Logistinen monitasomalli: rekisteritutkimus mielenterveyden häiriöistä, sosioekonomisesta asemasta ja alueellisista eroista lapsilla Suomen kunnissa

Mental disorders are common during childhood and they are associated with various negative consequences later in life, such as lower educational attainment and unemployment. In addition, the reduction of socioeconomic health disparities has attracted both political, research and media interest. While mental health inequalities have been found consistently in literature and regional disparities in health have been well documented in Finland altogether, the question of possible variation in mental disorder inequalities during childhood among Finnish regions is not fully examined. This master’s thesis contributes to this gap in the research with a statistical perspective and use of a multilevel logistic model, which allows random variation between levels. Using register-based data, I ask whether the association between socioeconomic status and mental disorder in childhood varies between the child’s municipality of residence, and which regional factors possibly explain the differences. The second objective of this thesis is to find out whether the use of a multilevel logistic model provides additional value to this context. The method used in the thesis is a multilevel logistic model, which can also be called a generalized linear mixed-effects model. In multilevel models, the observations are nested within hierarchical levels, which all have corresponding variables. Both intercept and slopes of independent variables can be allowed to vary between the Level 2 units. Intraclass correlation coefficient and median odds ratio (MOR) are used to measure group level variation. In addition, centering of variables and choosing a suitable analysis strategy are central steps in model application. High-quality Finnish register data from Statistics Finland and the Finnish Institute of Health and Welfare is utilised. The study sample consists of 815 616 individuals aged 4–17 living in Finland in the year 2018. The individuals who are used as Level 1 units are nested within 306 Level 2 units based on their municipality of residence. The dependent variable is a dichotomous variable indicating a mental disorder and it is based on visits and psychiatric diagnoses given in specialised healthcare during 2018. Independent variables in Level 1 are maternal education level and household income quintile, and models are controlled for age group, gender, family structure and parental mental disorders. In Level 2, the independent variables are urbanisation, major region, share of higher-educated population and share of at-risk-of-poverty children. In the final model, children with the lowest maternal education level are more likely (OR=1.37, SE=0.0026) to have mental disorders than children with the highest maternal education level. Odds ratios for the household income quintile mostly decline close to one when control variables are included. Interestingly, children from the poorest quintile have slightly lower odds for mental disorder (OR=0.84, SE=0.017) compared with children from the richest quintile. Urbanisation, share of higher-educated population and share of at-risk-of-poverty children are statistically insignificant variables. Differences are found between major regions; children from Åland are more likely (OR=1.5, SE=0.209) to have a mental disorder compared with Helsinki-Uusimaa residents, whereas children from Western Finland (OR=0.71, SE 0.053) have lower odds compared to the same reference. Random slopes for maternal education are not significant, and the model fit does not improve. However, there is some variation among municipalities (MOR=1.34), and this finding defends the usefulness of the multilevel model in the context of mental disorders in childhood. The results show that mental disorder inequalities persist in childhood, but there is complexity. Although no variation in socioeconomic inequalities among municipalities is found, there are still contextual effects between municipalities. Health policies should focus on reducing overall mental health inequalities in the young population, but it is an encouraging finding that disparities in childhood mental disorders are not shown to be stronger in some municipalities than others. Multilevel models can contribute to the methodology of future mental disorder research, if societal context is assumed to affect the outcomes of individuals

Growing up unequal : Socioeconomic disparities in mental disorders throughout childhood in Finland

Problems in mental health and socioeconomic health inequalities during childhood and adolescence are receiving important scientific and political attention. This in mind, we study how current family income and parental education are associated with psychiatric disorders among children in a well-developed welfare state, Finland. To gain a deeper understanding of how these disparities develop through early life course, we study the differences between genders, age groups, types of mental disorders, and also take into account the role of parental mental disorders. We exploit high-quality Finnish register data containing the whole population aged 4–17 with information on their families and parents. Our results of linear probability models show that lower parental education is consistently associated with higher probability of mental disorders throughout childhood, although some gender and disorder-specific differences are also identified. Interestingly, household income is related to mental health in more complex ways, having both negative and positive associations with psychiatric disorders. Inequalities are stronger among boys than girls, and the strongest associations are found among boys aged 7–12 and girls aged 13–17. Parental mental disorders increase the risk of children's psychiatric disorders but do not explain socioeconomic disparities. Considering the negative effects of mental problems on socioeconomic outcomes, inequalities in childhood mental health can be expected to reinforce other social inequalities in later life and should therefore be a focus of interventions

Mental disorders and having a first child among young adults in Finland

Background: Fertility rates have declined during the 2010s in many high-income countries, with a strong decrease in Finland. Mental disorders might contribute to this decline, given that they became a major cause of work disability in Finland. We examined associations between broad and specific categories of mental disorders and the likelihood of having a first child among young people, and the role of partnership status in these associations. Methods: We conducted a nationwide register-based cohort study including all men and women born in 1980-1995 in Finland (n = 1,210,662). Exposures were mental disorders with ICD-10 subchapter F-diagnosis, and outcome was time to first childbirth. Results: The diagnosis of almost any mental disorder was associated with a lower likelihood of having a first child among men and women, with schizophrenia and intellectual disabilities having the strongest associations. People with substance use, childhood onset, anxiety, or any mental disorders had a higher rate of having a first child by age 25 than people without these diagnoses; by age 30-35 these associations became negative. People with mental disorders were also less likely to cohabit. Among those who never cohabited, women with substance use disorders or childhood onset disorders were more likely to have a first child compared to women without these disorders. Conclusions: Almost all mental disorders were associated with a lower rate of having a first child, especially among men. These findings imply that well-functioning mental health services are important also from a fertility perspective, which should be considered by policy makers

Transmission of mental disorders in adolescent peer networks: a Finnish nationwide registry study

ImportancePrevious research indicates that mental disorders may be transmitted from one individual to another within social networks. However, there is a lack of population-based epidemiological evidence that pertains to the full range of mental disorders.ObjectiveTo examine whether having classmates with a mental disorder diagnosis in the ninth grade of comprehensive school is associated with later risk of being diagnosed with a mental disorder.DesignCohort members were followed from August 1 in the year they completed ninth grade (around age 16) until a diagnosis of mental disorder, emigration, death, or December 31, 2019, whichever occurred first.SettingPopulation-based registry study.ParticipantsData of all Finnish citizens born between January 1, 1985 and December 31, 1997 whose demographic, health, and school information were linked from nationwide registers.ExposureThe exposure was one or more individuals diagnosed with a mental disorder in the same school class in the ninth grade. Main Outcomes and MeasuresBeing diagnosed with a mental disorder during follow-up.ResultsAmong the 713 809 cohort members (50.4% of whom were males), 47 433 had a mental disorder diagnosis by the ninth grade. Of the remaining 666 376 cohort members, 167 227 persons (25.1%) received a mental disorder diagnosis during follow-up (7 324 958 person-years). A weak dose-response association was found, with no significant increase in later risk of being diagnosed with one diagnosed classmate (HR=1.01, 95% CI 1.00–1.02), but a 5% increase with more than one diagnosed classmate (HR=1.05, 95% CI 1.04–1.06). The risk was not proportional over time but was highest during the first year of follow-up, showing a 9% increase for one diagnosed classmate (HR=1.09, 95% CI 1.04–1.14), and an 18% increase for more than one diagnosed classmate (HR=1.18, 95% CI 1.13–1.24). Of the examined mental disorders, the association was strongest for mood, anxiety, and eating disorders. These associations persisted after adjusting for an array of parental, school-level, and area-level confounders.Conclusions and RelevanceMental disorders might be transmitted within adolescent peer networks. More research is required to elucidate the mechanisms underlying the possible transmission of mental disorders. <br/