (41.1% vs. 40.5%, log-rank p = 0.66).

Conclusion: Although eating disorders are common and symptoms are persistent for many, they remain under-diagnosed and under-treated. In real-world settings, effectiveness of provided treatments may be limited.
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http://dx.doi.org/10.1002/erv.2838DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8349843PMC
September 2021

Detection, treatment, and course of eating disorders in Finland: A population-based study of adolescent and young adult females and males.

Eur Eat Disord Rev 2021 09 18;29(5):720-732. Epub 2021 May 18.

Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland.

Objective: We assessed the detection, treatment and outcomes of DSM-5 eating disorders in a nationwide community setting.

Method: The FinnTwin12 cohort comprises twins born in 1983-1987 in Finland (n = 5,600), with follow-up starting at age 12. We outline treatment and outcomes of the 127 females and 15 males diagnosed with a lifetime DSM-5 eating disorder in interviews conducted for a subsample (n = 1,347) in their early 20s.

Results: Only 45 (32%) of those diagnosed with eating disorder in the interviews had their condition detected in healthcare, and even fewer received treatment (30% of females, 13% of males). Anorexia nervosa (AN), bulimia nervosa, and atypical AN were detected and treated more often than other eating disorders. Five years after disease onset, 41% of those diagnosed had recovered. There were no statistically significant differences in the course of different eating disorders (log-rank p = 0.66) but the outcome was more favourable among males (log-rank p = 0.008). The likelihood of 5-year recovery did not differ between those who had and who had not received treatment (41.1% vs. 40.5%, log-rank p = 0.66).

Conclusion: Although eating disorders are common and symptoms are persistent for many, they remain under-diagnosed and under-treated. In real-world settings, effectiveness of provided treatments may be limited.
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http://dx.doi.org/10.1002/erv.2838DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8349843PMC
September 2021

Factors contributing to psychological distress in the working population, with a special reference to gender difference.

BMC Public Health 2021 03 29;21(1):611. Epub 2021 Mar 29.

Department of Public Health and Welfare, Finnish Institute for Health and Welfare in Finland (THL), Helsinki, Finland.

Background: Psychological distress refers to non-specific symptoms of stress, anxiety and depression, and it is more common in women. Our aim was to investigate factors contributing to psychological distress in the working population, with a special reference to gender differences.

Methods: We used questionnaire data from the nationally representative Finnish Regional Health and Well-being Study (ATH) collected in the years 2012-2016 (target population participants aged 20 +, n = 96,668, response rate 53%), restricting the current analysis to those persons who were working full-time and under 65 of age (n = 34,468). Psychological distress was assessed using the Mental Health Inventory-5 (MHI-5) (cut-off value <=52). We studied the following factors potentially associated with psychological distress: sociodemographic factors, living alone, having children under18 years of age, lifestyle-related factors, social support, helping others outside of the home and work-related factors. We used logistic regression analysis to examine association between having work-family conflict with the likelihood for psychological distress. We first performed the models separately for men and women. Then interaction by gender was tested in the combined data for those independent variables where gender differences appeared probable in the analyses conducted separately for men and women.

Results: Women reported more psychological distress than men (11.0% vs. 8.8%, respectively, p < 0.0001). Loneliness, job dissatisfaction and family-work conflict were associated with the largest risk of psychological distress. Having children, active participation, being able to successfully combine work and family roles, and social support were found to be protective factors. A significant interaction with gender was found in only two variables: ignoring family due to being absorbed in one's work was associated with distress in women (OR 1.30 (95% CI 1.00-1.70), and mental strain of work in men (OR 2.71 (95% CI 1.66-4.41).

Conclusions: Satisfying work, family life and being able to successfully combine the two are important sources of psychological well-being for both genders in the working population.
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http://dx.doi.org/10.1186/s12889-021-10560-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8006634PMC
March 2021

Effectiveness and Predictors of Outcome for Psychotherapeutic Interventions in Clinical Settings Among Adolescents.

Front Psychol 2021 16;12:628977. Epub 2021 Feb 16.

Department of Adolescent Psychiatry, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.

Background: The aim of this study was to investigate the effectiveness of psychotherapeutic interventions for clinically referred adolescents, as well as to examine whether sociodemographic, clinical, or treatment-related variables and patients' role expectations predict treatment outcome or are possible predictors of treatment dropout.

Method: The study comprised 58 adolescents (mean age 14.2, 65.5% female) suffering from diverse psychiatric disorders referred to psychotherapeutic interventions conducted in outpatient care. The outcome measures, The Beck Depression Inventory, and the Clinical Outcomes in Routine Evaluation - Outcome Measure were filled in at baseline and at 3-, 6-, and 12-month follow-ups. Possible predictors were assessed at baseline.

Results: The results indicate that the mean level of symptoms and psychological distress decreased during the treatment, most reduction occurring in the first 6 months. The frequency of treatment sessions was the strongest predictor of good outcome. Adolescents with a higher level of externalizing problems or lower level of expectations for their own active role in treatment seem to have a higher risk of dropping out.

Conclusion: Offering intensive treatment for a shorter period might be the most efficient way to gain symptom reduction and decrease psychological distress in psychotherapeutic interventions with adolescents. Being aware of externalizing behavior and increasing the adolescents' own agency during the assessment could strengthen commitment and result in the adolescent benefiting more from treatment.
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http://dx.doi.org/10.3389/fpsyg.2021.628977DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7921706PMC
February 2021

Normative and negative sexual experiences of transgender identifying adolescents in the community.

Scand J Child Adolesc Psychiatr Psychol 2020 20;8:166-175. Epub 2020 Nov 20.

University of Tampere, Faculty of Medicine and Health Technology, Tampere, Finland.

Background: Sexuality is a major facet of development during adolescence. Apace with normal sexual development, sexual experiences become more common and intimate. Recent research reports mixed results as to whether this is the case among transgender identifying adolescents. Recent research also suggests that trans youth experience negative sexual experiences (such as dating violence and sexual harassment) more often than their cisgender identifying peers. However, most studies have had clinical or selected samples.

Objective: The aim of this study is to compare the normative as well as negative sexual experiences of trans youth with their cisgender peers in the general population.

Method: Our study included 1386 pupils of the ninth year of comprehensive school in Finland, mean age (SD) 15.59 (0.41) years. We compared sexual experiences, sexual harassment and dating violence among trans youth and their cisgender identifying peers. Distributions of the outcome variables were calculated among the whole sample and by sex. Next, multivariate associations were studied using logistic regression adjusting for age, sex, honesty of responding and depression. Odds Ratios (OR) with 95% confidence intervals (CI) are given.

Results: After adjusting for age, sex, honesty of responding and ultimately for depression, normative sexual experiences of trans youth did not differ systematically from those of the mainstream, cisgender identifying youth. After adjusting for sex, age and honesty, transgender youth had increased Odds Ratios for experiences of sexual coercion and dating violence perpetration. In the final models however, no statistically significant differences were detected in the negative sexual experiences between transgender and cisgender youth.

Conclusions: Transgender identifying adolescents presented neither with delayed nor with excessively advanced sexual experiences. However, transgender youth seem to be more susceptible to subjection to sexual coercion and, unexpectedly, dating violence perpetration than their cisgender peers. However, these associations may in fact relate more closely to depression, a prevalent phenomenon among trans youth, than transgender identity itself.
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http://dx.doi.org/10.21307/sjcapp-2020-017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7866780PMC
November 2020

Changes in cannabis use according to socioeconomic status among Finnish adolescents from 2000 to 2015.

J Cannabis Res 2020 Dec 24;2(1):44. Epub 2020 Dec 24.

Faculty of Medicine and Life Sciences, University of Tampere, 33014, Tampere, Finland.

Background: Despite reduced sanctions and more permissive attitudes toward cannabis use in the USA and Europe, the prevalences of adolescent cannabis use have remained rather stable in the twenty-first century. However, whether trends in adolescent cannabis use differ between socioeconomic groups is not known. The aim of this study was to examine trends in cannabis use according to socioeconomic status among Finnish adolescents from 2000 to 2015.

Methods: A population-based school survey was conducted biennially among 14-16-year-old Finns between 2000 and 2015 (n = 761,278). Distributions for any and frequent cannabis use over time according to socioeconomic adversities were calculated using crosstabs and chi-square test. Associations between any and frequent cannabis use, time, and socioeconomic adversities were studied using binomial logistic regression results shown by odds ratios with 95% confidence intervals.

Results: At the overall level, the prevalences of lifetime and frequent cannabis use varied only slightly between 2000 and 2015. Cannabis use was associated with socioeconomic adversities (parental unemployment in the past year, low parental education, and not living with both parents). The differences in any and frequent cannabis use between socioeconomic groups increased significantly over the study period.

Conclusions: Although the overall changes in the prevalence of adolescent cannabis use were modest, cannabis use increased markedly among adolescents with the most socioeconomic adversities. Socioeconomic adversities should be considered in the prevention of adolescent cannabis use.
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http://dx.doi.org/10.1186/s42238-020-00052-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7819333PMC
December 2020

The predictive capacity of AUDIT and AUDIT-C among adolescents in a one-year follow-up study.

Drug Alcohol Depend 2021 01 22;218:108424. Epub 2020 Nov 22.

Mental Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland; Adolescent Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Aim: The Alcohol Use Disorders Identification Test (AUDIT) has been validated for use with adolescents to screen their harmful alcohol consumption. How well AUDIT or its derivative consumption version AUDIT-C predicts the development of problematic alcohol use among adolescents remains unknown. The aim of our study was to examine the predictive capacity of AUDIT and AUDIT-C among adolescents in a one-year follow-up.

Methods: Finnish adolescents (N = 337) were examined at baseline with AUDIT and one year later with the Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime version (K-SADS-PL) interview to assess alcohol problem use. Test characteristics and regression models were analyzed in predicting alcohol problem use.

Results: The sensitivity of AUDIT (cut-off ≥5) was 0.809 and specificity 0.621 in predicting alcohol problem use among adolescents one year later. The positive test posterior probability was 0.51. For those who screened negative at baseline, the positive test posterior probability was 0.13. With AUDIT-C (cut-off ≥3), the posterior probabilities were 0.47 and 0.12, respectively (sensitivity 0.855, specificity 0.529). The odds ratio was 6.95 for those screening positive with AUDIT and 6.59 with AUDIT-C at baseline to have alcohol problem use one year later.

Conclusions: AUDIT has utility in screening youth at risk for developing alcohol problem use. It has significant predictive capacity in detecting risk especially among adolescents with depression.
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http://dx.doi.org/10.1016/j.drugalcdep.2020.108424DOI Listing
January 2021

Diagnostic conversion from unipolar depression to bipolar disorder, schizophrenia, or schizoaffective disorder: A nationwide prospective 15-year register study on 43 495 inpatients.

Bipolar Disord 2020 09 22;22(6):582-592. Epub 2020 May 22.

Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Objective: To examine temporal patterns and predictors for diagnostic conversion from unipolar depression (UD) to bipolar disorder (BD), schizophrenia, and schizoaffective disorder (SAD).

Methods: A prospective nationwide register-based cohort (n = 43 495) of all first psychiatric hospitalizations due to UD during 1996-2011 was followed up to 15 years. We used cumulative incidence function (CIF) analyses and the Fine-Gray subdistribution model to define the cumulative incidence of the conversions and subdistribution hazard ratios (SHRs) for predictors.

Results: The overall 15-year cumulative incidence of conversion was 11.1% (95% CI 10.7-11.6): 7.4% (95% CI 7.0-7.8) for BD, 2.5% (95% CI 2.3-2.7) for schizophrenia, and 1.3% (95% CI 1.1-1.4) for SAD. The highest crude incidence rate emerged during the first year. Psychotic depression predicted higher conversion risk to BD (SHR = 2.0, 95% CI 1.5-2.7), schizophrenia (SHR = 5.3, 95% CI 3.3-8.7), and SAD (SHR = 10.6, 95% CI 4.0-28.4) than mild depression. Female sex, greater overall disturbance, and comorbid personality disorder predicted conversion to BD, whereas young age and male sex to psychotic disorders.

Conclusions: Among patients with first hospitalization due to UD, approximately one in nine converts to another major psychiatric disorder during 15 years, with the highest risk occurring within the first year. Patients with psychotic depression are particularly vulnerable for conversion to other major psychiatric disorders. Conversion to psychotic disorders occurs earlier than to BD. Males are at higher risk for progression to psychotic disorders, whereas females, patients with recurrent depressive episodes, severe disturbance of overall functioning, and personality disorder are at higher risk for converting to BD.
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http://dx.doi.org/10.1111/bdi.12929DOI Listing
September 2020

Outcome of depressive mood disorder among adolescent outpatients in an eight-year follow-up.

J Affect Disord 2020 04 29;266:520-527. Epub 2020 Jan 29.

Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland; Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Objectives: This study investigated the eight-year course and outcomes of depressive mood disorders and the key outcome predictors among adolescent outpatients.

Methods: Depressive adolescent outpatients (N = 148) in a naturalistic clinical setting were assessed at baseline, six months, 12 months and eight years using diagnostic and self-report instruments. Baseline predictors covered selected sociodemographic, clinical and treatment-related characteristics. The outcomes were time to recovery, recurrence, time spent being ill and longitudinal latent profiles of depressive symptoms.

Results: The recovery rate from any depressive mood disorder was 73% at two years, 91% at five years and 94% by the end of the eight-year follow-up. Two thirds (67%) of the subjects presented at least one recurrence and 57% of them were depressed for 25% or more of the follow-up period. At the eight-year follow-up, 36% had a mood disorder, 48% suffered from anxiety and 26% had a personality disorder. Less severe depression at baseline predicted a shorter time to recovery, whereas recurrence was predicted by a younger age. A latent profile with initially moderate-level depressive symptoms but a poor distal outcome was associated with being female and borderline personality disorder.

Limitations: The female preponderance in the sample warrants caution when interpreting sex differences in the findings.

Conclusions: Although the depression outcome for some adolescents making the transition to young adulthood is promising, many of them experience long, even chronic episodes, and recurrences are common. Personality-disorder characteristics appeared to be significant outcome predictors in this adolescent population.
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http://dx.doi.org/10.1016/j.jad.2020.01.174DOI Listing
April 2020

DSM-5 eating disorders among adolescents and young adults in Finland: A public health concern.

Int J Eat Disord 2020 05 30;53(5):520-531. Epub 2020 Jan 30.

Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland.

Objective: We aimed to assess the lifetime prevalence, 10-year incidence, and peak periods of onset for eating disorders as defined by the Fifth Diagnostic and Statistical Manual of Mental Disorders (DSM-5) among adolescents and young adults born in the 1980s in Finland.

Method: Virtually all Finnish twins born in 1983-1987 (n = 5,600) were followed prospectively from the age of 12 years. A subsample of participants (n = 1,347) was interviewed using a semi-structured diagnostic interview in their early twenties.

Results: The prevalence of lifetime DSM-5 eating disorders was 17.9% for females and 2.4% for males (pooled across genders, 10.5%). The estimated lifetime prevalences for females and males, respectively, were 6.2 and 0.3% for anorexia nervosa (AN), 2.4 and 0.16% for bulimia nervosa (BN), 0.6 and 0.3% for binge-eating disorder (BED), 4.5 and 0.16% for other specified feeding or eating disorder (OSFED), and 4.5 and 1.6% for unspecified feeding or eating disorder (UFED). Among females, the prevalence of OSFED subcategories was as follows: atypical AN 2.1%, purging disorder 1.3%, BED of low frequency/limited duration 0.7%, and BN of low frequency/limited duration 0.4%. The 10-year incidence rate of eating disorders was 1,700 per 100,000 person-years among females (peak age of onset 16-19 years) and 220 per 100,000 person-years among males.

Discussion: Eating disorders are a common public health concern among youth and young adults, affecting one in six females and one in 40 males. Adequate screening efforts, prevention, and interventions are urgently needed.
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http://dx.doi.org/10.1002/eat.23236DOI Listing
May 2020

Sleep symptoms and long-term outcome in adolescents with major depressive disorder: a naturalistic follow-up study.

Eur Child Adolesc Psychiatry 2020 May 6;29(5):595-603. Epub 2019 Nov 6.

Department of Public Health Solutions, Mental Health Unit, National Institute for Health and Welfare, P.O.Box 30, 00271, Helsinki, Finland.

Sleep abnormalities in major depressive disorder (MDD) have been suggested to represent a vulnerability trait, which might predispose the individual to long-term psychiatric morbidity. In this study, we sought to assess whether the presence of sleep symptoms among adolescents with MDD is associated with poorer long-term outcome in young adulthood during naturalistic follow-up. Adolescent outpatients diagnosed with MDD (n = 166; age 13-19 years, 17.5% boys) were followed up during 8 years in naturalistic settings. N = 112 adolescents (16.1% boys) completed the 8-year assessment. Sleep symptoms and psychosocial functioning were assessed with structured clinical interviews, and depressive and anxiety symptoms with questionnaires. The severity of sleep symptoms at baseline was not associated with worse outcome at 8 years in terms of any of the outcome measures tested. In particular, the presence of a disturbed sleep-wake rhythm at baseline was associated with a more favourable outcome at 8 years: less depression and anxiety symptoms and higher level of psychosocial functioning. The presence of sleep symptoms in young adulthood was associated with the presence of current depression and anxiety symptoms and poorer psychosocial functioning. The presence of sleep symptoms at follow-up seems to be state-dependent: they are observed in conjunction with other psychiatric symptoms. Contrary to our hypothesis, our results suggest that sleep complaints among adolescents with MDD do not lead to poorer long-term clinical outcome in young adulthood. The link between sleep-wake rhythm disturbance and better long-term outcome needs to be confirmed and examined in detail in further studies, but here we speculate about possible explanations.
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http://dx.doi.org/10.1007/s00787-019-01436-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7250797PMC
May 2020

Feasibility, Acceptability, and Preliminary Impacts of Web-Based Patient Education on Patients With Schizophrenia Spectrum Disorder: Quasi-Experimental Cluster Study.

J Med Internet Res 2019 10 17;21(10):e13073. Epub 2019 Oct 17.

Department of Nursing Science, University of Turku, Turku, Finland.

Background: Web-based interventions are promising tools for increasing the understanding of illness and treatment among patients with serious mental disorders.

Objective: This study aimed to test the feasibility and acceptability of a Web-based patient education intervention using a quasi-experimental cluster design to report feedback on patient education sessions and the website used and to report preliminary evidence of the intervention's impact on patients with schizophrenia spectrum disorder.

Methods: A single-blind, parallel, quasi-experimental cluster study over a 6-month period comparing Web-based education (n=33) with a nonequivalent control group (treatment as usual, n=24) for people with schizophrenia spectrum disorder was conducted. Participants (N=57) were recruited from one psychiatric hospital (6 wards). Feasibility was assessed by participants' commitment (refusal rate, dropout rate) to the study. Acceptability was assessed as participants' commitment to the intervention. Patient education sessions and website feedback were assessed by the patients and health care professionals. The preliminary impact of the sessions on patients' self-efficacy, self-esteem, illness cognition, and knowledge level was measured at baseline and follow-ups (8 weeks, 6 months) with self-rated questionnaires.

Results: The refusal rate among patients was high with no statistically significant difference (69% [74/107] in the intervention group, 76% [76/100] in the control group; P=.21). The same result was found for the dropout rates (48% [16/33] vs 58% [14/24]; P=.46). The acceptability of the intervention was good; 31 participants out of 33 (94%) completed all five sessions. Feedback on the intervention was mainly positive; three out of four subscales of session were rated above the midpoint of 4.0. Feedback on the website was also positive, with a grade of good for content (69%, 20/29 patients; 75%, 21/28 professionals), layout (62%, 18/29 patients; 61%, 17/28 professionals), and usability (62%, 18/29 patients; and 68%, 19/28 professionals). The patients using the intervention had significantly higher scores 6 months after the sessions in self-efficacy (baseline mean 26.12, SD 5.64 vs 6-month mean 29.24, SD 6.05; P=.003) and regarding knowledge level about schizophrenia (mean 11.39, SD 4.65 vs 6-month mean 15.06, SD 5.26; P=.002), and lower scores in the subscale of helplessness in illness cognition (mean 2.26, SD 0.96 vs 6-month mean 1.85, SD 0.59; P=.03). Differences from the control group were not significant. No differences were found in patients' self-esteem or other subscales in illness cognition.

Conclusions: The patients were reluctant to participate in the study and tended to drop out before the follow-ups. Once they had participated, their acceptance of the intervention was high. A more effective recruitment strategy and monitoring method will be needed in future studies. To assess the impact of the intervention, a more rigorous study design with an adequately powered sample size will be used in cooperation with outpatient mental health services.
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http://dx.doi.org/10.2196/13073DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6913382PMC
October 2019

Trajectories of mothers' and fathers' depressive symptoms from pregnancy to 24 months postpartum.

J Affect Disord 2020 01 10;260:629-637. Epub 2019 Sep 10.

Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland; Pediatric Research Center, Child Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Objectives: This study investigated trajectories of mothers' and fathers' depressive symptoms from prenatal to 24 months postpartum. Prenatal correlates of the trajectories were also examined.

Methods: Mothers (N = 1670) and fathers (N = 1604) from the Finnish CHILD-SLEEP birth cohort, reported depressive symptoms at 32nd pregnancy week and 3, 8, and 24 months postpartum using the Center for Epidemiologic Studies Depression Scale (CES-D, 10-item). Profile analysis was used to group participants according to their longitudinal patterns of depressive symptoms. Prenatal predictors (sociodemographic, health, substance use, sleep, and stress related factors, family atmosphere) of depressive symptom trajectories as well as association between parents' trajectories were analyzed using multinomial logistic regression.

Results: For both mothers and fathers, a solution with three stable depressive symptom trajectories (low: 63.1% mothers and 74.9% fathers; moderate: 28.1% and 22.6%; high: 8.8% and 2.6%) was considered the best fitting and most informative. Insomnia, earlier depression, anxiousness, stressfulness, and poor family atmosphere predicted the moderate and high (compared to low) depressive symptom trajectories among both mothers and fathers in multivariate analyses. Mother's higher depressive symptom trajectory was significantly associated with father's higher symptom trajectory (p < 0.001).

Limitations: Number of cases in the high depressive symptom trajectory group among fathers was low.

Conclusions: Maternal and paternal depressive symptom trajectories from prenatal period up to two years postpartum seem stable, indicating the chronic nature of perinatal depressive symptoms. Mothers' and fathers' trajectories are associated with each other and their strongest predictors are common to both.
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http://dx.doi.org/10.1016/j.jad.2019.09.038DOI Listing
January 2020

Epigenetic dysregulation of genes related to synaptic long-term depression among adolescents with depressive disorder and sleep symptoms.

Sleep Med 2019 09 7;61:95-103. Epub 2019 Mar 7.

Department of Genetics and Biomarkers, National Institute for Health and Welfare, Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Objectives: This study aimed to test the hypothesis that sleep and depression have independent effects on brain development and plasticity in adolescents, and that these changes are reflected in changes in the epigenome.

Methods: Participants were 17 medication-free adolescent boys (age 16.05 ± 0.80 years, mean ± standard deviation (SD); eight cases with depression and sleep symptoms, nine healthy controls). Sleep was assessed by polysomnography recordings and the Pediatric Daytime Sleepiness Scale (PDSS) and Athens Insomnia Scale (AIS). Participants underwent a clinical evaluation. DNA methylation of blood leukocytes was measured by Illumina 450K array, and Ingenuity Pathway analysis was applied to identify the most significant pathways with differentially methylated positions (DMPs). Secondary analysis of the identified loci included linear correlations between methylation and the subjectively rated scales of sleep, depression and sleep microarchitecture.

Results: Due to small sample size, we found no genome-wide significant differences in methylation between cases and controls. However, pathway analysis identified the synaptic long-term depression (LTD) canonical pathway (p = 0.00045) when the best 500 DMPs from the original case-control design were included. A flattened dissipation of slow wave sleep, tiredness and depression severity values correlated with five of 10 sites from the LTD pathway (IGF1R, PLAG16, PLA2R1, PPP2C5 and ERK12) in the secondary analysis when the case-control status was controlled for.

Conclusion: Among adolescents, depressive disorder with sleep symptoms is associated with a distinctive epigenetic pattern of DNA methylation in blood leukocytes. The enrichment of DMPs on genes related to synaptic LTD emphasizes the role of sleep in synaptic plasticity and the widespread physiological consequences of disturbed sleep.
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http://dx.doi.org/10.1016/j.sleep.2019.01.050DOI Listing
September 2019

Experiences of sexual harassment are associated with high self-esteem and social anxiety among adolescent girls.

Nord J Psychiatry 2019 Aug 16;73(6):365-371. Epub 2019 Jul 16.

a Faculty of Medicine and Health Technology, Tampere University , Tampere , Finland.

Subjection to sexual harassment among adolescents have been associated with negative mental health outcomes, such as depression and social anxiety. Self-esteem and social support may modify these associations. The Adolescent Mental Health Cohort 10-year replication data were used. It is a cross-sectional classroom survey involving 656 girls and 636 boys aged (mean (sd)) 15.6 (0.4) years and 15.7 (0.4) years, respectively. Subjection to sexual harassment was elicited with five questions. Depression was measured by the Beck's 13-item Depression Inventory, social anxiety by the SPIN-Fin Inventory, self-esteem by Rosenberg's Self-Esteem Scale and social support by the PSSS-R scale. The data were analysed using cross-tabulations with chi-square statistics and logistic regressions. Among girls, social anxiety and higher self-esteem were positively associated with experiencing subjection to sexual harassment in multivariate models. No statistically significant associations were detected among boys between experiences of sexual harassment and any of the four variables. Experiences of being sexually harassed correlate among adolescents with high social anxiety but also with high self-esteem. Sexual harassment among adolescents may partly be explained as inept ways of showing interest, but it may nevertheless have detrimental effects on the well-being of the those subjected to it.
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http://dx.doi.org/10.1080/08039488.2019.1640790DOI Listing
August 2019

Changes in delinquency according to socioeconomic status among Finnish adolescents from 2000 to 2015.

Scand J Child Adolesc Psychiatr Psychol 2019 30;7:52-59. Epub 2019 May 30.

University of Tampere, Faculty of Medicine and Life Sciences, Tampere, Finland.

Scientific literature suggests that the prevalence of delinquency amongst adolescents has decreased internationally in past decades. However, whether this change is consistent across all socioeconomic groups has not yet been studied. The aim of this study was to examine changes in delinquency amongst Finnish adolescents according to socioeconomic status between 2000 and 2015. A population-based school survey was conducted biennially amongst 14-16-year-old Finns between 2000 and 2015 ( = 761,278). Distributions for delinquency and socioeconomic adversities (low parental education, not living with both parents and parental unemployment in the past year) were calculated using crosstabs. Associations between delinquency, time, and socioeconomic adversities were studied using binomial logistic regression results shown by odds ratios with 95 % confidence intervals. Delinquency was positively associated with all three socioeconomic adversities studied and cumulative socioeconomic adversity. Although the prevalence of delinquency varied only slightly between 2000 and 2015 in the overall population, it increased significantly amongst adolescents with most socioeconomic adversities. The findings indicate that socioeconomic differences in delinquency have increased amongst Finnish adolescents in past decades. Delinquency prevention and intervention programs should take socioeconomic adversities into account.
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http://dx.doi.org/10.21307/sjcapp-2019-008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7709941PMC
May 2019

CAPMH health-related quality of life among adolescent psychiatric outpatients: a 12-month follow-up study among 12-14-year-old Finnish boys and girls.

Child Adolesc Psychiatry Ment Health 2019 26;13:17. Epub 2019 Mar 26.

4Helsinki University Hospital, Administration, Research, and Development, Helsinki, Finland and Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland.

Background: Little is known about adolescents' perceptions about their health-related quality of life (HRQoL) in the course of routine adolescent psychiatric treatment. The aim of this 1-year follow-up study was to investigate HRQoL and changes in it among youths receiving adolescent psychiatric outpatient treatment.

Methods: The study comprised 158 girls and 82 boys aged 12-14 years from 10 psychiatric outpatient clinics in one Finnish hospital district. Same-aged population controls (210 girls and 162 boys) were randomly collected from comprehensive schools. HRQoL was measured using the 16D instrument. The questionnaire was self-administered when the adolescents entered the polyclinics (= baseline), after a treatment period of 6 months, and after 12 months.

Results: The mean age of respondents was 13.8 years (SD 0.63). At baseline, the mean HRQoL score of both female and male outpatients was significantly lower than that of population controls (p < 0.001). HRQoL of female patients was significantly worse than that of male patients (p < 0.001). In girls, HRQoL improved continuously during the 12-month follow-up, yet it remained worse than that of female population controls. Among boys, HRQoL was substantially better at the 6-month follow-up than at baseline, but this positive development was no longer seen at the 12-month follow-up.

Conclusions: From the perspective of HRQoL, girls seem to benefit more than boys from adolescent psychiatric outpatient treatment. Possible explanations for this finding are discussed.
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http://dx.doi.org/10.1186/s13034-019-0278-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6434830PMC
March 2019

Adolescents with same-sex interest: experiences of sexual harassment are more common among boys.

Health Psychol Behav Med 2019 Mar 28;7(1):105-127. Epub 2019 Mar 28.

Adolescent Psychiatry, Helsinki University and Helsinki University Hospital, Helsinki, Finland.

To explore whether sexual harassment experiences are more common among adolescents reporting romantic and erotic interests in the same sex and both sexes, when sociodemographic and mental health confounding are controlled for, and whether the associations are similar in both sexes and in different phases of adolescence. A cross-sectional survey among a nationally representative dataset of 25,147 boys and 25,257 girls in comprehensive school, and 33,231 boys and 36,765 girls in upper secondary education. Self-reports of experiences of sexual harassment, and emotional (depression) and behavioral (delinquency) symptoms were used. All associations between sexual minority status and harassment diminished clearly when mental disorder dimensions were controlled for. In the comprehensive school sample (mean age 15.4 years), sexual harassment experiences were 4-7-fold more common among boys, and 1.5-3-fold among girls, with same-sex/both-sexes interest, compared to those interested exclusively in the opposite sex. In the upper secondary education sample (mean age 17.4 years), among boys, sexual harassment was reported 3-6-fold more commonly by those not exclusively heterosexually interested. Among older girls, a slight increase in sexual harassment experiences was seen among those interested in both sexes. Sexual harassment experiences are associated with sexual minority status, particularly among boys. Confounding by mental disorders needs to be accounted for when studying sexual minority status and sexual harassment.
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http://dx.doi.org/10.1080/21642850.2019.1598864DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8114400PMC
March 2019

The Impact of a Web-Based Course Concerning Patient Education for Mental Health Care Professionals: Quasi-Experimental Study.

J Med Internet Res 2019 03 1;21(3):e11198. Epub 2019 Mar 1.

Department of Nursing Science, University of Turku, Turku, Finland.

Background: Continuing education has an important role in supporting the competence of health care professionals. Although Web-based education is a growing business in various health sectors, few studies have been conducted in psychiatric settings to show its suitability in demanding work environments.

Objective: We aimed to describe the impact of a Web-based educational course to increase self-efficacy, self-esteem, and team climate of health care professionals. Possible advantages and disadvantages of the Web-based course are also described.

Methods: The study used nonrandomized, pre-post intervention design in 1 psychiatric hospital (3 wards). Health care professionals (n=33) were recruited. Self-efficacy, self-esteem, and team climate were measured at 3 assessment points (baseline, 8 weeks, and 6 months). Possible advantages and disadvantages were gathered with open-ended questions at the end of the course.

Results: Our results of this nonrandomized, pre-post intervention study showed that health care professionals (n=33) had higher self-efficacy after the course, and the difference was statistically significant (mean 30.16, SD 3.31 vs mean 31.77, SD 3.35; P=.02). On the other hand, no differences were found in the self-esteem or team climate of the health care professionals before and after the course. Health care professionals found the Web-based course useful in supporting their work and relationships with patients. The tight schedule of the Web-based course and challenges in recruiting patients to use the patient education program with health care professionals were found to be the disadvantages.

Conclusions: Web-based education might be a useful tool to improve the self-efficacy of health care professionals even in demanding work environments such as psychiatric hospitals. However, more studies with robust and sufficiently powered data are still needed.
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http://dx.doi.org/10.2196/11198DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6418488PMC
March 2019

Socioeconomic Trends in Adolescent Smoking in Finland From 2000 to 2015.

J Adolesc Health 2019 06 26;64(6):776-782. Epub 2019 Jan 26.

Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland; Vanha Vaasa Hospital, Vaasa, Finland; Tampere University Hospital, Department of Adolescent Psychiatry, Pitkäniemi, Finland.

Purpose: Smoking is a significant cause of morbidity and mortality worldwide. In the past decades, the prevalence of adolescent smoking has decreased in industrial countries. However, whether the decreasing trend can be seen across all socioeconomic groups is unknown. The aim of this study was to examine time trends in adolescent smoking according to the socioeconomic status among Finnish adolescents between 2000 and 2015.

Methods: A population-based school survey was conducted biennially among 14- to 16-year-old Finns between 2000 and 2015 (n = 761,278). Distributions for frequent smoking, lifelong nonsmoking, and socioeconomic adversities (low parental education, not living with both parents and parental unemployment during the past year) were calculated. Associations were studied using binomial logistic regression results shown by odds ratios with 95% confidence intervals.

Results: Frequent smoking was positively associated and lifelong nonsmoking was negatively associated with socioeconomic adversities. Over the study period, the overall prevalence of frequent smoking decreased and lifelong nonsmoking increased. However, no similar changes were observed among adolescents with most socioeconomic adversities.

Conclusion: Socioeconomic differences in adolescent smoking increased in Finland between 2000 and 2015. Although the overall prevalence of frequent smoking decreased, no similar decrease was observed among adolescents with most socioeconomic adversities. Similarly, although the overall prevalence of lifelong nonsmoking increased, this was not observed among adolescents with most socioeconomic adversities. Socioeconomic adversities should be considered in the prevention of adolescent smoking.
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http://dx.doi.org/10.1016/j.jadohealth.2018.11.017DOI Listing
June 2019

Psychometric properties of the 7-item Generalized Anxiety Disorder Scale (GAD-7) in a large representative sample of Finnish adolescents.

Psychiatry Res 2019 02 3;272:30-35. Epub 2018 Dec 3.

Mental Health Unit, National Institute for Health and Welfare, Box 30, 00271 Helsinki, Finland; Helsinki University Central Hospital, Department of Adolescent Psychiatry, PO Box 590,00029 HUS, Finland.

Symptoms of generalized anxiety disorder (GAD) are common among adolescents and can lead to severe psychosocial impairment, yet there is a lack of a good quality scale to measure symptoms of generalized anxiety in young people. The 7-item Generalized Anxiety Disorder Scale (GAD-7) is a self-report scale used to measure GAD symptoms and has been validated in adult populations, but the measure's psychometric properties regarding adolescents are unknown. The aim of this study was to investigate the reliability, factorial validity, and construct validity of the GAD-7 in adolescents in a nationally representative sample from a general population. Our study was based on Finnish survey data on 111,171 adolescents aged 14-18 years. Our results show that the GAD-7 demonstrates good psychometric properties in adolescents. The internal consistency of the GAD-7 was good (Cronbach's α = 0.91) and the instrument's unidimensional factor structure was supported. The associations of GAD-7 sum scores with self-report measures of depression and social anxiety supported construct validity. The psychometric properties of the GAD-7 in this sample of adolescents were similar to those reported among adults. However, studies in which diagnostic interviews are performed are needed to demonstrate the diagnostic efficacy of the measure in this age group.
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http://dx.doi.org/10.1016/j.psychres.2018.12.004DOI Listing
February 2019

Socioeconomic trends in school bullying among Finnish adolescents from 2000 to 2015.

Child Abuse Negl 2018 12 28;86:100-108. Epub 2018 Sep 28.

Faculty of Medicine and Life Sciences, 33014 University of Tampere, Finland; Vanha Vaasa Hospital, Vierinkiventie 1, 65380, Vaasa, Finland; Tampere University Hospital, Department of Adolescent Psychiatry, 33380, Pitkäniemi, Finland. Electronic address:

Bullying at school has far-reaching impacts on adolescent well-being and health. The aim of this study was to examine trends in bullying at school according to socioeconomic adversities among Finnish adolescents from 2000 to 2015. A population-based school survey was conducted biennially among 14-16-year-old Finns between 2000 and 2015 (n = 761,278). Distributions for bullying, being bullied and socioeconomic adversities were calculated. Associations between bullying involvement, time and socioeconomic adversities were studied using binomial logistic regression with results shown by odds ratios with 95% confidence intervals. At the population level, the likelihoods of bullying and being bullied varied only slightly between 2000 and 2015. Bullying and being bullied were associated with socioeconomic adversities (low parental education, not living with both parents and parental unemployment in the past year). Unlike in the general population, the likelihoods of bullying and being bullied increased markedly among adolescents with most socioeconomic adversities. The increased socioeconomic differences in bullying involvement observed in this study add to the mounting evidence of polarization of adolescent health and well-being. Socioeconomic adversities should be considered in the prevention of bullying at school. In addition, socio-political measures are needed to decrease socioeconomic inequalities among Finnish adolescents.
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http://dx.doi.org/10.1016/j.chiabu.2018.09.011DOI Listing
December 2018

AUDIT and AUDIT-C as screening instruments for alcohol problem use in adolescents.

Drug Alcohol Depend 2018 07 19;188:266-273. Epub 2018 May 19.

Adolescent Psychiatry, University of Helsinki and Helsinki University Hospital, Välskärinkatu 12, 00260, Helsinki, Finland.

Background: The Alcohol Use Disorders Identification Test (AUDIT) is commonly used in adults to screen for harmful alcohol consumption but few studies exist on its use among adolescents. Our aim was to validate the AUDIT and its derivative consumption questionnaire (AUDIT-C) as screening instruments for the detection of problem use of alcohol in adolescents.

Methods: 621 adolescents (age-range, 12-19 years) were drawn from clinical and population samples who completed the AUDIT questionnaire. Psychiatric diagnoses were assessed using K-SADS-PL. A rating based on the K-SADS-PL was used to assess alcohol use habits, alcohol use disorders, screening and symptom criteria questions. Screening performance of the AUDIT and AUDIT-C sum scores and Receiver Operating Characteristic (ROC) curves were calculated. The diagnostic odds ratios (dOR) were calculated to express the overall discrimination between cut-offs.

Results: Comparisons of ROC between the AUDIT and AUDIT-C pairs indicated a slightly better test performance by AUDIT for the whole sample and in a proportion of the subsamples. Optimal cut-off value for the AUDIT was ≥5 (sensitivity 0.931, specificity 0.772, dOR 45.22; 95% CI: 24.72-83.57) for detecting alcohol problem use. The corresponding optimal cut-off value for the AUDIT-C was ≥3 in detecting alcohol problem use (sensitivity 0.952, specificity 0.663, dOR 39.31; 95% CI: 19.46-78.97). Agreement between the AUDIT and AUDIT-C using these cut-off scores was high at 91.9%.

Conclusions: Our results for the cut-off scores for the early detection of alcohol problem use in adolescents are ≥5 for AUDIT, and ≥3 for AUDIT-C.
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http://dx.doi.org/10.1016/j.drugalcdep.2018.04.015DOI Listing
July 2018

High Beck Depression Inventory 21 scores in adolescents without depression are associated with negative self-image and immature defense style.

Psychiatry Res 2018 05 2;263:61-68. Epub 2018 Mar 2.

Adolescent Psychiatry, University of Helsinki and Helsinki University Hospital, PO BOX 660, 00029 HUS Helsinki, Finland; Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland. Electronic address:

Beck Depression Inventory (BDI) is widely used in assessing adolescents' psychological wellbeing, but occasionally the result diverges from diagnostics. Our aim was to identify factors associated with discrepancies between BDI scores and diagnostic assessment in adolescent psychiatric patients and general population. The study comprised 206 inpatients (13-17 years old) and 203 age and gender matched non-referred adolescents. Study subjects filled self-reports on depression symptoms (BDI-21), alcohol use (AUDIT), defense styles (DSQ-40) and self-image (OSIQ-R), and on background information and adverse life events. Diagnostics was based on K-SADS-PL interview, and/or clinical interview and clinical records when available. We compared subjects who scored in BDI-21 either 0-15 points or 16-63 points firstly among subjects without current unipolar depression (n = 284), secondly among those with unipolar depression (n = 105). High BDI-21 scores in subjects without depression diagnosis (n = 48) were associated with female sex, adverse life events, parents' psychiatric problems, higher comorbidity, higher AUDIT scores, worse self-image and more immature defense styles. Low BDI-21 scores among subjects with depression diagnosis (n = 23) were associated with male sex, more positive self-image and less immature defense style. In conclusion, high BDI-21 scores in the absence of depression may reflect a broad range of challenges in an adolescent's psychological development.
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http://dx.doi.org/10.1016/j.psychres.2018.02.040DOI Listing
May 2018

High Beck Depression Inventory 21 scores in adolescents without depression are associated with negative self-image and immature defense style.

Psychiatry Res 2018 05 2;263:61-68. Epub 2018 Mar 2.

Adolescent Psychiatry, University of Helsinki and Helsinki University Hospital, PO BOX 660, 00029 HUS Helsinki, Finland; Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland. Electronic address:

Beck Depression Inventory (BDI) is widely used in assessing adolescents' psychological wellbeing, but occasionally the result diverges from diagnostics. Our aim was to identify factors associated with discrepancies between BDI scores and diagnostic assessment in adolescent psychiatric patients and general population. The study comprised 206 inpatients (13-17 years old) and 203 age and gender matched non-referred adolescents. Study subjects filled self-reports on depression symptoms (BDI-21), alcohol use (AUDIT), defense styles (DSQ-40) and self-image (OSIQ-R), and on background information and adverse life events. Diagnostics was based on K-SADS-PL interview, and/or clinical interview and clinical records when available. We compared subjects who scored in BDI-21 either 0-15 points or 16-63 points firstly among subjects without current unipolar depression (n = 284), secondly among those with unipolar depression (n = 105). High BDI-21 scores in subjects without depression diagnosis (n = 48) were associated with female sex, adverse life events, parents' psychiatric problems, higher comorbidity, higher AUDIT scores, worse self-image and more immature defense styles. Low BDI-21 scores among subjects with depression diagnosis (n = 23) were associated with male sex, more positive self-image and less immature defense style. In conclusion, high BDI-21 scores in the absence of depression may reflect a broad range of challenges in an adolescent's psychological development.
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http://dx.doi.org/10.1016/j.psychres.2018.02.040DOI Listing
May 2018
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