Adolescent cannabis use, depression and anxiety disorders in the Northern Finland Birth Cohort 1986

BackgroundCannabis use has been associated with increased risk of psychiatric disorders. However, associations between adolescent cannabis use, depression and anxiety disorders are inconsistently reported in longitudinal samples.AimsTo study associations of adolescent cannabis use with depression and anxiety disorders.MethodWe used data from the Northern Finland Birth Cohort 1986, linked to nationwide registers, to study the association between adolescent cannabis use and depression and anxiety disorders until 33 years of age (until 2018).ResultsWe included 6325 participants (48.8% male) in the analyses; 352 (5.6%) participants reported cannabis use until 15–16 years of age. By the end of the follow-up, 583 (9.2%) participants were diagnosed with unipolar depression and 688 (10.9%) were diagnosed with anxiety disorder. Cannabis use in adolescence was associated with an increased risk of depression and anxiety disorders in crude models. After adjusting for parental psychiatric disorder, baseline emotional and behavioural problems, demographic factors and other substance use, using cannabis five or more times was associated with increased risk of anxiety disorders (hazard ratio 2.01, 95% CI 1.15–3.82), and using cannabis once (hazard ratio 1.93, 95% CI 1.30–2.87) or two to four times (hazard ratio 2.02, 95% CI 1.24–3.31) was associated with increased risk of depression.ConclusionsCannabis use in adolescence was associated with an increased risk of future depression and anxiety disorders. Further research is needed to clarify if this is a causal association, which could then inform public health messages about the use of cannabis in adolescence.</p

Does cannabis use in adolescence predict self-harm or suicide? Results from a Finnish Birth Cohort Study

ObjectiveLongitudinal studies examining the association between adolescent cannabis use and self-harm are rare, heterogeneous and mixed in their conclusions. We study this association utilizing a large general population-based sample with prospective data.MethodsThe Northern Finland Birth Cohort 1986 (n = 6582) with linkage to nationwide register data was used to study the association of self-reported cannabis use at age 15–16 years and self-harm and suicide death until age 33 (until year 2018), based on register information. Cox regression analysis with Hazard Ratios (HR) and 95% confidence intervals (CI) was used. Psychiatric disorders, parental psychiatric disorders and other substance use were considered as confounders.ResultsIn all, 6582 (49.2% male) were included in the analysis, and 377 adolescents (5.7%) reported any cannabis use until the age of 15–16 years. Based on register information, 79 (55.7% male) had visited in health care services due to self-harm, and 22 (90.1% male) had died by suicide. In crude analyses, adolescent cannabis use was associated with self-harm (HR = 3.93; 95% CI 2.24–6.90). The association between cannabis use and self-harm remained statistically significant after adjusting for sex, psychiatric disorders at baseline, frequent alcohol intoxications, other illicit drug use, and parental psychiatric disorders (HR 2.06; 95% CI 1.07–3.95). In contrast, the association of cannabis use with suicide did not reach statistical significance even in crude analysis (HR 2.60; 95% CI 0.77–8.78).ConclusionCannabis use in adolescence may increase risk of self-harm independent of adolescent psychopathology and other substance use.</div

By their own young hand: non-suicidal self-harm and suicide attempts in young people with psychotic experiences

Background: Non-suicidal self-harm (NSSH) and suicide attempts, which for this thesis are grouped under the umbrella term of ‘self-harm’, account for a considerable portion of disability burden and are robust predictors of suicide death in young people. Psychotic experiences (PEs), such as hallucinatory and delusional experiences, have become increasingly of interest as potential markers of youth self-harm, although it remains unclear as to why there is an association. The purpose of this thesis was to investigate the PE–self harm association in adolescents (aged 12–17 years), as well as bio-psychosocial mechanisms underlying the relationship. This involved investigating (1) the role of third variables (confounders, mediators) in the PE–self harm association; (2) how the PE–self harm association fits in with self-injurious and suicidal behaviour theories; (3) the direction and dynamic nature of the relationship; and (4) whether the association varies by PE subtype.Method: A systematic review of the literature was undertaken, which critically examined the role of confounders and mediators in the PE–self harm association. Relevant variables, as identified in the review, were included and examined in an epidemiological analysis of PEs and self-harm, using a nationally representative sample of Australian adolescents (the Young Minds Matter survey). Structural equation modelling was then conducted to investigate proposed mediating pathways of the association, across three waves of prospective adolescent cohort data (the HEALing study). Using the same Australian adolescent cohort study, the role of the Interpersonal Theory of Suicide (IPTS), a well-established suicidal behaviour theory, was examined; where hallucinatory experiences and IPTS constructs were explored in the suicidal thought-to-attempt transition. This was conducted to address gaps in previous epidemiological studies which have been largely atheoretical and data driven. Alternative pathways which challenge broad assumptions about directionality were also investigated. Multivariable logistic regression analyses were used to examine potential reverse causal pathways, including relationships between baseline self-harm and incident PEs, across three waves of prospective adolescent data (the HEALing study).Results: The systematic review demonstrated the PE–self harm association has been well-replicated, but that almost 30% of all studies did not control or adjust for confounders or other third variables of interest. In the majority of studies where adjustment did occur, the association persisted, but its strength was attenuated. Common mental disorders such as depression, as well as various psychosocial factors (including psychological distress\ua0and negative environmental exposures such as bullying) explained a substantial amount of the variance, whereas most demographic and family history variables were of less importance. Nationally representative analyses found PEs are common in Australian adolescents (3.3–14.0% 12-month prevalence) and that their clinical relevance varies by subtype. Auditory hallucinatory experiences, in particular, were strongly and consistently associated with NSSH (OR=2.44; 95%CI=1.48–4.03) and suicide attempts (OR=3.35; 95%CI=1.61–6.97), after adjustment and consideration for an extensive set of bio-psychosocial confounders and mediators. Variables such as depression, psychological distress, self-esteem, and being bullied were identified as potential key explanatory variables and were included in subsequent longitudinal mediation analyses. Auditory hallucinatory experiences were found to be indirectly associated with future NSSH and suicide attempts via recent traumatic life events (e.g. bullying, sexual assault), high psychological distress, and low self-esteem, across three waves of prospective cohort data. Other PE subtypes were mostly not associated with incident NSSH and suicide attempts at 1- and 2-year follow-ups, either directly or indirectly. Regarding theoretical frameworks, the IPTS theoretical model provided limited explanatory value to the PE–self harm association (albeit statistical power and measurement concerns). Alternative pathways of reverse causality were also considered, however, there was little evidence of an association between NSSH, suicide attempts, and subsequent PEs.Conclusion: PEs are common in adolescents, even among young people who do not have a mental health condition. These experiences are indicative of increased risk across a wide range of poor mental health and psychosocial outcomes, including NSSH and suicide attempts. Overall, the collection of evidence presented in this thesis suggested the PE–self harm association is not direct but instead explained by shared risk factors, including recent negative life events and trauma, as well as affective and negative self-evaluation processes. In addition to identifying important explanatory and modifiable factors, this thesis highlighted that “not all PEs are created equal”, where the phenomenological qualities of PEs are key considerations to understanding and predicting self-harm and suicide risk in this group. Adolescents reporting persistent auditory hallucinatory experiences, over several years, are at particularly high risk for engaging in NSSH and suicide attempts. Despite measurement and sampling limitations, this thesis has provided a strong foundation for future research and can be used to guide ongoing self-harm/suicide prevention and early intervention efforts among young people with PEs. Such efforts would likely benefit most from targeting mediating and modifiable factors of acute distress, low self-esteem, and exposure to traumatic events with interpersonal harm

Managing disclosure of personal information: an opportunity to enhance supported employment

To first provide an overview of studies that explore mental health disclosure in the workplace; including factors that influence the decision to disclose, and differing approaches to disclosure (binary, multidimensional, and evolving and ongoing). Second, to provide a critical overview of existing tools designed to help clients manage their mental health disclosure decisions.Electronic searches of PubMed, PsycINFO and ScienceDirect were undertaken, excluding all articles published prior to 1990. The following search terms were used: mental health disclosure, employment, severe and persistent mental illness, psychosis, schizophrenia, supported employment, individual placement and support (IPS).We found that mental health disclosure involves a complex decision-making process, and yet clients of IPS supported employment are currently provided with little structured guidance on how to manage their personal information in the workplace.More extensive investigations are required of existing mental health disclosure tools before they can be developed into a standardized intervention for practitioners. However, preliminary evidence suggests that facilitating better disclosure decisions and management of personal information is a promising area of future research. This line of investigation is likely to find ways to enhance competitive employment outcomes in supported employment for people with severe and persistent mental illness

Thematic congruence and acceptability of a plan for managing personal information among people with psychiatric disabilities

The purpose of this study was to investigate (1) thematic congruence, and (2) service user acceptability of a tool for managing personal information (MPI) in the workplace. Twenty-five repeated pairs of semi-structured interviews were conducted. Participants were 18 years and older, diagnosed with a severe and persistent mental illness, and either current volunteers for supported employment assistance or reported having a vocational goal. Across the two-four week interval, the MPI was moderately congruent in terms of the themes discussed although the specific wording was not often consistent. The exceptions were discussions about work restrictions and terms to describe those restrictions, which both demonstrated lower levels of thematic congruence. In terms of service user acceptability, more than 80% of participants found the approach to be an empowering and positive experience. The MPI is a promising tool that is moderately congruent over time and is highly acceptable to service users when used as intended in vocational rehabilitation settings. However further investigation of its psychometric properties are needed, particularly its expected utility for preventing stigma and unfair discrimination in the workplace

Self-stigma and fears of employment among adults with psychiatric disabilities

Introduction: Although mental illness stigma has been extensively investigated, it is not known whether stigma experiences increase general fears of employment and impact on employment goals and on attaining employment. The aims of this study were to develop and trial brief measures of employment values and employment fears that could be used to further investigate any impacts of community stigma on personal employment goals. Method: The psychometric properties of a new Employment Fears Scale and an Employment Values Scale were examined over a 2–4-week period, following repeated administration to 25 adult community residents with severe mental illness. Concurrent validity with respect to experiences of stigma, self-stigma, and current and previous employment were also examined. Results: Employment fears and employment values can be reliably measured. Employment fears were more closely related to self-stigma than either current employment or employment over the previous year. Conclusion: The Employment Fears Scale in particular appears to be useful for investigating stigma-related barriers to employment among people with psychiatric disabilities. Occupational therapists can use these tools to explore how those fears might be reduced through tailored interventions aiming to improve an individual’s employment prospects in vocational rehabilitation