Migrant stay-at-home mothers learning to eat and live the Finnish way

Peer reviewe

Psykodynaamisen fysioterapiakokonaisuuden kehittäminen unihäiriöisille nuorille : syklinen työskentelytapa

Opinnäytetyö on kehittämistyö, jonka tarkoituksena oli kehittää nuorten psykiatrian poliklinikalle ryhmämuotoinen fysioterapiakokonaisuus unihäiriöisille nuorille. Viidestä kerrasta koostuva ryhmämuotoinen fysioterapia sisälsi psykodynaamisen fysioterapian harjoitteita, kuten hengitys-kehotietoisuus- ja rentoutumisharjoitteita. Tavoitteena oli tarkastella ryhmän myötä saavutettuja nuorten kokemia vaikutuksia muun muassa kehotietoisuudessa, rentoutumiskyvyssä ja hengityksessä. Kehittämistyössä on käytetty Kurt Lewinin kehittelemää spiraalimallia, joka vei interventioprosessia eteenpäin. Tarkoituksena on, että aloitettua työtä voisi edelleen kehittää samaa syklistä työskentelytapaa käyttäen. Työn aineisto koostui kehittäjien laatimista haastattelu- ja kyselylomakkeista ja niihin interventioon osallistuneen nuoren intervention alussa ja lopussa antamista vastauksista. Lisäksi aineistoon kuului interventioryhmää ohjanneen fysioterapeutin sähköpostiviestit, joissa hän arvioi esimerkiksi kehittäjien laatimia lomakkeita ja tuntisuunnitelmia sekä toteutuneiden interventiokertojen tunnelmaa, nuorten motivaatiota ja käyttäytymistä sekä yleistä ilmapiiriä. Saatuja palautteita ja arviointeja lähdettiin purkamaan kirjoittamalla jokaisesta interventiokerrasta oma syklinsä, joka koostui suunnittelusta, toteutuksesta, havainnoinnista ja reflektoinnista. Jokaista interventiokertaa erikseen ja interventiota kokonaisuudessaan arvioitiin ja kehitettiin toimivammaksi. Myös ryhmään osallistuneen nuoren kokemukset ja antama palaute ohjasi lopullisen tuotoksen muovautumista. Lopullinen paranneltu kokonaisuus jää nuorten psykiatrian yksikköön käyttöön edelleen kehitettäväksi.The objective of this thesis was to create a physiotherapy method for young people suffering from sleeping disorders. The work was commissioned by psychiatric unit for young people. The therapy executed in the intervention was led by a physiotherapist, and it contained exercises of psychodynamic physiotherapy, for example breathing-, body awareness- and relaxation exercises. The target was to examine one young person’s experienced effects of the intervention. A spiral model and a cyclic approach to a developmental study created by Kurt Lewin, were used to guide this work. The purpose of this thesis was not to study exact phenomenon but to create a therapy method which could be further developed using the same spiral model. A portfolio of this created method was collected together and was given to the psychiatric unit. The material for this thesis consisted of the interviews and questionnaires created by the developers and of the answers given by the young person attending the intervention. Also as a study material were the e-mails sent by the physiotherapist leading the intervention group. In the e-mails the physiotherapist assessed for example the questionnaires and therapy plans, the atmosphere of the group and the motivation of the young people attending the group. The received feedbacks and assessments were dismantled into their own cycles that contained the planning, the execution, the observation and the reflectation. Every intervention class separately, and the whole intervention process were evaluated and developed forward according to the feedback and assessment. The feedback and evaluation given by the young person participating the intervention was also influencing in the final version of the method. The final version of the method stays within the psychiatric unit to be further developed

Changes in the social networks of three women with an intellectual disability : A qualitative follow-up study

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Lifetime psychiatric diagnoses among adolescents with severe conduct problems-A register-based follow-up study

Background: Both delinquency and out-of-home care (OOHC) are associated with a wide spectrum of psychiatric disorders. Reform schools (RS) are Finnish OOHC institutions for adolescents with severe conduct problems. Objective: We investigated the prevalence of psychiatric diagnoses among individuals with a history of RS placement. Participants and setting: The data consisted of individuals placed in a RS on the last day of the years 1991, 1996, 2001, 2006 or 2011 (N = 1074) and a matched comparison group (N = 5313). Methods: Information on lifetime psychiatric diagnoses, grouped into eight categories, was collected from the nationwide health care registry. The follow-up time ranged from 17 to 44 years. Results: Among RS population, 59.5 % had some psychiatric diagnosis, which was 12-fold compared to general population peers (hazard ratio HR = 12.4). The most prevalent categories were Conduct disorders and/or ADHD (30.7 %, HR = 41.5), Substance use disorders (29.3 %, HR = 16.8,), Other childhood disorders (8.6 %, HR = 11.9) and Personality disorders (10.9 %, HR = 11.6) followed by Mental retardation (6.4 %, HR = 8.4), Schizophrenia spectrum disorders (9.7 %, HR = 7.9), Affective disorders (17.9 %, HR = 7.3), and Disorders of psychological development (6.1 %, HR = 4.4). All differences were statistically significant (p < .001). Conclusions: RS background associates with an excess of psychiatric disorders, which adds to the burden of other known risk factors for adult age well-being. Effective screening and intervention for psychiatric problems should be available both during the RS placement and after-care.Peer reviewe

Psychotic-like experiences of young adults in the general population predict mental disorders

Psychotic-like experiences (PLEs) have been identified as risk markers for psychotic disorders and may indicate an individual's susceptibility to mental disorders in general. We examined whether 23 PLEs (assessed with MCIDI questionnaire) reported in young adulthood (n = 1313) predict subsequent psychotic or any mental disorders in the general population. We also investigated whether these possible associations are explained by general psychological distress assessed with the General Health Questionnaire-12 (GHQ-12). The register follow-up period spanned 10-12 years. In Cox regression models, PLEs predicted subsequent psychotic disorders (n = 12) when the effects of age, sex, education, and marital status were adjusted for, but not when general psychological distress was added to the model. Having any mental disorders during follow-up (n = 91) was predicted by PLEs reported at a younger age, when controlling for age, sex, education, marital status, and general psychological distress. In line with earlier results in other age groups, PLEs can be seen as a sign of vulnerability to not just psychotic but all mental disorders during the following years also among young adults in the general population. PLEs were a predictive marker of general psychopathology independently from general psychological distress.Peer reviewe

Depression and anxiety disorders among immigrants living in Finland: Comorbidity and mental health service use

Background: The aims of this study were to (1) compare differences in psychiatric comorbidity of depression and anxiety disorders between immigrants and native Finns and to (2) compare differences in the intensity of psychiatric care received by different immigrant groups and Finnish-born controls with depression and/or anxiety disorders. Methods: The study uses registered-based data, which includes all immigrants living in Finland at the end of 2010 and matched Finnish-born controls. For this study, we selected individuals who had received a diagnosis of depression and/or an anxiety disorder during the follow-up (2011?2015) (immigrants n = 6542, Finnish-born controls n = 9281). We compared differences in comorbidity between the immigrants and the Finnish-born controls using chi-squared tests. Multinomial logistic regression was used to predict psychiatric treatment intensity by immigrant status, region of origin, and other background factors. Results: In both diagnosis groups, Finnish-born participants exhibited greater comorbidity of other psychiatric disorders. Immigrants more often received lower intensity treatment and less often higher intensity treatment. These differences were most striking among those from Eastern Europe, the Middle East, and Africa. Limitations: We did not have the information on the perceived need for the services, which limits us from drawing further conclusions about the mechanisms behind the observed patterns. Conclusions: Immigrants in Finland receive less intensive treatment for depression and anxiety disorders compared to the Finnish-born population. Since lower symptom levels can unlikely alone explain these differences, they could reflect a need for improvement in the psychiatric services for immigrants.Peer reviewe

Toxoplasma gondii infection and common mental disorders in the Finnish general population

Objective: We investigated whether T. gondii seropositivity is associated with 12-month depressive, anxiety and alcohol use disorders and current depressive symptoms and whether inflammation, measured by C-reactive protein (CRP) level, explains these associations. Method: Health 2000 study (BRIF8901), conducted in years 2000-2001, is based on a nationally representative sample of Finns aged 30 and above, with 7112 participants and 88.6% response rate. DSM-IV depressive, anxiety and alcohol use disorders were assessed with the Composite International Diagnostic Interview and depressive symptoms with the Beck Depressive Inventory (BDI-21). We used logistic regression to investigate the association of T. gondii seropositivity with mental disorders and linear regression with BDI-21 scores. Results: T. gondii seroprevalence was significantly associated with 12-month generalized anxiety disorder but not with other anxiety, depressive or alcohol use disorders. T. gondii seropositivity was associated with higher BDI-21 scores (beta 0.56, 95% CI 0.12-1.00, P = 0.013) and with having a comorbid depressive and anxiety disorder (OR 1.86, 95% CI 1.16-2.97, P = 0.010). Higher CRP levels were associated with these outcomes and with T. gondii seropositivity, but adjusting for CRP did not change the effect of T. gondii seropositivity. Limitations: Cross-sectional study design with no information on the timing of T. gondii infection. Conclusion: T. gondii seropositivity is associated with generalized anxiety disorder, depressive symptoms and comorbid depressive and anxiety disorders, which is not mediated by inflammation.Peer reviewe

The association between toxoplasma and the psychosis continuum in a general population setting

Toxoplasma gondii infection is associated with increased risk for psychosis. However, the possible association between T. gondii and psychotic-like symptoms in the general adult population is unknown. We investigated whether T. gondii is associated with psychotic-like symptoms and psychosis diagnoses using data from Health 2000, a large cross-sectional health survey of the Finnish general population aged 30 and above. Seropositivity to toxoplasma was defined as a cutoff of 50 IU/ml of IgG antibodies. Lifetime psychotic-like symptoms were identified with section G of the Composite International Diagnostic Interview, Munich version (M-CIDI). Symptoms were considered clinically relevant if they caused distress or help-seeking or there were at least three of them. Lifetime psychotic disorders were screened from the sample and were diagnosed with DSM-IV using SCID-I interview and information from medical records. All data were available for 5906 participants. We adjusted for variables related to T. gondii seropositivity (age, gender, education, region of residence, cat ownership, and C-reactive protein measuring inflammation) in regression models. We found that T. gondii seropositivity was significantly associated with clinically relevant psychotic-like symptoms (OR 1.77, p = 0.001) and with the number of psychotic-like symptoms (IRR = 1.55, p = 0.001). The association between toxoplasma and diagnosed psychotic disorders did not reach statistical significance (OR 1.45 for schizophrenia). In a large sample representing the whole Finnish adult population, we found that serological evidence of toxoplasma infection predicted psychotic-like symptoms, independent of demographic factors and levels of C-reactive protein. Toxoplasma infection may be a risk factor for manifestation of psychotic-like symptoms. (c) 2017 Elsevier B.V. All rights reserved.Peer reviewe

Association of cytomegalovirus and Epstein-Barr virus with cognitive functioning and risk of dementia in the general population : 11-year follow-up study

Background: Earlier studies have documented an association between cytomegalovirus and cognitive impairment, but results have been inconsistent. Few studies have investigated the association of cytomegalovirus and Epstein-Barr virus with cognitive decline longitudinally. Our aim was to examine whether cytomegalovirus and Epstein-Barr virus are associated with cognitive decline, in adults. Method: The study sample is from the Finnish Health 2000 Survey (BRIF8901, n = 7112), which is representative of the Finnish adult population. The sample was followed up after 11 years in the Health 2011 Survey. In addition, persons with dementia were identified from healthcare registers. Results: In the Finnish population aged 30 and over, the seroprevalence of cytomegalovirus was estimated to be 84% and the seroprevalence of Epstein-Barr virus 98%. Seropositivity of the viruses and antibody levels were mostly not associated with cognitive performance. In the middle-aged adult group, cytomegalovirus serointensity was associated with impaired performance in verbal learning. However, the association disappeared when corrected for multiple testing. No interactions between infection and time or between the two infections were significant when corrected for multiple testing. Seropositivity did not predict dementia diagnosis. Conclusions: The results suggest that adult levels of antibodies to cytomegalovirus and Epstein-Barr virus may not be associated with a significant decline in cognitive function or with dementia at population level. (C) 2018 Published by Elsevier Inc.Peer reviewe

Immigrants’ mental health service use compared to that of native Finns: a register study

Purpose Many aspects related to migration might predispose immigrants to mental health problems. Yet immigrants have been shown to underuse mental health services. The aim of this study was to compare the intensity of psychiatric care, as an indicator of treatment adequacy, between natives and immigrants living in Finland. Methods We used nationwide register data that included all the immigrants living in Finland at the end of 2010 (n = 185,605) and their matched controls. Only those who had used mental health services were included in the analyses (n = 14,285). We used multinomial logistic regression to predict the categorized treatment intensity by immigrant status, region and country of origin, length of residence, and other background variables. Results Immigrants used mental health services less than Finnish controls and with lower intensity. The length of residence in Finland increased the probability of higher treatment intensity. Immigrants from Eastern Europe, sub-Saharan Africa, the Middle East, and Northern Africa were at the highest risk of receiving low-intensity treatment. Conclusions Some immigrant groups seem to persistently receive less psychiatric treatment than Finnish-born controls. Identification of these groups is important and future research is needed to determine the mechanisms behind these patterns.Peer reviewe