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Ringbom I, Suvisaari J, Sourander A, Gissler M, Gyllenberg D. Temporal changes in the associations between diagnosed psychiatric disorders and dropping out of school early. Eur Child Adolesc Psychiatry 2024; 33:1443-1450. [PMID: 37380876 PMCID: PMC11098921 DOI: 10.1007/s00787-023-02252-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/21/2023] [Indexed: 06/30/2023]
Abstract
Psychiatric problems are risk markers for poor educational attainment. The number of adolescents receiving treatment has increased. We investigated whether the association between psychiatric problems in early adolescence and dropping out of school had changed. We used the register-based 1987 and 1997 Finnish Birth Cohort studies, which include all live births in Finland. Hospital districts with incomplete records were excluded, leaving 25,421 participants born in 1987 and 32,025 born in 1997. The main outcome was not having applied for secondary education by the year the cohort members turned 18. Our main predictors were psychiatric and neurodevelopmental disorders diagnosed by specialized services during 1998-2003 and 2008-2013, when the cohort members were 10-16 years old. We found that 511 (2.0) of subjects born in 1987 and 499 (1.6%) born in 1997 dropped out of school. Having any diagnosis at 10-16 of age was associated with dropping out of school early in both cohorts: 3.9% in 1987 and 4.8% in 1997. The highest proportions were in the subgroup with autism spectrum disorders (ASD), 19.4% in 1987 and 16.2% in 1997. Dropping out early increased among adolescents diagnosed with any psychiatric or neurodevelopmental disorder, from 3.9 to 4.8%, with the clearest increase for learning disabilities, from 3.4 to 9.0%. Dropping out decreased for those with depression, from 4.5 to 2.1%. Adolescents with psychiatric and especially neurodevelopmental disorders, need effective interventions to prevent them dropping out of school early. Increased detection of psychopathology did not result in decreased dropout rates.
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Affiliation(s)
- Ida Ringbom
- Department of Child Psychiatry and Invest Flagship, University of Turku, Lemminkäisenkatu 3, 3rd. Floor, 20014, Turku, Finland.
- Finnish Institute for Health and Welfare, Helsinki, Finland.
- Department of Adolescent Psychiatry, Helsinki University Hospital, Helsinki, Finland.
| | | | - Andre Sourander
- Department of Child Psychiatry and Invest Flagship, University of Turku, Lemminkäisenkatu 3, 3rd. Floor, 20014, Turku, Finland
- Department of Child Psychiatry, Turku University Central Hospital, Turku, Finland
| | - Mika Gissler
- Department of Child Psychiatry and Invest Flagship, University of Turku, Lemminkäisenkatu 3, 3rd. Floor, 20014, Turku, Finland
- Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Molecular Medicine and Surgery, Sweden and Region Stockholm, Academic Primary Health Care Centre, Karolinska Institute, Stockholm, Sweden
| | - David Gyllenberg
- Department of Child Psychiatry and Invest Flagship, University of Turku, Lemminkäisenkatu 3, 3rd. Floor, 20014, Turku, Finland
- Finnish Institute for Health and Welfare, Helsinki, Finland
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Pitkänen J, Remes H, Aaltonen M, Martikainen P. Socioeconomic differences in psychiatric treatment before and after self-harm: an observational study of 4,280 adolescents and young adults. BMC Psychiatry 2022; 22:14. [PMID: 34986806 PMCID: PMC8728977 DOI: 10.1186/s12888-021-03654-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/13/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Individuals in higher socioeconomic positions tend to utilise more mental health care, especially specialist services, than those in lower positions. Whether these disparities in treatment exist among adolescents and young adults who self-harm is currently unknown. METHODS The study is based on Finnish administrative register data on all individuals born 1986-1994. Adolescents and young adults with an episode of self-harm treated in specialised healthcare at ages 16-21 in 2002-2015 (n=4280, 64% female) were identified and followed 2 years before and after the episode. Probabilities of specialised psychiatric inpatient admissions and outpatient visits and purchases of psychotropic medication at different time points relative to self-harm were estimated using generalised estimation equations, multinomial models and cumulative averages. Socioeconomic differences were assessed based on parental education, controlling for income. RESULTS An educational gradient in specialised treatment and prescription medication was observed, with the highest probabilities of treatment among the adolescents and young adults with the highest educated parents and lowest probabilities among those whose parents had basic education. These differences emerged mostly after self-harm. The probability to not receive any treatment, either in specialised healthcare or psychotropic medication, was highest among youth whose parents had a basic level of education (before self-harm 0.39, 95% CI 0.34-0.43, and after 0.29, 95% CI 0.25-0.33 after) and lowest among youth with higher tertiary educated parents (before self-harm: 0.22, 95% CI 0.18-0.26, and after 0.18, 95% CI 0.14-0.22). The largest differences were observed in inpatient care. CONCLUSIONS The results suggest that specialised psychiatric care and psychotropic medication use are common among youth who self-harm, but a considerable proportion have no prior or subsequent specialised treatment. The children of parents with lower levels of education are likely to benefit from additional support in initiating and adhering to treatment after an episode of self-harm. Further research on the mechanisms underlying the educational gradient in psychiatric treatment is needed.
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Affiliation(s)
- Joonas Pitkänen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, P.O. Box 18, FIN-00014, Helsinki, Finland. .,International Max Planck Research School for Population, Health and Data Science, Rostock, Germany.
| | - Hanna Remes
- grid.7737.40000 0004 0410 2071Population Research Unit, Faculty of Social Sciences, University of Helsinki, P.O. Box 18, FIN-00014 Helsinki, Finland
| | - Mikko Aaltonen
- grid.7737.40000 0004 0410 2071Institute of Criminology and Legal Policy, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland ,grid.9668.10000 0001 0726 2490Law School, University of Eastern Finland, Joensuu, Finland
| | - Pekka Martikainen
- grid.7737.40000 0004 0410 2071Population Research Unit, Faculty of Social Sciences, University of Helsinki, P.O. Box 18, FIN-00014 Helsinki, Finland ,grid.419511.90000 0001 2033 8007Max Planck Institute for Demographic Research, Rostock, Germany ,grid.10548.380000 0004 1936 9377Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
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Kronström K, Tiiri E, Vuori M, Ellilä H, Kaljonen A, Sourander A. Multi-center nationwide study on pediatric psychiatric inpatients 2000-2018: length of stay, recurrent hospitalization, functioning level, suicidality, violence and diagnostic profiles. Eur Child Adolesc Psychiatry 2021; 32:835-846. [PMID: 34807298 PMCID: PMC10147780 DOI: 10.1007/s00787-021-01898-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 10/14/2021] [Indexed: 01/01/2023]
Abstract
Inpatient treatment is an important part of child and adolescent psychiatric (CAP) care. This nationwide study explores the changes in length of stay, recurrent hospitalization, functioning level, suicidality, violence and diagnoses of CAP inpatients in Finland in 2000, 2011 and 2018. We obtained comprehensive questionnaire data on each study year from 93 to 95% of all CAP wards in Finland. We split the 1276 inpatients into two age groups in each study year: under 13 and 13-18. The median length of stay in inpatient treatment decreased from 82.0 days in 2000 to 20.5 days in 2018 (p < 0.001) and recurrent hospitalization increased from 38 to 46%. General functioning, which was evaluated by the Children's Global Assessment Scale, deteriorated by an average of six points between 2000 and 2018. Violent threats decreased from 21.5 to 16.6% and violent acts decreased from 26.9 to 20.3%. Suicidal threats decreased from 42.6 to 23.3% in those aged under 13 and remained stable among those aged 13-18. In the 13-18 group, there was an increase in the diagnoses of ADHD, from 5.0 to 16.9% and depression, from 25.1 to 41.7%. However, psychosis decreased from 23.2 to 12.6% in the older age group. In the whole cohort, anxiety disorders increased from 7.6 to 15.6%. The overall picture does not show that CAP inpatients have become more disturbed. While the general functioning of CAP inpatients deteriorated somewhat over the 2000-2018 study period, symptoms of suicidality and violence remained stable or decreased. There was also a continuous increase in short-term treatment.
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Affiliation(s)
- Kim Kronström
- Department of Adolescent Psychiatry, Turku University Hospital, Hospital District of Southwest Finland, Turku, Finland.,Research Centre for Child Psychiatry, University of Turku, Turku, Finland
| | - Elina Tiiri
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland.,Department of Child Psychiatry, Turku University Hospital, Hospital District of Southwest Finland, Turku, Finland
| | - Miika Vuori
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
| | - Heikki Ellilä
- Master School, Faculty of Health and Wellbeing, Turku University of Applied Sciences, Turku, Finland
| | - Anne Kaljonen
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
| | - Andre Sourander
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland. .,Department of Child Psychiatry, Turku University Hospital, Hospital District of Southwest Finland, Turku, Finland.
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Abstract
The northern provinces of Finland are mostly not densely populated, with long distances to healthcare services. This creates a challenge for how to reach all children and adolescents with mental health services. In order to assess the effectiveness of school-based mental health promotion interventions, it is essential to understand the views of school professionals on student well-being and mental health promotion activity in schools. This study was carried out in urban area comprehensive schools where psychiatric nurses delivered additional mental health promotion interventions. The data were collected using a questionnaire, and a mixed-methods approach was utilised in the analysis. School professionals perceived that students are more unwell than before; they exhibit a general disregard for their well-being and more mental health problems. The respondents regarded the promotion of students’ mental health as a basic function of schools. Teachers need adequate support with this work.
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Affiliation(s)
- Anna Onnela
- PEDEGO Research Unit, Child Psychiatry, University of Oulu , Finland
| | - Tuula Hurtig
- PEDEGO Research Unit, Child Psychiatry, University of Oulu , Finland.,Clinic of Child Psychiatry, Oulu University Hospital , Finland.,Research Unit of Clinical Neuroscience, Psychiatry , University of Oulu, Finland
| | - Hanna Ebeling
- PEDEGO Research Unit, Child Psychiatry, University of Oulu , Finland.,Clinic of Child Psychiatry, Oulu University Hospital , Finland
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Kronström K, Multimäki P, Ristkari T, Parkkola K, Sillanmäki L, Sourander A. Ten-year changes in the psychosocial well-being, psychopathology, substance use, suicidality, bullying, and sense of coherence of 18-year-old males: a Finnish population-based time-trend study. Eur Child Adolesc Psychiatry 2021; 30:313-325. [PMID: 32232581 PMCID: PMC7932936 DOI: 10.1007/s00787-020-01517-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 03/16/2020] [Indexed: 11/28/2022]
Abstract
We studied Finnish 18-year-old males attending obligatory military call-up assessments in 1999 (n = 2340) and 2009 (n = 4309) on time-trend changes in psychosocial well-being, psychopathology, substance use, suicidality, bullying, and sense of coherence. Subjects filled in questionnaires, including the Young Adult Self-Report (YASR) for psychopathology and the Orientation to Life Questionnaire (SOC-13) for sense of coherence. The prevalence of minor mental health problems in the last 6 months decreased from 22.3% in 1999 to 18.6% in 2009 (OR 0.8, 95% CI 0.7-0.9), whereas severe mental health problems remained stable. Suicidal thoughts decreased from 5.7 to 3.7% (OR 0.6, 95% CI 0.5-0.8). The use of illicit drugs decreased from 6.0 to 4.7% (OR 0.8, 95% CI 0.6-0.95), but being drunk at least once a week increased from 10.3 to 13.4% (OR 1.3, 95% CI 1.0-1.5). Attention problems increased in YASR syndrome domains (mean score 2.9 vs 3.2, p < 0.001) and so did somatic complains (mean score 1.7 vs 1.9, p = 0.005). The SOC-13 scores remained stable. The percentage of males who had studied during the past 6 months increased from 91.4 to 93.4% (OR 1.3, 95% CI 1.1-1.6), while being employed decreased from 64.9 to 49.4% (OR 0.5, 95% CI 0.5-0.6). The positive findings included reductions in the prevalence of suicidal thoughts and the use of illicit drugs, but being drunk at least once a week increased. Self-reported somatic problems and attention problems increased. Despite changes in society and family structures, there were only minor overall changes in psychopathology.
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Affiliation(s)
- Kim Kronström
- Department of Adolescent Psychiatry, Turku University Hospital, Hospital District of Southwest Finland, Turku, Finland
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
| | - Petteri Multimäki
- Department of Adolescent Psychiatry, Turku University Hospital, Hospital District of Southwest Finland, Turku, Finland
| | - Terja Ristkari
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
| | | | - Lauri Sillanmäki
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
| | - Andre Sourander
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland.
- Department of Child Psychiatry, Turku University Hospital, Hospital District of Southwest Finland, Turku, Finland.
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Kakko K, Pihlakoski L, Keskinen P, Salmelin R, Puura K. Current follow-up practices often fail to detect metabolic and neurological adverse reactions in children treated with second-generation antipsychotics. Acta Paediatr 2020; 109:342-348. [PMID: 31359492 DOI: 10.1111/apa.14951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 06/10/2019] [Accepted: 07/24/2019] [Indexed: 11/30/2022]
Abstract
AIM This study examined the use and adverse reactions of second-generation antipsychotics (SGAs), alone or combined with other psychotropic medication, to identify areas for standardising prescribing and monitoring practices. METHODS We conducted a retrospective study at Tampere University Hospital, Finland, involving 128 patients (81% boys) who were under 13 years old at SGA initiation and had SGA treatment between October 2013 and October 2014. RESULTS The median age at baseline was 9.4 years. Weight gain was reported as an adverse reaction in 33%, but an increase in standardised body mass index, adjusted for age and sex (BMI z-score), was detected in 75% of patients with sufficient data. The statistically significant median changes during the study were an increase of 0.46 in BMI z-score, a reduction of 0.25 mmol/L in fasting plasma high-density lipoprotein and an increase of 0.28 mmol/L in triglyceride values. The weight gain was most apparent in patients treated with just an SGA or SGA plus melatonin. Patients treated with an SGA plus medication for attention deficit hyperactivity disorder were less likely to gain weight. CONCLUSION SGA-induced metabolic disturbances remained partly unrecognised in children under 13 years of age and more systematic monitoring is needed.
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Affiliation(s)
- Kirsi Kakko
- Department of Child Psychiatry Tampere University Hospital Tampere Finland
- Faculty of Medicine and Health Technology Tampere University Tampere Finland
| | - Leena Pihlakoski
- Department of Child Psychiatry Tampere University Hospital Tampere Finland
- Faculty of Medicine and Health Technology Tampere University Tampere Finland
| | - Päivi Keskinen
- Department of Paediatrics Tampere University Hospital Tampere Finland
- Center for Child Health Research Tampere University Tampere Finland
| | - Raili Salmelin
- Department of Child Psychiatry Tampere University Hospital Tampere Finland
- Faculty of Social Sciences/Health Sciences Tampere University Tampere Finland
| | - Kaija Puura
- Department of Child Psychiatry Tampere University Hospital Tampere Finland
- Faculty of Medicine and Health Technology Tampere University Tampere Finland
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Kronström K, Tiiri E, Jokiranta-Olkoniemi E, Kaljonen A, Sourander A. Suicidality among child and adolescent psychiatric inpatients: time trend study comparing 2000 and 2011. Eur Child Adolesc Psychiatry 2019; 28:1223-1230. [PMID: 30741340 PMCID: PMC6751151 DOI: 10.1007/s00787-019-01286-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 02/04/2019] [Indexed: 11/28/2022]
Abstract
Child and adolescent inpatient treatment has faced major changes since the year 2000, including shorter inpatient stays and a greater use of psychotropic drugs. This study explored changes and correlates of suicidal threats and suicide acts among inpatients, by comparing Finnish cross-sectional surveys from 2000 to 2011. A questionnaire that explored the background, diagnosis and treatment characteristics of inpatients was sent to all child and psychiatric wards in Finland. The data collection was carried out on specified days in 2000 and 2011. We received comprehensive data on 504 patients from 64/69 (93%) wards in 2000 and on 412 patients from 75/79 (95%) wards in 2011. The Spectrum of Suicidal Behaviour Scale was used to explore suicidality. The prevalence of suicidality did not change in this nationwide study: suicidal threat rates were 38% in 2000 and 37% in 2011, and suicide attempts in both years were 11%. The prevalence of suicidal acts was higher among girls and teenagers, while low general functioning, defined as Children's Global Assessment Scale scores of under 30, was associated with both suicidal threats and acts. Violent acts were associated with both suicidal threats and acts in 2000, but not in 2011. Despite changes in treatment practices and shorter inpatient stays, the prevalence of suicidality in child and adolescent inpatient treatment remained unchanged in Finland in 2000 and 2011.
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Affiliation(s)
- Kim Kronström
- Department of Adolescent Psychiatry, Turku University Hospital, Hospital District of Southwest Finland, Turku, Finland.
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland.
| | - Elina Tiiri
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
- Department of Child Psychiatry, Turku University Hospital, Hospital District of Southwest Finland, Turku, Finland
| | - Elina Jokiranta-Olkoniemi
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
- Department of Child Psychiatry, Turku University Hospital, Hospital District of Southwest Finland, Turku, Finland
| | - Anne Kaljonen
- Turku Institute for Child and Youth Research, University of Turku, Turku, Finland
| | - Andre Sourander
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
- Department of Child Psychiatry, Turku University Hospital, Hospital District of Southwest Finland, Turku, Finland
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Mishina K, Tiiri E, Lempinen L, Sillanmäki L, Kronström K, Sourander A. Time trends of Finnish adolescents' mental health and use of alcohol and cigarettes from 1998 to 2014. Eur Child Adolesc Psychiatry 2018; 27:1633-1643. [PMID: 29704065 DOI: 10.1007/s00787-018-1158-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 04/18/2018] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Kaisa Mishina
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori, 20014, Turku, Finland
| | - Elina Tiiri
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori, 20014, Turku, Finland
- Turku University Hospital, Kiinamyllynkatu 4-8, 20521, Turku, Finland
| | - Lotta Lempinen
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori, 20014, Turku, Finland
| | - Lauri Sillanmäki
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori, 20014, Turku, Finland
| | - Kim Kronström
- Turku University Hospital, Kiinamyllynkatu 4-8, 20521, Turku, Finland
| | - Andre Sourander
- Department of Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori, 20014, Turku, Finland.
- Turku University Hospital, Kiinamyllynkatu 4-8, 20521, Turku, Finland.
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