Itsetunnon kehitys nuoruudesta aikuisuuteen ja siihen vaikuttavat tekijät : 26 vuoden seurantatutkimus

Self-esteem can be regarded as an essential component of mental health. Research has also shown that self-esteem is associated with happiness and life satisfaction as well as other indicators of well-being, including educational attainment for example. Research on self-esteem and its development has traditionally focused on child and adolescent samples, but during the last decade studies have begun to shed light on the life-span development of self-esteem. Finnish studies on self-esteem employing life course approach are relatively scarce, however. The present study examines the developmental trajectory of self-esteem from adolescence to mid-adulthood and its correlates. The study is part of a larger research project called Stress, development and mental health, conducted in National Institute for Health and Welfare. The original target population included all Finnish-speaking ninth-grade pupils attending secondary school in the spring of 1983 in Tampere. In 1983, 2194 pupils completed a questionnaire during school hours. Participants in the 1983 baseline study have been followed up by postal questionnaires at ages 22 (n = 1656), 32 (n = 1471) and 42 (n = 1334). The results showed that in this study cohort self-esteem developed favorably from adolescence to adulthood: the growth was linear between ages 16 and 32, but it stopped thereafter. Males had a higher self-esteem throughout the study period, while the growth rate was faster among females. Better school achievement and higher parental socioeconomic status were associated with a high self-esteem in adolescence, although the association relating to parental socioeconomic status was explained by adolescent s school achievement. Parental divorce among females and daily smoking among males were associated with poorer self-esteem in adolescence. Daily smoking in adolescence predicted also slower self-esteem growth rate among males from adolescence to adulthood. Among females higher and increasing body mass index (BMI) was associated with lower and more slowly increasing self-esteem. Among females also the negative association between self-esteem and BMI got stronger in adulthood, whereas among males the (negative) association between the two emerged only in the last measurement point at age 42. Among both females and males those who reported constantly low numbers of interpersonal conflicts throughout the study period had the most favorably developing self-esteem trajectory, whereas those with an increasing number of interpersonal conflicts had the slowest self-esteem development. As to the directionality of effects between interpersonal conflicts and self-esteem, the results indicated effects from low self-esteem to later conflicts, although they were relatively weak and observed among males only. No effects were observed in the opposite direction. Higher socioeconomic status at ages 22 and 32 was associated with higher self-esteem and among females higher socioeconomic status at age 22 predicted more favorably developing self-esteem from age 22 to 32 years. Positive change in self-esteem also buffered the negative effects of lower socioeconomic status on psychosomatic symptoms. The results of this study indicate that self-esteem develops positively from adolescence to adulthood, but this development stops somewhere between ages 30 and 40. Males was shown to have higher self-esteem than females. Daily smoking among males, more rapidly increasing BMI among females and increasing number of interpersonal conflicts among both genders, were the factors that were associated with more slowly developing self-esteem. These factors are thus possible focal points of effective interventions to promote favorable self-esteem development from adolescence to adulthood. However, also factors that are associated only with the level of self-esteem, not with its growth rate, may reflect mechanisms of persistent disparities in well-being. Regarding such factors it is important to gain knowledge on the exact mechanism that produce the disparities to begin with as well as to study means for reducing such disparities. Favorably developing self-esteem is likely to have beneficial effects on other measures of well-being, both directly but also indirectly through its buffering mechanisms, for example in the context of low socioeconomic status and poor health. However, it is important to recognize that healthy self-esteem should be cherished in its own right, as one of the key components of good mental health.Hyvä itsetunto on osa hyvää mielenterveyttä. Hyvän itsetunnon on todettu olevan yhteydessä onnellisuuteen ja elämäntyytyväisyyteen, mutta myös muihin hyvinvoinnin tekijöihin, kuten esimerkiksi parempaan koulutukseen. Itsetuntoa ja sen kehitystä on tyypillisesti tutkittu lapsuudessa ja nuoruudessa, mutta viimeisen vuosikymmenen aikana myös itsetunnon koko elämänaikaista kehitystä on alettu enenevässä määrin kartoittaa. Suomalaisia, elämänkaaritutkimuksen otetta soveltavia tutkimuksia aiheesta on kuitenkin vähän. Tämä tutkimus tarkastelee itsetunnon kehitystä nuoruudesta keski-ikään ja siihen yhteydessä olevia tekijöitä. Tutkimus on osa Terveyden ja hyvinvoinnin laitoksen (THL) Stressi, kehitys ja mielenterveys tutkimusprojektia, jossa on seurattu yhtä tamperelaisnuorten kohorttia, joka koostui keväällä 1983 Tampereella peruskoulun yhdeksättä luokkaa käyneistä, keskimäärin 16-vuotiaista nuorista. Vuoden 1983 koululaiskyselyyn osallistuneita (n = 2194) on seurattu postikyselyin 22-vuotiaina (n = 1656), 32-vuotiaina (n = 1471) sekä 42-vuotiaina (n = 1334). Tulosten mukaan itsetunto kehittyi positiivisesti nuoruudesta aikuisuuteen: kasvu oli suoraviivaista ikävuosien 16 ja 32 välillä, minkä jälkeen se pysähtyi. Miesten itsetunto oli koko tarkasteluajanjaksolla parempi kuin naisten, vaikka naisilla itsetunnon kasvuvauhti oli nopeampaa. Hyvä koulumenestys ja vanhempien korkeampi sosioekonominen asema olivat yhteydessä parempaan itsetuntoon nuoruudessa, joskin sosioekonomiset erot itsetunnossa selittyivät korkeamman sosioekonomisen aseman ja hyvän koulumenestyksen välisellä yhteydellä. Naisilla vanhempien avioero ja miehillä päivittäinen tupakointi olivat yhteydessä huonompaan itsetuntoon nuoruudessa. Miehillä tupakointi nuorena ennusti myös keskimääräistä hitaampaa itsetunnon kehitystä. Naisilla korkeampi ja nopeammin kasvava painoindeksi (BMI) oli yhteydessä matalampaan ja hitaammin kehittyvään itsetuntoon. Naisilla myös ylipainon ja heikomman itsetunnon välinen yhteys vahvistui iän myötä, miehillä vastaava yhteys ilmeni vasta 42 vuoden iässä. Yhteydet painon ja itsetunnon välillä eivät kuitenkaan olleet kovin voimakkaita. Itsetunto oli yhteydessä ihmissuhteissa ilmeneviin konflikteihin: sekä miehillä että naisilla itsetunnon kehitys oli suotuisinta ryhmässä, jossa oli keskimääräistä vähemmän ihmissuhdevaikeuksia. Hitainta itsetunnon kehitys puolestaan oli ryhmässä, jossa ihmissuhdevaikeudet lisääntyivät ajan myötä. Tuloksissa oli lisäksi viitteitä siitä, joskin vain miehillä, että huono itsetunto ennustaa myöhempiä ihmissuhdevaikeuksia. Päinvastaiseen suuntaan meneviä, so. ihmissuhdevaikeuksista myöhempään huonoon itsetuntoon johtavia vaikutuksia ei löytynyt. Tutkittavien oma korkeampi sosioekonominen asema oli yhteydessä parempaan itsetuntoon sekä 22 että 32 vuoden iässä. Naisilla korkeampi sosioekonominen asema 22 vuoden iässä myös ennusti parempaa itsetunnon kehitystä ikävuosien 22 ja 32 välillä. Tämän tutkimuksen tulosten perusteella itsetunto kehittyy positiivisesti nuoruudesta aikuisuuteen, mutta kehitys näyttää pysähtyvän jossain 30 ja 40 ikävuoden välillä. Miehillä todettiin naisia parempi itsetunto. Tekijät, jotka olivat yhteydessä itsetunnon hitaampaan kehitykseen, olivat miehillä tupakointi nuoruudessa, naisilla nopeammin kasvava painoindeksi sekä molemmilla sukupuolilla lisääntyvät ihmissuhdevaikeudet elämänkulun aikana. Nämä tekijät ovat siten asioita, jotka itsetunnon suotuisaa kehitystä turvaavissa interventioissa on syytä ottaa huomioon. Toisaalta tekijät, jotka ovat yhteydessä itsetunnon tasoon, mutta eivät sen kehityskulkuun (tässä tutkimuksessa esim. koulumenestys), voivat heijastella pysyviä eriarvoisuutta ylläpitäviä mekanismeja tällaisten tekijöiden kohdalla on syytä pohtia, miten erot itsetunnossa ovat syntyneet, mikä niitä ylläpitää, ja minkälaisin toimin eriarvoisuutta voitaisiin vähentää. Vaikka itsetunnon suotuisalla kehityksellä voi olla positiivinen vaikutus myös muun hyvinvoinnin kannalta, tulisi hyvä ja nuoruudesta aikuisuuteen suotuisasti kehittyvä itsetunto kuitenkin nähdä itsessään tärkeänä tavoitteena, osana hyvää mielenterveyttä

Psychosocial resources and depression among chronically ill young adults : Are males more vulnerable?

Only abstract. Paper copies of master’s theses are listed in the Helka database (http://www.helsinki.fi/helka). Electronic copies of master’s theses are either available as open access or only on thesis terminals in the Helsinki University Library.Vain tiivistelmä. Sidottujen gradujen saatavuuden voit tarkistaa Helka-tietokannasta (http://www.helsinki.fi/helka). Digitaaliset gradut voivat olla luettavissa avoimesti verkossa tai rajoitetusti kirjaston opinnäytekioskeilla.Endast sammandrag. Inbundna avhandlingar kan sökas i Helka-databasen (http://www.helsinki.fi/helka). Elektroniska kopior av avhandlingar finns antingen öppet på nätet eller endast tillgängliga i bibliotekets avhandlingsterminaler.This study examined whether chronic illness associates with depression and psychosocial resources, including coping styles, locus of control and social support, among young adults. Additionally, the role of psychosocial resources in the association of chronic illness and depression was explored. The cross-sectional data used in this study were drawn from the latest follow-up phase of a Finnish cohort study. At the time of this follow-up in 1999 subjects were aged 32 years. For the analyses two groups were constructed: (1) a chronic illness group (n=257) consisting of participants reporting at least one chronic somatic illness (e.g. diabetes, asthma, migraine) and (2) a healthy control group (n=664) consisting of participants without any long-term somatic illness. Depressive symptoms were measured using a Finnish modification of the short 13-item Beck Depression Inventory. The checklist of coping dispositions were factor-analysed and the four factors were interpreted as: 1) cognitive-focused coping, and 2) emotion-focused coping, 3) seeking social support, and 4) active problem-solving. Measures of social support covered social integration (married/cohabiting, the size of social networks) and perceived social support (availability of and satisfaction with support). The results showed that the chronically ill males were more depressed than healthy males. They also used more emotion-focused coping, had more external locus of control and were less often married or cohabiting than healthy males. The association between chronic illness and depression among males attenuated when the effects of emotion-focused coping disposition and locus of control were taken into account, indicating a possible mediational role of these resources. Among females no differences were found in depression or psychosocial resources between the chronically ill and healthy controls. Only a few buffering effects of psychosocial resources emerged: an active problem-solving coping disposition among the chronically ill males and perceived social support among the chronically ill females seemed to act as buffers against depression. The results indicated a significant gender disparity in the association between chronic illness and depression among young adults: males, but not females, report more symptoms of depression when affected by chronic illness. Psychosocial resources may play an important role in explaining the chronic illness - depression association, and especially in understanding any gender differentials in this relationship. With regard to prevention, chronically ill young adult males should be recognized as a risk group for depression that would probably benefit from guidance in learning more active coping skills and maintaining a sense of personal control in facing chronic physical illness.Tutkimuksen tavoitteena oli tutkia kroonisen somaattisen sairauden yhteyttä depressioon ja psykososiaalisiin resurssitekijöihin nuorten aikuisten keskuudessa. Tutkitut psykososiaaliset resurssitekijät käsittivät coping-tyylit, kontrolliodotukset (locus of control) sekä sosiaalisen tuen. Tavoitteena oli lisäksi selvittää psykososiaalisten resurssien roolia kroonisen sairauden ja depression välisessä yhteydessä. Tutkimus perustui kyselyaineistoon, joka saatiin tamperelaisnuorten keskuudessa suoritetun kohorttitutkimuksen seurantavaiheesta vuodelta 1999, jolloin vastaajat olivat 32-vuotiaita. Tutkimus oli luonteeltaan poikkileikkaustutkimus. Kroonisesti sairaiden ryhmä (n=257) muodostettiin vastaajien itsensä ilmoittamien sairauksien (mm. diabetes, astma, migreeni) perusteella. Terveiden verrokkien ryhmä (n=664) koostui vastaajista, jotka eivät ilmoittaneet yhtään kroonista somaattista sairautta. Depressiota mitattiin Beck Depression Inventoryn 13-osioisen version suomalaisella muunnoksella. Coping-taipumusten mittari käsitti faktorianalyysin perusteella seuraavat neljä komponenttia: 1) kognitiivinen, 2) emotionaalinen, 3) sosiaalisen tuen hakeminen ja 4) aktiivinen, ongelmanratkaisuun keskittyvä. Sosiaalisen tuen mittarit käsittivät sosiaalisen integraation (avio-/avoliitto ja verkoston koko) sekä koetun tuen (tuen saatavus ja tyytyväisyys tukeen). Analyysimenetelminä käytettiin Khiin neliö -testiä, yksisuuntaista varianssianalyysiä, Mann-Whitney U -testiä sekä logistista regressiota. Tulokset osoittivat, että kroonisesti sairaat miehet raportoivat enemmän depressiota kuin terveet miehet. Sairaat miehet olivat myös useammin taipuvaisia käyttämään emootioden säätelyyn keskittyviä selviytymisstrategioita, heidän kontrolliodotuksensa olivat enemmän ulkoisia ja lisäksi he olivat harvemmin avio- tai avoliitossa verrattuna terveisiin miehiin. Havaittu kroonisen sairauden ja depression välinen yhteys miehillä hävisi, kun emootioihin keskittyvän coping-taipumuksen ja kontrolliodotusten vaikutukset otettiin huomioon, mikä indikoi näiden resurssitekijöiden mahdollista välittävää roolia kroonisen sairauden ja depression välisessä yhteydessä. Naisilla krooninen sairaus ei assosioitunut depressioon tai psykososiaalisiin resursseihin. Muutamien psykososiaalisten resurssitekijöiden kohdalla havaittiin resurssitekijän depressiolta suojaavan vaikutuksen esiintyvän tai korostuvan vain sairaiden ryhmässä (buffering effect): sairailla miehillä aktiivinen, ongelmakeskeinen coping-taipumus, samoin kuin sairailla naisilla koettu sosiaalinen tuki, näyttivät toimivan depressiolta suojaavina puskureina. Tulosten perusteella nuorten aikuisten keskuudessa kroonisen sairauden ja depression välinen yhteys on sukupuolisidonnainen ilmiö: kroonisesti sairaat miehet raportoivat enemmän depressiota kuin terveet miehet, mutta naisten keskuudessa krooninen sairaus ja depressio eivät näytä olevan yhteydessä toisiinsa. Tulokset korostavat psykososiaalisten resurssitekijöiden merkitystä kroonisen sairauden ja depression välisen yhteyden tutkimuksessa yleensä sekä erityisesti havaitunkaltaisten sukupuolierojen ymmärtämisessä tässä yhteydessä. Prevention kannalta kroonisesti sairaat nuoret aikuiset miehet tulisi tunnistaa mahdollisena depression riskiryhmänä. Heille tulisi tarvittaessa tarjota neuvontaa ja tukea aktiivisten coping-strategioiden oppimisessa sekä sisäisen kontrollintunteen säilyttämisessä

Lasten ja nuorten mielenterveysoireilu ei näytä laantumisen merkkejä

Pääkirjoitu

Parenting in place : The reception centre as the spatial context for laying the foundations for asylum-seeking children's healthy development

Brain architecture is shaped by early childhood experiences, which thus affect future physical and mental health. These experiences consist primarily of parenting, intertwined with environment. The mental health of migrants has received much attention in research; however, early childhood experiences and the spatiality of parenting have largely been ignored. This study examines asylum-seeking parents' perceptions of parenting their 2-6-year old children, focusing on the spatial context of the reception centre. We conducted 26 semi-structured interviews among parents in three reception centres in Finland. The results show that parenting was challenged by all three dimensions of place: location, locale and sense of place. The findings indicate that for parents, the reception centre is an essential factor interacting with parenting, enabling or impeding caregiving. These findings are discussed from the viewpoints of transnationalism, insufficient children's spaces and activities and lost sense of place. We urge policy-makers to improve the spatial context for parenting in reception centres by ensuring adequate children's spaces and activities, including opportunities for early learning, privacy of the family, parents' social support and possibilities for establishing everyday routines. We suggest that these improvements would have far-reaching beneficial implications for the healthy development and future mental health of asylum seeking children.Peer reviewe

Parent- and teacher-reported long-term effects of parent training on child conduct problems in families with child protection and other support services : a randomized controlled trial

Background: This randomized controlled trial (RCT) evaluated the long-term effectiveness of the Incredible Years(R) (IY) Parenting Program in modifying children's externalizing problems among families in Child Protection Services (CPS) and using other special support services. We also examined whether parent-reported effects of the IY(R) generalize to the daycare/school setting as reported by teachers. Methods: Participants in the study were 3-7-year-old children with behavioural problems (N = 102 at baseline, N = 89 at one-year follow-up). Participants were randomized to intervention (N = 50) and control groups (N = 52) after the baseline assessment. The intervention group received 19-week IY(R) Parenting Program. The effectiveness of the intervention was analyzed using linear mixed model. Results: Our previously reported pre-post intervention effects on CBCL (Child Behavior Checklist) and ECBI (Eyberg Child Behavior Inventory) were not sustained to the one-year follow-up. Child conduct problems decreased from baseline to follow-up in both intervention and control groups. The positive changes were not observed at daycare/school from baseline to post-intervention or to the one-year follow-up, and there were no significant differences in changes between the groups. Conclusions: Evidence-based parenting program IY(R) seems to be an effective intervention for child conduct problems in the short term in families in the CPS context, but sustaining the positive effects and generalizing them to the daycare/school context are challenging.Peer reviewe

Pathways from problems in adolescent family relationships to midlife mental health via early adulthood disadvantages - a 26-year longitudinal study

Poor childhood family conditions have a long-term effect on adult mental health, but the mechanisms behind this association are unclear. Our aim was to study the pathways from problematic family relationships in adolescence to midlife psychological distress via disadvantages in early adulthood. Participants of a Finnish cohort study at the age of 16 years old in 1983 were followed up at ages 22, 32 and 42 years old (N = 1334). Problems in family relationships were measured with poor relationship with mother and father, lack of parental support in adolescent's individuation process and poor home atmosphere, and mental health was assessed using Kessler's Psychological Distress Scale (K10). We analyzed the indirect effects of adolescent family relations on mental health at age 42 years old via various disadvantages (somatic and psychological symptoms, relationship/marital status, low education/unemployment and heavy drinking) at ages 22 and 32 years old. Problematic adolescent family relationships were associated with midlife psychological distress in women (0.19; 95% CI 0.11, 0.26) and men (0.13; 95% CI 0.04, 0.21). However, after adjustment for adolescent psychological symptoms, the association was only significant for women (0.12; 95% CI 0.04, 0.20). Poor family relationships were associated with various disadvantages in early adulthood. The association from poor family relationships (16 years old) to psychological distress (42 years old) was in part mediated via psychological symptoms in women (0.03; 95% CI 0.01, 0.04) and men (0.02; 95% CI 0.00, 0.04) and in women also via heavy drinking in early adulthood (0.02; 95% CI 0.00, 0.03). Adolescent family relationships have a role in determining adult mental health. Targeted support addressing psychological well-being and hazardous drinking for adolescents with problematic family relationships might prevent disadvantages in early adulthood, and further prevent poor midlife mental health.Peer reviewe

Stress, development and mental health study, the follow-up study of Finnish TAM cohort from adolescence to midlife : cohort profile

Purpose This cohort profile describes the Stress, development and mental health study (TAM), which is a cohort study investigating risk and protective factors as well as longitudinal associations regarding mental health and well-being from adolescence to midlife. This interdisciplinary cohort study operates, for example, in the fields of public health, social medicine, psychiatry and the life course perspective. Participants In 1981 (n=2242, 98.0% of the target population), 1982 (n=2191, 95.6%) and 1983 (n=2194, 96.7%) during school classes, surveys were conducted to all Finnish-speaking pupils (mostly born 1967) in the Tampere region in Finland. Participants of the school study at age 16 in 1983 (n=2194) comprised the base population for the longitudinal data and were followed-up using postal questionnaires in the years 1989, 1999, 2009 and 2019 at ages 22 (n=1656, 75.5% of the age 16 participants), 32 (n=1471, 67.0%), 42 (n=1334, 60.8%) and 52 (n=1160, 52.9%). Findings to date The self-reported questionnaires include information on physical and mental health (eg, depression and mood disorders, anxiety disorders), health behaviour and substance misuse (eg, alcohol, tobacco and exercise), socioeconomic conditions, psychosocial resources (eg, self-esteem), social relationships and support, life events, etc. The numerous studies published to date have examined mental health and various factors from several perspectives such as risk and protective factors, individual developmental paths (eg, trajectories) and pathway models (mediation and moderation). Future plans Current and future research areas include, for example, longitudinal associations between mental health (eg, depressive symptoms, self-esteem) and (1) substance use (alcohol and tobacco), (2) family transitions (eg, parenthood, relationship status) and (3) retirement. Next follow-up is planned to be conducted at the latest at age 62 in 2029. Before that it is possible to link the data with cause-of-death register.Peer reviewe

Cost-Effectiveness/Utility Analysis of Two Drug Regimens in the Treatment of Depression

This paper compares the cost-effectiveness/utility of drug regimens based on fluoxetine and moclobemide in the treatment of depression in Finland. The outcome data are based on a 6 week double-blind RCT (n=209) and the cost data on a cost study linked to the RCT (n=141). Quality of life changes were measured by 15D. Five different outcome measures were used. Moclobemide showed consistently a better outcome in all outcome measures, but the differences did not generally reach the conventional limit of statistical significance (5%). The difference in the average time-weighted quality-of-life gain on a 0-1 scale was 0.02 (p=0.08). The direct costs were on average lower in the moclobemide regimen, but the difference was not significant (p=0.14), whereas the average total costs (direct and indirect) were almost the same in both regimens. These results suggest that in terms of incremental cost-effectiveness/utility the moclobemide regimen would dominate (produce a better marginal outcome at a equal or less cost), but this conclusion is surrounded by a slightly higher degree of uncertainty than what is conventionally applied. A larger study is needed to give more precision especially to the cost estimates

Socioeconomic disparities in adolescent anxiety and depression in Finland have not increased during the COVID-19 pandemic

Aims: The purpose of this research was to assess whether socioeconomic disparities in adolescent depression and anxiety in Finland increased among middle adolescents during the COVID-19 pandemic. Methods: Repeated cross-sectional surveys (the School Health Promotion Study) from spring 2019 and spring 2021 were compared. The respondents were 87,283 eighth and ninth graders (14–16-year-olds) in 2019 and 91,560 in 2021, corresponding respectively to 73% and 75% of the age groups. Depression was measured by Patient Health Questionnaire-2 (PHQ-2), and anxiety with GAD-7, and adverse socioeconomic background using low parental education, not living with both parents, and family’s poor financial situation. Associations of socioeconomic adversities with depression and generalised anxiety, and the effect of COVID-19 (2021 vs 2019), were analysed using logistic regression. Results: Depression and anxiety were more common in both sexes the more sociodemographic adversities there were in the adolescent’s background. However, increases in the prevalence of anxiety and depression from pre- to in-pandemic time did not differ with accumulating sociodemographic adversities. Conclusions: Depression and anxiety increased in prevalence among Finnish adolescents during the pandemic. Sociodemographic disparities in depression and anxiety show no increase. Emotional symptoms are nevertheless more common in adolescents from lower socioeconomic status families.publishedVersionPeer reviewe