Help-seeking behaviour among Finnish adolescent males

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

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.

Severe conduct problems in adolescence and risk of schizophrenia in early adulthood

AIM

Reform school (RS) is a foster care institution for adolescents with severe conduct problems. Both instability of early rearing environment and severe conduct problems in adolescence may associate with later psychotic disorders. We studied whether the risk of schizophrenia in adulthood is elevated in RS adolescents, and whether it is related to the age at first foster care placement or placement instability.

METHODS

Adult age schizophrenia spectrum disorder data from RS subjects (N = 1099) were compared to a comparison group matched by age, sex, and place of birth (N = 5437) in a register based follow-up study, with up to 23 years follow-up time. Schizophrenia was also predicted with chosen placement factors. Cox proportional regression model was used in the analysis.

RESULTS

RS subjects had an 8-fold (HR = 7.82, 95% CI 5.63-10.87) risk of schizophrenia compared to the comparison group. RS subjects also had an earlier age of schizophrenia onset. RS cohort, gender, placement instability, or age during the first out-of-home placement did not predict later schizophrenia.

CONCLUSIONS

Adolescents with severe conduct problems are a specific high-risk group for later schizophrenia. The risk manifests early, which compromises the pathway to the adult well-being. Specialized screening procedures for psychosis risk should be implemented in the standard clinical procedures when working with adolescents with severe behaviour problems, and early intervention programs should be available.

CAPMH health-related quality of life among adolescent psychiatric outpatients: a 12-month follow-up study among 12-14-year-old Finnish boys and girls

BACKGROUND

Little is known about adolescents' perceptions about their health-related quality of life (HRQoL) in the course of routine adolescent psychiatric treatment. The aim of this 1-year follow-up study was to investigate HRQoL and changes in it among youths receiving adolescent psychiatric outpatient treatment.

METHODS

The study comprised 158 girls and 82 boys aged 12-14 years from 10 psychiatric outpatient clinics in one Finnish hospital district. Same-aged population controls (210 girls and 162 boys) were randomly collected from comprehensive schools. HRQoL was measured using the 16D instrument. The questionnaire was self-administered when the adolescents entered the polyclinics (= baseline), after a treatment period of 6 months, and after 12 months.

RESULTS

The mean age of respondents was 13.8 years (SD 0.63). At baseline, the mean HRQoL score of both female and male outpatients was significantly lower than that of population controls (p < 0.001). HRQoL of female patients was significantly worse than that of male patients (p < 0.001). In girls, HRQoL improved continuously during the 12-month follow-up, yet it remained worse than that of female population controls. Among boys, HRQoL was substantially better at the 6-month follow-up than at baseline, but this positive development was no longer seen at the 12-month follow-up.

CONCLUSIONS

From the perspective of HRQoL, girls seem to benefit more than boys from adolescent psychiatric outpatient treatment. Possible explanations for this finding are discussed.

Serious delinquency and later schizophrenia: A nationwide register-based follow-up study of Finnish pretrial 15- to 19-year-old offenders sent for a forensic psychiatric examination

BACKGROUND

Aggressive and disruptive behaviors often precede the onset of schizophrenia. In this register-based follow-up study with a case-control design, we wanted to investigate if serious delinquency was associated with future diagnoses of schizophrenia or schizoaffective disorder (here, broadly defined schizophrenia) among a nationwide consecutive sample of 15- to 19-year-old Finnish delinquents sent for a forensic psychiatric examination in 1989-2010.

METHODS

The sample comprised 313 delinquents with no past or current psychotic disorder. For each delinquent, four age-, gender- and place of birth -matched controls were randomly selected from the Central Population Register. Five controls (0.4%) had been treated for schizophrenia before their respective index-dates and were thus excluded from further analysis, leaving us with a control population of 1247 individuals. The subjects were followed till death, emigration or the end of 2015, whichever occurred first. Diagnoses were obtained from the Care Register for Health Care.

RESULTS

Forty (12.8%) of the delinquents and 11 (0.9%) of the controls were diagnosed with schizophrenia later in life (HR 16.6, 95% CI 8.53-32.39, P<0.001). Almost half of the pretrial adolescents with later schizophrenia were diagnosed within 5years of the forensic psychiatric examination, but latency was longer among the other half of the sample, reaching up to 20.5years.

CONCLUSIONS

The study supports the previous research indicating a potential link between serious delinquency and later schizophrenia. Accurate psychiatric assessments should be made in correctional services but also later in life so that any possible psychotic symptoms can be detected in individuals with a history of serious delinquency even if there were no signs of psychosis before or at the time of the crime. Future research should explore which factors influence the delinquent's risk of developing later schizophrenia.

Fire-setting performed in adolescence or early adulthood predicts schizophrenia: a register-based follow-up study of pre-trial offenders

BACKGROUND

Aggressive and disruptive behaviours often precede the onset of serious mental illnesses. Fire-setting is a type of crime that is associated with psychotic disorders.

AIM

The aim of this prospective follow-up study was to investigate if fire-setting performed in adolescence or early adulthood was associated with future diagnoses of schizophrenia or schizoaffective disorder.

METHODS

The consecutive sample consisted of 111 Finnish 15-25-year old males with fire-setting crimes, decreed to a pre-trial forensic psychiatric examination in 1973-1998, and showing no past nor current psychosis at the time of examination. For each firesetter, four age-, gender-, and place of birth-matched controls were randomly selected from the Central Population Register. The subjects were followed until the death of the individual, until they moved abroad, or until the end of 2012.

RESULTS

Fourteen firesetters (12.6%) and five controls (1.1%) were diagnosed with either schizophrenia or schizoaffective disorder later in life, corresponding to a hazard ratio of 12.5. The delay between the fire-setting offense and the future diagnosis was on average nearly 10 years.

CONCLUSIONS

Young male offenders undergoing a forensic psychiatric examination because of fire-setting crimes had a significant propensity for schizophrenia and schizoaffective disorder. Accurate assessments should be made both during imprisonment and later in life to detect possible psychotic signs in these individuals.

Psychometric properties of the Trauma and Distress Scale, TADS, in an adult community sample in Finland

BACKGROUND

There is increasing evidence that a history of childhood abuse and neglect is not uncommon among individuals who experience mental disorder and that childhood trauma experiences are associated with adult psychopathology. Although several interview and self-report instruments for retrospective trauma assessment have been developed, many focus on sexual abuse (SexAb) rather than on multiple types of trauma or adversity.

METHODS

Within the European Prediction of Psychosis Study, the Trauma and Distress Scale (TADS) was developed as a new self-report assessment of multiple types of childhood trauma and distressing experiences. The TADS includes 43 items and, following previous measures including the Childhood Trauma Questionnaire, focuses on five core domains: emotional neglect (EmoNeg), emotional abuse (EmoAb), physical neglect (PhyNeg), physical abuse (PhyAb), and SexAb.This study explores the psychometric properties of the TADS (internal consistency and concurrent validity) in 692 participants drawn from the general population who completed a mailed questionnaire, including the TADS, a depression self-report and questions on help-seeking for mental health problems. Inter-method reliability was examined in a random sample of 100 responders who were reassessed in telephone interviews.

RESULTS

After minor revisions of PhyNeg and PhyAb, internal consistencies were good for TADS totals and the domain raw score sums. Intra-class coefficients for TADS total score and the five revised core domains were all good to excellent when compared to the interviewed TADS as a gold standard. In the concurrent validity analyses, the total TADS and its all core domains were significantly associated with depression and help-seeking for mental problems as proxy measures for traumatisation. In addition, robust cutoffs for the total TADS and its domains were calculated.

CONCLUSIONS

Our results suggest the TADS as a valid, reliable, and clinically useful instrument for assessing retrospectively reported childhood traumatisation.