Vanhuus ja viisaus

Teema: vanhuuden vallankumous

Incidence and Risk Factors of Schizophrenia in Finland

Väitöskirja, liitteenä alkuperäisartikkelit

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

Family structure and risk factors for schizophrenia: case-sibling study

BACKGROUND: Several family structure-related factors, such as birth order, family size, parental age, and age differences to siblings, have been suggested as risk factors for schizophrenia. We examined how family-structure-related variables modified the risk of schizophrenia in Finnish families with at least one child with schizophrenia born from 1950 to 1976. METHODS: We used case-sibling design, a variant of the matched case-control design in the analysis. Patients hospitalized for schizophrenia between 1969 and 1996 were identified from the Finnish Hospital Discharge Register, and their families from the Population Register Center. Only families with at least two children (7914 sibships and 21059 individuals) were included in the analysis. Conditional logistic regression with sex, birth cohort, maternal schizophrenia status, and several family-related variables as explanatory variables was used in the case-sibling design. The effect of variables with the same value in each sibship was analyzed using ordinary logistic regression. RESULTS: Having a sibling who was less than five years older (OR 1.46, 95% CI 1.29–1.66), or being the firstborn (first born vs. second born 1.62, 1.87–1.4) predicted an elevated risk, but having siblings who were more than ten years older predicted a lower risk (0.66, 0.56–0.79). CONCLUSIONS: Several family-structure-related variables were identified as risk factors for schizophrenia. The underlying causative mechanisms are likely to be variable

Onko masennus lisääntynyt suomalaisessa aikuisväestössä?

English summaryMaailmanlaajuisesti masennuksen esiintyvyys ei ole muuttunut viime vuosikymmeninä. Suomessa masennushäiriöiden esiintyvyys edustavissa väestötutkimuksissa oli vuonna 2000 7,3% ja vuonna 2011 9,6%. Esiintyvyyden kasvu oli merkitsevä naisilla, mutta ei miehillä. Masennuslääkkeiden kulutus ja erikoissairaanhoidon polikliiniset käynnit masennuksen vuoksi ovat myös lisääntyneet 2000-luvulla, kun taas sairaalahoito on vähentynyt. Masennushäiriöiden hoito on lisääntynyt enemmän kuin esiintyvyys, mikä viittaa siihen, että entistä useampi osaa hakeutua oireiden vuoksi hoitoon. Masennushäiriöiden esiintyvyyden vertailua vaikeuttavat mittaus- ja haastattelumenetelmien erot ja osallistumisaktiivisuuden vaihteluun liittyvä valikoitumisharha. Masennushäiriöiden esiintyvyys Suomessa on jonkin verran korkeampi kuin maailmanlaajuinen keskiarvo, mutta lukuja vertailtaessa on otettava huomioon, että suomalaisissa esiintyvyysarvioissa on korjattu valikoitumisharhan vaikutusta moni-imputoinnilla, toisin kuin useimmissa muissa tutkimuksissa. Siksi voidaan päätellä, että masennuksen esiintyvyys Suomessa ei todennäköisesti ole poikkeuksellisen korkea verrattuna muihin länsimaihin. Masennuksen esiintyvyyden muutokset voivat heijastaa muita yhteiskunnallisia muutoksia. Erityisesti talouden laskusuhdanteilla on usein kielteisiä seurauksia mielenterveydelle. Masennuksen ilmeinen yleistyminen suomalaisilla naisilla on tapahtunut samaan aikaan 2010-luvun taloudellisen taantuman kanssa. On kuitenkin mahdollista, että masennushäiriöiden nykyiseen esiintyvyyteen vaikuttaa myös 1990-luvun lama, sillä lapsena koetut vaikeudet ovat voimakas riskitekijä masennushäiriöiden kehittymiselle. Masennushäiriöiden lisääntyminen Suomessa erityisesti naisten keskuudessa edellyttää tarkempia tutkimuksia ja toimenpiteitä tämän huolestuttavan kehityksen muuttamiseksi.Peer reviewe

Is symptom connectivity really the most important issue in depression? : Depression as a dynamic system of interconnected symptoms revisited

According to the network theory strong associations between symptoms drive the disease process. We compared those with and without diagnosed depressive disorders (DD+/DD-) and analysed the effects of differences in (a) network connectivity, (b) symptom thresholds, and (c) autoregressive loops (i.e. how strongly specific symptoms predict themselves) on the potential activation of symptoms over time using simulations developed by Cramer and others (2016). The parameters for the simulation (symptom connectivity and symptom threshold) were obtained from Ising models and cross-lagged panel network analyses. Data were from the nationally representative samples (Health 2000-2011 Study) of 4190 participants measured in 2011 (cross-sectional analyses) and 3201 participants measured in 2000 and 2011 (longitudinal analyses). DD diagnosis was based on the Composite International Diagnostic Interview and depressive symptoms were self-reported using the 13-item version of the Beck Depression Inventory (BDI). Differences in symptom connectivity between participants with and without DD were not observed, but the mean probability (threshold) of symptom existence in the DD + group was higher than in the DD-group (0.41 vs. 0.12). Simulation showed that there are more active symptoms in the DD + group after 10 000 time points (means 1.2 vs. 4.6) than in the DD-group. This difference largely disappeared when we used longitudinal networks, including autoregressive loops, in the connectivity matrix. Our results suggest that the differences in symptom thresholds and autoregressive loops may be more important features than symptom connectivity in differentiating people with and without DD.Peer reviewe