Psychiatric and neurodevelopmental diagnoses in adolescence and adulthood over-indebtedness among Finns born in 1987

Background Adolescence psychiatric and neurodevelopmental diagnoses are common but their link to adulthood over-indebtedness is unknown. This study aims to determine this relationship and explores the possible mediating role of upper secondary education completion. Methods We analyzed the 1987 Finnish Birth Cohort, which consisted of a complete census of children born in Finland in 1987 and registered in the Medical Birth Register (n = 53 743). Records of debt payment defaults, at the age of 33, were used as a measure of over-indebtedness. Adolescent psychiatric and neurodevelopmental diagnoses at ages 13-17 were derived from the national hospital discharge register. Inverse probability treatment weighting was used to investigate the role of pre-exposure variables in this relationship, and the mediating role of upper secondary education completion. Results Compared to unexposed individuals, those affected by an adolescent psychiatric or neurodevelopmental diagnosis had a 15 percentage points higher prevalence of over-indebtedness in adulthood. This association was more common for males and was additionally notably strong for suicidality and conduct and oppositional disorders. Controlling for measured potential confounding factors, the diagnoses were linked to a 11-percentage point (95% confidence interval 9-12) higher risk of over-indebtedness. Completing at least upper secondary education reduced this effect by some 39%. Conclusion People with psychiatric and neurodevelopmental disorders diagnosed in adolescence are at elevated risk of over-indebtedness in adulthood. Recognizing this high risk may help in efforts to prevent further debt problems. Better education may serve as a protective factor against over-indebtedness and perhaps similar other behavioural consequences.</p

Psychiatric and neurodevelopmental diagnoses in adolescence and adulthood over-indebtedness among Finns born in 1987

BACKGROUND: Adolescence psychiatric and neurodevelopmental diagnoses are common but their link to adulthood over-indebtedness is unknown. This study aims to determine this relationship and explores the possible mediating role of upper secondary education completion. METHODS: We analyzed the 1987 Finnish Birth Cohort, which consisted of a complete census of children born in Finland in 1987 and registered in the Medical Birth Register (n = 53 743). Records of debt payment defaults, at the age of 33, were used as a measure of over-indebtedness. Adolescent psychiatric and neurodevelopmental diagnoses at ages 13-17 were derived from the national hospital discharge register. Inverse probability treatment weighting was used to investigate the role of pre-exposure variables in this relationship, and the mediating role of upper secondary education completion. RESULTS: Compared to unexposed individuals, those affected by an adolescent psychiatric or neurodevelopmental diagnosis had a 15 percentage points higher prevalence of over-indebtedness in adulthood. This association was more common for males and was additionally notably strong for suicidality and conduct and oppositional disorders. Controlling for measured potential confounding factors, the diagnoses were linked to a 11-percentage point (95% confidence interval 9-12) higher risk of over-indebtedness. Completing at least upper secondary education reduced this effect by some 39%. CONCLUSION: People with psychiatric and neurodevelopmental disorders diagnosed in adolescence are at elevated risk of over-indebtedness in adulthood. Recognizing this high risk may help in efforts to prevent further debt problems. Better education may serve as a protective factor against over-indebtedness and perhaps similar other behavioural consequences.publishedVersionPeer reviewe

The association between treated psychiatric and neurodevelopmental disorders and out-of-home care among Finnish children born in 1997

Comprehensive overviews of the use of psychiatric services among children and adolescents placed in out-of-home care (OHC) by child welfare authorities are scarce. We examine specialized service use for psychiatric and neurodevelopmental disorders among children and adolescents in a total population involving children in OHC. We used the longitudinal administrative data of a complete Finnish birth cohort 1997 (N = 57,174). We estimated risk ratios (RRs) for a range of diagnosed psychiatric and neurodevelopmental disorders among children in OHC. We also estimated RRs for OHC among those with diagnosed disorders. We used descriptive methods to explore the timing of first entry into OHC relative to the first diagnosis. Among children in OHC, 61.9% were diagnosed with any psychiatric or neurodevelopmental disorder, compared with 18.0% among those never in OHC (RR: 3.7; 95% CI 3.6-3.8). The most common diagnosed disorders among children in OHC were depression and anxiety disorders, neurodevelopmental disorders, and oppositional defiant disorder/conduct disorder (ODD/CD). Among all children with any diagnosis, 18.1% experienced OHC, compared with 2.5% among those without a diagnosis (RR: 7.4; 95% CI 6.9-7.9). Of those diagnosed with self-harm and suicidality, ODD/CD, substance-related disorders, and psychotic and bipolar disorders, 43.5-61.2% experienced OHC. Of the children in OHC receiving psychiatric services, half were diagnosed before first placement in OHC. The majority of children with experience in OHC were diagnosed with psychiatric or neurodevelopmental disorders. They comprised a significant proportion of individuals treated for severe and complex psychiatric disorders and self-harm.Peer reviewe

Predicting the stability of early employment with its timing and childhood social and health-related predictors : a mixture Markov model approach

To extend work careers, it is important to focus on all working-aged people including young adults. The aim of this study was to identify typical patterns of work participation among young adults after their first entry into the labour market and to examine whether the timing of entry together with parental and own socio-economic position and health predict early work participation. More in-depth understanding of early careers and their early determinants is important to plan targeted interventions and to promote more stable work participation among young adults. We used the Finnish Birth Cohort 1987 including data from several registers from all 59,476 children born in 1987 as well as their parents, followed until 2015. We estimated a mixture Markov model that allowed for joint identification of latent classes of labour-market attachment, estimation of labour-market transitions within classes, and prediction of class membership using childhood social and health-related determinants. We observed that the first entry into the labour market as measured by six months in continuous employment was not a permanent entry for many, not only due to negative reasons such as unemployment and ill health but also due to more voluntary reasons such as studies. Individuals entering the labour market at a later age were more likely to be in continuous employment thereafter. More advantaged background predicted exits due to studies or - when following a late entry - stable employment, while disadvantaged background factors predicted more unstable work and long-term exits from the labour market.Peer reviewe

The association between treated psychiatric and neurodevelopmental disorders and out-of-home care among Finnish children born in 1997

Comprehensive overviews of the use of psychiatric services among children and adolescents placed in out-of-home care (OHC) by child welfare authorities are scarce. We examine specialized service use for psychiatric and neurodevelopmental disorders among children and adolescents in a total population involving children in OHC. We used the longitudinal administrative data of a complete Finnish birth cohort 1997 (N = 57,174). We estimated risk ratios (RRs) for a range of diagnosed psychiatric and neurodevelopmental disorders among children in OHC. We also estimated RRs for OHC among those with diagnosed disorders. We used descriptive methods to explore the timing of first entry into OHC relative to the first diagnosis. Among children in OHC, 61.9% were diagnosed with any psychiatric or neurodevelopmental disorder, compared with 18.0% among those never in OHC (RR: 3.7; 95% CI 3.6-3.8). The most common diagnosed disorders among children in OHC were depression and anxiety disorders, neurodevelopmental disorders, and oppositional defiant disorder/conduct disorder (ODD/CD). Among all children with any diagnosis, 18.1% experienced OHC, compared with 2.5% among those without a diagnosis (RR: 7.4; 95% CI 6.9-7.9). Of those diagnosed with self-harm and suicidality, ODD/CD, substance-related disorders, and psychotic and bipolar disorders, 43.5-61.2% experienced OHC. Of the children in OHC receiving psychiatric services, half were diagnosed before first placement in OHC. The majority of children with experience in OHC were diagnosed with psychiatric or neurodevelopmental disorders. They comprised a significant proportion of individuals treated for severe and complex psychiatric disorders and self-harm.</p

Cumulative incidences of hospital-treated psychiatric disorders are increasing in five Finnish birth cohorts

Objective The aim of this study was to explore changes in the incidences of childhood and early adulthood hospital-treated psychiatric disorders in five large Finnish birth cohorts of individuals born between 1966 and 1997. Methods The five birth cohorts were as follows: Northern Finland Birth Cohort 1966 (NFBC 1966) and 1986 (NFBC 1986), 1987 Finnish Birth Cohort (FBC 1987) and 1997 (FBC 1997), and Finnish 1981 Birth Cohort Study (FBCS 1981). Incidences of hospital-treated psychiatric disorders in each cohort were calculated separately for males (N = 71,209) and females (N = 65,190). Poisson regression was used to test difference in proportions of psychiatric disorders in wide range of diagnosis classes separately in childhood and adolescence, and early adulthood. Results The total incidences of psychiatric disorders in childhood and adolescence among males has increased in the birth cohorts over decades (Incidence Rate Ratio, IRR = 1.04 (1.04-1.05); p <0.001). Similar result was seen among females (IRR = 1.04 (1.03-1.04); p <0.001). In early adulthood, there was significant increase among females (IRR = 1.04 (1.03-1.05); p <0.001), but among males, the change was not significant (IRR = 0.99 (0.99-1.00), p = 0.051). Conclusions The main finding was that the cumulative incidence of hospital-treated psychiatric disorders increased over the decades in Finland. The increasing trend in hospital-treated psychiatric disorders in early adulthood was detected in females but not in males. In the youngest cohorts, the cumulative incidence of hospital-treated psychiatric disorders was at the same level in males and females, whereas in oldest cohort, males had higher incidence than females.Peer reviewe

Suomi seuraavan sukupolven kasvuympäristönä : Seuranta Suomessa vuonna 1997 syntyneistä lapsista, joilla on ulkomailla syntynyt vanhempi

Tässä raportissa tarkastellaan Suomessa vuonna 1997 syntynyttä ikäluokkaa ja erityisesti niitä lapsia, joiden vanhemmista toinen tai molemmat ovat syntyneet ulkomailla. Kyseessä on ensimmäinen yleiskatsaus näiden lasten kehityksestä ja kasvuympäristöistä. Tutkimuskohteina olivat lasten perhetaustat, koulutus, terveys, lastensuojelu ja rikollisuus. Lisäksi tutkittiin lasten asuinpaikkojen alueellista jakautumista ja heidän asuinalueidensa piirteitä. Tutkimustulosten mukaan suurin osa ikäluokan lapsista voi hyvin riippumatta siitä, ovatko heidän vanhempansa syntyneet Suomessa vai ulkomailla. Eroja lasten hyvinvoinnissa ja palveluiden käytössä havaittiin kuitenkin sen mukaan, onko vanhemmista toinen vai molemmat syntyneet ulkomailla, sekä sen mukaan, missä maassa vanhemmat ovat syntyneet. Eroja oli muun muassa perheiden taloudellisessa tilanteessa, lasten koulutuksessa sekä sosiaali- ja terveyspalveluiden käytössä. Raportti tuo kaivattua tietoa hyvinvointipolitiikan haasteista, ongelmista ja kehittämiskohteista. Se on suunnattu päätöksentekijöille, asiantuntijoille ja tutkijoille, jotka toimivat sosiaali-, terveys-, koulutus-, työllisyys-, alue-, asunto- ja kotoutumispolitiikan sekä -palveluiden parissa

Suomi lasten kasvuympäristönä : Kahdeksantoista vuoden seuranta vuonna 1997 syntyneistä

Suomi lasten kasvuympäristönä -raportissa kuvataan Suomessa vuonna 1997 syntyneiden lasten elämänkulkua täysi-ikäisyyteen asti. Raportissa tarkastellaan lasten hyvinvointia usealla ulottuvuudella: koulumenestys, somaattinen ja psyykkinen terveys, kuntoutus, lastensuojelu ja rikollisuus. Lasten hyvinvointia peilataan suhteessa perheen tilanteisiin, kohortin vanhempien sosioekonomisten, terveydellisten ja perhesuhdetilanteiden kautta. Lasten hyvinvoinnin ulottuvuuksia tarkastellaan myös alueellisesti, lähialueen kautta, maakuntatasolla, sekä kaupunki–maaseutu-luokitteluin. Aineistona on käytetty Terveyden ja hyvinvoinnin laitoksen Kansallinen syntymäkohortti 1997 -tutkimusaineistoa, johon on kerätty useita eri rekisteritietoja kaikista Suomessa vuonna 1997 syntyneistä henkilöistä sikiöajalta täysi-ikäisyyteen. Raportti on jatkoa vuonna 1987 Suomessa syntyneiden seurantatutkimukselle. Raportissa vertaillaankin hyvinvoinnin ulottuvuuksia näiden kahden syntymäkohortin välillä. Tulosten mukaan suurin osa ikäluokan lapsista voi hyvin ja on saanut viettää lapsuutensa ilman perheen hyvinvointia uhkaavien tekijöiden kasautumista. Osalla lapsista on kuitenkin ollut hyvinvointia haastavia tekijöitä matkalla täysi-ikäisyyteen. Tutkimuksessa havaittiin merkittäviä sukupuolieroja eroja useiden hyvinvoinnin alueiden osalta. Psykiatrisen diagnoosin on saanut ikäluokasta noin viidesosa (20,7 %). Psyykenlääkkeiden ostokertoja tarkastellessa sukupuolittainen ero on huomattava tyttöjen (12,7 %) ja poikien (9,6 %) välillä. Rangaistusmääräyksiä on määrätty seuranta-aikana lähes joka viidennelle pojalle (19,5 %). Vastaavasti 5,2 prosenttia tytöistä on saanut rangaistusmääräyksen. Kodin ulkopuolelle sijoitettuna on ollut 5,7 prosenttia koko kohortista, aikaisempaan kohorttiin verrattuna kasvu on lähes kaksinkertainen. Noin 3 prosenttia kohorttilaisista ei ole saanut paikkaa 2. asteen koulutuksessa seurannan loppuun mennessä. Ilman paikkaa jääneistä hieman yli puolet eivät olleet hakeneet paikkaa. Vanhempien matala koulutusaste ja heikko taloudellinen tilanne on selkeästi yhteydessä lasten hyvinvointiin, ja esimerkiksi koulumenestys määrittyi vahvasti vanhempien taloudellisen tilanteen mukaan. Kodin ulkopuolelle sijoitettujen lasten hyvinvointia haastavia tekijöitä oli kasautunut muuhun ikäluokkaan verrattuna merkittävästi enemmän. Alueelliset erot ovat paikoitellen voimakkaita. Raportin johtopäätöksissä tuodaan esiin lapsiperheisiin suunnattujen sosiaalisten investointien merkitys sekä muiden kasvuympäristöjen rooli varhaisen hyvinvoinnin tukemisessa

The contribution of CACNA1A, ATP1A2 and SCN1A mutations in hemiplegic migraine : A clinical and genetic study in Finnish migraine families

Objective To study the position of hemiplegic migraine in the clinical spectrum of migraine with aura and to reveal the importance of CACNA1A, ATP1A2 and SCN1A in the development of hemiplegic migraine in Finnish migraine families. Methods The International Classification of Headache Disorders 3rd edition criteria were used to determine clinical characteristics and occurrence of hemiplegic migraine, based on detailed questionnaires, in a Finnish migraine family collection consisting of 9087 subjects. Involvement of CACNA1A, ATP1A2 and SCN1A was studied using whole exome sequencing data from 293 patients with hemiplegic migraine. Results Overall, hemiplegic migraine patients reported clinically more severe headache and aura episodes than non-hemiplegic migraine with aura patients. We identified two mutations, c.1816G>A (p.Ala606Thr) and c.1148G>A (p.Arg383His), in ATP1A2 and one mutation, c.1994C>T (p.Thr665Met) in CACNA1A. Conclusions The results highlight hemiplegic migraine as a clinically and genetically heterogeneous disease. Hemiplegic migraine patients do not form a clearly separate group with distinct symptoms, but rather have an extreme phenotype in the migraine with aura continuum. We have shown that mutations in CACNA1A, ATP1A2 and SCN1A are not the major cause of the disease in Finnish hemiplegic migraine patients, suggesting that there are additional genetic factors contributing to the phenotype.Peer reviewe