Social determinants of mental health: a Finnish nationwide follow-up study on mental disorders

Life course and mental health: a thematic and systematic review

Objective

This study explored the influence of the life course on mental health by identifying key trends, seminal works, and themes in existing research. Additionally, it highlights the major discussions at the intersection of life course and mental health.

Methods

Documents were extracted from the Web of Science Core Collection (WoSCC), to systematically analyze themes on mental health outcomes across the life course. The analysis was based on key bibliometric tools, including VOSviewer 1.6.11, R Studio software, and GraphPad Prism 9 to analyze the evolution and impact of scholarly contributions in this domain.

Results

The accumulated body of research concerning the life course's impact on mental health, which began to emerge around 1990 displayed a consistently upward trend. Predominant contributions originate from developed nations and frequently look into the psychosocial determinants of mental health over life course. Life course and mental health studies have been extensively infused with biopsychosocial frameworks that consider the role of genetic makeup, neurodevelopment, cognition, affect, sociocultural dynamics, and interpersonal relationships. Life course theory application in mental health highlight the substantive effects of accumulated adversities, notably social determinants of health, adverse childhood experiences (ACEs), and their implications for subsequent mental health outcomes.

Conclusion

The nexus of life course and mental health outcomes demands further scholarly interrogation, particularly within underserved regions, to strengthen protective mechanisms for vulnerable populations.

The future of psychological treatments: The Marburg Declaration

Although psychological treatments are broadly recognized as evidence-based interventions for various mental disorders, challenges remain. For example, a substantial proportion of patients receiving such treatments do not fully recover, and many obstacles hinder the dissemination, implementation, and training of psychological treatments. These problems require those in our field to rethink some of our basic models of mental disorders and their treatments, and question how research and practice in clinical psychology should progress. To answer these questions, a group of experts of clinical psychology convened at a Think-Tank in Marburg, Germany, in August 2022 to review the evidence and analyze barriers for current and future developments. After this event, an overview of the current state-of-the-art was drafted and suggestions for improvements and specific recommendations for research and practice were integrated. Recommendations arising from our meeting cover further improving psychological interventions through translational approaches, improving clinical research methodology, bridging the gap between more nomothetic (group-oriented) studies and idiographic (person-centered) decisions, using network approaches in addition to selecting single mechanisms to embrace the complexity of clinical reality, making use of scalable digital options for assessments and interventions, improving the training and education of future psychotherapists, and accepting the societal responsibilities that clinical psychology has in improving national and global health care. The objective of the Marburg Declaration is to stimulate a significant change regarding our understanding of mental disorders and their treatments, with the aim to trigger a new era of evidence-based psychological interventions.

Social determinants of anxiety and mood disorders in a nationally-representative sample - Results from the Saudi National Mental Health Survey (SNMHS)

INTRODUCTION

Social determinants of health (SDH) influence and modify the risk for mental health disorders. To our knowledge, no study has explored SDH in the context of mental health in Saudi Arabia (SA) using population-based data. This study investigated the association between several SDH and anxiety and mood disorders in SA.

METHODS

We utilized data from the nationally-representative Saudi National Mental Health Survey (SNMHS) conducted in 2014 to 2016. This study examined associations between personal-level, socioeconomic, physical health, and family environment characteristics and anxiety and mood disorders. Participants were classified as having anxiety-only disorders, mood-only disorders, or comorbidity of both disorders. Multinomial logistic regression models were employed to examine the associations between SDH and anxiety and/or mood disorders, comparing them to participants who had not experienced these disorders.

RESULTS

A total of 4,004 participants were included in this analysis; the lifetime prevalence of disorders was: anxiety only (18%), mood only (3.8%), and comorbidity of both (5.3%). Regression models indicated that females, young adults (26-35 years), individuals with a higher level of education, and those who were separated or widowed had higher odds of experiencing anxiety and/or mood disorders. Furthermore, there was a significant and direct association between having physical chronic conditions and all three categories of anxiety and mood disorders. Experiencing Adverse Childhood Events (ACEs) was also associated with a significant risk of developing anxiety and/or mood disorders, with the highest risk associated with physical or sexual abuse, followed by violence and neglect.

CONCLUSION

This study underscores the correlation between several personal-level, socioeconomic, and environmental SDH and anxiety and mood disorders in SA. These findings provide a foundation for future analyses examining the intricate interplay between upstream and downstream SDH in SA. Such research can enhance local scientific knowledge, aid in planning for social services, and inform policy decisions and treatment strategies.

Association of common mental disorders and related multimorbidity with subsequent labor market marginalization among refugee and Swedish-born young adults

Background

Common mental disorders (CMDs), multimorbidity, and refugee status are associated with poor labor market outcome. Little is known about how these factors interact in young adults.

Objective

We aimed to i) investigate whether the association of CMDs and multimorbidity with labor market marginalization (LMM) differs between refugee and Swedish-born young adults and ii) identify diagnostic groups with particularly high risk for LMM.

Methods

This longitudinal registry-based study included individuals aged 20–25 years followed from 2012 to 2016 in Sweden (41,516 refugees and 207,729 age and sex-matched Swedish-born individuals). LMM was defined as granted disability pension (DP) or > 180 days of unemployment (UE). A disease co-occurrence network was constructed for all diagnostic groups from 2009 to 2011 to derive a personalized multimorbidity score for LMM. Multivariate logistic regression was used to estimate odds ratios of LMM in refugee and Swedish-born youth as a function of their multimorbidity score. The relative risk (RR, 95% CI) of LMM for refugees with CMDs compared to Swedish-born with CMDs was computed in each diagnostic group.

Results

In total, 5.5% of refugees and 7.2% of Swedish-born with CMDs were granted DP; 22.2 and 9.4%, respectively received UE benefit during follow-up. While both CMDs and multimorbidity independently elevated the risk of DP considerably in Swedish-born, CMDs but not multimorbidity elevated the risk of UE. Regarding UE in refugees, multimorbidity with the presence of CMDs showed stronger estimates. Multimorbidity interacted with refugee status toward UE (p < 0.0001) and with CMDs toward DP (p = 0.0049). Two diagnostic groups that demonstrated particularly high RR of UE were schizophrenia, schizotypal and delusional disorders (RR [95% CI]: 3.46 [1.77, 6.75]), and behavioral syndromes (RR [95% CI]: 3.41 [1.90, 6.10]).

Conclusion

To combat LMM, public health measures and intervention strategies need to be tailored to young adults based on their CMDs, multimorbidity, and refugee status.

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.

Election promises on children's wellbeing and health 2015 to 2021 - a study of Finnish voting advice applications database

BACKGROUND

According to the UN Convention on the Rights of the Child, children's views should be heard in policymaking. But it remains unclear to what extent children's wellbeing is considered in election promises.

METHODS

We investigated the extent to which Finnish political candidates consider children and their wellbeing in their election promises. We used YLE, the national broadcaster's voting advice application database, and analysed some 35,000 politicians' election promises made in the 2015 and 2019 parliamentary and the 2017 and 2021 municipal elections. We calculated the proportion of candidates who mentioned children and examined the content of the election promises in which children were mentioned. Logistic regression models were used to examine the role of the background of the characteristics of candidates.

RESULTS

In the 2015 and 2019 elections, some 12% and 19% of candidates, respectively, mentioned children in their election promises. The figures for the 2017 and 2021 municipal elections were higher at 19% and 24%, respectively. In the 2021 election, the candidates considering children in their election promises were younger and had higher education qualifications. Inspection of a random set of 350 promises indicated that common issues mentioned in respect of children were education and hobby activities. Concrete proposals to improve the wellbeing of children were rarely put forward.

CONCLUSIONS

Political candidates are increasingly considering children in their election promises but concrete proposals to improve the wellbeing and health of children are rare. Effective policy solutions to improve the health of children should be discussed in election debates.

Jumping back onto the giants' shoulders: Why emotional memory should be considered in a network perspective of psychopathology

Clinical psychology finds itself with a paradox: On the one hand, there is abundant empirical evidence showing that aversive experiences increase the risk for psychopathology. In fact, a learning and memory framework forms the foundation of numerous psychological theories and treatments. For example, various CBT approaches aim to target maladaptive emotional memories (e.g., schemas or cognitions) that are deemed to lie at the core of mental health conditions. On the other hand, a new approach - the network theory - is gaining ground, which ignores underlying causes for mental disorders and instead dictates a focus on symptoms and their causal interactions. While radical shifts are sometimes necessary in science, we argue why completely neglecting common causes, such as emotional memory, is not justified. We critically discuss the strengths and limitations of the network approach: While its transdiagnostic nature and recognition of symptom interactions have the potential to invigorate the field, the framework is merely descriptive, its concepts not well defined, and its clinical utility still to be established. To move forward, we propose an incorporation of latent constructs into the network model, starting with clearer definitions and operationalisations of concepts in both network and latent variable models.

Income Disparity and Mental Wellbeing among Adults in Semi-Urban and Rural Areas in Malaysia: The Mediating Role of Social Capital

Mental illness is rising worldwide and is more prevalent among the older population. Among others, socioeconomic status, particularly income, has a bearing on the prevalence of mental health. However, little is known about the underlying mechanism that explains the association between income and mental health. Hence, this study seeks to examine the mediating effect of social capital on the association between income and mental illness. Cross-sectional data consisting of 6651 respondents aged 55 years and above were used in this study. A validated tool known as the Depression, Anxiety and Stress Scale, 21 items (DASS-21) was applied to examine mental illness, namely depression, anxiety, and stress. The Karlson, Holm, and Breen (KHB) method was employed to assess the intervening role of social capital on the association between income and mental illness. Results showed that those who disagreed in trust within the community had the highest partial mediation percentage. Those who disagreed in reciprocity, however, had the lowest partial mediation percentage, which explained the positive association between the middle 40% (M40) of the income group and depression, anxiety, and stress. Overall, the study suggests the need to increase trust and attachment within society to curb the occurrence of depression and anxiety.

Time trends in treated incidence, sociodemographic risk factors and comorbidities: a Finnish nationwide study on anxiety disorders

BACKGROUND

There has been a lack of research about the time trends and socio-demographic risk factors for children and adolescents who receive treatment for anxiety disorders. This study aimed to fill these gaps in our knowledge by examining a nationwide sample of Finnish children and adolescents diagnosed in specialized healthcare settings.

METHODS

This study comprised national register data of all singleton children born in Finland from 1992-2006 who were diagnosed with anxiety disorders from 1998-2012. The changes in time trends in incidence were studied by dividing the study sample into three cohorts by birth years: 1992-1996, 1997-2001 and 2002-2006, who were followed up until the age of 20, 15 and 10 years, respectively. The 22,388 individuals with anxiety disorders were age and gender matched with 76,139 controls from the general population. Logistic regression was used to examine the socio-demographic risk factors and anxiety disorders in the entire sample. Comorbid disorders were examined in the oldest birth cohort (1992-1996 born).

RESULTS

Comparing the 1992-1996 and 2002-2006 cohorts showed that the cumulative incidence of treated anxiety disorders at the age of 10 increased from 0.3 to 1.2% among females and 0.46 to 1.9% among males. Subjects had higher likelihood for being diagnosed with an anxiety disorder if their mothers had low maternal socio-economic status class at birth (OR 1.53, 95% CI 1.45-1.61) compared to higher SES class, and marital status was single at the time of birth (OR 2.02, 95% CI 1.87-2.17) compared to married or in a relationship. They had lower risk of anxiety disorders diagnosis if born in rural (OR 0.82, 95% CI 0.79-0.86) or semi-urban areas (OR 0.79, 95% CI 0.76-0.82) when compared to urban residence. There was a wide range of psychiatric comorbidities, and unipolar depression was the most common (31.2%).

CONCLUSION

Anxiety disorders diagnosed by specialized Finnish services increased from 1998-2012 in both genders. This could indicate a real increase in overall anxiety disorders or an increase in treatment seeking. The findings on maternal socioeconomic status and single parenting improve the recognition of the environmental risk factors for anxiety disorders among children and adolescents.

Mental health trajectories in undergraduate students over the first year of university: a longitudinal cohort study

OBJECTIVE

This study examined the association between candidate psychosocial and lifestyle variables and the trajectories of clinically significant anxiety and depressive symptoms from entry to completion of first-year university.

DESIGN

A longitudinal cohort study PARTICIPANTS: First-year undergraduate students METHODS: We analysed the responses of 1686 first-year undergraduate students attending Queen's University who completed electronic surveys at both the beginning and completion of their academic year. Predictors of change in positive anxiety and depressive symptom screens (based on exceeding validated symptom threshold scores) were identified using logistic regression.

RESULTS

Increased university connectedness reduced the odds of emergent significant depressive and anxiety symptoms in healthy students and increased the odds of recovery in students who screened positive at the start of university. Students who screened positive for depression or anxiety at university entry were less likely to recover if they had a lifetime history of internalising disorders. Healthy students who increased their drug use over their first year had higher odds of developing significant levels of both anxiety and depressive symptoms by completion of the academic year.

CONCLUSIONS

Moderate to severe levels of anxiety and depressive symptoms are common among students at entry to university and persist over the first year. University connectedness may mitigate the risk of persistent or emergent symptoms, whereas drug use appears to increase these risks. Findings have implications for university well-being initiatives.

Gender Self-Perception and Psychological Distress in Healthcare Students during the COVID-19 Pandemic

The aim of this study was to analyze university Health Sciences students’ self-perception regarding gender stereotypes, and to explore whether there was any association between gender stereotypes and clinical/socio-demographic variables. Methods: This cross-sectional study was conducted with a sample of 252 university students who completed a self-administrated online questionnaire (18.3% males, 81.7% females). We evaluated the self-perception of gender stereotypes as determined using the BSRI-12 questionnaire and explored the association of this measure with the impact of perceived stress measured using a modified scale (PSS-10-C) as well as anxiety and depression according to scores on the Goldberg scale (GADS). Results: According to the students’ self-perception of gender stereotypes, 24.9% self-perceived themselves as feminine, 20.1% as masculine, 24.9% as androgynous, and 30% as undifferentiated. The degree determines self-identification with gender stereotypes. Nursing and Occupational Therapy are studied mostly by women, 28.4% and 45%, respectively, while Physiotherapy is studied mainly by men (71.2%). Females indicated more anxiety (75.7%) and depression (81.7%) than males (52.9% and 67.3%, respectively). In contrast, males developed more stress (88.5%) than females (74.1%). Conclusions: University degree, anxiety, depression, and stress determined self-identification with gender stereotypes. The results of this study indicate that gender roles influence the possibility of developing mental disorders and should be taken into account in future studies.

Psychiatric disorders in incident patients with juvenile idiopathic arthritis - a case-control cohort study

BACKGROUND

Chronic illness, such as juvenile idiopathic arthritis (JIA), appears to have an impact on the mental health of children and adolescents. The aim of this study was to explore the incidence of mental and behavioural disorders according to age at JIA onset and gender in JIA patients compared to a control population.

METHODS

Information on all incident patients with JIA in 2000-2014 was collected from the nationwide register, maintained by the Social Insurance Institution of Finland. The National Population Registry identified three controls (similar regarding age, sex and residence) for each case. They were followed up together until 31st Dec. 2016. ICD-10 codes of their psychiatric diagnoses (F10-F98) were obtained from the Care Register of the National Institute for Health and Welfare. The data were analysed using generalized linear models.

RESULTS

The cumulative incidence of psychiatric morbidity was higher among the JIA patients than the controls, hazard ratio 1.70 (95% Cl 1.57 to 1.74), p < 0.001. Phobic, anxiety, obsessive-compulsive, stress-related and somatoform disorders (F40-48) and mood (affective) disorders (F30-39) were the most common psychiatric diagnoses in both the JIA patients (10.4 and 8.2%) and the control group (5.4 and 5.1%), respectively. Female patients were more prone to mental and behavioural disorders than males were, and the risk seemed to be higher in patients who developed JIA in early childhood or adolescence.

CONCLUSION

Patients with JIA are diagnosed with mental and behavioural disorders more often than controls, and the age at onset of JIA could have implications for future mental health.

Socioeconomic factors in disability retirement due to mental disorders in Finland

Background

Previous research has identified low socioeconomic status (SES) as an epidemiological risk factor for early retirement and disability pension (DP) due to mental disorders. This study aims to examine these associations in greater detail, with separate consideration of the risk factors for mood disorders (F30–39) and non-affective psychotic disorder (F20–29) DP.

Methods

In this case–control setting the subjects (N = 36 879) were all those granted DP due to a mental disorder for the first time between 2010 and 2015 in Finland. All the subjects were matched with three controls for their gender, age and hospital district (N = 94 388). Three measures of dimensions of SES were used: education, income and occupational status, as well as family type as a control factor. Differences between DP recipients and controls, and between diagnostic groups, were studied using calculated characteristics and conditional logistic regression models.

Results

DP recipients often lived alone and had low educational and income levels. These characteristics were more prominent in non-affective psychotic disorder than in mood disorder DP. In white-collar occupational groups, the risk of DP was greater compared with blue-collar workers. Students were associated with the highest level of risk for all mental and mood disorder DPs.

Conclusions

We found evidence of SES factors associating with mental disorder-related severe loss of working and studying ability in a disorder-specific way. Notably, white-collar workers had an increased risk of mental disorder DP. This could be related to the psychosocially demanding contemporary working life in non-manual work.

Educational inequalities in mental disorders in the Czech Republic: data from CZEch Mental health Study (CZEMS)

PURPOSE

We aimed to study the association of educational attainment with occurrence of mental disorders in the Czech Republic.

METHODS

Data were derived from the CZEch Mental health Study (CZEMS), a cross-sectional study of community-dwelling individuals. Mental disorders were assessed with Mini International Neuropsychiatric Interview (M.I.N.I.), and information on completed education was acquired as a part of a paper and pencil interview. Logistic regression was used to estimate odds ratio (OR) with 95% confidence intervals (CI) for the association of educational attainment with all mental disorders as well as with specific groups (affective, anxiety, alcohol use and substance use disorders), stepwise adjusting for socio-demographic, social and health-related characteristics.

RESULTS

We studied 3175 individuals (average age 50 years, range 18-96 years; 54% women). Compared to individuals with higher education, those educated below high school graduation had higher odds of mental disorders (OR 2.07; 95% CI 1.58-1.71), even after adjustment for all covariates (OR 1.64; 95% CI 1.21-2.23). Education showed the strongest association with alcohol use disorders, even when covariates were adjusted for, but was not related to anxiety disorders. The association of education with affective as well as substance use disorders was explained by covariates.

CONCLUSIONS

Interventions aimed at reducing the burden of mental disorders should target individuals with low education. Strategies to improve population mental health need to go hand in hand with policies to enhance education as well as reduce alcohol consumption in the Czech Republic.

Intergenerational transmission of psychiatric disorders: the 1987 Finnish Birth Cohort study

The causes of mental disorders are multifactorial including genetic and environmental exposures, parental psychopathology being the greatest risk factor for their offspring. We set out to quantify the risk of parental psychiatric morbidity with the incidence of mental disorders among their offspring before the age of 22 years and study the sex- and age-specific associations. The present study utilises the 1987 Finnish Birth Cohort (FBC) data, which is a register-based follow-up of all 60,069 children born in Finland 1987 and followed-up until 2008. Data on psychiatric morbidity are based on inpatient care episodes of parents and both inpatient and outpatient visits of offspring and were collected from the Finnish Hospital Discharge Register which covers all Finnish citizens accessing specialized care. Altogether 7.6% of the cohort members had a parent or both parents treated at psychiatric inpatient care during the follow-up. Parental psychiatric morbidity increased the offspring's risk for psychiatric diagnoses two to threefold versus those children without parental psychiatric hospitalization, mother's morbidity comprising a greater risk than that of father's. The risk was prominent for both sexes of the offspring throughout childhood and adolescence. Psychiatric disorders possess significant intergenerational continuum. It is essential to target preventive efforts on the high-risk population that comprises families with a parent or both having mental disorders. It also implies developing appropriate social and health care interventions to support the whole family.

Social and sex differences in psychiatric comorbidity and psychosocial functioning among adolescents with depression

BACKGROUND

To determine social and sex differences in psychosocial functioning and psychiatric comorbidity among adolescents with depression.

METHODS

A cohort-based study in Stockholm, Sweden. Adolescents who turned 13 years during 2001-2007, were followed in registers until they turned 18 in 2005-2011, (n = 169,262). In the current study, those with depression at age 13-17 were included (n = 6,439).

RESULTS

Adolescents with parents with low (OR=1.5, CI 1.1-2.2) education were more likely to have low psychosocial functioning. Those with parents with low education and low household income were more likely to have comorbid internalizing (OR=1.3, CI 1.0-1.7/1.3, CI 1.0-1.7) and externalizing disorders (OR=2.5, CI 1.5-4.0/2.4, CI 1.4-4.2). Adolescents with parents born outside the Nordic countries were more likely to have comorbid externalizing disorders (OR=1.6, CI 1.1-2.4). No social differences were evident in relation to family receipt of unemployment benefits. Social differences were found for both girls and boys in relation to psychosocial functioning and comorbidity but the magnitude of social differences in depression with comorbidity was overall larger for boys than girls.

LIMITATIONS

The findings of the current study can only be generalized to adolescents that have sought care for and been diagnosed with depression, within a setting similar to this study, e.g. with free access to care.

CONCLUSION

Adolescents with depression and with more disadvantaged social circumstances in the childhood run a higher risk of psychiatric comorbidity and low psychosocial functioning, which can indicate a lengthy clinical course and poorer response to treatment. Both boys and girls follow this path but partly in different kinds of psychiatric comorbidity.

Prognosis after Mild Traumatic Brain Injury: Influence of Psychiatric Disorders

BACKGROUND

We evaluated the prevalence of psychiatric disorders in mild traumatic brain injury (MTBI) patients and investigated psychiatric comorbidity in relation to subjective symptoms and return to work (RTW).

METHODS

We recruited 103 MTBI patients (mean age 40.8 years, SD 3.1) prospectively from University Hospital. The patients were followed up for one year. The Rivermead Post-Concussion Symptom Questionnaire (RPQ) and Extended Glasgow Outcome Scale (GOSE) were administered one month after MTBI. Three months after MTBI, any psychiatric disorders were assessed using the Structured Clinical Interview for DSM-IV Axis I Disorders.

RESULTS

Psychiatric disorders were diagnosed in 26 patients (25.2%). The most common disorders were previous/current depression. At three months, there was no difference between patients with psychiatric disorders versus those without them in RTW (95.7% vs. 87.3%, p = 0.260) or at least in part-time work (100% vs. 94.4%, p = 0.245). In Kaplan-Meier analysis, the median time to RTW was 10 days for both groups. The median RPQ score was 13.0 (Interquartile range (IQR) 6.5-19.0) in patients with a psychiatric disorder compared to 8.5 (IQR 2.3-14.0) in those without one (p = 0.021); respectively, the median GOSE was 7.0 (IQR 7.0-8.0) compared to 8.0 (IQR 7.0-8.0, p = 0.003).

CONCLUSIONS

Approximately every fourth patient with MTBI had a psychiatric disorder. These patients reported more symptoms, and their functional outcome measured with GOSE at one month after MTBI was worse. However, presence of any psychiatric disorder did not affect RTW. Early contact and adequate follow-up are important when supporting the patient's return to work.

Prenatal substance exposure, adverse childhood experiences and diagnosed mental and behavioral disorders - A longitudinal register-based matched cohort study in Finland

Both prenatal substance exposure (PSE, alcohol/drugs) and experiences during the first years of life have powerful effects on brain development. However, only a few studies have investigated the combined effect of PSE and adverse childhood experiences (ACEs) on mental and behavioral disorders among exposed adolescents and adults. This longitudinal register-based cohort study 1) compared the nature and extent of diagnosed mental and behavioral disorders among youth with PSE and matched unexposed controls, and 2) investigated the influence of PSE, health in infancy and ACEs (maternal risk factors and out-of-home care, OHC) on diagnoses of mental and behavioral disorders. The data consisted of 615 exposed youth aged 15-24 years and 1787 matched unexposed controls. Data from hospital medical records and nine registers were merged for the analysis. Descriptive analysis methods and Cox regression were used. The results showed that the prevalence of mental and behavioral disorders was twice as high among exposed compared with controls. The highest levels of mental and behavioral disorders and ACEs were found among exposed with at least one OHC episode. The difference in the risk of mental and behavioral disorders between exposed and controls diminished after controlling for the effect of ACEs. Low birth weight, maternal risk factors, and OHC were the strongest predictors of mental and behavioral disorders. The results suggest that PSE alone does not explain poorer mental health among exposed youth. Risk factors accumulate, and low birth weight and ACEs are strongly associated with increased risk of mental and behavioral disorders.

Investigation of the Trend in Adolescent Mental Health and its Related Social Factors: A Multi-Year Cross-Sectional Study For 13 Years

We aimed to investigate the mental health change and associated social correlates in adolescents in terms of depression, suicidal ideation, and suicidal attempt. In total, 978,079 students (12–18 years old, 7th–12th grade) participated in the survey for 13 years (2006–2018) by a multiple-year cross-sectional design (not a repeat measure for smaller group). Mental health outcome variables were assessed using self-report surveys with the independent variables of sex, age, economic status, school achievement, and parental educational level. Korean social indices of income inequality (Gini index, higher scores representing greater economic inequity with score range of 0–1), education (national proportion of tertiary education attainment), and actual suicides were investigated together as related social factors. The prevalence of depressive episodes, suicidal ideation, and suicidal attempt markedly dropped by 34.6%, 42.2%, and 48.3%, respectively. Moreover, the Gini index (from 0.314 in 2008 to 0.295 in 2015) and proportion of tertiary education (from 82.1% in 2006 to 69.7% in 2018) showed a decreasing tendency. These indices and adolescent mental health outcomes highly correlated with each other (Pearson’s r between Gini index and depressive episode = 0.789, suicidal ideation = 0.724, and suicidal attempt = 0.740; Pearson’s r between proportion of tertiary education and depressive episode = 0.930, suicidal ideation = 0.809, and suicidal attempt = 0.851). Adolescent mental health has improved in the last 13 years in Korea, and improvements in social inequality (decreased Gini index) and lessened burden of academic competition (decreased national proportion of tertiary education) were significantly associated with the improvement of adolescent’s mental health. However, the impact of parental educational level on children’s mental health was relatively minimal, compared with the impact of economic inequality and academic burden. Further studies are needed to reveal the underlying mechanism for the association between adolescent mental health and sociodemographic factors to save adolescents from psychological distress.

Self-reported symptoms of depression, anxiety and stress in Portuguese primary school-aged children

BACKGROUND

Symptoms of depression, anxiety and stress experienced during childhood might have a negative impact on development. This study explores factors associated with such symptoms among Portuguese primary school-aged children.

METHODS

A sample of children (n = 1022, mean age = 8.77 years old) was recruited in public and private schools from the cities of Coimbra, Lisbon and Porto, Portugal. The children's version of the Depression, Anxiety and Stress Scale (DASS-C) was self-administered. Multivariate logistic regression models were fitted to measure associations (expressed as Odds Ratio, OR and 95% Confidence Intervals, CI) between each DASS-C subscale, dichotomized by its 4th vs. 3rd or less quartiles (symptoms increase with scores), and covariates: child sex, age, socioeconomic status (SES), sports activity beyond school, children self-assessed health status, child and mother's body mass index and mother's DASS scores.

RESULTS

Age was negatively associated with anxiety symptoms (adjusted OR, 95% CI: 0.70, 0.57-0.87) and girls, compared to boys, presented lower odds of depressive and stress symptoms (adjusted OR, 95% CI: 0.65, 0.47-0.92 and 0.57, 0.41-0.80, respectively). A low socioeconomic status was associated with more frequent symptoms of stress (adjusted OR, 95%CI for low compared to high SES: 1.61, 1.01-2.56). Children with poorer self-assessed health status and whose mothers scored higher in the DASS also presented significantly higher odds of scoring in the 4th quartile (vs. 3rd or less) of the three DASS-C subscales.

CONCLUSIONS

These results suggest the need to tailor preventive efforts targeting childhood mental health symptoms.

Unravelling the relationship between parental resources and disability pension in young adulthood

A vast literature exists on the relationship between family background and health outcomes. However, there is a shortage of evidence on the relationship between parental resources and offsprings' disability pension, a severe form of general poor health and functionability. This article analyses how parental income and education are associated with offsprings' disability pension in young adulthood (19-27 years) among 1980-1985 birth cohorts using Finnish register data. The results of discrete-time event history analysis demonstrate that parental income and education have contrasting impacts. High parental income is found to decrease, and parental education to increase, the probability of offspring having disability pension, although mainly among offspring with compulsory education. Further, young adults with high parental resources are better off two years after their first disability pension. We conclude that the influence of parental resources operates via offsprings' educational attainment but also has divergent direct impacts on offsprings' disability pension.

Perceived impact of contextual determinants on depression, anxiety and stress: a survey with university students

Background

Young adults starting college or university education encounter multiple stressors related to transitional life-stage and novel environments. Current studies reveal high rates of symptoms related to common mental health problems like depression, anxiety and stress. However, limited knowledge exists on the determinants on these problems among Canadian students. The primary aim of the study was to investigate the impact of contextual determinants, as perceived by students, on self-reported mental health, and how these impacts varied by depression, anxiety and stress.

Methods

A cross-sectional survey was conducted with students attending a large university in Toronto, Canada. Participants completed a self-administered online questionnaire as part of a larger project. The questions asked about contextual determinants related to personal, interpersonal, family, social, socio-economic and political factors along with levels of depression, anxiety and stress as measured by Patient Health Questionnaire-9, Beck Anxiety Inventory and Perceived Stress Scale.

Results

A total of 148 students completed the questionnaire (37 males and 111 females) with an age range of 19–54 years (median 22, IQR 21–24.8). English was reported as first language by 62.8% while 34.5% self-identified as white and 58.1% reported being born in Canada. Overall, 39.5% reported symptoms of moderate to severe depression, 23.8% reported moderate–severe anxiety and 80.3% reported moderate–severe levels of perceived stress, with no significant differences between males and females. In the final multivariate analysis, variables significantly associated with depression were grade-point-average (aOR 2.46, 95% CI 1.017–5.97), family factors (aOR 3.46, 95% CI 1.50–7.94), social factors (aOR 3.24, 1.30–8.1), self-rated health (aOR 0.34, 95% CI 0.14–0.82) and political factors (aOR 0.40, 95% CI 0.16–0.97). Anxiety was significantly associated with family factors (aOR 2.79, 1.09–7.18), socioeconomic factors (aOR 2.59, 95% CI 1.05–6.42) and age (aOR 0.33, 95% CI 0.11–0.98). The significant factors for stress were grade-point-average (aOR 2.41, 1.01–5.75) and social factors (aOR 3.87, 95% CI 1.59–9.43).

Conclusion

The study found strong to moderate impact of several determinants on depression, anxiety and stress. The results suggest a need to address a variety of factors affecting students’ mental health.

Trial registration Parent trial: http://www.isrctn.com/ISRCTN92827275

Childhood determinants for early psychiatric disability pension: A 10-year follow-up study of the 1987 Finnish Birth Cohort

BACKGROUND

Mental disorders can affect work ability and lead to early exit from the labour market through disability pension.

AIMS

This study aimed to identify childhood determinants of psychiatric disability pension in early adulthood.

METHODS

The 1987 Finnish Birth Cohort includes a complete census of children born in a single year. The children were followed up from birth until 31 December 2012 using official registers maintained by the Finnish authorities. Risk factors for disability pension were examined in the full 1987 cohort (N = 58,739) and among children who had received mental health care (N = 9,599). Odds ratios were calculated for disability pension due to all mental disorders and separately for schizophrenia, depressive and anxiety and other mental and behavioural disorders in association with childhood determinants.

RESULTS

Altogether, 1.4% of cohort members had retired due to mental disorders in 2003-2012. In the full 1987 cohort, female sex, parental divorce and social assistance, both mother's and father's psychiatric care and mother's psychiatric disability pension increased the risk for disability pension due to mental disorders. Among children who had received mental health care, risk factors for psychiatric disability pension were father's psychiatric care and mother's psychiatric disability pension.

CONCLUSION

Childhood determinants were related to the risk of psychiatric disability pension before the age of 25. The risk factors varied by the diagnosis of the disability pension. Using knowledge of this study's risk factors should enable the identification of adolescents and young adults in general population and especially in the mental health care population who are at greatest risk of receipt of psychiatric disability pension.

Social differences in diagnosed depression among adolescents in a Swedish population based cohort

BACKGROUND

Population based research regarding social differences in diagnosed depression in adolescence is sparse. In this study unique material containing in-and outpatient data was used to determine if low social position in childhood increases the risk of diagnosed depression in adolescence. To further examine this association, gender differences and interactions were explored.

METHODS

The study population was extracted from the Stockholm Youth Cohort (SYC), a register based cohort containing psychiatric care for all young people in Stockholm County and information about social position. For the purpose of this study, all in the SYC who turned 13 years old during 2001-2007, in total 169,262 adolescents, were followed up in 2005-2011 for diagnoses of depression until age 18. Associations were estimated with Cox regression models and presented as Hazard Ratios (HR).

RESULTS

The risk of diagnosed depression was higher for adolescents with parents with low education (HR = 1.1, CI = 1.0-1.2) and medium education (HR = 1.1, CI = 1.1-1.2) compared to high as well as for those with lower household income (for example, medium low, HR = 1.2, CI = 1.1-1.3) and for those with parents who received an unemployment benefit (HR = 1.3, CI = 1.2-1.4). No differences were found for those with the lowest household income compared to those with the highest level. Adolescents with parents born outside the Nordic countries had a lower risk of diagnosed depression (HR = 0.7, CI = 0.6-0.7). An interaction effect was found between gender and parental education.

CONCLUSIONS

Social differences were found but the magnitude was modest and gender differences small.

Parental hospital-treated somatic illnesses during offspring's childhood associated with later offspring use of psychotropic medication during childhood to young adult - The 1987 Finnish Birth Cohort study

This study aimed to systematically examine whether parental hospital-treated somatic illnesses, diagnosed during an offspring's childhood (1987-1995), are associated with later use of psychotropic medication (1996-2012) by the offspring. If so, which parental somatic illnesses, in particular, increase the likelihood for later use of psychotropic medication among the offspring. The 1987 Finnish Birth Cohort study yields longitudinal nationwide follow-up data that include a complete census of children born in a single year. A total 58,551 offspring are included in this study and, of these 57,752 had a known father. Offspring who had used psychotropic medication between the ages of 9 and 24 years, more often had parents who had experienced a greater number of somatic illnesses when their child was aged under 9, compared to offspring without any use of psychotropic medication. The specific parental somatic illnesses early in life, for example disorders of female tract (OR 1.12, 95%CI 1.01-1.23), pregnancy with abortive outcome (1.18, 1.09-1.28), paternal acute infections (1.20, 1.05-1.38), and paternal symptoms, signs, and ill-defined conditions (1.21, 1.03-1.42), were found to be associated with psychotropic medication treatment using parental-related determinants; death, education, receipt of social assistance and psychiatric inpatient care as covariates. This suggests that these specific parental somatic illnesses can affect psychological well-being of the offspring. Preventive actions and support for the child, should be provided in situations where a parent with a somatic illness has limited ability to care for and rear their child.

Comorbid psychiatric disorders in a clinical sample of adults with ADHD, and associations with education, work and social characteristics: a cross-sectional study

OBJECTIVES

Adults with attention-deficit hyperactive disorder (ADHD) report high rates of comorbid disorders, educational and occupational failure, and family instability. The aim of this study was to examine the prevalence of comorbid psychiatric disorders in a clinical population of adults with ADHD and to examine associations between educational level, work participation, social characteristics and the rates of psychiatric comorbidity.

METHODS

Out of 796 patients diagnosed with ADHD in a specialised outpatient clinic in Oslo, Norway, 548 (68%) agreed to participate in this cross-sectional study: 277 women and 271 men. ADHD was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. Comorbid disorders were diagnosed using the Mini-International Neuropsychiatric Interview.

RESULTS

In this clinical sample, 53.5% had at least one current comorbid psychiatric disorder. The most prevalent disorders were major depression, substance use disorders and social phobia. Women had more eating disorders than men, whereas men had more alcohol and substance use disorders. Education above high school level (>12 years) and work participation were associated with lower rates of comorbid disorders (adjusted ORs 0.52 and 0.63, respectively). Gender, age, marital status, living with children or living in a city were not associated with comorbidity.

CONCLUSIONS

Adult ADHD is associated with high rates of comorbid psychiatric disorders, irrespective of gender and age. It appears that higher education and work participation are related to lower probability of comorbidity.

Temporal changes in the incidence of treated psychiatric and neurodevelopmental disorders during adolescence: an analysis of two national Finnish birth cohorts

BACKGROUND

Comprehensive overviews of the temporal changes in treated psychiatric and neurodevelopmental disorders during adolescence are scarce. We reviewed data from two national cohorts, 10 years apart, to establish the change in use of specialised services for psychiatric and neurodevelopmental diagnoses in Finland.

METHODS

We compared the nationwide register-based incidence of psychiatric and neurodevelopmental diagnoses between the 12th birthday and 18th birthday of adolescents born in Finland in 1987 and 1997. Adolescents who emigrated or died before their 12th birthday and those with missing covariate data were excluded, as were those who, when aged 11 years, had lived in a municipality belonging to a hospital district with obviously incomplete data reports during any follow-up years in our study. Our primary outcomes were time to incident specialised service use for any psychiatric or neurodevelopmental disorder and for 17 specific diagnostic classes. We also investigated whether adolescents who died by suicide had accessed specialised services before their deaths.

FINDINGS

The cumulative incidence of psychiatric or neurodevelopmental disorders increased from 9·8 in the 1987 cohort to 14·9 in the 1997 cohort (difference 5·2 percentage points [95% CI 4·8-5·5]) among girls, and from 6·2 in the 1987 cohort to 8·8 in the 1997 (2·6 percentage points [2·4-2·9]) among boys. The hazard ratio for the overall relative increase in neurodevelopment and psychiatric disorders in the 1997 cohort compared with the 1987 cohort was 1·6 (95% CI 1·5-1·8) among girls and 1·5 (1·4-1·6) among boys. Of the studied diagnostic classes, we noted significant (ie, p<0·001) relative increases for ten of 17 diagnoses among girls and 11 among boys. Of the adolescents who died by suicide before age 18, only five of 16 in the 1987 cohort and two of 12 in the 1997 cohort had used specialised services in the 6 months before their death.

INTERPRETATION

The large absolute rise in service use for psychiatric or neurodevelopmental disorders points to the need to deliver effective treatment to a rapidly increased patient population, whereas the relative increase in specific diagnoses should inform clinical practice. Despite increasing service use, identification of adolescents at risk of suicide remains a major public health priority.

FUNDING

Academy of Finland, Brain and Behavior Research Foundation, Finnish Medical Foundation.

Gene-environment interaction and psychiatric disorders: Review and future directions

Empirical studies suggest that psychiatric disorders result from a complex interplay between genetic and environmental factors. Most evidence for such gene-environment interaction (GxE) is based on single candidate gene studies conducted from a Diathesis-Stress perspective. Recognizing the short-comings of candidate gene studies, GxE research has begun to focus on genome-wide and polygenic approaches as well as drawing on different theoretical concepts underlying GxE, such as Differential Susceptibility. After reviewing evidence from candidate GxE studies and presenting alternative theoretical frameworks underpinning GxE research, more recent approaches and findings from whole genome approaches are presented. Finally, we suggest how future GxE studies may unpick the complex interplay between genes and environments in psychiatric disorders.

Depression and Violence in Adolescence and Young Adults: Findings From Three Longitudinal Cohorts

OBJECTIVE

Despite recent research demonstrating associations between violence and depression in adults, links in adolescents are uncertain. This study aims to assess the longitudinal associations between young people's depression and later violent outcomes.

METHOD

We used data from three cohorts with different measurements of depression exposures and subsequent violent outcomes. In a Dutch community cohort Research on Adolescent Development And Relationships (RADAR; N = 623) and a population-based British birth cohort Avon Longitudinal Study of Parents and Children (ALSPAC; N = 4,030), we examined the longitudinal links between adolescent depressive symptoms and violent behaviors from age 13 to 17 years. In a total Finnish birth cohort (FBC 1987; N = 57,526), we estimated risk of violent convictions in individuals clinically diagnosed with depression from age 15 to 27 years.

RESULTS

During a mean follow-up period of 4 years, the adjusted odds ratio (aOR) of violent behaviors per unit of increase in depressive symptoms was 1.7 (95% CI = 1.2-2.5) in the Dutch RADAR community sample and 1.8 (95% CI = 1.4-2.3) in the British ALSPAC birth cohort. In the FBC 1987 cohort, the aOR of violent convictions was 2.1 (95% CI = 1.7-2.7) among individuals with a depression diagnosis compared with general population controls without depression. All risk estimates were adjusted for family socioeconomic status and previous violence.

CONCLUSION

Consistent findings across three longitudinal studies suggest that clinical guidelines should consider recommending risk assessment for violence in young people with depression. The benefits of targeting risk management in subgroups by gender need further investigation.

Family structure and childhood mental disorders: new findings from Australia

PURPOSE

Many children now live in non-traditional families-including one-parent, blended, and step families. While a substantial body of international evidence indicates that these children display poorer cognitive and socio-emotional outcomes than children living in traditional families, research on childhood mental disorders is scarce. This report provides new evidence of the relationships between family structure and childhood mental disorders in an under-researched context, Australia.

METHODS

We use recent, nationally representative data on children aged 4-17 from Young Minds Matter, the second Australian Child and Adolescent Survey of Mental Health and Well-being (N = 6310). Mental disorders were assessed using the Diagnostic Interview Schedule for Children-Version IV and included social phobia, separation anxiety disorder, generalised anxiety disorder, obsessive-compulsive disorder, major depressive disorder, attention-deficit/hyperactivity disorder, and conduct disorder.

RESULTS

Compared to children living in original families, children in one-parent, blended, and step families experienced a higher prevalence of mental disorders. Amongst children whose parents separated, the time since separation was not statistically significantly related to the prevalence of mental disorders.

CONCLUSIONS

Although we are unable to assess causality, our findings highlight the strength of the association between family structure and child and adolescent mental health. They also stress the need for programs to support children, parents, and families in non-traditional family types to reduce mental health inequalities in childhood and later life.

Parental separation in childhood and self-reported psychological health: A population-based study

The aim of the present study is to investigate associations between parental separation/divorce during childhood, and self-reported psychological health, adjusting for social capital, social support, civil status and economic stress in childhood. A cross-sectional public health survey was conducted in the autumn of 2012 in Scania, southern Sweden, with a postal questionnaire with 28,029 participants aged 18-80. Associations between parental separation/divorce during childhood and self-reported psychological health (GHQ12) were investigated using logistic regressions. A 16.1% proportion of all men 22.4% of all women reported poor psychological health. Among men, 20.4% had experienced parental separation during childhood until age 18 years, the corresponding prevalence among women was 22.3%. Parental separation/divorce in childhood was significantly associated with poor self-rated psychological health among men who had experienced parental separation/divorce at ages 0-4, and among women with this experience at ages 0-4, 10-14 and 15-18. These significant associations remained throughout the multiple analyses. The results support the notion that the experience of parental separation/divorce in childhood may influence psychological health in adulthood, particularly if it is experienced in the age interval 0-4 years.

Childhood Adversities and Educational Attainment in Young Adulthood: The Role of Mental Health Problems in Adolescence

PURPOSE

The aims of this study were to examine whether the association between childhood adversities and educational attainment in young adulthood can be explained by mental health problems in adolescence and whether associations and pathways differ for boys and girls.

METHODS

Data were used of 2,230 participants from the Tracking Adolescents' Individual Lives Survey, a Dutch prospective cohort study with a 9-year follow-up. Childhood adversities were measured at age 11 years, mental health problems (i.e., externalizing, internalizing and attention problems with Youth Self-Report) at age 16 years, and educational attainment at age 19 years. Structural equation modeling was performed to analyze the data, overall and stratified by gender.

RESULTS

Only among boys, childhood adversities were associated with low educational attainment in young adulthood. Externalizing problems in adolescence explained 5% of the association between childhood adversities and educational attainment. Furthermore, for both boys and girls, externalizing problems in adolescence had a direct effect on educational attainment in young adulthood.

CONCLUSIONS

Among boys, childhood adversities are associated with poorer educational outcomes of young adults. A part of this association runs via adolescent externalizing problems. The results suggest that boys, compared with girls, are less capable to cope with childhood adversities. Monitoring of exposed boys to childhood adversities is of utmost importance.

Public health nurses’ concerns in preschool-aged children’s health check-ups

The aim is to describe Finnish public health nurses’ concerns during regular health check-ups of preschool-aged children. In 2011, focus-group interviews were conducted with 12 public health nurses. The data were analysed using inductive content analysis. Public health nurses’ concerns dealt with the healthy growth and development of children and their ability to cope with difficult family situations, as well as the everyday reality of parenting. The concerns of public health nurses related to children’s health focused on their psychosocial development. Concerns also focused on the interaction between mother and baby, children’s behavioural problems and their cognitive development, parents’ mental health problems and families’ social circumstances. The everyday reality of parenting caused concern, including the lack of sufficient family time and conflicting parenting roles. Based on the available evidence, the role of public health nurses in child health care has broadened remarkably from the traditional physical follow-up of growth and development to support the well-being of the entire family. Children’s psychosocial problems and families’ difficult circumstances increasingly represent the challenges faced by public health nurses during preschool-aged children’s health check-ups. Public health nurses’ concerns revealed that, in order to respond to the needs of families, they may need to increasingly rely on multi-disciplinary cooperation with other professionals.

Maternal Grand Multiparity and the Risk of Severe Mental Disorders in Adult Offspring

BACKGROUND

Previous studies have shown that maternal grand multiparity may predict an increased risk of mental disorders in young adult offspring, but whether such effects persist throughout adulthood remains unknown. The current study examined if maternal grand multiparity predicts the risks of severe mental disorders, suicides, suicide attempts and dementias throughout adult life.

METHODS

Our study sample comprised 13243 Helsinki Birth Cohort Study 1934-1944 participants (6905 men and 6338 women). According to hospital birth records, 341 offspring were born to grand multiparous mothers. From Finnish national hospital discharge and causes of death registers, we identified 1682 participants diagnosed with mental disorders during 1969-2010.

RESULTS

Maternal grand multiparity predicted significantly increased risks of mood disorders (Hazard Ratio = 1.64, p = 0.03), non-psychotic mood disorders (Hazard Ratio = 2.02, p = 0.002), and suicide attempts (Hazard Ratio = 3.94, p = 0.01) in adult offspring. Furthermore, women born to grand multiparous mothers had significantly increased risks of any severe mental disorder (Hazard Ratio = 1.79, p = 0.01), non-psychotic substance use disorders (Hazard Ratio = 2.77, p = 0.02) schizophrenia, schizotypal and delusional disorders (Hazard Ratio = 2.40, p = 0.02), mood disorders (Hazard Ratio = 2.40, p = 0.002), non-psychotic mood disorders (Hazard Ratio = 2.91, p<0.001), and suicide attempts (Hazard Ratio = 5.05, p = 0.01) in adulthood. The effects of maternal grand multiparity on offspring psychopathology risk were independent of maternal age and body mass index at childbirth, and of year of birth, sex, childhood socioeconomic position, and birth weight of the offspring. In contrast, no significant effects were found among men.

CONCLUSIONS

Women born to grand multiparous mothers are at an increased risk of severe mental disorders and suicide attempts across adulthood. Our findings may inform the development of preventive interventions for mental disorders.

Social factors in childhood and risk of depressive symptoms among adolescents--a longitudinal study in Stockholm, Sweden

Background

In Sweden, self-reported depressive symptoms have increased among young people of both genders, but little is known about social differences in the risk of depressive symptoms among adolescents in welfare states, where such differences can be less pronounced. Therefore, the aim was to investigate whether multiple measures of low social status in childhood affect depressive symptoms in adolescence. A secondary aim was to explore potential gender effect modification.

Methods

Participants were recruited in 1998 for a longitudinal study named BROMS. The study population at baseline consisted of 3020 children, 11–12 years-old, from 118 schools in Stockholm County, followed up through adolescence. This study is based on 1880 adolescents answering the follow-up survey in 2004, at age 17–18 (62% of the initial cohort). Parental education, occupation, country of birth, employment status and living arrangements were reported at baseline, by parents and adolescents. Depressive symptoms were self-reported by the adolescents in 2004, using a 12-item inventory. The associations between childhood social status and depressive symptoms in adolescence are presented as Odds Ratios (OR), estimated through logistic regression. Gender interaction with social factors was estimated through Synergy Index (SI).

Results

Increased risk of depressive symptoms was found among adolescents whose parents had low education (OR 1.8, CI = 1.1-3.1), were unskilled workers (OR 2.1, CI = 1.2-3.7), intermediate non-manual workers (OR 1.8, CI = 1.0-3.0), or self-employed (OR 2.2, CI = 1.2-3.7), compared to parents with high education and high non-manual work. In addition, adolescents living exclusively with one adult had an increased risk compared to those living with two (OR 2.8, CI = 1.1-7.5), while having foreign-born parents was not associated with depressive symptoms. An interaction effect was seen between gender and social factors, with an increased risk for girls of low-educated parents (SI = 3.4, CI = 1.3-8.9) or living exclusively with one adult (SI = 4.9, CI = 1.4-6.8).

Conclusions

The low social position in childhood may increase the risk of depressive symptoms among adolescents even in countries with small social differences and a highly developed welfare system, such as Sweden. Girls with low educated parents or living exclusively with one adult may be particularly vulnerable. This knowledge is of importance when planning preventive interventions or treatment.

Electronic supplementary material

The online version of this article (doi:10.1186/s12939-014-0096-0) contains supplementary material, which is available to authorized users.

Gene-environment interactions in severe mental illness

Severe mental illness (SMI) is a broad category that includes schizophrenia, bipolar disorder, and severe depression. Both genetic disposition and environmental exposures play important roles in the development of SMI. Multiple lines of evidence suggest that the roles of genetic and environmental factors depend on each other. Gene-environment interactions may underlie the paradox of strong environmental factors for highly heritable disorders, the low estimates of shared environmental influences in twin studies of SMI, and the heritability gap between twin and molecular heritability estimates. Sons and daughters of parents with SMI are more vulnerable to the effects of prenatal and postnatal environmental exposures, suggesting that the expression of genetic liability depends on environment. In the last decade, gene-environment interactions involving specific molecular variants in candidate genes have been identified. Replicated findings include an interaction between a polymorphism in the AKT1 gene and cannabis use in the development of psychosis and an interaction between the length polymorphism of the serotonin transporter gene and childhood maltreatment in the development of persistent depressive disorder. Bipolar disorder has been underinvestigated, with only a single study showing an interaction between a functional polymorphism in the BDNF gene and stressful life events triggering bipolar depressive episodes. The first systematic search for gene-environment interactions has found that a polymorphism in CTNNA3 may sensitize the developing brain to the pathogenic effect of cytomegalovirus in utero, leading to schizophrenia in adulthood. Strategies for genome-wide investigations will likely include coordination between epidemiological and genetic research efforts, systematic assessment of multiple environmental factors in large samples, and prioritization of genetic variants.