Personality and Depression

The aim of this study was to illustrate the associations of personality variables and depression. The first study population consisted of 50 patients with DSM-IV defined major depressive disorder. Subjects were randomized to receive either fluoxetine medication or short-term psychodynamic psychotherapy. The Hamilton Depression Rating Scale was completed at the baseline and in the follow-up at four months. Baseline mature defense style measured with the Defense Style Questionnaire predicted favourable outcome in the fluoxetine treatment group, whereas no associations were found in psychotherapy group. The Psychological Mindedness Scale scores were not predictive for recovery in patients receiving psychotherapy or medication. The Psychological Mindedness Scale seems not to be useful in selecting optimal treatment in major depressive disorder. Harm Avoidance measured with the Temperament and Character Inventory associated with the baseline severity of the depressive state. In the fluoxetine treatment group high Reward Dependence, high Self-Directedness and high Cooperativeness were predictive for more severe depression in the four months follow-up, whereas no associations were found in the psychotherapy treatment group. It is possible that the result reflects the differences in the placebo response. The second data were derived from the Finnish Public Sector Study. These prospective studies with four years follow-up focused on the predictive value of optimism and pessimism, first, to work disability with a diagnosis of depression lasting at least 90 days and returning to work (N= 38214) , and second, to the likelihood of initiating antidepressant medication treatment lasting at least 100 days and ending the treatment (N= 29930). Results show that low optimism associates with the elevated risk of work disability and higher likelihood of antidepressant use. High pessimism associated with higher likelihood starting at least 100 days antidepressant medication and not stopping medication during the follow up. High pessimism did not seem to predict the entering to depression related work disability, but in the case of disability period it associated with the lower likelihood of returning to work. The thesis shows that personality features play a role as a vulnerability factor, and influence the onset and course of depression. Taking these factors into account more than is currently done may increase the possibilities to enhance the treatment results in depression.Persoonallisuus ja masennus Tämän väitöskirjatyön tavoitteena oli selvittää persoonallisuuspiirteiden yhteyksiä masennuksen syntyyn, sekä masennuksesta toipumiseen. Ensimmäinen väitöskirjassa käytetty aineisto koostui 50 masennusta sairastavasta potilaasta. Potilaat satunnaistettiin kahteen hoitoryhmään, jossa toisessa hoitona oli masennuslääke fluoksetiini ja toisessa psykodynaaminen lyhytpsykoterapia. Masennusoireiden voimakkuutta arvioitiin Hamiltonin depressioasteikolla tutkimuksen alussa, sekä neljän kuukauden hoidon jälkeen. Puolustusmekanismeja arvioitiin Defense Style Questionnary-kyselylomakkeella. Kypsät puolustusmekanismit ennustivat hyvää toipumista lääkehoitoryhmässä, kun taas psykoterapiaryhmässä puolustusmekanismien ja toipumisen välillä ei havaittu yhteyttä. Psykologista orientaatiota kartoitettiin Psychological Mindedness Scale-kyselyllä. Psykologisen orientaation ja toipumisen välillä ei ollut yhteyttä kummassakaan hoitoryhmässä. Tulos viittaa siihen että käytetty kysely ei ole käyttökelpoinen masennuksen ennusteen arvioinnissa tai hoitomuodon valinnassa. Persoonallisuuspiirteitä kartoitettiin Temperament and Character Inventory- kyselyllä. Lähtötilanteessa havaittiin yhteys korkeiden Harm Avoidance -pisteiden (”turvallisuushakuisuus”) sekä masennuksen voimakkuuden välillä. Korkeat pistemäärät persoonallisuuspiirteissä Reward Dependence (”hyväksynnän hakeminen”), Self-Directedness (”Itseohjautuvuus”) ja Cooperativeness (”yhteistoiminnallisuus”) olivat yhteydessä vakavampaan masentuneisuuteen neljän kuukauden seurannassa potilailla, jotka olivat saaneet masennuslääkehoitoa. Psykoterapiaryhmässä persoonallisuuspiirteet eivät olleet yhteydessä masennusoireiden voimakkuuteen seurannannassa. Erot lääkityksen lumevasteessa saattavat osaltaan selittää tulosta. Toinen väitöskirjatyössä käytetty aineisto perustui Kunta-10 tutkimukseen. Tutkimuksissa tarkasteltiin optimismin ja pessimismin yhteyksiä neljän vuoden seurannan aikana 1. masennukseen liittyvään vähintään 90 päivää kestävään työkyvyttömyyteen ja myöhempään paluuseen työelämään (N= 38214) ja 2. vähintään 100 päivää kestävään masennuslääkkeen käyttöön ja käytön lopetukseen (N= 29930). Tutkimuksissa matala optimismi ennusti masennuksesta aiheutuvaa työkyvyttömyyttä sekä masennuslääkkeiden käyttöä. Korkea pessimismi oli yhteydessä masennuslääkkeiden käytön todennäköisyyteen sekä masennukseen liittyvän työkyvyttömyyden pitkittymiseen. Tämän väitöskirjatyön tulokset viittaavat siihen, että persoonallisuuspiirteillä on vaikutusta sekä masennusalttiuteen että masennuksen kulkuun. Persoonallisuuspiirteiden arviointi ja huomioon ottaminen saattavat auttaa parantamaan masennuksen hoitotuloksia.Siirretty Doriast

Identiteetin muodostuminen ja sen eri osa-alueet nuoruusiässä

• Nuoruusikä on identiteettikehityksen aktiivista aikaa; tärkeitä identiteetin osa-alueita ovat koulutus, ihmissuhteet, seksuaalisuus ja sukupuolisuus. • Läheinen suhde vanhempiin tukee nuoren identiteettikehitystä ja auttaa luomaan vastavuoroisesti palkitsevia, kehitystä tukevia ystävyyssuhteita. • Epävarma identiteetti altistaa psykososiaalisille ongelmille, kuten masennusoireille ja antisosiaaliselle käyttäytymiselle. • Identiteettikehitystä voi tukea keskustelemalla nuoren kanssa tärkeisiin elämänalueisiin liittyvistä arvoista, päämääristä, valinnoista ja toiminnasta.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

Nuorten varhaisia psykososiaalisia hoitoja tulee ottaa laajemmin käyttöön

Teema : psykoterapia lääketieteessä

Suicidality among child and adolescent psychiatric inpatients: time trend study comparing 2000 and 2011

Child and adolescent inpatient treatment has faced major changes since the year 2000, including shorter inpatient stays and a greater use of psychotropic drugs. This study explored changes and correlates of suicidal threats and suicide acts among inpatients, by comparing Finnish cross-sectional surveys from 2000 to 2011. A questionnaire that explored the background, diagnosis and treatment characteristics of inpatients was sent to all child and psychiatric wards in Finland. The data collection was carried out on specified days in 2000 and 2011. We received comprehensive data on 504 patients from 64/69 (93%) wards in 2000 and on 412 patients from 75/79 (95%) wards in 2011. The Spectrum of Suicidal Behaviour Scale was used to explore suicidality. The prevalence of suicidality did not change in this nationwide study: suicidal threat rates were 38% in 2000 and 37% in 2011, and suicide attempts in both years were 11%. The prevalence of suicidal acts was higher among girls and teenagers, while low general functioning, defined as Children’s Global Assessment Scale scores of under 30, was associated with both suicidal threats and acts. Violent acts were associated with both suicidal threats and acts in 2000, but not in 2011. Despite changes in treatment practices and shorter inpatient stays, the prevalence of suicidality in child and adolescent inpatient treatment remained unchanged in Finland in 2000 and 2011.</p

Ten-year changes in the psychosocial well-being, psychopathology, substance use, suicidality, bullying, and sense of coherence of 18-year-old males: a Finnish population-based time-trend study

We studied Finnish 18-year-old males attending obligatory military call-up assessments in 1999 (n = 2340) and 2009 (n = 4309) on time-trend changes in psychosocial well-being, psychopathology, substance use, suicidality, bullying, and sense of coherence. Subjects filled in questionnaires, including the Young Adult Self-Report (YASR) for psychopathology and the Orientation to Life Questionnaire (SOC-13) for sense of coherence. The prevalence of minor mental health problems in the last 6 months decreased from 22.3% in 1999 to 18.6% in 2009 (OR 0.8, 95% CI 0.7-0.9), whereas severe mental health problems remained stable. Suicidal thoughts decreased from 5.7 to 3.7% (OR 0.6, 95% CI 0.5-0.8). The use of illicit drugs decreased from 6.0 to 4.7% (OR 0.8, 95% CI 0.6-0.95), but being drunk at least once a week increased from 10.3 to 13.4% (OR 1.3, 95% CI 1.0-1.5). Attention problems increased in YASR syndrome domains (mean score 2.9 vs 3.2, p < 0.001) and so did somatic complains (mean score 1.7 vs 1.9, p = 0.005). The SOC-13 scores remained stable. The percentage of males who had studied during the past 6 months increased from 91.4 to 93.4% (OR 1.3, 95% CI 1.1-1.6), while being employed decreased from 64.9 to 49.4% (OR 0.5, 95% CI 0.5-0.6). The positive findings included reductions in the prevalence of suicidal thoughts and the use of illicit drugs, but being drunk at least once a week increased. Self-reported somatic problems and attention problems increased. Despite changes in society and family structures, there were only minor overall changes in psychopathology

Multi-center nationwide study on pediatric psychiatric inpatients 2000-2018: length of stay, recurrent hospitalization, functioning level, suicidality, violence and diagnostic profiles

Inpatient treatment is an important part of child and adolescent psychiatric (CAP) care. This nationwide study explores the changes in length of stay, recurrent hospitalization, functioning level, suicidality, violence and diagnoses of CAP inpatients in Finland in 2000, 2011 and 2018. We obtained comprehensive questionnaire data on each study year from 93 to 95% of all CAP wards in Finland. We split the 1276 inpatients into two age groups in each study year: under 13 and 13-18. The median length of stay in inpatient treatment decreased from 82.0 days in 2000 to 20.5 days in 2018 (p </p

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

BackgroundThere 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.MethodsThis 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).ResultsComparing 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%).ConclusionAnxiety 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.</div

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. </p