Psyykkiset häiriöt nuoruusiässä

Pääkirjoitus

Childhood Predictors of Later Psychotropic Medication Use and Psychiatric Hospital Treatment : Findings from the Finnish Nationwide 1981 Birth Cohort Study

Early identification of individuals who later develop psychiatric problems requiring psychotropic medication and psychiatric hospital treatment has implications for prevention. The aims of this thesis are to describe the cumulative incidence of psychotropic medication use from age 12 to age 25, and to study factors at age eight that predict psychotropic medication use and psychiatric hospital treatment between age 12 and 25. A representative random sample of all children born in 1981 and alive at age eight in 1989 was primarily selected in 1989 (6,017 of 60,007; 10%). At age eight, 5,813 children were assessed using questionnaires (97% of 6,017). The parents and the teacher completed questionnaires with items concerning family structure, parental education level, conduct problems, hyperactive problems, emotional symptoms, bullying, and victimization of bullying behavior. The children themselves completed questions regarding depressive symptoms, bullying, and victimization of bullying behavior. Between 1994 and 2005, when the participants were 12-13 to 24-25 years old, the personal identification numbers of 5,525 subjects (92% of 6,017) were linked to the nationwide Drug Prescription Register and the nationwide Finnish Hospital Discharge Register. Information about psychotropic medication use and psychiatric hospital treatment between age 12 and 25 was collected from these registers. The main results in the thesis are that more than every seventh subject had used psychotropic medications by age 25, and that psychotropic medication use and psychiatric hospital treatment are strongly associated with psychiatric symptoms at age eight. Depressive symptoms predicted treatment of depressive disorders and non-intact family structure predicted a wide range of different psychiatric treatments in both sexes. Among males, particularly acting-out behaviors, while among females, especially depressive and anxiety symptoms and being a victim of bullying behavior predicted antipsychotic use, antidepressant use, and psychiatric hospital treatment by age 25. The study shows that a considerable proportion of the population has used psychotropic medication at some point by age 25. The novel result that the psychiatric outcomes are partly predicted differently among males versus females, should be further studied using large population-based cohorts. If the results are replicated and screening of mental health problems is implemented in primary schools, sex-specific screening strategies might be warranted.Ennaltaehkäisyn kannalta on tärkeä tunnistaa varhaisessa vaiheessa henkilöitä, joilla on kohonnut riski myöhempiin, psyykelääkitystä tai psykiatrista sairaalahoitoa vaativiin mielenterveysongelmiin. Tämän väitöskirjan tarkoituksena on selvittää psyykelääkkeiden käytön kumulatiivista ilmaantuvuutta 12 25 vuotiailla ja selvittää kahdeksan vuoden iässä arvioituja tekijöitä, jotka ennustavat psyykelääkkeiden käyttöä ja psykiatrista sairaalahoitoa 12 25 vuoden iässä. Kaikista vuonna 1981 syntyneistä ja vuonna 1989 kahdeksan vuoden iässä elossa olleista lapsista poimittiin vuonna 1989 edustava otos (6017 lasta eli noin 10 % kaikista 60 007 lapsesta). Kahdeksan vuoden iässä tietoja kerättiin kyselylomakkeiden avulla 5817 lapsesta (97 % 6017 lapsesta). Lasten vanhemmat ja opettajat vastasivat kysymyksiin, jotka koskivat perherakennetta, vanhempien koulutustasoa, lapsen käytösongelmia, ylivilkkauteen liittyviä ongelmia, tunne-elämän ongelmia sekä kiusaamista tai kiusaamisen uhriksi joutumista. Lapset itse täyttivät kyselylomakkeen, joka sisälsi kysymyksiä masennusoireista, kiusaamisesta ja kiusaamisen uhriksi joutumisesta. Seurantavaiheessa 5525 henkilön (92 % 6017 lapsesta) henkilötunnus yhdistettiin valtakunnallisista lääkekorvaus- ja hoitoilmoitusrekistereistä vuosina 1994 2005 kerättyihin tietoihin psyykelääkkeiden ja psykiatrisen sairaalahoidon käytöstä ikävuosina 12 25. Väitöskirjatutkimuksen päätulokset osoittivat, että 25 vuoden ikään mennessä useampi kuin joka seitsemäs henkilö on käyttänyt psyykelääkitystä ja että psyykelääkkeiden käyttö ja psykiatrinen sairaalahoito ovat yhteydessä kahdeksan vuoden iässä ilmoitettuihin psyykkisiin oireisiin. Molemmilla sukupuolilla masennusoireet olivat yhteydessä myöhempään masennuksen hoitoon ja rikkonainen perherakenne oli yhteydessä moniin erilaisiin psykiatrisiin hoitoihin. Miehillä varsinkin käytösongelmat ennusti antipsykoottisten lääkkeiden ja masennuslääkkeiden käyttöä sekä psykiatrista sairaalahoitoa ennen 25 vuoden ikää. Naisilla näiden hoitojen saamista ennustivat erityisesti lapsuusiän masennusoireet, ahdistuneisuusoireet ja kiusatuksi tuleminen. Tämä väitöskirja osoittaa, että huomattava osa väestöstä on käyttänyt psyykelääkkeitä 25 vuoden ikään mennessä. Nyt havaittua ilmiötä, jonka mukaan lapsuusiän psyykkiset oireet ovat miehillä ja naisilla osittain eri tavoin yhteydessä psykiatriseen hoitoon nuoruudessa ja varhaisaikuisuudessa, pitäisi tarkastella myös muissa laajoissa väestöpohjaisissa pitkittäistutkimuksissa. Mikäli tulokset ovat toistettavissa ja peruskoulun ensimmäisten luokkien oppilaille kehitetään mielenterveysongelmien seulontajärjestelmä, pitäisi tytöillä ja pojilla mahdollisesti käyttää erilaisia kriteereitä

Mental health services and allocation of resources : where should the money flow? Reply

Non peer reviewe

School performance and later diagnoses of nonaffective psychoses, bipolar disorder, and depression

Publisher Copyright: © 2022 The Authors. Acta Psychiatrica Scandinavica published by John Wiley & Sons Ltd.Objective: It is unclear whether there are differences between specific school subject performance and later psychiatric disorders. We examined whether mean grade point average (MGPA) and specific school subjects associated with diagnoses of nonaffective psychoses, bipolar disorder and depression. Methods: In this register-based study, we studied the Finnish population born in 1987 who had available MGPA and six specific school grades (age = 15.4–16.4 years; n = 50,508). Grades were analyzed with smoothing splines. Covariates included sex, urbanicity, parental education level and parental diagnosed psychiatric disorders. Outcomes were incident nonaffective psychosis, bipolar disorder and depression diagnosed in specialized services until year 2015 (age = 28.0–28.9 years). Results: During the follow-up, 727 individuals were diagnosed with nonaffective psychoses, 489 with bipolar disorder and 3492 with depression. MGPA was inversely associated with all outcomes. In multivariate models including specific school subjects and covariates, the school subject with largest risk ratios (RR) was Physical Education (RR and Bonferroni-corrected confidence interval [CI] at −1.5 SD: nonaffective psychoses 1.63, 1.36–1.95; bipolar disorder 1.64, 1.30–2.05; depression 1.72, 1.53–1.93). Higher grades in Art were associated with nonaffective psychoses and depression (RR and Bonferroni-corrected CI at +1.5 SD: nonaffective psychoses 1.48, 1.11–1.96; depression 1.22, 1.07–1.38). Conclusion: There was a robust association between poorer scores on Physical Education and risk for psychosis, bipolar disorder and depression. Higher grades in Art were also associated with risk for later disorders. Subject specific school performance may be more informative about mental disorder risk than overall school performance.Peer reviewe

Robust data-driven identification of risk factors and their interactions : A simulation and a study of parental and demographic risk factors for schizophrenia

Objectives Few interactions between risk factors for schizophrenia have been replicated, but fitting all such interactions is difficult due to high-dimensionality. Our aims are to examine significant main and interaction effects for schizophrenia and the performance of our approach using simulated data. Methods We apply the machine learning technique elastic net to a high-dimensional logistic regression model to produce a sparse set of predictors, and then assess the significance of odds ratios (OR) with Bonferroni-corrected p-values and confidence intervals (CI). We introduce a simulation model that resembles a Finnish nested case-control study of schizophrenia which uses national registers to identify cases (n = 1,468) and controls (n = 2,975). The predictors include nine sociodemographic factors and all interactions (31 predictors). Results In the simulation, interactions with OR = 3 and prevalence = 4% were identified with = 80% power. None of the studied interactions were significantly associated with schizophrenia, but main effects of parental psychosis (OR = 5.2, CI 2.9-9.7; p = 35 (1.3, 1.004-1.6; p = .04) were significant. Conclusions We have provided an analytic pipeline for data-driven identification of main and interaction effects in case-control data. We identified highly replicated main effects for schizophrenia, but no interactions.Peer reviewe

Time trends in treated incidence, sociodemographic risk factors and comorbidities : a Finnish nationwide study on anxiety disorders

Background There has been a lack of research about the time trends and socio-demographic risk factors for children and adolescents who receive treatment for anxiety disorders. This study aimed to fill these gaps in our knowledge by examining a nationwide sample of Finnish children and adolescents diagnosed in specialized healthcare settings. Methods This study comprised national register data of all singleton children born in Finland from 1992-2006 who were diagnosed with anxiety disorders from 1998-2012. The changes in time trends in incidence were studied by dividing the study sample into three cohorts by birth years: 1992-1996, 1997-2001 and 2002-2006, who were followed up until the age of 20, 15 and 10 years, respectively. The 22,388 individuals with anxiety disorders were age and gender matched with 76,139 controls from the general population. Logistic regression was used to examine the socio-demographic risk factors and anxiety disorders in the entire sample. Comorbid disorders were examined in the oldest birth cohort (1992-1996 born). Results Comparing the 1992-1996 and 2002-2006 cohorts showed that the cumulative incidence of treated anxiety disorders at the age of 10 increased from 0.3 to 1.2% among females and 0.46 to 1.9% among males. Subjects had higher likelihood for being diagnosed with an anxiety disorder if their mothers had low maternal socio-economic status class at birth (OR 1.53, 95% CI 1.45-1.61) compared to higher SES class, and marital status was single at the time of birth (OR 2.02, 95% CI 1.87-2.17) compared to married or in a relationship. They had lower risk of anxiety disorders diagnosis if born in rural (OR 0.82, 95% CI 0.79-0.86) or semi-urban areas (OR 0.79, 95% CI 0.76-0.82) when compared to urban residence. There was a wide range of psychiatric comorbidities, and unipolar depression was the most common (31.2%). Conclusion Anxiety disorders diagnosed by specialized Finnish services increased from 1998-2012 in both genders. This could indicate a real increase in overall anxiety disorders or an increase in treatment seeking. The findings on maternal socioeconomic status and single parenting improve the recognition of the environmental risk factors for anxiety disorders among children and adolescents.Peer reviewe

Risk for Premature Mortality and Intentional Self-harm in Autism Spectrum Disorders

To examine the risk for premature mortality and intentional self-harm in autism spectrum disorders (ASD). Based on a national birth cohort. Children born in 1987-2005, diagnosed with ASD by 2007 (n = 4695) were matched with four non-ASD subjects (n = 18,450) and followed until 2015 for mortality and intentional self-harm. The risk among ASD subjects was elevated only for natural cause of death. The risk for intentional self-harm was increased in the unadjusted analyses, but decreased to non-significant after adjusting for comorbid psychiatric disorders. ASD subjects are at increased risk for premature mortality due to natural causes of death. While ASD subjects die of suicide and present with more self-harm, the association is explained by comorbid psychiatric disorders.Peer reviewe