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

Mental Imagery in Early Psychosis

Dysfunction in mental imagery may contribute to the development of mental disorders. We studied the vividness and controllability of mental imagery in a sample of 42 individuals with recent-onset psychosis, using a cross sectional design. Contrary to earlier studies, the claim that mental imagery is enhanced and the controllability weak in psychotic disorder was not supported. Especially the negative and affective symptoms associated with low vividness, and the stronger the symptoms the patients had, the less vivid was their imagery. Anxiety and self-neglect were the best predictors of low vividness. Only an elevated mood associated with higher vividness. The cognitive performance of the participants did not associate significantly with imagery. Surprisingly, organic modality was reported to be the most vivid modality, whereas visual imagery was the least vivid. Understanding the role of mental imagery in early psychosis may help us to understand and treat these disorders better.Peer reviewe