According to studies carried out in various countries, many parents (7-28%) contact some professionals due to a child's behavioral or emotional disorder, but a large part of children presenting psychic symptoms has remained outside of mental health services. Seeking for care has strongly increased in Finland over the last few years. Schools and day care centers are important not only in recognizing the problems but also in providing support and directing to specialized services.
To study prevalence and factors associated with mental health service use among 18-year-old adolescent boys.
Predictors at age 8 and factors at age 18 associated with mental health service use during the preceding 12 months were studied in a general population sample of 2,316 Finnish boys born in 1981 attending military call-up (79% of the original sample).
Within the preceding 12 months, 2.1% of the boys had used mental health services. At age 18, internalizing, anxious-depressive, and withdrawal symptoms; health problems; not living with parents; use of illicit drugs; high level of alcohol use; and regular smoking were independently associated with service use. At age 8, a high level of emotional and behavioral symptoms, need for referral, and low school performance according to teacher evaluations predicted service use 10 years later.
Only a minority of adolescents with severe problems had used mental health services. Because of the wide range of problems and comorbidity among service users, there is a need for integration of different services. Education services have a central role in the early detection of those who will later use mental health services.
Comment In: Evid Based Ment Health. 2005 May;8(2):5615851819
This study reports time-trend changes in self-reported mental health problems, smoking, and alcohol habits among Finnish adolescents over a 16-year period using three cross-sectional studies with similar designs, methodologies, and geographical recruitment areas. There were 4508 participants with a mean age of 14.4 years (range 13-18) in 1998 (n?=?1449), 2008 (n?=?1560), and 2014 (n?=?1499). The information they provided on their mental health was measured with the Strengths and Difficulties Questionnaire and they were also asked questions about their alcohol and smoking habits. The findings showed that from 1998 to 2014 females reported less hyperactivity and conduct problems and males reported fewer peer problems and better prosocial skills. The only mental health problem that showed a significant increase was emotional symptoms among females. Smoking and alcohol use consistently decreased in males and females during the 16-year period. Our findings suggest that overall adolescent's self-reported mental health problems were either stable or falling, indicating increased well-being. The decreased smoking indicates that anti-smoking campaigns have been successfully changing teenagers' attitudes towards smoking. The important finding is that self-reported emotional symptoms had increased in females. This may indicate an increase or earlier onset of affective disorders.
To study the differences in children's psychiatric symptoms and child mental health service use at two time points: 1989 and 1999.
Two cross-sectional representative samples of 8- to 9-year-old children from southern Finland were compared. The 1989 sample consisted of 985 children, of whom 95% participated, and the 1999 sample consisted of 962 children, of whom 86% participated. Information was gathered from parents and teachers using Rutter's questionnaires and other related determinants of service use and from children using the Child Depression Inventory. The sampling, procedure, and methods were similar at both time points.
The overall rate of children's problems assessed by parents and teachers had not increased during the period 1989 to 1999. Boys had fewer psychiatric symptoms in 1999 than in 1989, whereas no clear change had occurred in girls' symptoms, except that, according to parents, girls in 1999 had more hyperactive symptoms. However, children themselves reported more depressive symptoms in the 1999 than in the 1989 sample. In 1989, 2.3% and in 1999, 5.3% of children had used child mental health services. The increase in service use among girls was fourfold. Parental evaluations of child psychopathology and teacher evaluations whether the child was psychologically healthy were the strongest determinants for referral at both time points. Parents preferred to seek help for their children's problems from teachers, school nurses, and school psychologists rather than from specialized child psychiatric services.
There has been an increase in mental health service use especially among girls as well as a convergence of symptom levels by gender. It is important to develop child psychiatric services that are as close to the child's living environment as possible to further reduce the threshold for seeking help and to promote early detection and intervention.
The present study examines the 10-year time-trend changes of adolescent psychiatric symptoms, smoking and alcohol use. Representative population-based samples with same methods at two time-points, same age range and with 10-year period between the time points were gathered in Finland to investigate secular changes in adolescents' emotional and behavioral problems. Seventh and ninth grade students filled in the Strengths and Difficulties Questionnaire (SDQ) and questions regarding alcohol use and smoking anonymously during a school lesson in 1998 (n = 1458) and 2008 (n = 1569). The self-reports of SDQ showed substantial stability in emotional and behavioral problems from 1998 to 2008. There was no increase between the two timepoints in self-reports of SDQ total, conduct, hyperactivity, emotional or peer problems when using the 90th percentile clinical cut-off points. However, there was a trend showing decreasing prosocial behavior among girls indicating that proportions of adolescent boys and girls having problems in prosocial behavior have converged, The self-reported alcohol use, drunkenness and cigarette smoking decreased within the 10-year time period. Of alcohol use, the number of non-users increased from 44 to 63 % between the years 1998 and 2008. Similarly, the proportion of non-smokers increased from 56 to 68 %. Although rates of substance use declined within the 10-year study period, drunkenness-oriented alcohol use and regular smoking are still prevalent among Finnish adolescents.
In a prospective population-based study, mothers and fathers of 1,247 children reported their physical and mental health during pregnancy, after delivery, within the child's first 18 months of life, and at 12 years. Additionally, maternal health clinic nurses rated parents' well-being and perceived need for support. At age 12, child outcomes were also measured using CBCL and YSR externalizing and internalizing scales. Results indicate that both ante- and postnatal maternal distress predicted future externalizing problems in offspring. Conversely, fathers' postnatal distress predicted subsequent internalizing problems. Furthermore, mother's depressed mood in the first trimester best predicted the child's externalizing problems at age 12. Nurses's ratings of mother's antenatal and perinatal need for support, perinatal distress, and family's need for support were associated with both internalizing and externalizing problems at age 12. Maternal antenatal distress increases the risk of offspring's externalizing problems in preadolescense, and postnatal distress in either parent increases the risk of internalizing problems. Parental self-reports and indirect ratings from health care providers during pregnancy and infancy may therefore reliably recognize offspring at risk for subsequent psychiatric symptomatology.
To study the associations between drunkenness frequency and adaptive functioning, psychopathology and service use among 18-year-old Finnish boys in a nation-wide population-based study.
Information about drunkenness frequency within the previous six months was collected from the Finnish boys born in 1981 (n = 2306) at the boys' obligatory military call-up in 1999. Self-report questionnaires were used to study demographic factors, adaptive functioning, risk behaviour, life events, and mental health service use. Psychopathology and adaptive functioning was assessed with the Young Adult Self-Report (YASR) questionnaire.
Of the boys, 85% reported drunkenness within the previous 6 months. Most of the subjects were occasionally drunk: 39% reported drunkenness less than a month, and 35% less than once a week, while 10% reported being frequently drunk once a week or more often. Occasional drunkenness was associated with better adaptive functioning and psychosocial well-being in general. Refraining from drunkenness was associated with suicidal ideation and internalizing problems in the YASR scale. Frequent drunkenness associated with daily smoking, illicit drug use, and externalizing problems in the YASR scale, especially delinquent behaviour. In the multivariate analysis, number of friends, having a regular relationship and cigarette smoking had a linear association with frequency of drunkenness, while drunkenness-related alcohol use was less common among those with poor friendship quality. Among the participants, entering substance use treatment was rare (0.2%). Frequent drunkenness was found to be common among mental health service users.
Among late-adolescent boys, occasional drunkenness is a normative alcohol use pattern and associates with social competence and good psychosocial functioning. Late-adolescent boys refraining from drunkenness in addition to those with frequent drunkenness may be in a need of mental health assessment. As entering substance use treatment is infrequent, establishing integrated services with multi-professional co-operation for late-adolescent males with frequent drunkenness is emphasized.
Bullying and being exposed to bullying among children is prevalent, especially among children with psychiatric symptoms, and constitutes a major concern worldwide. Whether childhood bullying or exposure to bullying in the absence of childhood psychiatric symptoms is associated with psychiatric outcomes in adulthood remains unclear.
To study the associations between bullying behavior at 8 years of age and adult psychiatric outcomes by 29 years of age.
Nationwide birth cohort study of 5034 Finnish children with complete information about childhood bullying behavior was followed up from 8 to 29 years of age. Follow-up was completed on December 31, 2009, and data were analyzed from January 15, 2013, to February 15, 2015.
Information about bullying, exposure to bullying, and psychiatric symptoms were obtained from parents, teachers, and child self-reports when children were 8 years of age. Use of specialized services for psychiatric disorders from 16 to 29 years of age was obtained from a nationwide hospital register, including outpatient and inpatient treatment.
Among the 5034 study participants, 4540 (90.2%) did not engage in bullying behavior; of these, 520 (11.5%) had received a psychiatric diagnosis at follow-up; 33 of 166 (19.9%) who engaged in frequent bullying, 58 of 251 (23.1%) frequently exposed to bullying, and 24 of 77 (31.2%) who both frequently engaged in and were frequently exposed to bullying had received psychiatric diagnoses at follow-up. When analyses were adjusted by sex, family factors, and child psychiatric symptoms at 8 years of age, we found independent associations of treatment of any psychiatric disorder with frequent exposure to bullying (hazard ratio [HR], 1.9; 95% CI, 1.4-2.5) and being a bully and exposed to bullying (HR, 2.1; 95% CI, 1.3-3.4). Exposure to bullying was specifically associated with depression (HR, 1.9; 95% CI, 1.2-2.9). Bullying was associated with psychiatric outcomes only in the presence of psychiatric problems at 8 years of age. Participants who were bullies and exposed to bullying at 8 years of age had a high risk for several psychiatric disorders requiring treatment in adulthood. However, the associations with specific psychiatric disorders did not remain significant after controlling for concurrent psychiatric symptoms.
Exposure to bullying, even in the absence of childhood psychiatric symptoms, is associated with severe adulthood psychiatric outcomes that require treatment in specialized services. Early intervention among those involved in bullying can prevent long-term consequences.
Adolescent males have a low rate of seeking help for mental health problems. The onset for many psychiatric disorders occur during the adolescence. Previous studies have identified previous help seeking, parental opinion, parental divorce and suicidal thoughts as factors associated with contacting mental health services. Yet studies on the rate of use of mental health services remain few, as do studies concerning factors associated with use of mental health services.
To study prevalence and risk factors of use of mental health services among Finnish adolescent males.
Factors associated with use of mental health services during the preceding 12 months were studied in a general population sample of 4309 men attending military call-up in 2009. The mean age was 18.3 ± 0.45 years.
Within the previous 12 months, 3.2% of men had used mental health services and an additional 2.3% had considered contacting mental health services. Factors associated with service use were living alone, having a poor paternal relationship, having no contact with father, death of father, high internalizing symptoms, suicidal thoughts, regular smoking and use of illicit drugs. Frequent drunkenness was associated with mental health service use, whereas occasional use of alcohol was inversely associated with use of mental health services.
The rate of mental health service use among males in late adolescence is very low. The inability of young people to contact service providers should be addressed more efficiently.
A majority of the troubled men did not contact professionals for help, although approximately a quarter of the men had a self-perceived mental health problem. A major challenge is to find ways for mental health services to be made more accessible to adolescent males.
The aim of this study was to study associations between sense of coherence (based on Antonovsky's theory), and mental health problems, the use of mental health services, substance use, predisposition to suicide and possible psychiatric diagnosis among Finnish young men. The study included 2314 18-year-old young men who attended military call-up in autumn 1999 and completed the 13-item Orientation to Life Questionnaire (SOC-13) questionnaire (89.1% of the study sample attending military call-up). Furthermore, all young men had a medical examination at military call-up, including evaluation of possible psychiatric disorder. Suicidality, perceived mental health problems, psychiatric diagnosis at military call-up medical examination, use of mental health services, excessive alcohol consumption and use of illicit drugs were identified as independent factors associated with sense of coherence. Sense of coherence is a valuable construction in psychiatric evaluation of adolescents. SOC-13 can be used both in clinical practice and in epidemiological research to evaluate the adolescent's health resources. Future research on its applications in clinical practice is warranted.
To study differences in children's psychiatric symptoms and child mental health service use at three time points: 1989, 1999, and 2005.
Three cross-sectional representative samples of 8-year-old children were compared from southern Finland. The sampling, procedure, and methods were similar at all three time points. Information was gathered from parents and teachers using Rutter questionnaires and other related determinants of service use and from children using the Children's Depression Inventory. The participation rate at the three time points was 96% in 1989, 86% in 1999, and 84% in 2005.
Overall, parent and teacher reports of children's problems did not show a significant increase during the 16-year period. Parent reports of boys' conduct symptoms decreased from 1989 to 1999. However, self-reported depressive symptoms among girls increased from 1989 to 2005. Low parental education level, broken family, and negative life events were associated with depressive symptoms among girls. Although 4% of boys and 1% of girls had used child mental health services in 1989, the respective figures in 2005 were 12% and 4%. The majority of children who were screen positive on either parent or teacher ratings of emotional and behavioral problems using Rutter scales had received some educational support from school in 2005.
Reports of depressive symptoms increased among girls, and this finding merits further studies. Use of services has continuously increased. School services play an important role in providing support and early detection of children who need to be referred to child mental health services.
To determine the effect of child-, parent- and family-related factors on the use of and need for mental health services by 12 years of age.
A prospective population-based questionnaire study of 1,287 first-born children was launched in Finland in 1985. The Child Behavior Checklist (CBCL) was completed by 1,086 parents when the children were aged 3 years. At the age of 12, the CBCL, the Youth Self-Report, and other potential determinants of service need and use were obtained from 908 parents and 900 children (80% response rate).
Of the total sample, 7.2% had used professional services, and 3.3% had needed services without obtaining them. Elevated scores on the age 3 CBCL Total Problems and Externalizing scale predicted independently later service use but not perceived need of services. In cross-sectional data at age 12, parental ratings of the child's problem behavior were associated with both the need for and use of services. Poor social competence and parental distress were independently associated with use of services.
Recognizing behavior problems in early childhood and evaluating family stress factors are important in social and health care systems designed for children.
Loneliness in childhood has a wide range of negative consequences for well-being and mental health later in life. This study reports time-trends in children's loneliness and the association between children's loneliness and psychiatric symptoms over a 24-year period.
Information on 3,749 eight-year-old Finnish-speaking children born in 1981, 1991, 1997, and 2004 was gathered at four time points from the area covered by Turku University Hospital in southwest Finland. The actual numbers of participants at these time points were 986 (1989), 891 (1999), 930 (2005), and 942 (2013), with participation rates of 86%-95%. The study design and methods were similar at every time point. Information on children's loneliness and friendships was obtained from the children and also parents and teachers evaluated how many friends children had and their psychiatric symptoms.
Approximately 20% of the children reported loneliness at each time point, 5% always felt lonely, and 25% wished they had more friends. Conduct and emotional problems, and hyperactivity were independently associated with loneliness in the multiple-regression analysis. The strength of these associations remained at similar levels over the 24-year study period. Living in a nonnuclear family, parents with a lower level of vocational education, and negative life events among the girls in the study were all associated with loneliness.
Loneliness was a common phenomenon in childhood, and no notable changes were found during the 24-year study period. Psychiatric symptoms were strongly associated with loneliness. It is important to pay attention to children's loneliness and make it an integral part of school health care. Further epidemiological research is needed.
To study early childhood predictors for early adulthood psychiatric disorders.
The sample included 2,712 Finnish boys born in 1981. Information about the 8-year-old boys' problem behavior was obtained from parents, teachers, and children. The 10-15-year follow-up information about psychiatric disorders in early adulthood was based on the national military register between the years 1999 and 2004.
According to the military register, 10.4% of men had a psychiatric disorder. All informant sources, parents, teachers, and the children themselves predicted early adulthood psychiatric disorders. Conduct symptoms at age 8 independently predicted substance abuse, antisocial personality, and psychotic disorders in early adulthood. Self-reported depressive symptoms, poor school performance, and living in a nonintact family had an independent predictive association with antisocial personality and depressive disorders. Parent-reported emotional symptoms and self-reported psychosomatic symptoms independently predicted anxiety disorders. About one third of those who had used services at age 8 had a psychiatric disorder in early adulthood. Among service users, conduct and hyperkinetic symptoms predicted psychiatric disorders in early adulthood.
Efforts to prevent early adult psychiatric disturbance already present in childhood are emphasized. Active screening to detect children in need of early interventions in childhood to prevent negative development in early adulthood is justified.
This national cross-sectional study investigates the prevalence rates, regional differences and factors associated with the involuntary inpatient treatment of adolescents in Finland on a chosen day in 2000. The proportion of inpatients with involuntary legal status was 29.5% (n=82) giving a prevalence rate of 2.5 per 10,000/12-17 years old inhabitants. Forty-eight per cent of involuntarily inpatients were 16-17 years old and 62% had psychotic disorders. Twenty-six per cent of inpatients with involuntary legal status were voluntarily admitted. Regional differences of involuntary treatment were rather modest. Psychotic disorders, suicidal acts, and substance use disorders were independently associated with involuntary legal status. There is a need for further studies to investigate the long-term effects of involuntary treatment on the adolescents' subsequent well-being. Further studies on alternatives methods for involuntary treatment are warranted, likewise the clinical guidelines for involuntary treatment practices.
The present population-based, case-control study examines associations between specific parental psychiatric disorders and autism spectrum disorders (ASD) including childhood autism, Asperger's syndrome and pervasive developmental disorder (PDD-NOS). The cohort includes 4713 children born between 1987 and 2005 with diagnoses of childhood autism, Asperger's syndrome or PDD-NOS. Cases were ascertained from the Finnish Hospital Discharge Register, and each was matched to four controls by gender, date of birth, place of birth, and residence in Finland. Controls were selected from the Finnish Medical Birth Register. Parents were identified through the Finnish Medical Birth Register and Finnish Central Population Register. Parental psychiatric diagnoses from inpatient care were collected from the Finnish Hospital Discharge Register. Conditional logistic regression models were used to assess whether parents' psychiatric disorders predicted ASD after controlling for parents' age, smoking during pregnancy and weight for gestational age. In summary, parental schizophrenia spectrum disorders and affective disorders were associated with the risk of ASD regardless of the subgroup. PDD-NOS was associated with all parental psychiatric disorders investigated. Further studies are needed to replicate these findings. These results may facilitate the investigation of shared genetic and familial factors between ASD and other psychiatric disorders.
Cites: Autism Res. 2011 Apr;4(2):143-821480539
Cites: J Autism Dev Disord. 2011 Aug;41(8):1090-621082229
Cites: Arch Gen Psychiatry. 2011 Nov;68(11):1104-1221727247
Cites: Arch Gen Psychiatry. 2011 Nov;68(11):1095-10221727249
Most studies on the diagnostic patterns of usage of specialized services for childhood psychiatric and neurodevelopmental disorders have been cross-sectional, and the aim of this study was to provide longitudinal data.
The Medical Birth Register and the Finnish Hospital Discharge Register were used to study the use of inpatient or public outpatient specialized services for psychiatric and neurodevelopmental disorders between birth and age 14 in 2010 (cumulative incidence) and in year 2010 at age 14 (one-year prevalence) among Finnish children born in 1996 (N=58,538 singleton live births).
The cumulative incidence of specialized service use for any psychiatric or neurodevelopmental disorders between birth and age 14 was 12.9%, and the one-year prevalence in 2010 at 14 years was 4.2%. The cumulative incidence by age 14 was 5.5% for learning and coordination disorders, 2.2% for anxiety disorders, 2.0% for hyperkinetic disorders, 1.7% for conduct disorders, 1.4% for depression, 1.0% for autism spectrum disorders, and .7% for stress and adjustment disorders. Learning and coordination, hyperkinetic, and autism spectrum disorders were more prevalent among boys, were often diagnosed before school age, and had 9%-51% lifetime comorbidity with each other. Depressive, anxiety, and stress and adjustment disorders had similar distributions between the sexes, were often diagnosed in early adolescence, and showed 8%-31% lifetime comorbidity with each other.
Every eighth Finnish child had visited specialized services for psychiatric or neurodevelopmental disorders sometime between birth and age 14. Learning and coordination disorders were diagnosed more than twice as often as anxiety, hyperkinetic, and conduct disorders.
To study the associations between psychiatric disorders and self-perceived problems among adolescent boys.
The study population consisted of 2348 Finnish boys born during 1981 attending obligatory military call-up (79.7% of the original sample). At military call-up in 1999, the boys filled in the Young Adult Self-Report (YASR) and Orientation of Life Questionnaire (SOC-13). Information about psychiatric disorders was obtained from the national military register during the years 1999-2004.
Most of the psychopathology, adaptive functioning and SOC scales were associated with a variety of psychiatric disorders at follow-up. However, when the effects of scales were controlled in multivariate analysis, only YASR somatic problems and SOC-13 showed an independent association with a wide range of psychiatric disorders at follow-up. Poor SOC-13 predicted anxiety, depression, antisocial personality and substance use disorders. The YASR somatic problems scale predicted anxiety, depression, substance use, psychotic, and adjustment disorders. Self-reported delinquency and poor competence at school predicted substance use and antisocial personality disorders.
Self-reports of poor sense of coherence and somatic complaints have a non-specific association with a wide range of psychiatric disorders. Clinical and theoretical implications of these findings are discussed.
This study is focused on psychosocial correlates of youth crime in a sample of 2330 Finnish boys born in 1981. Two kinds of data were combined: questionnaires completed by the boys at call-up in 1999 and crime registered in the Finnish National Police Register between 1998 and 2001. One-fifth of the boys were registered to offending during the 4-year period in late adolescence; 14% were registered for one or two offences, 4% for three to five offences, and 3% for more than five offences. Crime accumulated heavily in those with more than five offences, as they accounted for 68% of all crime. Independent correlates of crime were living in a small community, parents' low educational level and divorce, having a regular relationship, self-reported delinquency, daily smoking, and weekly drunkenness, whereas anxious-depressiveness was reversely associated with crime. Most psychosocial problems covaried linearly with offending frequency, being particularly manifested by multiple recidivists. However, recidivists had very rarely used mental health services. The results indicate that offending and various psychosocial problems accumulate in a small minority of boys not reached by mental health services.
To our knowledge, no population study examining psychosocial and psychiatric risk factors associated with cyberbullying among adolescents exists.
To study cross-sectional associations between cyberbullying and psychiatric and psychosomatic problems among adolescents.
Population-based cross-sectional study.
The sample consists of 2215 Finnish adolescents aged 13 to 16 years with complete information about cyberbullying and cybervictimization.
Self-reports of cyberbullying and cybervictimization during the past 6 months.
In the total sample, 4.8% were cybervictims only, 7.4% were cyberbullies only, and 5.4% were cyberbully-victims. Cybervictim-only status was associated with living in a family with other than 2 biological parents, perceived difficulties, emotional and peer problems, headache, recurrent abdominal pain, sleeping difficulties, and not feeling safe at school. Cyberbully-only status was associated with perceived difficulties, hyperactivity, conduct problems, low prosocial behavior, frequent smoking and drunkenness, headache, and not feeling safe at school. Cyberbully-victim status was associated with all of these risk factors. Among cybervictims, being cyberbullied by a same-sex or opposite-sex adult, by an unknown person, and by a group of people were associated with fear for safety, indicating possible trauma.
Both cyberbullying and cybervictimization are associated with psychiatric and psychosomatic problems. The most troubled are those who are both cyberbullies and cybervictims. This indicates the need for new strategies for cyberbullying prevention and intervention.