Mental disorders and the use of primary health care services among homeless shelter users in the Helsinki metropolitan area, Finland.

BACKGROUND: Homelessness is associated with increased morbidity, mortality and health care use. The aim of this study was to examine the role of mental disorders in relation to the use of 1) daytime primary health care services and 2) after hours primary health care emergency room (PHER) services among homeless shelter users in the Helsinki Metropolitan Area, Finland. METHODS: The study cohort consists of all 158 homeless persons using the four shelters operating in the study area during two selected nights. The health records were analyzed over a period of 3 years prior to the sample nights and data on morbidity and primary health care visits were gathered. We used negative binomial regression to estimate the association between mental disorders and daytime visits to primary health care and after hours visits to PHERs. RESULTS: During the 3 years the 158 homeless persons in the cohort made 1410 visits to a physician in primary health care. The cohort exhibited high rates of mental disorders, including substance use disorders (SUDs); i.e. 141 persons (89%) had a mental disorder. We found dual diagnosis, defined as SUD concurring with other mental disorder, to be strongly associated with daytime primary health care utilization (IRR 11.0, 95% CI 5.9-20.6) when compared with those without any mental disorder diagnosis. The association was somewhat weaker for those with only SUDs (IRR 4.9, 95% CI 2.5-9.9) or with only other mental disorders (IRR 5.0, 95% CI 2.4-10.8). When focusing upon the after hours visits to PHERs we observed that both dual diagnosis (IRR 14.1, 95% CI 6.3-31.2) and SUDs (11.5, 95% CI 5.7-23.3) were strongly associated with utilization of PHERs compared to those without any mental disorder. In spite of a high numbers of visits, we found undertreatment of chronic conditions such as hypertension and diabetes. CONCLUSIONS: Dual diagnosis is particularly strongly associated with primary health care daytime visits among homeless persons staying in shelters, while after hours visits to primary health care level emergency rooms are strongly associated with both dual diagnosis and SUDs. Active treatment for SUDs could reduce the amount of emergency visits made by homeless shelter users.

Adult criminality among former residential school adolescents.

BACKGROUND: There is evidence from around the world that disruptive behaviour during adolescence is associated with increased risk of later criminality. Outcomes for young people placed in the Finnish residential school because of severe conduct problems are not known. AIMS: Our aims were to investigate criminality after leaving a residential school placement during adolescence, and to compare trends in criminality between four successive graduate cohorts (1991, 1996, 2001 and 2006). METHODS: We used official records to study complete national cohort of all 861 people who had been resident in the Finnish residential school system on the last day of each of the years 1991, 1996, 2001 and 2006. They were compared with 4255 matched general population controls. The follow-up time was up to 20 years. RESULTS: Two-thirds (66%) of all residential school graduates (N = 566: 448/78% men, 118/41% women) had at least one criminal conviction in adulthood, a 13-fold elevation over the general population rate. The most prevalent crime categories were violence (N = 409, 48%: 331/58% men, 78/27% women) and property crimes (N = 405: 47%: 346/60% men, 51/21% women). The risk of violent crime was 18 times that among controls; 13 of residential school males (2.3%) had a homicide conviction. Once adult, the risk of offending decreased with age. There was a significant trend for improvement in offending rates between the earliest and latest residential school cohorts. CONCLUSIONS: The risk of committing crimes after a residential school placement is sufficiently elevated that alternative strategies, perhaps particularly longer-term post-release supervision and aftercare, should be considered. Indications of lower crime rates in later cohorts suggest that some positive changes to the school regime and/or aftercare may have been made already. Copyright © 2017 John Wiley & Sons, Ltd.

Predictors of new-onset depressive disorders - Results from the longitudinal Finnish Health 2011 Study.

BACKGROUND: Identifying risk factors for depression is important for understanding etiological mechanisms and targeting preventive efforts. No prior studies have compared risk factors of dysthymia and major depressive disorder (MDD) in a longitudinal setting. METHODS: Predictors of new-onset MDD and dysthymia were examined in a longitudinal general population study (Health 2000 and 2011 Surveys, BRIF8901). 4057 persons free of depressive disorders at baseline were followed up for 11 years. DSM-IV MDD and dysthymia were diagnosed with the Composite International Diagnostic Interview. RESULTS: 126 persons (4.4%, 95%CI 3.6-5.2) were diagnosed with MDD or dysthymia at follow-up. Predictors of new-onset depressive disorders were younger age (adjusted OR 0.97, 95%CI 0.95-0.99 per year), female gender (aOR 1.46, 95%CI 1.01-2.12), multiple childhood adversities (aOR 1.76, 95%CI 1.10-2.83), low trust dimension of social capital (aOR 0.58, 95%CI 0.36-0.96 for high trust), baseline anxiety disorder (aOR 2.75, 95%CI 1.36-5.56), and baseline depressive symptoms (aOR 1.65, 95%CI 1.04-2.61 for moderate and aOR 2.49, 95%CI 1.20-5.17 for severe symptoms). Risk factors for MDD were younger age, female gender, anxiety disorder and depressive symptoms, whereas younger age, multiple childhood adversities, low trust, and having 1-2 somatic diseases predicted dysthymia. LIMITATIONS: We only had one follow-up point at eleven years, and did not collect information on the subjects' health during the follow-up period. CONCLUSIONS: Persons with subclinical depressive symptoms, anxiety disorders, low trust, and multiple childhood adversities have a higher risk of depressive disorders. Predictors of MDD and dysthymia appear to differ. This information can be used to target preventive efforts and guide social policies.