Adolescent predictors of adult social and psychiatric adversities:a prospective follow-up study of the Northern Finland 1966 Birth Cohort

Abstract The aim of this study was to investigate, using a longitudinal design, the possible long-term effects of adolescent family background, school performance and substance use on educational performance, psychiatric disorders and substance use related problems during adulthood. A large, prospectively collected general population birth cohort (n = 11017), the Northern Finland 1966 Birth cohort, was used as study population. The database provided information on features of the primary family. The information on the cohort members' school performance, smoking, alcohol use and other substance use was obtained from a questionnaire mailed to the cohort members in 1980. Also information on school performance in various school subjects was obtained at the end of compulsory schooling at the age of 16. The level of education by the age of 31 was gathered from the national Registry of Educational Statistics in Finland. The relevant data for drunk driving offences were collected from the Ministry of Justice files. The Finnish Hospital Discharge Register was used to identify all hospital-treated psychiatric patients. Parental divorce increased the risk of adult educational underachievement. Other family background factors such as unwanted pregnancy, low maternal education and large family size were also associated with low adult educational performance. A history of drunk driving offences was associated both with impaired school performance in adolescence and with educational underachievement in early adulthood. Adolescent regular alcohol use, smoking and other substance use increased the risk for drunk driving offences and hospital-treated substance use disorders in adulthood. The smoking rate among psychiatric patients was about 1.5 times higher than among control subjects without psychiatric hospital treatment. The proportion of smokers was about 50% among subjects with schizophrenia. The initiation age of regular smoking was closely related to the age of onset of schizophrenia, but not to other mental disorders. Among schizophrenia patients the increased likelihood of smoking was associated with paternal smoking in the family environment, but not with any other background factors. Low overall mean scores and low combined mathematical and natural science scores at the end of compulsory school were associated with adult regular smoking among schizophrenia patients. This study gives new information on risk factors that affect educational attainment, substance use related problems and psychiatric morbidity within the developmental pathway from adolescence to adulthood

Itsetuhoisuuden ja itsensä vahingoittamisen eri muodot

Tiivistelmä Suomalainen Itsemurhien ehkäisyn ja itsemurhaa yrittäneen Käypä hoito -suositus määrittelee itsetuhoisuuden laajasti pyrkimykseksi tai käyttäytymiseksi, johon sisältyy itsensä vahingoittaminen tai tarkoituksellinen henkeä uhkaavan riskin ottaminen. Itsetuhoisuudella tarkoitetaan itsemurha-ajatuksia, itsemurhasta puhumista, keskeytynyttä itsemurhayritystä, itsemurhayritystä ja itsemurhaa. Vaikka itsetuhoiseen tekoon jollain hetkellä ei liittyisi lainkaan pyrkimystä kuolla, voi kuolemanpyrkimys ilmetä samalla henkilöllä myöhemmin

Adolescence predictors for drug crime offending:a follow-up study of former adolescent psychiatric inpatients

Abstract Our aim was to examine adolescent predictors (family- and school-related factors, substance use, and psychiatric disorders) for drug crime offending. The initial study population consisted of 508 former adolescent psychiatric inpatients aged between 13 and 17 years. Of them, 60 (12%) had committed a drug crime by young adulthood and they were matched with 120 (24%) non-criminal controls by sex, age and family type. During adolescent hospitalization, study participants were interviewed using valid semi-structured research instruments. Criminal records were obtained from the Finnish Legal Register Centre up to young adulthood. A distant relationship with a father, lying, and thieving, moderate/high nicotine dependence and weekly use of stimulants were shown to be the most prominent predictors for drug crime offending. Our findings encourage the use of modern child- and family-centered approaches in preventing youth involvement in illegal drug use and drug crimes

Profile of substance misuse among adolescent and young adult gabapentinoid users:a register-based follow-up study of former adolescent psychiatric inpatients

Abstract Aims: Our study examined characteristics of adolescent and young adult study participants using gabapentinoids (gabapentin, pregabalin), with previous history of adolescent psychiatric inpatient hospitalization. Particular focus was on temporal association of age, at first prescription for gabapentinoids, to age at tobacco smoking initiation, regular alcohol use, diagnosis of substance dependence and prescriptions for benzodiazepines and opioids. Methods: The initial study population contained 508 adolescents (300 females, 208 males) admitted to psychiatric inpatient care in Oulu University hospital between the ages 13–17 years. Register-based follow-up information on prescriptions for gabapentinoids, benzodiazepines and opioids, as well as ICD-10 diagnosis for hospital-treated substance dependence, was obtained from the Finnish national health care registers. Results: The users of gabapentinoids accounted for 9.1% of the initial study population. Of adolescence-related characteristics, suicidal ideation, suicide attempts and non-suicidal self-injury was emphasized in females using gabapentinoids. The majority of participants using gabapentinoids had benzodiazepines (80.4%) and opioids (71.7%) as comorbid drugs. Initiation of tobacco smoking and alcohol use and first prescriptions for of benzodiazepines and opioids, and a diagnosis of substance dependence commonly predated first prescriptions for gabapentinoids. Conclusions: In clinical practice, the decision to prescribe gabapentinoids to adolescents or young adults must be made with caution, particularly for those with substance use problems and/or without a clinically approved indication

Familial risk factors in relation to recurrent depression among former adolescent psychiatric inpatients

Abstract Treating recurrent depression is a challenge for clinical practitioners. We investigated which family environmental factors contribute to differences between recurrent and non-recurrent depression by the young adulthood of the former adolescent inpatients. The initial sample covered 237 adolescent psychiatric inpatients with depression, of which 35.4% had later diagnosed with recurrent depression. Recurrence in depression was associated to distant maternal relationships in both male (p = 0.022) and female patients (p = 0.042). In females, the likelihood for recurrent depression was also related to psychiatric problems of the father (p = 0.013) and siblings (OR = 3.7, p = 0.032), and having a grand multiparous mother (p = 0.005). Our results emphasise the need for effective family-centred approaches in treatment of adolescents with depression

Associations of adolescent psychosocial factors to later benzodiazepine use:a population-based follow-up study of adolescent psychiatric inpatients in Northern Finland

Abstract We investigated factors associated with benzodiazepine (BZD) use during late adolescence and early adulthood. The study population consisted of 508 adolescents admitted to psychiatric inpatient care between April 2001 and March 2006. Information on adolescents’ family- and school-related factors, suicidality and psychiatric disorders were obtained by semistructured interviews. Data on BZD prescriptions from 1999 to 2012 were collected from the Social Insurance Institution of Finland. In males heavy BZD use associated with adolescent substance-use disorder (OR, 3.5; P < 0.004) and parents’ psychiatric problems (OR, 3.5; P = 0.029). Among females, conduct disorder (OR, 3.3; P = 0.016), being a bully/bully-victim (OR, 3.3; P = 0.019) and parental substance-use problems (OR, 2.6; P = 0.024) were related to heavy BZD use. The mean (±SD) age of first BZD prescription was significantly lower in heavy, compared with mild users (men: 19.3 ± 2.5 vs. 21.0 ± 2.5 years, P = 0.027; women: 19.7 ± 2.6 vs. 21.5 ± 3.4 years, P = 0.027). Heavy, compared with mild, BZD use is associated with female suicide attempts (OR, 5.0; P = 0.049). Physicians should be cautious when prescribing BZDs to young adults and must allocate treatment to those with carefully evaluated clinical indications

Sex-specific predictors of exposure to hospital-treated assaults among former adolescent psychiatric inpatients

Abstract This study examined the associations of psychiatric disorders, suicidal behavior and family-related characteristics during adolescence, to subsequent experiences of hospital-treated physical, or sexual assaults, among 508 young adults with a history of psychiatric inpatient care at adolescence (aged 13–17 years). Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) based adolescent psychiatric disorders were assessed at index hospitalization using Schedule for Affective Disorder and Schizophrenia for School-Age children, Present and Lifetime version (K-SADS-PL). Treatment episodes for assaults were obtained from the health care register, provided by the Finnish National Institute for Health Welfare. About 14.4% of the participants had experienced physical or sexual assault during their lifetime. Results of logistic regression analysis indicated that anxiety disorder (odds ratio [OR] = 9.6) and nonsuicidal self-injury (OR = 3.7) in adolescence for males, and personality disorder (OR = 3.4) for females, were associated with increased likelihood for subsequent assault exposure leading to hospitalization. These findings can be used in targeting vulnerable adolescents and designing primary prevention strategies

Misuse of prescribed psychotropic medication and drug crime offending:a follow-up case-control study of former adolescent psychiatric inpatients

Abstract Background: Various psychotropic prescription drugs are known to have potential for misuse. Among teenagers, non-medical use of prescription drugs may predate illicit drug use or occur concomitantly. Aims: Our aim was to examine prescriptions of psychotropic medications among drug crime offenders and non-criminal controls in a psychiatric inpatient cohort of 13–17-year-olds. Our research question was: were prescribed psychotropic and potentially addictive drugs associated with later drug crime offending. Methods: Our sample was of all 60 adolescents who had been convicted of a drug crime by young adulthood with a twice-sized control group, matched for gender, age and family-type, from a cohort of 508 adolescents consecutively admitted to a psychiatric inpatient care in Finland between April 2001 and March 2006. Adolescence-related information on substance use and psychiatric disorders was obtained by semi-structured interviews. Follow-up information on crimes and medication purchases was obtained from Finnish nationwide registers. The association of studied factors to drug crime offending was examined using stepwise binary logistic regression analysis. Results: 75% of drug crime offenders and 47% of non-criminal controls had used addictive psychotropic medications during the follow-up period (p < 0.001). 74% of all drug crime offenders’ purchases of prescribed addictive drugs occurred within the year preceding drug crimes. Of addictive drugs, the use of clonazepam and gabapentinoids was most likely to associate with drug crime offending (AOR 7.77, p < 0.001). Conduct and substance use disorders diagnosed in adolescence (AOR 3.49, p = 0.010; AOR 2.34, p = 0.050) were predictors for drug crime offending. Conclusions: Our findings suggest that, when treating young adults with conduct disorder and a history of substance use, physicians should prescribe addictive medications with caution, favouring instead non-addictive medications complemented by psychosocial interventions

Bullying involvement in relation to personality disorders:a prospective follow-up of 508 inpatient adolescents

Abstract We examined the association of bullying behavior in adolescence to personality disorder (PD) diagnosed in early adulthood. The study sample consisted of 508 adolescents (300 girls, 208 boys) who were admitted to psychiatric inpatient treatment between April 2001 and March 2006. Data were based on semi-structured K-SADSPL-interviews and hospital treatments extracted from the Care Register for Health Care (CRHC). At the end of 2013, details of psychiatric diagnoses recorded on hospital discharges and outpatient visits were extracted from the CRHC. This study showed that female victims of bullying have an almost fourfold likelihood of developing a PD later in life compared to adolescents with no involvement in bullying behavior. Most of the females had Borderline PD. Female adolescents diagnosed with anxiety disorder during adolescence had an over threefold risk of developing a PD during late adolescence or early adulthood. Conversely, we found no associations between bullying involvement among men in adolescence and subsequent PDs. Bullying victimization may influence the development of PDs among females. Adolescent services should pay particular attention to female victims of bullying and those displaying symptoms of anxiety disorders

Prevalence of neoplasms among former adolescent psychiatric inpatients

Abstract Objective: To examine the association between psychiatric disorders and neoplasms. Methods: A follow-up study of a population-based cohort of patients admitted for psychiatric care between the ages 13–17 years. The cases were patients with a follow-up diagnosis of neoplasm. The K-SADS-PL interview was used to assess DSM-IV based psychiatric diagnoses at adolescence. The treatment episodes due to neoplasms and related psychiatric disorders were extracted from the National Health Care Registers. Results: Of the original cohort, 6.3% of subjects had a neoplasm diagnosis. Male cases were characterized as taking snuff and females as having a fear of becoming obese. 75% of cases had smoked regularly and 47% suffered from substance misuse disorder already in adolescence. At a mean age of 22 years, the diagnoses of skin or soft tissue neoplasms were prevailing, three being malignant neoplasms of the skin, mouth or colon. Non-psychotic disorders were comorbid both two years before (26%) and after (33%) the neoplasm diagnosis. Conclusion: Focus on psychiatric symptoms of patients with neoplasms may enhance their treatment outcome and quality of life