Life-Course Associations Between Smoking and Depressive Symptoms. A 30-Year Finnish Follow-up Study.

INTRODUCTION: Relatively little is known about whether the association between smoking and depressive symptoms changes with age and how the trajectories of smoking and depressive symptoms are intertwined during the life course. In this population-based study, these associations were examined from young adulthood to middle age. METHODS: Participants of a Finnish cohort study (N = 1955) were assessed at the ages of 22, 32, 42, and 52 using questionnaires covering daily smoking (yes/no) and the short 13-item Beck Depression Inventory. Longitudinal latent class and longitudinal latent profile analyses were used to identify life course trajectories of smoking and depressive symptoms. RESULTS: The proportions of daily smokers decreased, while levels of depressive symptoms increased among both females and males from age 22 to 52 years. Smoking was associated with higher levels of depressive symptoms from age 22 to 42 years, while not at 52. Associations among males prevailed when adjusting for education, marital status, and alcohol use. Four life course classes of daily smoking (nonsmokers, decreasing prevalence of smoking, persistent smokers, and increasing prevalence of smoking) and four trajectories of depressive symptoms (low, increasing/moderate, decreasing/moderate, and high) were identified. In males, persistent daily smokers (relative risk ratio (RRR) = 4.5, 95% confidence interval (CI): 2.2 to 9.2) and those in the class with increasing smoking prevalence (RRR = 3.2, 95% CI: 1.1 to 9.1) had an increased risk of belonging to the high depressive symptoms profile. In females these associations were nonsignificant. CONCLUSIONS: Compared to females, the relationship between smoking and depressive symptoms seems more robust among males during adulthood. Specifically, males smoking persistently from young adulthood to middle age have an increased risk of high depressive symptoms trajectory. IMPLICATIONS: This population-based cohort with 30 years of follow-up showed that the life course trajectories of daily smoking and depressive symptoms are associated. Persistent daily smokers and those starting late had an increased risk of belonging to the profile with constantly high levels of depressive symptoms during the life course. However, these associations were statistically significant only in males. Actions should be strengthened, especially in males, to prevent smoking initiation, to help smoking cessation, and to identify and treat depression in smokers with significant depressive symptoms.

Social anxiety in Finnish adolescents from 2013 to 2021: change from pre-COVID-19 to COVID-19 era, and mid-pandemic correlates.

PURPOSE: Social anxiety disorder (SAD) is prevalent in adolescents. Increase in levels of general anxiety since 2010's has been observed in young people. Little is known of time trends in symptoms of social anxiety during 2010's, of pre- to during-COVID-19 era changes, or of associations between social anxiety symptoms and pandemic severity, distance education, and COVID-19-related experiences in young people. METHODS: We examined social anxiety symptoms, their temporal changes, and their associations with COVID-19 related factors in a sample of 450 000 13-to-20-year-old Finns in 2013-2021. Data from nationwide School Health Promotion study was used. Social anxiety symptoms were assessed with the Mini-SPIN using cut-off score ≥ 6 as indicator of high social anxiety. Multivariate logistic regression analyses were used, controlling for gender, age, family SES, and symptoms of general anxiety and depression. RESULTS: High-level social anxiety symptoms increased markedly from 2013/2015 to 2021 among both sexes. A steeper increase was found among females. In 2021, 47% of females self-reported high social anxiety, a two-fold increase relative to 2013/2015. No association between regional COVID-19 incidence and change in social anxiety symptoms was found. No clear associations between time spent in distance education and social anxiety symptoms were found. Fears of getting infected or transmitting coronavirus, and reports of not getting needed support for schoolwork during distance education were all associated with high social anxiety. CONCLUSION: Prevalence of high social anxiety in young people aged 13-20 has increased considerably from 2013 to 2021, especially among girls. During COVID-19 pandemic, socially anxious young people report a need for educational support and suffer from infection-related fears.

Associations of generalized anxiety and social anxiety with perceived difficulties in school in the adolescent general population.

INTRODUCTION: Generalized anxiety disorder (GAD), marked by excessive worry, and social anxiety disorder (SAD) are among the clinically most important anxiety disorders in the adolescent population. This study aimed to explore the associations between perceived difficulties in school and heightened levels of self-reported noncomorbid and comorbid GAD and SAD symptoms. METHODS: Survey data of 37,905 Finnish upper secondary school students with a mean age of 17.33 years (SD = 0.63) were obtained from the School Health Promotion study, implemented in April and May 2015 in Finland. Exploratory factor analysis was used to determine indicators of academic and social difficulties in school. Logistic regression analysis was conducted to examine multivariate associations between anxiety symptoms and difficulties in the school. The anxiety symptom thresholds were based on the seven-item Generalized Anxiety Disorder Scale (≥10 points) for GAD-related symptoms and the Mini-SPIN (≥6 points) for SAD-related symptoms. RESULTS: Self-reported generalized anxiety and social anxiety were both significantly associated with various perceived difficulties in school among this adolescent general population sample. Noncomorbid and comorbid GAD and SAD symptoms were both associated with an increased risk of academic and social difficulties, even when controlling for school performance. Comorbid symptoms were associated with significantly higher rates of social difficulties than noncomorbid symptoms of GAD or SAD. Furthermore, GAD symptoms were associated with a high risk for academic difficulties, irrespective of comorbidity. CONCLUSIONS: Excessive worry, a defining feature of GAD, is central to school-related impairments among adolescents. The present study highlights the importance of school-based interventions for anxious adolescents. Interventions to improve adolescents'; school functioning should account for the interference of pathological worry related to GAD.

Paternal perinatal stress is associated with children's emotional problems at 2 years.

BACKGROUND: Paternal mental health in pregnancy and postpartum has been increasingly highlighted as important both in its own right, but also as crucial for the development of children. Rates of help-seeking among fathers is low, possibly due to conceptualising their own difficulties as stress rather than problems with mood. The relationship between paternal stress and child outcomes has not been investigated. METHODS: This study used data from the Finnish CHILD-SLEEP birth cohort. Data were available for 901 fathers and 939 mothers who completed questionnaires on demographics, stress, anxiety and depression at 32 weeks gestation, 3 months, 8 months and 24 months postpartum. Parental report of child emotional and behavioural problems was collected at 24 months. RESULTS: Around 7% of fathers experienced high stress (over 90% percentile) at each timepoint measured in the perinatal period, rising to 10% at 2 years postpartum. Paternal stress measured antenatally, at 3 and 24 months was associated with child total problems at 24 months, while paternal depression and anxiety were not related to child outcomes when in the same model. After adjusting for concurrent maternal depression, anxiety and stress, an association remained between paternal stress at each timepoint and child total problem scores at 24 months. The strongest association was with paternal stress at 3 months (OR 3.17; 95% CI 1.63-6.16). There were stronger relationships between paternal stress and boys' rather than girls' total problem scores, although the interactions were not statistically significant. CONCLUSIONS: Paternal stress is an important manifestation of perinatal distress and is related to child mental health, particularly when present in the early postpartum months. Paternal stress should therefore be assessed in the perinatal period, which presents opportunities for early intervention and prevention of difficulties for both father and child.

Socioeconomic disparities in adolescent anxiety and depression in Finland have not increased during the COVID-19 pandemic.

AIMS: The purpose of this research was to assess whether socioeconomic disparities in adolescent depression and anxiety in Finland increased among middle adolescents during the COVID-19 pandemic. METHODS: Repeated cross-sectional surveys (the School Health Promotion Study) from spring 2019 and spring 2021 were compared. The respondents were 87,283 eighth and ninth graders (14-16-year-olds) in 2019 and 91,560 in 2021, corresponding respectively to 73% and 75% of the age groups. Depression was measured by Patient Health Questionnaire-2 (PHQ-2), and anxiety with GAD-7, and adverse socioeconomic background using low parental education, not living with both parents, and family's poor financial situation. Associations of socioeconomic adversities with depression and generalised anxiety, and the effect of COVID-19 (2021 vs 2019), were analysed using logistic regression. RESULTS: Depression and anxiety were more common in both sexes the more sociodemographic adversities there were in the adolescent's background. However, increases in the prevalence of anxiety and depression from pre- to in-pandemic time did not differ with accumulating sociodemographic adversities. CONCLUSIONS: Depression and anxiety increased in prevalence among Finnish adolescents during the pandemic. Sociodemographic disparities in depression and anxiety show no increase. Emotional symptoms are nevertheless more common in adolescents from lower socioeconomic status families.

Development of Body Dissatisfaction in Women and Men at Different Educational Levels During the Life Course.

BACKGROUND: Our study examines the rarely investigated associations between body dissatisfaction and educational level over the life course in women and men. METHODS: A Finnish cohort (N = 1955) was followed by questionnaires at ages 22, 32, 42, and 52. Body dissatisfaction was measured by asking the respondents to evaluate their appearance using five response options. Analyses were done using logistic regression, while latent class analyses were used to identify classes of body dissatisfaction trajectories over the life course. RESULTS: Body dissatisfaction increased with age in women and men. Among men, body dissatisfaction was related to lower education at the ages of 32 and 42. Also, men with lower education were more likely to maintain a less positive body image over the life course. In women, increasing body dissatisfaction during the life course was associated with lower education. CONCLUSIONS: Differences in body dissatisfaction based on educational level are important to take into account in public health actions aiming to reduce socioeconomic inequalities in health and well-being.

Psychiatric symptoms and the association with parents' psychiatric symptoms among recently arrived asylum-seeking children in Finland.

This study examined psychiatric symptoms and the association with parents' psychiatric symptoms among recently arrived accompanied asylum-seeking children in the age groups of 2-6 years (n = 93) and 7-12 years (n = 91). Children and parents were assessed using mental health and trauma measures (SDQ, HSCL-25 and PROTECT). The prevalence of total difficulties was 34.9% among 2-6-year-olds and 29.6% among 7-12-year-olds. The most common symptoms in both age groups were peer problems, followed by conduct problems among 2-6-year-olds and emotional symptoms among 7-12-year-olds. In both age groups, the children's emotional symptoms were associated with the parents' anxiety and depression as well as the trauma symptoms, while the conduct problems were only associated with the parents' trauma symptoms. In conclusion, peer problems as well as conduct problems and emotional symptoms are common among recently arrived asylum-seeking children. To support the mental health of these children, both children and parents need adequate support.

Suicides from 2016 to 2020 in Finland and the effect of the COVID-19 pandemic.

The COVID-19 pandemic has had negative mental health outcomes in populations, but the suicide numbers in Finland have remained unchanged compared with expected levels based on the pre-pandemic period. We included all deaths from suicide verified by the official cause-of-death investigations, including forensic autopsy with analysis of forensic toxicology samples, between 1 January 2016 and 31 December 2020 in Finland. There was a decline in suicide incidence from 2016 to 2020 in men, and a declining tendency in suicide rates for every consecutive month during the COVID-19 pandemic period. The COVID-19 governmental policy responses do not seem to have led to an increase in suicide numbers.

The associations of socioeconomic status and financial strain with restrained and emotional eating among 42-year-old women and men.

The current study investigated how different aspects of socioeconomic status (SES) and experiencing financial strain are associated with restrained and emotional eating among 42-year-old Finnish women and men. Lower SES is shown to be associated with diets of poorer nutritional quality and obesity. Nevertheless, little research has been done on the association between SES, financial strain and psychological dimensions of eating behaviour. The study was based on questionnaire data from 734 women and 600 men aged 42 years who were participants in a Finnish cohort study. SES was measured through three different dimensions: education, occupation and household income. Data were analyzed using binary logistic regression models. Results showed that restrained eating was associated with higher household income level in women and with higher occupational position in men. Emotional eating was associated with higher financial strain among women. Also, women with lower college education had higher odds for emotional eating compared to women with vocational education or less. Among men, emotional eating was not statistically significantly associated with any of the SES variables nor with financial strain, which may also be due to the very low level of emotional eating reported by men. In conclusion, our findings indicate that restrained eating would be associated with higher status brought by belonging to a higher income or occupational group. Emotional eating, in turn, would be related to experiencing financial strain, rather than to traditional SES dimensions, in women. These results are relevant when health-related interventions are targeted to different SES groups.

Life course associations between smoking and depressive symptoms. A 30-year Finnish follow-up study.

BACKGROUND: While the association between smoking and depressive symptoms has been studied quite extensively, only little is known whether the association changes and how the trajectories of smoking and depressive symptoms are intertwined during the life course. In this population-based study, we examined these associations from young adulthood to middle age. METHODS: Participants of a Finnish cohort study (N = 1955) were addressed at ages 22, 32, 42 and 52 using postal questionnaires including questions of daily smoking and depressive symptoms (the short 13-item Beck Depression Inventory). Linear and logistic regression analyses and longitudinal latent class and profile analyses were used. RESULTS: The percentages of daily smokers decreased, while levels of depressive symptoms increased among both women and men from age 22 to 52 years. Daily smoking was associated with higher levels of depressive symptoms between ages 22 and 42, while not at age 52. Associations among men prevailed also in the adjusted models. Four life course trajectories of daily smoking (non-smokers, quitters, persistent smokers, and late starters) and four depressive symptoms (low, increasing/moderate, decreasing/moderate, and high) were identified. In the adjusted models, persistent daily smokers and late starters had significantly higher risk of belonging to the high depressive symptoms profile in men, but not in women. CONCLUSIONS: Compared to women the associations between daily smoking and depressive symptoms seem more robust among men during adulthood. Especially those men smoking persistently from young adulthood to middle age have an increased risk of high depressive symptoms trajectory during the life course.

Longitudinal associations between inhibitory control and externalizing and internalizing symptoms in school-aged children.

Inhibitory control (IC) deficits have been associated with psychiatric symptoms in all ages. However, longitudinal studies testing the direction of the associations in childhood are scarce. We used a sample of 2,874 children (7 to 9 years old) to test the following three hypotheses: (a) IC deficits are an underlying risk factor with a potentially causal role for psychopathology, (b) IC deficits are a complication of psychopathology, and (c) IC deficits and psychopathology are associated at the trait level but not necessarily causally related. We used the go/no-go task to assess IC, the parent-rated Strengths and Difficulties Questionnaire to evaluate externalizing/internalizing symptoms, and the random intercepts cross-lagged panel model to test the hypotheses. The results showed no support for the underlying risk factor hypothesis, suggesting that IC unlikely has a causal role in this age group's psychopathology. The complication hypothesis received support for externalizing symptoms, suggesting that externalizing symptoms may hamper the normal development of IC. IC deficits and both externalizing and internalizing symptoms were correlated at the trait level, indicating a possible common origin. We suggest that it may be useful to support children with externalizing symptoms to promote and protect their IC development.

Factors contributing to psychological distress in the working population, with a special reference to gender difference.

BACKGROUND: Psychological distress refers to non-specific symptoms of stress, anxiety and depression, and it is more common in women. Our aim was to investigate factors contributing to psychological distress in the working population, with a special reference to gender differences. METHODS: We used questionnaire data from the nationally representative Finnish Regional Health and Well-being Study (ATH) collected in the years 2012-2016 (target population participants aged 20 +, n = 96,668, response rate 53%), restricting the current analysis to those persons who were working full-time and under 65 of age (n = 34,468). Psychological distress was assessed using the Mental Health Inventory-5 (MHI-5) (cut-off value <=52). We studied the following factors potentially associated with psychological distress: sociodemographic factors, living alone, having children under18 years of age, lifestyle-related factors, social support, helping others outside of the home and work-related factors. We used logistic regression analysis to examine association between having work-family conflict with the likelihood for psychological distress. We first performed the models separately for men and women. Then interaction by gender was tested in the combined data for those independent variables where gender differences appeared probable in the analyses conducted separately for men and women. RESULTS: Women reported more psychological distress than men (11.0% vs. 8.8%, respectively, p < 0.0001). Loneliness, job dissatisfaction and family-work conflict were associated with the largest risk of psychological distress. Having children, active participation, being able to successfully combine work and family roles, and social support were found to be protective factors. A significant interaction with gender was found in only two variables: ignoring family due to being absorbed in one's work was associated with distress in women (OR 1.30 (95% CI 1.00-1.70), and mental strain of work in men (OR 2.71 (95% CI 1.66-4.41). CONCLUSIONS: Satisfying work, family life and being able to successfully combine the two are important sources of psychological well-being for both genders in the working population.

Emotional School Engagement and Psychiatric Symptoms among 6-9-Year-old Children with an Immigrant Background in the First Years of School in Finland.

The aim of this study is to examine emotional school engagement and psychiatric symptoms among 6-9-year-old children with an immigrant background (n = 148) in their first years of school compared to children with a Finnish native background (n = 2430). The analyzed data consisted of emotional school engagement measures completed by children and Strengths and Difficulties Questionnaires completed by both parents and teachers. Children with an immigrant background had lower self-reported emotional school engagement than children with a native background with reference to less courage to talk about their thoughts in the class and more often felt loneliness. Further, they reported that they had more often been bullies and seen bullying in the class. Children with an immigrant background had more emotional symptoms and peer problems reported by parents than children with a native background. However, teachers did not report any significant differences.

Maternal and paternal depressive symptoms and children's emotional problems at the age of 2 and 5 years: a longitudinal study.

BACKGROUND: Maternal and paternal depressive symptoms are related to children's emotional problems, but their combined effect remains unclear. Here, we constructed four parental longitudinal depressive symptom trajectory groups and studied their associations with children's emotional problems at the age of 2 and 5 years. METHODS: We did an assessment of maternal and paternal depressive symptoms (gestational week 32, as well as 3, 8 and 24 months postnatally) and children's emotional problems at ages two (N = 939) and five (N = 700) in the CHILD-SLEEP cohort. Three separate maternal and paternal depressive symptom trajectories based on latent profile analysis were combined to form four parental depressive symptom trajectory groups. We compared groups with a general linear model, with children's emotional (total, internalizing and externalizing) - problem scores serving as the dependent variables. RESULTS: At both ages, combined parental depressive symptom trajectories were associated with children's emotional problems: effect sizes were medium for total and small for other domains. According to post hoc comparisons, children whose mothers or both parents had persistent depressive symptoms had significantly more total, externalizing and internalizing problems than did children who had neither parent nor only the father showing depressive symptoms. A higher (and persistent) level of maternal depressive symptoms was related to a higher level of these children's emotional problems, a pattern not evident with paternal depressive symptoms. In all analyses, the interaction effect was nonsignificant between parental trajectories and child gender. CONCLUSIONS: Findings suggest that an absence of depressive symptoms in their fathers cannot compensate for the adverse effects of maternal depressive symptoms upon their children. Moreover, paternal depressive symptoms alone do not lead to increased risk for emotional problems in these 2- and 5-year-old children. In contrast, even subclinical levels of maternal depressive symptoms in late pregnancy are associated with increased risk for their children's experiencing internalizing and externalizing emotional problems.

Sleep symptoms and long-term outcome in adolescents with major depressive disorder: a naturalistic follow-up study.

Sleep abnormalities in major depressive disorder (MDD) have been suggested to represent a vulnerability trait, which might predispose the individual to long-term psychiatric morbidity. In this study, we sought to assess whether the presence of sleep symptoms among adolescents with MDD is associated with poorer long-term outcome in young adulthood during naturalistic follow-up. Adolescent outpatients diagnosed with MDD (n = 166; age 13-19 years, 17.5% boys) were followed up during 8 years in naturalistic settings. N = 112 adolescents (16.1% boys) completed the 8-year assessment. Sleep symptoms and psychosocial functioning were assessed with structured clinical interviews, and depressive and anxiety symptoms with questionnaires. The severity of sleep symptoms at baseline was not associated with worse outcome at 8 years in terms of any of the outcome measures tested. In particular, the presence of a disturbed sleep-wake rhythm at baseline was associated with a more favourable outcome at 8 years: less depression and anxiety symptoms and higher level of psychosocial functioning. The presence of sleep symptoms in young adulthood was associated with the presence of current depression and anxiety symptoms and poorer psychosocial functioning. The presence of sleep symptoms at follow-up seems to be state-dependent: they are observed in conjunction with other psychiatric symptoms. Contrary to our hypothesis, our results suggest that sleep complaints among adolescents with MDD do not lead to poorer long-term clinical outcome in young adulthood. The link between sleep-wake rhythm disturbance and better long-term outcome needs to be confirmed and examined in detail in further studies, but here we speculate about possible explanations.

Short Sleep Duration and Later Overweight in Infants.

OBJECTIVE: To provide further knowledge about the longitudinal association between sleep duration and overweight in infants. STUDY DESIGN: The data for this study are from the CHILD-SLEEP birth cohort (n = 1679). The sleep data are based on parent-reported total sleep duration collected at 3, 8, 18, and 24 months. For a subgroup of 8-month old participants (n = 350), an actigraph recording was also made. Growth data were derived from the child health clinic records. A logistic regression model was used to study the association between sleep duration and later weight development. RESULTS: Shorter sleep duration in 3-month-old infants was cross-sectionally associated with lower weight-for-length/height (all P values ≤ .026) and body mass index (all P values ≤ .038). Moreover, short sleep duration at the age of 3 months was associated with greater weight-for-length/height z score at the age of 24 months (aOR 1.56; 95% CI 1.02-2.38) as well as with a predisposition to gain excess weight between 3 and 24 months of age (aOR 2.61; 95% CI 1.75-3.91). No significant associations were found between sleep duration at 8, 18, or 24 months and concurrent or later weight status. Actigraph-measured short night-time sleep duration at the age of 8 months was associated with greater weight-for-length at the age of 24 months (aOR 1.51; 95% CI 1.02-2.23). CONCLUSIONS: Short total sleep duration at the age of 3 months and short night-time sleep duration at the age of 8 months are associated with the risk of gaining excess weight at 24 months of age.

Longitudinal prospective associations between psychological symptoms and heavy episodic drinking from adolescence to midlife.

AIM: This study examined whether development of psychological symptoms (PS) differed between persons with different longitudinal profiles of heavy episodic drinking (HED) from adolescence to midlife. In addition, the reciprocal associations between PS and HED were studied. METHODS: Participants of a Finnish cohort study in 1983 at age 16 ( N = 2194) were followed up at ages 22 ( N = 1656), 32 ( N = 1471), and 42 ( N = 1334). HED was assessed with frequency of intoxication (16-22 years) and having six or more drinks in a session (32-42 years). Using latent class analysis, the participants were allocated to steady high, increased, moderate, and steady low groups according to their longitudinal profiles of HED. The PS scale (16-42 years) covered five mental complaints. The latent growth curve of PS was estimated in the HED groups for comparisons. In addition, the prospective associations between symptoms and HED were examined using cross-lagged autoregressive models. RESULTS: PS grew from 16 to 32 years, but declined after that, with women having higher level of PS than men. PS trajectory followed a path at highest and lowest level in the steady high and steady low HED groups, respectively. Symptoms predicted later HED, but the association in the opposite direction was not found. CONCLUSIONS: The more the HED trajectory indicated frequent HED, the higher was the level of PS throughout the follow-up. Results support the self-medication hypothesis, suggesting that alcohol is used to ease the burden of PS. More attention should be paid to alcohol use of people with mental symptoms in health services.

Social relationships in adolescence and heavy episodic drinking from youth to midlife in Finland and Sweden - examining the role of individual, contextual and temporal factors.

BACKGROUND: Applying the Process-Person-Context-Time (PPCT) model of the bioecological theory, this study considers whether proximal processes between the individual and the microsystem (social relationships within family, peer group and school) during adolescence are associated with heavy episodic drinking (HED), from youth to midlife, and whether the macro level context (country) plays a role in these associations. METHODS: Participants of two prospective cohort studies from Finland and Sweden, recruited in 1983/1981 at age 16 (n = 2194/1080), were followed-up until their forties using postal questionnaires. Logistic regression analysis was used to examine associations between social relationships at age 16 and HED (at least monthly intoxication or having six or more units of alcohol in one occasion) at ages 22/21, 32/30 and 42/43. Additive interactions between microsystem settings, as well as between settings and country, were also considered. RESULTS: Consistent with the PPCT model, we found individual, contextual and temporal aspects to be associated with drinking habits. Higher levels of poor family relationships were associated with an increased likelihood of HED (ages 22/21 and 32/30) in both Finnish women and men and Swedish men. Higher levels of peer contact were associated with an increased likelihood of HED in both Finnish women (ages 32 and 42) and men (ages 22 and 32), and Swedish men (age 21). In contrast with the other groups, poorer relationships with classmates were associated with an increased likelihood of HED (age 30) for Swedish women only. For women, the combined effect of having both daily peer contact and living in Finland for HED at age 42/43 was statistically distinguishable from a pure additive effect. CONCLUSIONS: Micro and to a lesser extent macro level contexts are associated with heavy episodic drinking well into adulthood. The most relevant processes in the adolescent microsystem occur in family and peer settings. However, long-lasting protective or risk-raising effects between different settings and later HED were not found. Promoting good relationships across different contexts during adolescence may reduce the incidence of HED in adulthood.

Associations between unemployment and heavy episodic drinking from adolescence to midlife in Sweden and Finland.

Background: Unemployment and alcohol use have often been found to correlate and to act as risk factors for each other. However, only few studies have examined these associations at longitudinal settings extending over several life phases. Moreover, previous studies have mostly used total consumption or medical diagnoses as the indicator, whereas subclinical measures of harmful alcohol use, such as heavy episodic drinking (HED), have been used rarely. The aim of this study was to examine the associations between HED and unemployment from adolescence to midlife in two Nordic countries. Methods: Participants of separate cohort studies from Sweden and Finland were recruited at age 16 in 1981/1983 and followed up at ages 21/22, 30/32 and 43/42, (n = 1080/2194), respectively. Cross-lagged autoregressive models were used to determine associations between HED and unemployment. Results: In the Swedish cohort, HED at ages 16 and 30 in men and HED at age 21 in women were associated with subsequent unemployment. In the Finnish cohort, we found corresponding associations at age 16 in women and at age 22 in men. However, the gender differences were not statistically significant. The associations from unemployment to HED were non-significant in both genders, in both cohorts and at all ages. Conclusions: Our results suggest that heavy drinkers are more likely to experience unemployment in subsequent years. The associations from HED to unemployment seem to exist through the life course from adolescence to midlife. More emphasis should be put on reducing alcohol related harms in order to improve labour-market outcomes.

Stability and Change in Personality Disorder Symptoms in 1-Year Follow-up of Depressed Adolescent Outpatients.

We investigated stability and change in personality disorder (PD) symptoms and whether depression severity, comorbid clinical psychiatric disorders, and social support predict changes in personality pathology among adolescent outpatients. The 1-year outcome of PD symptoms among consecutive adolescent psychiatric outpatients with depressive disorders (N = 189) was investigated with symptom count of depression, comorbid psychiatric disorders, and perceived social support as predictors. An overall decrease in PD symptoms in most PD categories was observed. Decreases in depression severity and in number of comorbid diagnoses correlated positively with decreases in PD symptoms of most PD categories. Social support from close friends predicted a decrease in schizotypal and narcissistic, whereas support from family predicted a decrease in paranoid symptoms. Our results suggest that among depressed adolescent outpatients, PD symptoms are relatively unstable, changes co-occuring with changes/improvement in overall psychopathology. Social support seems a possibly effective point for intervention efforts regarding positive outcome of PD symptoms.