Skitsofreniaa ja skitsoaffektiivista häiriötä sairastavien suomalaisten naisten lisääntymisterveydestä

During the 19th century and beginning of the 20th century the concept of eugenic ideology raised its head. In Finland the law for forced sterilization was accepted in 1934 and government-funded sterilization program took place all over the country. Between the years 1935-1970, approximately 7500 people, mostly women were sterilized according to current sterilization law (Hietala, 2009). Almost half of the sterilized individuals suffered from intellectual disability, but there were also persons with schizophrenia. The position and role of women with schizophrenia and schizoaffective disorder has improved since the times described above, but the road has not been easy. However, both the ongoing de-institutialization, as well as the use of modern antipsychotic medications with less endocrine side-effects has led to an increase in relative fertility and pregnancies of the women with schizophrenia. The purpose of this nationally representative follow-up study was to assess induced abortions and pregnancy-related and delivery-related health outcomes of women with schizophrenia or schizoaffective disorder, as well as to investigate negative perinatal health outcomes and out-of-home placements of their offspring. Using the Care Register for Health Care, Finnish women, born between the years 1965 and 1980 and diagnosed with schizophrenia or schizoaffective disorder were identified during the follow-up period ending 31.12.2013 (n= 5214). For each case, five age- and place of birth-matched controls were obtained from the population Register (n= 25,999). The Medical Birth Register, the Induced Abortion Register, the Register of Congenital Malformations and the Child Welfare Register were used to gather information about mothers and their offspring. The incidence of induced abortions in women with schizophrenia or schizoaffective disorder is similar to that of population controls, but their risk per pregnancy was over two-fold. Women with schizophrenia or schizoaffective disorder were significantly older and more often single at the beginning of the pregnancy. Their body mass index (BMI) before pregnancy was significantly higher and they smoked significantly more often both in the beginning of the pregnancy and after the first trimester. During pregnancy, the risk of pathologic oral glucose test, initiation of insulin, fast fetal growth, premature contractions and hypertension was significantly higher among affected women. Focusing on obstetric complications, the risk of induction of labor, delivery by cesarean section and delivery by elective cesarean section was significantly higher among affected women. The risk of premature birth, low birth weight, low Apgar score at 1 minute, and having a major congenital anomaly to name a few was significantly increased among babies with a mother suffering from schizophrenia or schizoaffective disorder. Children with an affected mother were placed out of home significantly more often than those with a non-affected mother. Among affected mothers, single motherhood and smoking in the beginning of pregnancy but not unwanted perinatal health outcomes of the child increased the risk of out-of-home placement. Schizophrenia and schizoaffective disorder are associated with some risk factors related to pregnancy, as well as with some pregnancy- and delivery-related complications. Maternal schizophrenia and schizoaffective disorder associate with some negative perinatal health outcomes, as well as with out-of-home placements of the offspring. Family planning services,Viime vuosisadalla negatiivinen eugeniikka eli rotuhygienia tavoitteli ”heikoimpien” yksilöiden lisääntymisen rajoittamista; keinoina olivat eristäminen, avioliittokiellot ja sterilisaatiot. Vuosien 1935–1970 välisenä aikana Suomessa steriloitiin 7 500 ihmistä rotuhygieenisin perustein (Hietala 2009). Skitsofreniaa ja skitsoaffektiivista häiriötä sairastavien naisten asema Suomessa on parantunut edellä kuvatuista ajoista, mutta tie ei ole ollut helppo. Psykiatrisen sairaalahoidon vähentäminen ja modernien, antipsyykosilääkkeiden kehittyminen ovat kuitenkin mahdollistaneet psykoosisairauksiin sairastuneiden ihmisten integraation yhteiskuntaan ja normaalin arjen elämisen. Tämä on lisännyt näiden naisten raskauksia. Väitöskirjatutkimuksen tavoitteena oli tutkia suomalaisten skitsofreniaa tai skitsoaffektiivista häiriötä sairastavien naisten aborttien yleisyyttä ja abortteihin, raskauksiin ja synnytyksiin liittyviä tekijöitä. Yhtenä tavoitteena oli myös tutkia lasten vastasyntyneisyyskauden terveysongelmia ja kodin ulkopuolelle sijoittamista. Väitöskirjan aineistona toimi kansallinen rekisteri (HILMO), josta poimittiin vuosien 1965–1980 välillä syntyneet naiset joilla oli diagnosoitu skitsofrenia tai skitsoaffektiivinen häiriö 31.12.2013 mennessä (n = 5214). Jokaista tapausta kohti valittiin väestörekisteristä satunnaisotoksella viisi ikä- ja syntymäpaikkakaltaistettua verrokkia (n =25999). Tutkimuksessa hyödynnettiin myös syntymärekisteriä, aborttirekisteriä, epämuodostumarekisteriä ja lastensuojelurekisteriä. Päätulosten mukaan skitsofreniaa tai skitsoaffektiivista häiriötä sairastavien naisten aborttien ilmaantuvuus ei eronnut tilastollisesti merkitsevästi terveiden naisten aborttien ilmaantuvuudesta, mutta kun aborttien määrä suhteutettiin kaikkien raskauksien määrään, skitsofreniaa tai skitsoaffektiivista häiriötä sairastavien naisten riski päätyä aborttiin oli yli kaksinkertainen. Skitsofreniaa tai skitsoaffektiivista häiriötä sairastavat henkilöt olivat raskauden alussa tilastollisesti merkitsevästi vanhempia, useammin vailla parisuhdetta, heillä oli korkeampi painoindeksi, ja he tupakoivat useammin raskauden alussa ja ensimmäisen raskauskolmanneksen jälkeen verrattuna verrokkiryhmään. Skitsofreniaryhmässä myös riski raskaudenaikaisiin komplikaatioihin, mm.insuliinihoidon aloittamiseen, keisarinleikkauksiin, korkeaan verenpaineeseen ja sikiön nopeaan kasvuun oli merkitsevästi suurempi terveisiin naisiin nähden. Vastasyntyneillä, joiden äiti sairasti skitsofreniaa, oli terveiden äitien lapsia kohonnut riski mm.syntyä ennenaikaisena ja alhaiseen syntymäpainoon. Skitsofreniaa sairastavien naisten lapset sijoitettiin kodin ulkopuolelle tilastollisesti merkitsevästi useammin kuin verrokkien lapset. Lasten kodin ulkopuolelle tehtävät sijoitukset vaihtelivat muutamasta useaan kymmeneen heidän elinikänsä aikana. Tupakointi ja parisuhteen puuttuminen raskauden alussa lisäsivät lasten kodin ulkopuolelle sijoittamisen riskiä sekä skitsofreniaa tai skitsoaffektiivista häiriötä sairastavien naisten keskuudessa että terveiden naisten ryhmässä. Johtopäätöksenä voidaan todeta, skitsofreniaa tai skitsoaffektiivista häiriötä sairastavien naisten raskauksiin ja synnytyksiin, mutta myös seksuaalisuuteen liittyvän tiettyjä riskitekijöitä ja erityispiirteitä.Perhesuunnittelupalveluja, kohdennettuja terveyskasvatus- ja elämäntapainterventioita sekä vanhemmuustaitojen tukemista tulisi tarjota niille skitsofreniaa tai skitsoaffektiivista häiriötä sairastaville naisille, jotka suunnittelevat raskautta, ovat tulevia äitejä tai joilla on jo lapsia

Reproductive Health among Finnish Women with Schizophrenia or Schizoaffective Disorder

During the 19th century and beginning of the 20th century the concept of eugenic ideology raised its head. In Finland the law for forced sterilization was accepted in 1934 and government-funded sterilization program took place all over the country. Between the years 1935-1970, approximately 7500 people, mostly women were sterilized according to current sterilization law (Hietala, 2009). Almost half of the sterilized individuals suffered from intellectual disability, but there were also persons with schizophrenia. The position and role of women with schizophrenia and schizoaffective disorder has improved since the times described above, but the road has not been easy. However, both the ongoing de-institutialization, as well as the use of modern antipsychotic medications with less endocrine side-effects has led to an increase in relative fertility and pregnancies of the women with schizophrenia. The purpose of this nationally representative follow-up study was to assess induced abortions and pregnancy-related and delivery-related health outcomes of women with schizophrenia or schizoaffective disorder, as well as to investigate negative perinatal health outcomes and out-of-home placements of their offspring. Using the Care Register for Health Care, Finnish women, born between the years 1965 and 1980 and diagnosed with schizophrenia or schizoaffective disorder were identified during the follow-up period ending 31.12.2013 (n= 5214). For each case, five age- and place of birth-matched controls were obtained from the population Register (n= 25,999). The Medical Birth Register, the Induced Abortion Register, the Register of Congenital Malformations and the Child Welfare Register were used to gather information about mothers and their offspring. The incidence of induced abortions in women with schizophrenia or schizoaffective disorder is similar to that of population controls, but their risk per pregnancy was over two-fold. Women with schizophrenia or schizoaffective disorder were significantly older and more often single at the beginning of the pregnancy. Their body mass index (BMI) before pregnancy was significantly higher and they smoked significantly more often both in the beginning of the pregnancy and after the first trimester. During pregnancy, the risk of pathologic oral glucose test, initiation of insulin, fast fetal growth, premature contractions and hypertension was significantly higher among affected women. Focusing on obstetric complications, the risk of induction of labor, delivery by cesarean section and delivery by elective cesarean section was significantly higher among affected women. The risk of premature birth, low birth weight, low Apgar score at 1 minute, and having a major congenital anomaly to name a few was significantly increased among babies with a mother suffering from schizophrenia or schizoaffective disorder. Children with an affected mother were placed out of home significantly more often than those with a non-affected mother. Among affected mothers, single motherhood and smoking in the beginning of pregnancy but not unwanted perinatal health outcomes of the child increased the risk of out-of-home placement. Schizophrenia and schizoaffective disorder are associated with some risk factors related to pregnancy, as well as with some pregnancy- and delivery-related complications. Maternal schizophrenia and schizoaffective disorder associate with some negative perinatal health outcomes, as well as with out-of-home placements of the offspring. Family planning services,Viime vuosisadalla negatiivinen eugeniikka eli rotuhygienia tavoitteli ”heikoimpien” yksilöiden lisääntymisen rajoittamista; keinoina olivat eristäminen, avioliittokiellot ja sterilisaatiot. Vuosien 1935–1970 välisenä aikana Suomessa steriloitiin 7 500 ihmistä rotuhygieenisin perustein (Hietala 2009). Skitsofreniaa ja skitsoaffektiivista häiriötä sairastavien naisten asema Suomessa on parantunut edellä kuvatuista ajoista, mutta tie ei ole ollut helppo. Psykiatrisen sairaalahoidon vähentäminen ja modernien, antipsyykosilääkkeiden kehittyminen ovat kuitenkin mahdollistaneet psykoosisairauksiin sairastuneiden ihmisten integraation yhteiskuntaan ja normaalin arjen elämisen. Tämä on lisännyt näiden naisten raskauksia. Väitöskirjatutkimuksen tavoitteena oli tutkia suomalaisten skitsofreniaa tai skitsoaffektiivista häiriötä sairastavien naisten aborttien yleisyyttä ja abortteihin, raskauksiin ja synnytyksiin liittyviä tekijöitä. Yhtenä tavoitteena oli myös tutkia lasten vastasyntyneisyyskauden terveysongelmia ja kodin ulkopuolelle sijoittamista. Väitöskirjan aineistona toimi kansallinen rekisteri (HILMO), josta poimittiin vuosien 1965–1980 välillä syntyneet naiset joilla oli diagnosoitu skitsofrenia tai skitsoaffektiivinen häiriö 31.12.2013 mennessä (n = 5214). Jokaista tapausta kohti valittiin väestörekisteristä satunnaisotoksella viisi ikä- ja syntymäpaikkakaltaistettua verrokkia (n =25999). Tutkimuksessa hyödynnettiin myös syntymärekisteriä, aborttirekisteriä, epämuodostumarekisteriä ja lastensuojelurekisteriä. Päätulosten mukaan skitsofreniaa tai skitsoaffektiivista häiriötä sairastavien naisten aborttien ilmaantuvuus ei eronnut tilastollisesti merkitsevästi terveiden naisten aborttien ilmaantuvuudesta, mutta kun aborttien määrä suhteutettiin kaikkien raskauksien määrään, skitsofreniaa tai skitsoaffektiivista häiriötä sairastavien naisten riski päätyä aborttiin oli yli kaksinkertainen. Skitsofreniaa tai skitsoaffektiivista häiriötä sairastavat henkilöt olivat raskauden alussa tilastollisesti merkitsevästi vanhempia, useammin vailla parisuhdetta, heillä oli korkeampi painoindeksi, ja he tupakoivat useammin raskauden alussa ja ensimmäisen raskauskolmanneksen jälkeen verrattuna verrokkiryhmään. Skitsofreniaryhmässä myös riski raskaudenaikaisiin komplikaatioihin, mm.insuliinihoidon aloittamiseen, keisarinleikkauksiin, korkeaan verenpaineeseen ja sikiön nopeaan kasvuun oli merkitsevästi suurempi terveisiin naisiin nähden. Vastasyntyneillä, joiden äiti sairasti skitsofreniaa, oli terveiden äitien lapsia kohonnut riski mm.syntyä ennenaikaisena ja alhaiseen syntymäpainoon. Skitsofreniaa sairastavien naisten lapset sijoitettiin kodin ulkopuolelle tilastollisesti merkitsevästi useammin kuin verrokkien lapset. Lasten kodin ulkopuolelle tehtävät sijoitukset vaihtelivat muutamasta useaan kymmeneen heidän elinikänsä aikana. Tupakointi ja parisuhteen puuttuminen raskauden alussa lisäsivät lasten kodin ulkopuolelle sijoittamisen riskiä sekä skitsofreniaa tai skitsoaffektiivista häiriötä sairastavien naisten keskuudessa että terveiden naisten ryhmässä. Johtopäätöksenä voidaan todeta, skitsofreniaa tai skitsoaffektiivista häiriötä sairastavien naisten raskauksiin ja synnytyksiin, mutta myös seksuaalisuuteen liittyvän tiettyjä riskitekijöitä ja erityispiirteitä.Perhesuunnittelupalveluja, kohdennettuja terveyskasvatus- ja elämäntapainterventioita sekä vanhemmuustaitojen tukemista tulisi tarjota niille skitsofreniaa tai skitsoaffektiivista häiriötä sairastaville naisille, jotka suunnittelevat raskautta, ovat tulevia äitejä tai joilla on jo lapsia

Terveysvaikutukset ja kunnallinen Päätöksenteko. Helsingin opetusviraston pilottihanke

Terveysvaikutusten arviointi (TVA) on keino toteuttaa terveys kaikissa politiikoissa -periaatetta. TVA:lla voidaan järjestelmällisesti tunnistaa ja arvioida ennalta päätösten myönteisiä ja kielteisiä vaikutuksia yhteisön terveyteen. Helsingin opetusvirastossa toteutettiin Helsingin terveyskeskuksen aloitteesta vuonna 2006 Terveysvaikutusten huomioon ottaminen päätöksenteossa -pilottihanke. Pilottihankkeen arvioinnissa haettiin vastausta siihen, miten Helsingin kaupungin opetusviraston päätösesityksissä otetaan huomioon päätösten terveysvaikutukset. Arvioinnin tulos on hyvin samansuuntainen muiden vaikutusten arviointia selvittäneiden tutkimusten kanssa. Vain hiukan yli puolelle käsitellyistä terveysvaikutteisista asioista oli tehty TVA pilottihankkeen aikana. Saadun palautteen mukaan TVA vaatii päätöksentekoprosessiin osallistuvilta uudenlaista asennetta ja osaamista. Vasta käytännön kokemusten ja arviointien kautta TVA:lla on mahdollisuus hioutua osaksi päätöksentekoprosessia

Schizophrenia and pregnancy: a national register-based follow-up study among Finnish women born between 1965 and 1980

To assess psychosocial and somatic risk factors related to pregnancy, and pregnancy-related complications or disorders in women with schizophrenia compared to population controls. In this register-based cohort study, we identified all Finnish women who were born in 1965–1980 and diagnosed with schizophrenia in psychiatric care before 31 December 2013. For each case, five age- and place-of-birth matched controls were randomly selected. They were followed from the day when the disorder was diagnosed in specialized health care till the end of 2013. The mean follow-up time was 14.0 + 6.91 vs. 14.3 + 6.89 years. Altogether, 1162 singleton pregnancies were found among affected women and 4683 among controls. Affected women were significantly older and more often single; their body mass index before pregnancy was significantly higher, and they smoked significantly more often both in the beginning of pregnancy and after the first trimester than controls. They showed a significantly higher odds for pathologic oral glucose tolerance test (odds ratio (OR) 1.66, 95% confidence interval (95% CI) 1.27–2.17), initiation of insulin treatment (OR 1.84, 95% CI 1.15–2.93), fast fetal growth (OR 1.62, 95% CI 1.03–2.52), premature contractions (OR 2.42, 95% CI 1.31–4.49), hypertension (OR 1.81, 95% CI 1.01–3.27), and pregnancy-related hospitalizations (OR 1.97, 95% CI 1.66–2.33). Suspected damage to the fetus from alcohol/drugs was significantly more common among affected women than controls. Women with schizophrenia have higher prevalence of psychosocial and somatic risk factors related to pregnancy, as well as pregnancy-related complications and disorders than non-affected women.Peer reviewe

Obstetric and perinatal health outcomes related to schizophrenia : A national register-based follow-up study among Finnish women born between 1965 and 1980 and their offspring

Background: This national register-based study assesses obstetric and perinatal health outcomes in women with schizophrenia and their offspring. Methods: Using the Care Register for Health Care, we identified Finnish women who were born in 19651980 and diagnosed with schizophrenia. For each case, five age-and place-of-birth-matched controls were obtained from the Central Population Register of Finland. They were followed from the day when the disorder was diagnosed in specialized health-care (the index day) until 31.12.2013. Information related to births was obtained from the Medical Birth Register and the Register of Congenital Malformations. We focused on singleton pregnancies that led to a delivery after the index day. We restricted the analysis of deliveries in controls to those that occurred after the index day of the case. Maternal age, marital status, smoking status, sex of the newborn, and parity were used as covariates in adjusted models. Results: We identified 1162 singleton births among women with schizophrenia and 4683 among controls. Schizophrenic women had a 1.4-fold increased risk of induction of labor, delivery by cesarean section, and delivery by elective cesarean section. Regarding offspring, the risk of premature birth and the risk of low Apgar score at 1 min ( Conclusions: Schizophrenia associates with some specific delivery methods, but delivery complications are rare and their prevalence does not differ from that observed among community women. Maternal schizophrenia associates with some negative perinatal health outcomes of the offspring. (c) 2018 Elsevier Masson SAS. All rights reserved.Peer reviewe

Maternal schizophrenia and out-of-home placements of offspring : A national follow-up study among Finnish women born 1965-1980 and their children

Schizophrenia may affect a mother's ability to parent. We investigated out-of-home placements among children with a biological mother having schizophrenia, and their relation to maternal characteristics and adverse perinatal health outcomes of the offspring. For each Finnish woman born between 1 JAN 1965 - 31 DEC 1980 and diagnosed with schizophrenia before 31 DEC 2013 (n = 5214), five matched controls were randomly selected from the Finnish Central Population Register. Children born to these women were identified and followed till 31 DEC 2013. The Child Welfare Register, the Medical Birth Register and the Register of Congenital Malformations were used to gather information. Altogether 35.1% of children with an affected mother and 3.2% of control children were placed out of home during the follow-up. The incidence rate ratio (IRR) of out-of-home placement among children with an affected mother was 12.6 (95% confidence interval (CI) 10.80-13.46) when children with a non-affected mother served as a reference. Single motherhood (IRR 2.2, 95% CI 1.88-2.60) and maternal smoking (IRR 1.9, 95% CL 1.68-2.16), but not an adverse perinatal outcome of the offspring, increased the risk of out-of-home placement. To conclude, maternal schizophrenia is a strong risk factor for placement of children in out-of-home care.Peer reviewe

Schizophrenia and induced abortions : A national register-based follow-up study among Finnish women born between 1965-1980 with schizophrenia or schizoaffective disorder

Background: The objectives of this study were to investigate, in women with schizophrenia or schizoaffective disorder, the number and incidence of induced abortions (= pregnancy terminations performed by a physician), their demographic characteristics, use of contraceptives, plus indications of and complications related to pregnancy termination. Methods: Using the Care Register for Health Care, we identified Finnish women born between the years 19651980 who were diagnosed with either schizophrenia or schizoaffective disorder during the follow-up period ending 31.122013. For each case, five age- and place-of-birth- matched controls were obtained from the Population Register of Finland. Information about births and induced abortions were obtained from the Medical Birth Register and the Induced Abortion Register. Results: The number and incidence of induced abortions per 1000 follow-up years did not differ between cases and their controls. However, due to fewer pregnancies, cases exhibited an over 2-fold increased risk of pregnancy termination (RR 228; 95% CI 2.20-2.36). Cases were younger, were more often without a partner at the time of induced abortion, and their pregnancies resulted more often from a lack of contraception. Among cases, the indication for pregnancy termination was more often mother-to-be's medical condition. Induced abortions after 12 weeks gestation were more common among cases. However, cases had no more complications related to termination. Conclusions: The incidence of induced abortions among Finnish women with schizophrenia or schizoaffective disorder is similar to the general population, but their risk per pregnancy over two-fold. They need effective, affordable family planning services and long-term premeditated contraception. (C) 2017 Elsevier B.V. All rights reserved.Peer reviewe

Schizophrenia and pregnancy: a national register-based follow-up study among Finnish women born between 1965 and 1980

To assess psychosocial and somatic risk factors related to pregnancy, and pregnancy-related complications or disorders in women with schizophrenia compared to population controls. In this register-based cohort study, we identified all Finnish women who were born in 1965–1980 and diagnosed with schizophrenia in psychiatric care before 31 December 2013. For each case, five age- and place-of-birth matched controls were randomly selected. They were followed from the day when the disorder was diagnosed in specialized health care till the end of 2013. The mean follow-up time was 14.0 + 6.91 vs. 14.3 + 6.89 years. Altogether, 1162 singleton pregnancies were found among affected women and 4683 among controls. Affected women were significantly older and more often single; their body mass index before pregnancy was significantly higher, and they smoked significantly more often both in the beginning of pregnancy and after the first trimester than controls. They showed a significantly higher odds for pathologic oral glucose tolerance test (odds ratio (OR) 1.66, 95% confidence interval (95% CI) 1.27–2.17), initiation of insulin treatment (OR 1.84, 95% CI 1.15–2.93), fast fetal growth (OR 1.62, 95% CI 1.03–2.52), premature contractions (OR 2.42, 95% CI 1.31–4.49), hypertension (OR 1.81, 95% CI 1.01–3.27), and pregnancy-related hospitalizations (OR 1.97, 95% CI 1.66–2.33). Suspected damage to the fetus from alcohol/drugs was significantly more common among affected women than controls. Women with schizophrenia have higher prevalence of psychosocial and somatic risk factors related to pregnancy, as well as pregnancy-related complications and disorders than non-affected women.</p

Maternal schizophrenia and out-of-home placements of offspring: A national follow-up study among Finnish women born 1965–1980 and their children

Schizophrenia may affect a mother's ability to parent. We investigated out-of-home placements among children with a biological mother having schizophrenia, and their relation to maternal characteristics and adverse perinatal health outcomes of the offspring. For each Finnish woman born between 1 JAN 1965 – 31 DEC 1980 and diagnosed with schizophrenia before 31 DEC 2013 (n = 5214), five matched controls were randomly selected from the Finnish Central Population Register. Children born to these women were identified and followed till 31 DEC 2013. The Child Welfare Register, the Medical Birth Register and the Register of Congenital Malformations were used to gather information. Altogether 35.1% of children with an affected mother and 3.2% of control children were placed out of home during the follow-up. The incidence rate ratio (IRR) of out-of-home placement among children with an affected mother was 12.6 (95% confidence interval (CI) 10.80–13.46) when children with a non-affected mother served as a reference. Single motherhood (IRR 2.2, 95% Cl 1.88–2.60) and maternal smoking (IRR 1.9, 95% Cl 1.68–2.16), but not an adverse perinatal outcome of the offspring, increased the risk of out-of-home placement. To conclude, maternal schizophrenia is a strong risk factor for placement of children in out-of-home care.</p

National Identification and Attitudes Towards Russian Immigrants in Finland: Investigating the Role of Perceived Threats and Gains

In this cross-sectional study, we examined the relationship between national identification of majority Finns (nation-wide probability sample, N = 335) and their attitudes towards Russian immigrants living in Finland. As previous research indicates both possibilities, we tested whether this relationship was moderated or mediated by threats and gains perceived to result from immigration. The results supported the mediation hypothesis; those individuals who identified stronger with their national ingroup perceived more threats than gains related to increased immigration and these perceptions, in turn, were associated with more negative attitudes towards immigrants. The role of realistic as opposed to symbolic threats and gains was particularly pronounced. The implications of the results are discussed in terms of their theoretical relevance and practical means to improve intergroup relations, with a particular focus on the relations between Finns and Russian immigrants in Finland.Peer reviewe