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Rissanen E, Kuvaja-Köllner V, Elonheimo H, Sillanmäki L, Sourander A, Kankaanpää E. The long-term cost of childhood conduct problems: Finnish Nationwide 1981 Birth Cohort Study. J Child Psychol Psychiatry 2022; 63:683-692. [PMID: 34402045 DOI: 10.1111/jcpp.13506] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Commonly recognized childhood conduct problems often lead to costly problems in adulthood. This study aimed to evaluate the long-term cumulative cost of childhood conduct problems until the age of 30. The costs included inpatient care, nervous system medicine purchases, and criminal offences. METHODS The study used population-based nationwide 1981 birth cohort data. Families and teachers assessed the conduct problems of the eight-year-olds based on Rutter questionnaires. We grouped 5,011 children into low-level of conduct problems (52%), intermediate-level of conduct problems (37%), and high-level of conduct problems (11%) groups, based on combined conduct symptoms scores. The analysis included the cohort data with the Care Register for Health Care, the Drug Prescription Register, and the Finnish Police Register. The cost valuation of service use applied national unit costs in 2016 prices. We used Wilcoxon rank-sum test to test the differences between groups and gender. RESULTS During 1989-2011, average cumulative costs of the high-level (€44,348, p < .001) and the intermediate-level (€19,405, p < .001) of conduct problems groups were higher than the low-level of conduct problems group's (€10,547) costs. In all three groups, the boys' costs were higher than girls' costs. CONCLUSIONS The costs associated with conduct problems in childhood are substantial, showing a clear need for cost-effective interventions. Implementation decisions of interventions benefit from long-term cost-effectiveness modelling studies. Costing studies, like this, provide cost and cost offset information for modelling studies.
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Affiliation(s)
- Elisa Rissanen
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Virpi Kuvaja-Köllner
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | | | - Lauri Sillanmäki
- Research Centre for Child Psychiatry, Department of Child Psychiatry, University of Turku, Turku, Finland.,Turku University Hospital, Turku, Finland.,INVEST Research Flagship Center, University of Turku, Turku, Finland
| | - André Sourander
- Research Centre for Child Psychiatry, Department of Child Psychiatry, University of Turku, Turku, Finland
| | - Eila Kankaanpää
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
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di Giacomo E, Pessina R, Santorelli M, Rucco D, Placenti V, Aliberti F, Colmegna F, Clerici M. Therapeutic termination of pregnancy and women's mental health: Determinants and consequences. World J Psychiatry 2021; 11:937-953. [PMID: 34888166 PMCID: PMC8613757 DOI: 10.5498/wjp.v11.i11.937] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 07/27/2021] [Accepted: 09/14/2021] [Indexed: 02/06/2023] Open
Abstract
The therapeutic termination of pregnancy (TToP) is an induced abortion following a diagnosis of medical necessity. TToP is applied to avoid the risk of substantial harm to the mother or in cases of fetal unviability. This type of induced abortion is provided after the second semester of gestation if fetal illness or the pregnancy cause physical danger or pathological mental distress to the mother. Socio-cultural and economic determinants could influence the desire for children and family planning in couples, as well as the use of effective contraception and the choice to perform an induced abortion. Also, pre-existing mental health problems could affect the decision between carrying on a problematic pregnancy or having TToP. Furthermore, the TToP is a reproductive event with an important traumatic burden, but also with an intrinsic therapeutic effect and it can produce different psychological and psychopathological effects on women and couples. The aim of this review is to evaluate what demographic, reproductive and psychopathological determinants are involved in the choice of undergoing a TToP in women. Also, we will examine both positive and negative consequences of this procedure on women's mental health, underlying which factors are related to a worse outcome in order to provide the best clinical support to vulnerable groups.
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Affiliation(s)
- Ester di Giacomo
- School of Medicine and Surgery, University Milan Bicocca, Monza 20900, Lombardy, Italy
- Department of Psychiatric, ASST Monza, Monza 20900, Lombardy, Italy
| | - Rodolfo Pessina
- Psychiatric Residency Training Program, University Milan Bicocca, Monza 20900, Lombardy, Italy
| | - Mario Santorelli
- Psychiatric Residency Training Program, University Milan Bicocca, Monza 20900, Lombardy, Italy
| | - Daniele Rucco
- PhD Program in Psychology, Linguistics and Cognitive Neuroscience, University Milan Bicocca, Milano 20126, Lombardy, Italy
| | - Valeria Placenti
- Psychiatric Residency Training Program, University of Genova, Genova 16126, Liguria, Italy
| | - Francesca Aliberti
- Psychiatric Residency Training Program, University Milan Bicocca, Monza 20900, Lombardy, Italy
| | | | - Massimo Clerici
- School of Medicine and Surgery, University Milan Bicocca, Monza 20900, Lombardy, Italy
- Department of Psychiatric, ASST Monza, Monza 20900, Lombardy, Italy
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Liu N, Farrugia MM, Vigod SN, Urquia ML, Ray JG. Intergenerational abortion tendency between mothers and teenage daughters: a population-based cohort study. CMAJ 2019; 190:E95-E102. [PMID: 29378869 DOI: 10.1503/cmaj.170595] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND A teenage woman's sexual health practices may be influenced by her mother's experience. We evaluated whether there is an intergenerational tendency for induced abortion between mothers and their teenage daughters. METHODS We conducted a retrospective population-based cohort study involving daughters born in Ontario between 1992 and 1999. We evaluated the daughters' data for induced abortions between age 12 years and their 20th birthday. We assessed each mother's history of induced abortion for the period from 4 years before her daughter's birth to 12 years after (i.e., when her daughter turned 12 years of age). We used Cox proportional hazard models to estimate a daughter's risk of having an induced abortion in relation to the mother's history of the same procedure. We adjusted hazard ratios (HRs) for maternal age and world region of origin, mental or physical health problems in the daughter, mother- daughter cohabitation, neighbourhood-level rate of teen induced abortion, rural or urban residence, and income quintile. RESULTS A total of 431 623 daughters were included in the analysis. The cumulative probability of teen induced abortion was 10.1% (95% confidence interval [CI] 9.8%-10.4%) among daughters whose mother had an induced abortion, and 4.2% (95% CI 4.1%-4.3%) among daughters whose mother had no induced abortion, for an adjusted HR of 1.94 (95% CI 1.86-2.01). The adjusted HR of a teenaged daughter having an induced abortion in relation to number of maternal induced abortions was 1.77 (95% CI 1.69-1.85) with 1 maternal abortion, 2.04 (95% CI 1.91-2.18) with 2 maternal abortions, 2.39 (95% CI 2.19-2.62) with 3 maternal abortions and 2.54 (95% CI 2.33-2.77) with 4 or more maternal abortions, relative to none. INTERPRETATION We found that the risk of teen induced abortion was higher among daughters whose mother had had an induced abortion. Future research should explore the mechanisms for intergenerational induced abortion.
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Affiliation(s)
- Ning Liu
- Institute of Health Policy, Management and Evaluation (Liu, Ray), Department of Obstetrics and Gynaecology (Farrugia), Department of Psychiatry (Vigod) and Dalla Lana School of Public Health (Urquia), University of Toronto; Institute for Clinical Evaluative Sciences (Liu, Vigod, Ray); Mount Sinai Hospital (Farrugia); Women's College Hospital (Vigod); Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute (Urquia), Department of Medicine (Ray), St. Michael's Hospital, Toronto, Ont.; Manitoba Centre for Health Policy (Urquia), Department of Community Health Sciences, University of Manitoba, Winnipeg, Man
| | - M Michèle Farrugia
- Institute of Health Policy, Management and Evaluation (Liu, Ray), Department of Obstetrics and Gynaecology (Farrugia), Department of Psychiatry (Vigod) and Dalla Lana School of Public Health (Urquia), University of Toronto; Institute for Clinical Evaluative Sciences (Liu, Vigod, Ray); Mount Sinai Hospital (Farrugia); Women's College Hospital (Vigod); Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute (Urquia), Department of Medicine (Ray), St. Michael's Hospital, Toronto, Ont.; Manitoba Centre for Health Policy (Urquia), Department of Community Health Sciences, University of Manitoba, Winnipeg, Man
| | - Simone N Vigod
- Institute of Health Policy, Management and Evaluation (Liu, Ray), Department of Obstetrics and Gynaecology (Farrugia), Department of Psychiatry (Vigod) and Dalla Lana School of Public Health (Urquia), University of Toronto; Institute for Clinical Evaluative Sciences (Liu, Vigod, Ray); Mount Sinai Hospital (Farrugia); Women's College Hospital (Vigod); Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute (Urquia), Department of Medicine (Ray), St. Michael's Hospital, Toronto, Ont.; Manitoba Centre for Health Policy (Urquia), Department of Community Health Sciences, University of Manitoba, Winnipeg, Man
| | - Marcelo L Urquia
- Institute of Health Policy, Management and Evaluation (Liu, Ray), Department of Obstetrics and Gynaecology (Farrugia), Department of Psychiatry (Vigod) and Dalla Lana School of Public Health (Urquia), University of Toronto; Institute for Clinical Evaluative Sciences (Liu, Vigod, Ray); Mount Sinai Hospital (Farrugia); Women's College Hospital (Vigod); Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute (Urquia), Department of Medicine (Ray), St. Michael's Hospital, Toronto, Ont.; Manitoba Centre for Health Policy (Urquia), Department of Community Health Sciences, University of Manitoba, Winnipeg, Man
| | - Joel G Ray
- Institute of Health Policy, Management and Evaluation (Liu, Ray), Department of Obstetrics and Gynaecology (Farrugia), Department of Psychiatry (Vigod) and Dalla Lana School of Public Health (Urquia), University of Toronto; Institute for Clinical Evaluative Sciences (Liu, Vigod, Ray); Mount Sinai Hospital (Farrugia); Women's College Hospital (Vigod); Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute (Urquia), Department of Medicine (Ray), St. Michael's Hospital, Toronto, Ont.; Manitoba Centre for Health Policy (Urquia), Department of Community Health Sciences, University of Manitoba, Winnipeg, Man.
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Jalanko E, Leppälahti S, Heikinheimo O, Gissler M. Increased risk of premature death following teenage abortion and childbirth-a longitudinal cohort study. Eur J Public Health 2018; 27:845-849. [PMID: 28510640 DOI: 10.1093/eurpub/ckx065] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Teenage pregnancy is associated with an increased risk of premature death. However, it is not known whether the outcome of pregnancy, i.e. induced abortion or childbirth, affects this risk. Methods A Finnish population-based register study involving a cohort of 13 691 nulliparous teenagers who conceived in 1987-89; 6652 of them underwent induced abortion and 7039 delivered. The control group consisted of 41 012 coeval women without teenage pregnancy. Follow-up started at the end of pregnancy and lasted until 6th June 2013. Results Women with teenage pregnancy had a higher risk of overall mortality vs. controls (mortality rate ratio [MRR] 1.6, [95% CI 1.4-1.8]) and were more likely to die prematurely as a result of suicide, alcohol-related causes, circulatory diseases and motor vehicle accidents. A low educational level appeared to explain these excess risks, except for suicide (adj. MRR 1.5, [95% CI 1.1-2.0]). After adjusting for confounders, the childbirth group faced lower risks of suicide (adj. MRR 0.5, [95% CI 0.3-0.9]) and dying from injury and poisoning (adj. MRR 0.6, [95% CI 0.4-0.8]) compared with women who had undergone abortion. Conclusions A low educational level is associated with the increased risk of premature death among women with a history of teenage pregnancy, except for suicide. Extra efforts should be made to encourage pregnant teenagers to continue education, and to provide psychosocial support to teenagers who undergo induced abortion.
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Affiliation(s)
- Eerika Jalanko
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Suvi Leppälahti
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Oskari Heikinheimo
- Department of Obstetrics and Gynaecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mika Gissler
- THL, National Institute for Health and Welfare, Helsinki, Finland, Research Centre for Child Psychiatry, University of Turku, Turku, Finland, and Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Stockholm, Sweden
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Leppälahti S, Heikinheimo O, Paananen R, Santalahti P, Merikukka M, Gissler M. Determinants of underage induced abortion--the 1987 Finnish Birth Cohort study. Acta Obstet Gynecol Scand 2016; 95:572-9. [PMID: 26915819 DOI: 10.1111/aogs.12879] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 02/09/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Although underage pregnancies often end in induced abortion, data on girls who undergo termination of pregnancy are lacking. Our aim was to identify determinants of underage induced abortion and compare them with those of childbirth. MATERIAL AND METHODS All girls born in 1987 in Finland surviving the perinatal period (n = 29 041) were included in the study and divided into three study groups: Girls undergoing induced abortion (n = 1041, 3.6%) or childbirth (n = 395, 1.4%) at <18 years of age and girls with no underage pregnancies (n = 27 605, 95.0%). RESULTS Shared risk factors of underage induced abortion and childbirth included early onset behavioral and emotional disorders [adjusted OR 1.9 (1.4-2.5) and 2.7 (95% CI 1.8-3.9)], a history of foster care [1.5 [1.1-1.9] and 3.0 [2.3-4.1)], and socioeconomic factors, including living in a family receiving income support [1.8 (1.5-2.1) and 3.4 (2.7-4.4)], respectively. Specific risk factors of underage induced abortion were psychoactive substance use disorders [2.2 (1.3-3.5)], having a mother who smoked during pregnancy [1.5 (1.3-1.8)] or had undergone induced abortion [1.8 (1.5-2.2)]. Coping with a chronic physical illness [0.7 (0.5-0.9)], and perinatal problems [0.6 (0.4-0.7)] were inversely associated with underage induced abortion. CONCLUSIONS The traditionally acknowledged determinants of underage childbirth played a less prominent role in induced abortion. Novel risk factors of underage induced abortion were found, including severe substance abuse and adverse maternal reproductive history, and should be addressed at all levels offering youth healthcare and social welfare services.
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Affiliation(s)
- Suvi Leppälahti
- Department of Obstetrics and Gynecology, University of Helsinki and Kätilöopisto Hospital, Helsinki University Central Hospital, Helsinki, Finland
| | - Oskari Heikinheimo
- Department of Obstetrics and Gynecology, University of Helsinki and Kätilöopisto Hospital, Helsinki University Central Hospital, Helsinki, Finland
| | - Reija Paananen
- THL, National Institute for Health and Welfare, Oulu, Finland
| | - Päivi Santalahti
- THL, National Institute for Health and Welfare, Helsinki, Finland
| | - Marko Merikukka
- THL, National Institute for Health and Welfare, Oulu, Finland
| | - Mika Gissler
- THL, National Institute for Health and Welfare, Helsinki, Finland
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Lehti V, Gissler M, Suvisaari J, Manninen M. Induced abortions and birth outcomes of women with a history of severe psychosocial problems in adolescence. Eur Psychiatry 2015; 30:750-5. [PMID: 26117381 DOI: 10.1016/j.eurpsy.2015.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 05/28/2015] [Accepted: 05/29/2015] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To increase knowledge on the reproductive health of women who have been placed in a residential school, a child welfare facility for adolescents with severe psychosocial problems. METHODS All women (n=291) who lived in the Finnish residential schools on the last day of the years 1991, 1996, 2001 and 2006 were included in this study and compared with matched general population controls. Register-based information on induced abortions and births was collected until the end of the year 2011. RESULTS Compared to controls, women with a residential school history had more induced abortions. A higher proportion of their births took place when they were teenagers or even minors. They were more often single, smoked significantly more during pregnancy and had a higher risk of having a preterm birth or a baby with a low birth weight. CONCLUSIONS The findings have implications for the planning of preventive and supportive interventions that aim to increase the well-being of women with a residential school history and their offspring.
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Affiliation(s)
- V Lehti
- Department of Psychiatry, Helsinki University Central Hospital, P.O. Box 442, 00029 HUS, Finland.
| | - M Gissler
- National Institute for Health and Welfare (THL), Department of Information Services, P.O. Box 30, 00271 Helsinki, Finland; Nordic School of Public Health, Gothenburg, Sweden
| | - J Suvisaari
- National Institute for Health and Welfare (THL), Mental Health Unit, P.O. Box 30, 00271 Helsinki, Finland
| | - M Manninen
- National Institute for Health and Welfare (THL), Mental Health Unit, P.O. Box 30, 00271 Helsinki, Finland
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