Associations between alexithymia and mental well-being in adolescents

Nuorten tunneilmaisun yhteys psyykkiseen oireiluun Aleksitymialla tarkoitetaan persoonallisuuden piirteistöä, jolle on tyypillistä heikko kyky tunnistaa ja ilmaista tunteita sekä vähäinen mielikuvitus ja konkreettinen, ulkokohtainen ajattelutapa. Tämän tutkimuksen tarkoituksena on tarkastella aleksitymian yhteyttä psyykkiseen oireiluun nuorilla sekä tutkia aleksitymian kehittymiselle altistavia yksilöllisiä lapsuudenaikaisia tekijöitä. Tutkimusaineisto koostui aiempaan nuorten syömishäiriöoireilua tarkastelevaan tutkimukseen osallistuneista nuorista (n = 320) ja heille satunnaisotannalla poimituista verrokeista (n = 640). Seurantakyselyssä käytettiin vastaajan itsensä täytettäviä mittareita ja aineisto kerättiin postikyselynä. Yhteensä 729 henkilöä (78 %) palautti lomakkeen täytettynä, muodostaen näin lopullisen tutkimusaineiston. Tyttöjä vastanneista oli 74 % ja poikia 26 %. Aineiston keski-ikä oli 19 vuotta tämän tutkimuksen aikaan. Aineistosta oli käytettävissä neuvolatiedot syntymästä lähtien. Tutkimusaineistossa todettiin aleksitymian yleisyydeksi tytöillä 8,2 % ja pojilla 8,5 %. Sukupuolten välillä ei todettu eroa 20-osioisella Toronto Alexithymia Scale-kyselyllä (TAS-20) pistemäärissä (tytöillä 44.7 ja pojilla 46.0). Syömishäiriöoireiden todettiin olevan yleisempiä aleksityymisillä nuorilla verrattuna ei-aleksityymisiin. Syömishäiriöoireita mitattiin SCOFF-mittarilla (“Sick”, “Control”, “One”, “Fat”, “Food”). Aleksityymisten nuorten keskimääräinen SCOFF-pistemäärä oli merkitsevästi korkeampi kuin ei-aleksityymisten ja SCOFF-positiivisten (pistemäärä vähintään 2) osuus oli aleksityymisten ryhmässä kolminkertainen ei-aleksityymisten ryhmään verrattuna. Myös ahdistuneisuuden todettiin olevan yhteydessä aleksitymiaan nuorilla. Ahdistuneisuutta mitattiin State-Trait Anxiety Inventory-mittarilla (STAI) ja lisäksi mitattiin masennusoireita ja alkoholinkäyttöä. Aleksityymisten nuorten STAI-pisteet olivat merkitsevästi korkeammat kuin eialeksityymisten. Ahdistuneet aleksityymiset nuoret olivat myös yleisemmin masentuneita ja käyttivät runsaammin alkoholia kuin yhtä ahdistuneet ei-aleksityymiset nuoret. Tutkimuksessa selvitettiin aleksitymian yhteyttä sosiaaliseen tukeen sekä koettuun vanhempien hoivaan ja ylisuojelevaisuuteen. Käytetyt mittarit olivat Multidimensional Scale of Perceived Social Support ja Parental Bonding Instrument. Aleksitymia oli merkitsevästi yhteydessä sekä heikompaan koettuun sosiaaliseen tukeen – erityisesti ystäviltä saatavaan − että korkeampaan vanhempien ylisuojelevaisuuteen. Tutkimuksessa käytettiin 5-vuotisneuvolatarkastuksen tietoja sen arviointiin, mitkä kehitykselliset tekijät saattavat olla yhteydessä aleksitymian ilmenemiseen. Puheenkehityksen ongelmien todettiin olevan miehillä selvästi yhteydessä aleksitymiaan. Tutkimuksen perusteella aleksityymisillä nuorilla esiintyy ei-aleksityymisiin ikätovereihin verrattuna selvästi yleisemmin psyykkisiä oireita. Koska aleksitymia heikentää hoitovastetta todennäköisesti myös nuorilla, tulisi aleksitymian mahdollisuus selvittää tehokkaasti psyykkisesti oireilevilla nuorilla. Lisääntyvä tutkimustieto aleksitymian kehittymisestä mahdollistaa riskitapausten varhaisemman tunnistamisen ja tilanteeseen puuttumisen.Alexithymia signifies a personality construct that represents reduced ability to identify and describe feelings, a limited imagination, and externally oriented thinking. The objective of this study was to assess the associations between alexithymia and psychiatric symptoms, as well as to evaluate the significance of childhood developmental factors for alexithymia. The study population was recruited from a sample of adolescents, who had participated in previous studies investigating eating disorder symptoms (n=320), and a group of matched controls (n=640). Altogether 729 individuals (78%) participated in the study by answering the questionnaire. Of the sample, 74% were female and 26% male, and the mean age was 19 years at the time of the data were collected. The material also included child welfare centre check-up records since birth for all subjects. The prevalence of alexithymia was 8.2% for females and 8.5% for males. No significant gender difference was observed in the mean 20-item Toronto Alexithymia Scale (TAS-20) total scores (44.7 for females and 46.0 for males). Alexithymia was found to be associated with eating disorder symptoms in adolescents. Eating disorder symptoms were measured using the SCOFF (“Sick”, “Control”, “One”, “Fat”, “Food”) questionnaire. The mean SCOFF scores and the proportion of the SCOFF positive individuals (scoring 2 or more) were significantly higher among the alexithymic subjects. The association between alexithymia and anxiety symptoms was also assessed. Anxiety was measured using the State-Trait Anxiety Inventory (STAI), and in order to assess the association reliably, depression and alcohol consumption were included as covariates. The alexithymic subjects had significantly higher mean STAI scores than the non-alexithymic subjects. Highly anxious alexithymic subjects also presented a significantly higher level of depressive symptoms and they used more alcohol, as compared with their equally anxious non-alexithymic peers. The associations of alexithymia with perceived social support and parental attitude were explored using the Multidimensional Scale of Perceived Social Support and Parental Bonding Instrument scales. Alexithymia was significantly associated with a lower degree of experienced social support – particularly from friends − and higher parental overprotection both in females and males. The significance of childhood developmental factors for alexithymia in late adolescence was assessed using data from the child welfare centre check-ups at the age of five years, thus avoiding recall bias. The results suggested speech development to be a significant factor in the developmental process of alexithymia, at least in males. According to this study, alexithymic late adolescents have significantly more mental disorder symptoms compared with their peers. Since alexithymia is also in adolescents likely to predict poorer outcome in several different mental disorders, the possibility of alexithymia should be explored efficiently. Moreover, the increasing amount of evidence on the aetiology of alexithymia may enable earlier identification and intervention in individuals at a high risk to develop a mental disorder.Siirretty Doriast

Association of a Two-month Summer School with a Residency in Psychiatry – Results from a Four-year Follow-up Study

In 2013, a two-month summer school programme combining clinical work, tutoring and multifaceted teaching was developed. The present study aimed at evaluating the long-term impact of the programme in terms of the participants’ subsequent specialization and work experience in psychiatry. The association of psychiatric knowledge development during the programme with these aspects was also assessed. Of the original 86 participants, 51 (66.2%) individuals who had completed the programme in the years 2013−2016 participated in the 4-year follow-up assessments in 2017−2020. A residency in psychiatry served as the main response variable in the online questionnaire study. The residents also evaluated the impact of the programme on their career choice. Information regarding possible work experience in psychiatry after the programme was collected as well. The association of the participants’ psychiatric knowledge development during the programme was analysed in relation to the response variables. At follow-up, 25.5% (n=13) of the respondents had a residency in psychiatry and 54.9% (n=28) had worked in psychiatry after the programme. Of the residents, 69.2% (n=9) reported that the programme had significantly impacted on their career choice. Additionally, 60.5% (n=23) of the non-residents reported they seriously considered psychiatry as a career choice. The development of the participants’ psychiatric knowledge during the programme was not associated with residency or later work experience in psychiatry. In addition to providing short-term alleviation to the shortage of psychiatrists, the programme’s long-term results are encouraging both in terms of specialization and work experience in psychiatry after the programme

The Growing Trend of Prescribing Antipsychotics for Young People in Finland, 2000 to 2010

According to previous reports from many countries (e.g., the United States, Germany, the United Kingdom), the use of antipsychotic drugs has increased among young people. Antipsychotics have also increasingly been prescribed for non-psychotic disorders.The purpose of this study was to estimate the rate at which antipsychotics were prescribed for young people in the age groups of 10 to 14 years, 15 to 19 years, and 20 to 24 years in Finland in the years 2000, 2005, and 2010.This was a nationwide register study using data from the databases of Statistics Finland and the Finnish National Prescription Register. Statistics Finland's databases provided background information, including the total number of young people and the Finnish National Prescription Register keeps record of all drug orders reimbursed by the Social Insurance Institution of Finland.The prescription of antipsychotics grew 6.8-, 4.6-, and 2.6-fold over the study period for these three age groups, respectively. For the youngest age group, use was more common among males than females in all three periods studied. During the course of the study period, the use of antipsychotics became more common among females: in 2010, antipsychotics were more commonly used among females than males in both the 15- to 19-year-old age group and the 20- to 24-year-old age group. The younger the patient, the higher the probability that the indication for medication was a non-psychotic disorder.In Finland, the trends involved in the prescription of antipsychotic medications resemble those seen in many Western countries. Therefore, it is important that the safety and effectiveness of these pharmaceuticals be investigated among young people as well

Early maladaptive schemas and psychiatric symptoms in adolescence

Early maladaptive schemas (EMS) represent harmful schemas that are rooted in childhood experiences. Schema therapy is an integrative psychotherapeutic approach and its main aim is to find feasible ways of meeting individual core emotional needs. Core reasons for the emergence of EMSs was their association with difficult and long-term mental disorders. Since then, EMS have been linked to a wide variety of mental and somatic illnesses. Although adolescence is clearly of importance in the developmental process of EMS, studies exploring EMS in adolescents are still limited. However, evidence on interesting associations, including findings typical to this developmental phase, has recently increased. In this review, we describe the current status regarding the concept of EMS and review the present literature on the associations of EMS with psychiatric symptoms in adolescents.</p

Clinical importance of personality difficulties : diagnostically sub-threshold personality disorders

Background: Current categorical classification of personality disorders has been criticized for overlooking the dimensional nature of personality and that it may miss some sub-threshold personality disturbances of clinical significance. We aimed to evaluate the clinical importance of these conditions. For this, we used a simple four-level dimensional categorization based on the severity of personality disturbance. Methods: The sample consisted of 352 patients admitted to mental health services. All underwent diagnostic assessments (SCID-I and SCID-II) and filled in questionnaires concerning their social situation and childhood adversities, and other validated tools, including the Beck Depression Inventory (BDI), Alcohol Use Disorders Identification Test (AUDIT), health-related quality of life (15D), and the five-item Mental Health Index (MHI-5). The patients were categorized into four groups according to the level of personality disturbance: 0 = No personality disturbance, 1 = Personality difficulty (one criterion less than threshold for one or more personality disorders), 2 = Simple personality disorder (one personality disorder), and 3 = Complex/Severe personality disorder (two or more personality disorders or any borderline and antisocial personality disorder). Results: The proportions of the groups were as follows: no personality disturbance 38.4% (n = 135), personality difficulty 14.5% (n = 51), simple personality disorder 19.9% (n = 70), and complex/severe personality disorder 24.4% (n = 86). Patients with no personality disturbance were significantly differentiated (p <0.05) from the other groups regarding the BDI, 15D, and MHI-5 scores as well as the number of Axis I diagnoses. Patients with complex/severe personality disorders stood out as being worst off. Social dysfunction was related to the severity of the personality disturbance. Patients with a personality difficulty or a simple personality disorder had prominent symptoms and difficulties, but the differences between these groups were mostly non-significant. Conclusions: An elevated severity level of personality disturbance is associated with an increase in psychiatric morbidity and social dysfunction. Diagnostically sub-threshold personality difficulties are of clinical significance and the degree of impairment corresponds to actual personality disorders. Since these two groups did not significantly differ from each other, our findings also highlight the complexity related to the use of diagnostic thresholds for separate personality disorders.Peer reviewe

Burden of mental, behavioral, and neurodevelopmental disorders in the Finnish most preterm children : a national register study

Etiologies and the whole picture in childhood mental, behavioral, and neurodevelopmental disorders related to gestational age are unclear. This study included all Finnish children (N = 341,632) born between January 1, 2001, and December 31, 2006, whose data including their mothers (N = 241,284) were collected from national registers. Children with unclear gestational age (GA) (N = 1245), severe congenital malformations (N = 11,746), and moderate/severe/undefined cognitive impairment (N = 1140), and those who died during the perinatal period (N = 599) were excluded. The main outcome was the prevalence of mental and behavioral disorders (International Classification of Disorders) at 0 − 12 years of age in association with GA, adjusted for gender and prenatal variables. Out of all included (N = 326,902) children 16.6% (N = 54,270) were diagnosed to have any mental health disorder at 0 − 12 years. Adjusted Odd Ratio (OR) were for any disorder in preterm (< 37 weeks) 1.37 [1.28 − 1.46] and 4.03 [3.08 − 5.26] in extreme preterm (≤ 28 weeks) versus term born children, p < 0.05. The lower the GA at birth, the higher the risk for multiple disorders and earlier onset of disorder, p < 0.05. Adjusted ORs were for male/female 1.94 [1.90 − 1.99], maternal mental health disorder (yes/not) 1.99 [1.92 − 2.07], and smoking during pregnancy (yes/not) 1.58 [1.54 − 1.62], and these risks were more common in preterm versus term born children (p < 0.05). Extreme early birth was a strong risk factor per se for any or multiple and early shown mental health disorders. Other risk factors for mental health accumulated to preterm children.© The Author(s) 2023. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.fi=vertaisarvioitu|en=peerReviewed

The Effectiveness of Individual Mental Health Interventions for Depressive, Anxiety and Conduct Disorder Symptoms in School Environment for Adolescents Aged 12-18-A Systematic Review

Background: Mental health problems are a major health issue for children and adolescents around the world. The school environment allows adolescents to be reached comprehensively and on a low threshold, making it a potential environment for mental health interventions. The aim of this review was to describe interventions delivered by health-care workers in school environment for individual adolescents aged 12-18 with mental health problems and to assess the effectiveness of these interventions.Methods: This systematic review was conducted in adherence with the PRISMA guidelines. Altogether 349 studies were screened and 24 of them were included in full text assessment. Eight studies were included in the qualitative synthesis. Only in three studies the intervention was compared to another intervention or the study setting included a control group. Five of the interventions were based on cognitive-behavioral therapy and three on other approaches. In seven studies, one of the main response variables was based on assessment of depressive symptoms and/or a depressive disorder. The quality of the studies was limited with notable risk for bias for some studies.Results: Based on reported symptom reductions, for most of the interventions, the results were good. Symptom reductions were also typically achieved in a rather low number of sessions (12 or less) supporting the feasibility of these type of interventions in school environment. However, the lack of use of control groups and actual comparisons between the interventions, limit the possibility to draw firm conclusions regarding their effectiveness and thus, the results should be interpreted with caution. Confirming the effectiveness of the studied interventions requires more robust evidence and thus, improving the quality of studies in the school environment is encouraged

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

Clinical importance of personality difficulties: diagnostically sub-threshold personality disorders

ConclusionsAn elevated severity level of personality disturbance is associated with an increase in psychiatric morbidity and social dysfunction. Diagnostically sub-threshold personality difficulties are of clinical significance and the degree of impairment corresponds to actual personality disorders. Since these two groups did not significantly differ from each other, our findings also highlight the complexity related to the use of diagnostic thresholds for separate personality disorders.</p

Sex‐specific role of alexithymia in associations between parental bonding and mental health: A moderated mediation model

Objective: This study aimed to explore the role of alexithymia and potential sex differences in the associations between perceived parental bonding and mental health.Methods: The sample consists of 2421 parents from the FinnBrain Birth Cohort Study who completed the Parental Bonding Instrument (PBI), the Toronto Alexithymia Scale (TAS-20), the Edinburgh Postnatal Depression Scale (EPDS) and the anxiety subscale of the Symptom Checklist-90 (SCL-90). Moderated mediation analyses were conducted to examine possible mediating role of alexithymia and moderating role of sex in the associations between parental bonding and depressive/anxiety symptomsResults: Alexithymia was found to be a potential mediator and sex be a moderator in the relations between perceived dysfunctional parental bonding and the psychological symptoms. Specifically, dysfunctional paternal bonding, especially paternal overprotection, had stronger indirect effects (via alexithymia) on the psychological symptoms in males.Conclusions: This study indicates the importance of alexithymia in the parenting-related mental health impacts and highlights the significance of paternal bonding for the development of alexithymia and mental health problems in male populations. The findings improve the limited understanding of sex-related parental factors for alexithymia and mental health problems. Future studies in longitudinal designs are warranted to clarify the causal process of the mediation.</p