Cancer Patients' Social Relationships During 3 Years After Diagnosis-Generic and Cancer-Specific Social Networks.

BACKGROUND: Social relationships are important health resources and may be investigated as social networks. We measured cancer patients' social subnetworks divided into generic social networks (people known to the patients) and disease-specific social networks (the persons talked to about the cancer) during 3 years after diagnosis. METHOD: Newly diagnosed patients with localized breast cancer (n = 222), lymphoma (n = 102), and prostate cancer (n = 141) completed a questionnaire on their social subnetworks at 2-5 months after diagnosis and 9, 18, and 36 months thereafter. Generic and cancer-specific numbers of persons of spouse/partner; other family; close relatives, in detail; and friends were recorded as well as cancer-specific numbers of persons in acquaintances; others with cancer; work community; healthcare professionals; and religious, hobby, and civic participation. The data was analyzed with regression models. RESULTS: At study entry, most patients had a spouse/partner, all had close relatives (the younger, more often parents; and the older, more often adult children with families) and most also friends. The cancer was typically discussed with them, and often with acquaintances and other patients (74-86%). Only minor usually decreasing time trends were seen. However, the numbers of distant relatives and friends were found to strongly increase by the 9-month evaluation (P < 0.001). CONCLUSION: Cancer patients have multiple social relationships and usually talk to them about their cancer soon after diagnosis. Most temporal changes are due to the natural course of life cycle. The cancer widened the patients' social networks by including other patients and healthcare professionals and by an increased number of relatives and friends.

Psychiatric Symptoms, Posttraumatic Growth, and Life Satisfaction Among Parents of Seriously Ill Infants: A Prospective Case-Controlled Study.

We evaluated psychiatric symptoms, posttraumatic growth, and life satisfaction among the parents (n = 34) of newborns (n = 17) requiring therapeutic hypothermia or urgent surgery (interest group). Our control group included 60 parents of healthy newborns (n = 30). The first surveys were completed soon after diagnosis or delivery and the follow-up surveys 1 year later (participation rate 88% in the interest group and 70% in the control group). General stress was common in both groups but was more prevalent in the interest group as were depressive symptoms, too. Anxiety was more common in the interest group, although it showed a decrease from the baseline in both groups. Life satisfaction had an inverse correlation with all measures of psychiatric symptoms, and it was lower in the interest group in the early stage, but similar at 12 months due to the slight decline in the control group. Mothers in the interest group had more anxiety and depressive symptoms than fathers in the early stage. Mothers had more traumatic distress than fathers at both time points. Half of the parents experienced substantial posttraumatic growth at 12 months. In conclusion, the serious illness of an infant substantially affects the well-being of the parents in the early stages of illness and one year after the illness.

Comparison of the level of allostatic load between patients with major depression and the general population.

OBJECTIVE: We compared the level of allostatic load (AL) between patients with major depressive disorder (MDD) and non-depressed controls using two definitions of AL: continuous AL scores (AL index) and clinically significant high AL (≥4). We examined whether MDD was associated with AL independent of basic socioeconomic (age, sex, cohabiting status and level of education) and lifestyle factors (smoking and alcohol use). METHODS: The MDD patient sample consisted of 177 psychiatric outpatients (mean age 33.7, SD 10.7 years), who were recruited from the Department of Psychiatry at Kuopio University Hospital, Finland, in 2016-19. The non-depressed controls (n = 228, mean age 49.8, SD 10.1 years) lived in the municipality of Lapinlahti, Finland. Ten biomarkers were used to construct the two AL variables. These indicators were systolic and diastolic blood pressure, total cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, glucose, creatinine, waist circumference, body mass index (BMI) and C-reactive protein (CRP). RESULTS: The mean AL scores did not significantly differ between MDD patients (2.97) and non-depressed controls (3.12), thus it was not associated with MDD in univariate analysis. In multivariate models a higher AL index was associated with a 1.42 to 1.82 times higher likelihood of belonging to the MDD group. Furthermore, we found that high AL (i.e. AL ≥ 4) was associated with MDD, with the likelihood ranging between 2.27 and 2.96 compared with the non-depressed controls in multivariate models. CONCLUSIONS: Even young adult patients with MDD appear to display clinically significant, high AL compared with non-depressed controls. Thus, it is important to pay attention to the somatic health of depressed patients in addition to their mental health.

Purine metabolism is dysregulated in patients with major depressive disorder.

INTRODUCTION: The purine cycle and altered purinergic signaling have been suggested to play a role in major depressive disorder (MDD). Nevertheless, data on this topic are scarce. Based on previous studies, we hypothesized that compared with non-depressed controls, MDD patients have distinct purine metabolite profiles. METHODS: The samples comprised 99 MDD patients and 253 non-depressed controls, aged 20-71 years. Background data were collected with questionnaires. Fasting serum samples were analyzed using ultra-performance liquid chromatography coupled to mass spectrometry (UPLC-MS) to determine seven purine cycle metabolites belonging to the purine cycle. We investigated the levels of these metabolites in three settings: (1) MDD patients vs. non-depressed controls and (2) remitted vs. non-remitted MDD patients, and also (3) within-group changes in metabolite levels during the follow-up period. RESULTS: In logistic regression adjusted for age, gender, smoking, alcohol use, physical exercise, glycosylated hemoglobin, and high-density lipoprotein cholesterol, lower levels of inosine (OR 0.89, 95% CI 0.82-0.97) and guanosine (OR 0.32, 95% CI 0.17-0.59), and higher levels of xanthine (OR 2.21, 95% CI 1.30-3.75) were associated with MDD vs. the non-depressed group. Levels of several metabolites changed significantly during the follow-up period in the MDD group, but there were no differences between remitted and non-remitted groups. CONCLUSIONS: We observed altered purine metabolism in MDD patients compared with non-depressed controls. Furthermore, our observations suggest that circulating xanthine may accumulate in MDD patients.

Alcohol use among adolescents, aggressive behaviour, and internalizing problems.

Alcohol use is common among adolescents, but its association with behavioural and emotional problems is not well understood. This study aimed to investigate how self-reported psychosocial problems were associated with the use of alcohol in a community sample consisting of 4074 Finnish adolescents aged 13-18 years. Aggressive behaviour associated with alcohol use and a high level of alcohol consumption, while internalizing problems did not associate with alcohol use. Having problems in social relationships associated with abstinence and lower alcohol consumption. Tobacco smoking, early menarche and attention problems also associated with alcohol use.

Reduced serum adiponectin levels in alexithymia.

OBJECTIVES: Clinical studies have demonstrated that circulating cytokine profiles may differ between alexithymic and non-alexithymic subjects. We examined whether the levels of adiponectin (µg/ml) and resistin (ng/ml) are independently related to alexithymic features in a population-based sample. METHODS: In 2005, clinical data including laboratory assessments were obtained from a sub-sample (n = 308) of the Kuopio Depression Study general population study including subjects aged 25-64 years. Based on the Toronto Alexithymia Scale score in 1998, 1999, 2001 and 2005, a group of subjects with high alexithymic features (n = 85) was formed and compared with non-alexithymic controls (n = 206). RESULTS: Serum adiponectin levels were significantly lower in subjects with alexithymic features than in non-alexithymic control subjects. No difference was found in resistin levels. Similarly, in a logistic regression model adjusted for age, gender and body mass index (BMI), lowered levels of adiponectin, but not resistin, were associated with an increased likelihood of belonging to the group with alexithymic features. Further adjustments for cardiovascular risk factors (i.e. smoking, BMI, metabolic syndrome, alcohol use, and coronary heart disease), depressive symptoms (Hamilton Depression Rating Scale with 17 items) and the use of antidepressants in addition to age and gender did not change these patterns. CONCLUSIONS: Our findings suggest that a disturbed anti-inflammatory balance may characterize alexithymia. In addition, our results widen the concept of alexithymia and highlight the role of immune system alterations and stress in alexithymic individuals.

Biological and other health related correlates of long-term life dissatisfaction burden.

BACKGROUND: Mental health is interconnected with somatic health and can manifest itself in biological processes. Life dissatisfaction is an indicator of subjective well-being, but information on its biological correlates is scarce. The aim of this study was to investigate the biological correlates along with other health-related factors of long-term life dissatisfaction in a population-based sample. METHODS: As part of the Kuopio Depression Study, health questionnaires were sent to a randomly selected population-based sample in 1998, 1999, and 2001. In 2005, among a clinically studied sub-sample (n = 305), the 7-year long-term life dissatisfaction burden was assessed by summing life satisfaction scores from previous health questionnaires. Several sociodemographic, health, health behavior, and biological factors were investigated in respect to their associations to categorized (low and high) and continuous (linear regression) life satisfaction burden score (higher values indicating dissatisfaction). RESULTS: In the final linear regression model long-term life dissatisfaction burden was significantly associated with poor social support (B = 0.138; p < 0.001), marital status (i.e. living alone) (B = 0.049; p = 0.019), current smoking (B = 0.087; p < 0.001), poor sleep (B = 0.052; p = 0.001), use of statins (B = -0.052; p = 0.002) and lower serum adiponectin level (B = -0.001; p = 0.039) whereas association of metabolic syndrome was marginally nonsignificant (B = 0.029; p = 0.055). CONCLUSION: Long-term life dissatisfaction is associated with adverse health, health behavioral, and social factors, as well as with a decreased anti-inflammatory buffer capacity, all indicating close relationships between subjective well-being and somatic morbidity.

Self-reported sleep disturbance is associated with elevated levels of PAI-1 in individuals with a recorded history of depressive symptoms.

BACKGROUND: The majority of depressed individuals report insomnia. Self-reported symptoms of insomnia, in particular, more strongly predict adverse health effects than the actual measured sleep time. The physiological alterations in individuals with insomnia are complex, as both autonomic and endocrine dysfunctions are present. Plasminogen activator inhibitor (PAI)-1 is a stress-related acute-phase reactant that has also been suggested to regulate the circadian rhythm and sleep patterns. It has been suggested to contribute to both depressive symptoms and sleep disorders, although data on the relationships between these parameters are scarce. OBJECTIVE: This study examined the role of self-reported sleep disturbance and its association with PAI-1 among individuals with a history of depressive symptoms. METHODS: Differences in the serum levels of PAI-1 between two groups (group 1: moderate to very severe sleep disturbance, n=37; group 2: mild or no sleep disturbance, n = 90) were examined in a population-based sample of individuals with a recorded history of depressive symptoms. RESULTS: Multivariate analysis controlling for potential confounding factors (age, sex, body mass index, depression severity) showed that each 1-unit increase in PAI-1 (µg/mL) increased the likelihood for belonging to the group with moderate to very severe sleep disturbance by 23% (OR = 1.23, C.I. 95% = 1.04-1.45, p = 0.016). This statistical significance remained after additional adjustments for regular smoking and the use of sleep or lipid-lowering medication. CONCLUSION: Our observations may further clarify the physiological alterations related to sleep disturbance in depressive individuals. In the present study, self-reported sleep disturbance in individuals with a recorded history of depressive symptoms was associated with an elevation of PAI-1. This finding may illustrate the association of subjective sleep disturbance with sympathetic activation. Our study highlights the importance of effects of perceived sleep disturbance on individual homeostasis, and may provide potential directions for research on treatment options.

Serum adipokine levels in adults with a history of childhood maltreatment.

Individuals with a history of childhood maltreatment present increased rates of metabolic disturbances, but the underlying mechanisms for such phenomena are poorly understood. This study examined whether the secretion of adipokines, adipocyte-derived inflammation markers closely associated with metabolic disorders, is altered in individuals with a history of childhood maltreatment. The serum levels of inflammatory markers adiponectin and resistin were measured from 147 general population participants who had a history of adverse mental symptoms, and who also reported their experiences of childhood maltreatment. Participants with experiences of childhood maltreatment (n=30) had lowered levels of serum adiponectin (p=0.007) and resistin (p=0.028). The differences in adiponectin levels persisted in multivariate modeling with adjustments for age, gender, and body mass index (OR for each 1 standard deviation decrease in the serum adiponectin level 2.65, 95% CI 1.31-5.35, p=0.007). Additional adjustments for marital status or a diagnosis of major depressive disorder, or the exclusion of individuals using NSAIDs, oral corticosteroids, or antidepressants did not alter the results. The association between resistin levels and childhood maltreatment did not remain independent in the same models. Our findings suggest that in individuals with previously reported adverse mental symptoms, a history of childhood maltreatment is independently associated with lowered levels of the anti-inflammatory marker adiponectin. This may lead to a lowered anti-inflammatory buffer capacity, which can, in turn, increase the susceptibility to physical and psychological states characterized by pronounced pro-inflammation.

Elevated levels of serum IL-5 are associated with an increased likelihood of major depressive disorder.

BACKGROUND: Inflammatory mediators in both the peripheral circulation and central nervous system (CNS) are dysregulated in major depressive disorder (MDD). Nevertheless, relatively little is known about the role of the T-helper (Th)-2 effector cytokines interleukin (IL)-5 and IL-13 in MDD. METHODS: We examined the serum levels of these cytokines and a Th-1 comparison cytokine, interferon (IFN)-γ, in 116 individuals (MDD, n = 58; controls, n = 58). RESULTS: In our basic multivariate model controlling for the effects of potential confounders on the associations between MDD and the examined cytokines, each 1-unit increase in the serum IL-5 level increased the likelihood of belonging to the MDD group by 76% (OR 1.76, 95% CI 1.03-2.99, p = 0.04; model covariates: age, gender, marital status, daily smoking and alcohol use). The likelihood further increased in models additionally controlling for the effects of the use of antidepressants and NSAIDS, and a diagnosis of asthma. No such associations were detected with regard to IL-13 (OR 1.08, 95% CI 0.96-1.22, p = 0.22) or IFN-γ (OR 1.02, 95% CI 0.99-1.05, p = 0.23). CONCLUSIONS: Elevated levels of IL-5, which uses the neural plasticity-related RAS GTPase-extracellular signal-regulated kinase (Ras-ERK) pathway to mediate its actions in the central nervous system (CNS), could be one of the factors underlying the depression-related changes in CNS plasticity.

Alexithymia and tissue inflammation.

BACKGROUND: Altered immune responses are seen in depression, and recent data suggest that similar changes could also be observable in alexithymia. We examined whether the inflammatory markers high-sensitivity C-reactive protein (hs-CRP) and interleukin (IL)-6 are independently related to alexithymia or its factors in a population-based sample. METHODS: This study formed a clinical part of the Kuopio Depression (KUDEP) general population study focusing on the mental health of a general population of adults aged 25-64 years (n = 308). Alexithymia was measured using the Toronto Alexithymia Scale (TAS-20), and depressive symptoms were assessed using the Beck Depression Inventory (BDI-21). RESULTS: The levels of IL-6 (in picograms per milliliter) and hs-CRP (in milligrams per liter) were significantly higher in alexithymic than in nonalexithymic subjects (IL-6 effect size, ES: 0.50; hs-CRP ES: 0.27). The BDI scores, hs-CRP and IL-6 explained 33.5% of the variation in TAS scores in the whole study population. According to logistic regression analysis, hs-CRP but not IL-6 increased the likelihood of belonging to the alexithymic group. This observation remained unaltered after additional adjustments for chronic inflammation-related disorders, the use of inflammation-modulating medications and depressive symptoms. CONCLUSIONS: Our findings suggest that the association between hs-CRP and alexithymia resembles that observed in depressed patients. It is, however, independent of depressive symptoms. These findings widen our view on the stress-alexithymia concept.

Stability of alexithymia in the general population: an 11-year follow-up.

OBJECTIVES: There is an ongoing debate concerning the temporal stability of alexithymia. Most previous studies have been conducted on clinical populations of psychiatric and somatic patients. However, psychiatric and somatic morbidity have been found to confound the findings so that in their presence, alexithymia appears to be less stable. Nevertheless, few general population studies have been published, and there have been no follow-ups longer than 5 years. METHOD: In a population-based sample of middle-aged Finnish men, 755 participants completed the Toronto Alexithymia Scale (TAS)-26 at baseline and on 11-year follow-up. Absolute or mean stability refers to the extent to which scores change over time, and it was measured with group comparisons of paired samples. Relative stability refers to the consistency of relative differences in alexithymia levels among the study subjects, and it was measured with test-retest correlations. RESULTS: Changes in the total scores and the subscales of the TAS-26 were all statistically significant but had low effect sizes (0.09-0.20) for the change-suggested absolute stability. The correlations between baseline and follow-up scores were high (ρ = 0.51-0.63), indicating relative stability. The exclusion of depressive symptoms, a history of mental illnesses, and cancer or cardiovascular diseases at baseline and at the 4- and 11-year follow-ups did not essentially alter these findings. Of the background variables, a higher age independently associated with the increase in the TAS-26 scores. Those with alexithymia at baseline were more likely to have elevated depressive symptoms at the 4- and 11-year follow-ups. CONCLUSIONS: Both the absolute and relative stabilities of alexithymia in the general population are high, even for a long follow-up period. These results may support the assumption that alexithymia represents a stable personality trait in general. Alexithymia may increase vulnerability to depressive symptoms.

Low serum HDL-cholesterol levels are associated with long symptom duration in patients with major depressive disorder.

AIMS: The purpose of the present study was to examine whether the association between depression and the serum high-density lipoprotein cholesterol (HDL-C) is modified by symptom duration. METHODS: Depressed patients (n = 88) and an age- and sex-matched group of healthy general population controls (n = 88) underwent a Structured Clinical Interview for DSM-IV (SCID), and depressed participants reported the duration of their symptoms. The serum levels of total cholesterol (TC), HDL-C, low-density lipoprotein cholesterol (LDL-C), triglycerides (TG) and non-HDL, and the ratios of LDL-C/HDL and TC/HDL-C were assessed. RESULTS: Major depressive disorder (MDD) subjects with a long symptom duration (>or=3 years) had lower levels of HDL-C compared with healthy controls or MDD subjects with a symptom duration <3 years. The likelihood for long symptom duration doubled for each 0.5-mmol/L decrease in HDL-C levels in regression models adjusted for age, gender, marital status, overweight, symptom severity, alcohol consumption, smoking, physical exercise, medication use, and non-HDL-C (P < 0.05). CONCLUSIONS: These findings suggest that a low serum HDL-C level, a risk factor for coronary heart disease, is specifically associated with long-term depressive symptomatology.

Serum IL-7 and G-CSF in major depressive disorder.

Major depressive disorder (MDD) has been associated with dysregulated immune systems and impaired T cell function, but data on depression-related alterations in the levels of immunomodulatory growth factors are scarce. In order to further clarify the mechanisms underlying immune system dysregulation in depressed subjects, we examined the associations between MDD and serum levels of two immunomodulatory growth factors, interleukin (IL)-7 and granulocyte-colony stimulating factor (G-CSF), in 122 subjects (MDD with long-term symptomatology, n=61; controls, n=61). The MDD subjects had lowered levels of IL-7. In a model adjusted for age, gender and body mass index, subjects in the lowest tertile of IL-7 had a 3.4-fold increased likelihood for MDD (p=0.010). Further adjustments for sleep disturbances, alcohol use, smoking, and metabolic syndrome did not alter these findings. Moreover, the exclusion of subjects with rheumatoid arthritis, coronary heart disease, or the use of non-steroidal anti-inflammatory medications or oral corticosteroids only slightly attenuated the findings. The G-CSF levels did not differ between the two groups. The lowering of the serum levels of IL-7, a regulator of T cell homeostasis, in MDD subjects may underlie the depression-related impaired T cell function.

Serum chemokine levels in major depressive disorder.

OBJECTIVE: To examine the role of chemokines of two major chemokine families, CC and CXC, in major depressive disorder (MDD) in a population-based sample. METHOD: The serum levels of CC chemokines MCP-1 and MIP-1beta, and CXC chemokine IL-8 were measured from 122 participants (MDD group, n=61; controls, n=61). Depression severity was assessed with the 29-item Hamilton Depression Rating Scale. RESULTS: The MDD group had lower levels of MCP-1, MIP-1beta and IL-8 than the healthy controls. The likelihood of major depressive disorder for participants with chemokine levels below the median (MCP-1: < 26.26 pg/mL; MIP-1beta: < 42.57 pg/mL; IL-8: < 2.86 pg/mL) was 3.6 (p=0.002) for MIP-1beta and 2.4 (p=0.037) for IL-8 in regression models adjusted for age, gender, body mass index, smoking, and alcohol consumption. MCP-1 did not associate with the presence of MDD after adjustments for potential confounders. Further adjustments for somatic illnesses or medications did not affect these findings. CONCLUSION: Our findings suggest that depression-related alterations of inflammatory markers may be more complex than previously assumed, and that at least some of the chemokines may be down-regulated.

Unemployment and ill health: a connection through inflammation?

BACKGROUND: Unemployment is a source of acute and long-term psychosocial stress. Acute and chronic psychosocial stress can induce pronounced changes in human immune responses. In this study we tested our hypothesis that stress-induced low-grade tissue inflammation is more prevalent among the unemployed. METHODS: We determined the inflammatory status of 225 general population subjects below the general retirement age (65 years in Finland). Those who had levels of both interleukin-6 (>or= 0.97 pg/mL) and high-sensitivity C-reactive protein (>or= 1.49 mg/L) above the median were assessed to have an elevated inflammatory status (n = 72). RESULTS: An elevated inflammatory status was more common among the unemployed than among other study participants (59% versus 30%, p = 0.011). In the final multivariate model, those who were unemployed had over five-fold greater odds for having an elevated inflammatory status (OR 5.20, 95% CI 1.55-17.43, p = 0.008). CONCLUSION: This preliminary finding suggests that stress-induced low-grade inflammation might be a link between unemployment and ill health.

Are factors associated with suicidal ideation true risk factors? A 3-year prospective follow-up study in a general population.

BACKGROUND: Adverse life events or the commencement of adverse lifestyles associate with suicidal ideation, but most associations only have been identified in cross-sectional studies. More information is needed about whether they are true risk factors and independently predict the development of suicidal ideation. METHOD: A sample of the general population from Eastern Finland (n = 1,339) was followed-up for three-years with baseline and two follow-up assessments using postal questionnaires. The main adverse life events and changes in lifestyles were screened at baseline and on one- and three-year follow-up. The Beck Depression Inventory was used to assess the level of depression and the presence of suicidal ideation. RESULTS: Suicidal ideation was common in the sample (annual incidence 4.3%). At baseline it associated with a cluster of adverse life events and lifestyles, as well as depression. Nevertheless, only the Beck Depression Inventory score on 3-year follow-up (OR 1.33, 95% CI 1.22-1.45) and the onset of daily smoking during the follow-up period (OR 5.38, 95% CI 1.41-20.62) independently predicted the presence of suicidal ideation on 3-year follow-up among those who had been non-suicidal at baseline and on 1-year follow-up. CONCLUSION: Depressive mood appears to be a necessary precondition for the occurrence of suicidal ideation even after adverse life events.

Low HDL cholesterol associates with major depression in a sample with a 7-year history of depressive symptoms.

Long-term depression may increase the risk for adverse coronary events. Low levels of high-density lipoprotein cholesterol (HDL-C) have in particular been suggested to underlie this connection. A total of 124 participants with a recorded seven-year history of depressive symptoms (depressed, n=63) or euthymic state (controls, n=61) underwent a Structured Clinical Interview for DSM-IV to confirm their psychiatric diagnosis. Total cholesterol (TC), HDL-C and low-density lipoprotein cholesterol (LDL-C) levels, triglycerides, non-HDL-C and atherogenic indices (LDL-C/HDL-C and TC/HDL-C) were assessed. The HDL-C levels were lower and atherogenic indices higher in the depressed group compared with the controls. Furthermore, those with HDL-C level below the gender-adjusted median (<1.54 mmol/l in women, <1.16 mmol/l in men) were 2.4-fold more likely to be depressed in a model adjusting for age and non-HDL-C (p=0.019). After further adjustment for educational level, marital status, alcohol use, daily smoking and overweight this association remained significant (p=0.049). These findings suggest that compared with the healthy controls, those with long-term depression may have lower HDL-C values and higher atherogenic indices.

The course of dissociation in the general population: a 3-year follow-up study.

OBJECTIVE: There have been no previous general population studies on the stability of dissociative symptoms. The aim of this study was to examine the course of and the changes in dissociative symptoms and factors associated with these changes during a 3-year follow-up of a Finnish general population sample. METHODS: The general population sample included a cohort of 1497 subjects. Dissociative symptoms were assessed with the Dissociative Experiences Scale (DES) and the DES-taxon (DES-T). Depressive symptoms and suicidal ideation were measured with the Beck Depression Inventory (BDI). The sample was categorized into low dissociators with DES scores less than 20 and high dissociators with DES scores of 20 or more. RESULTS: At baseline, 98 subjects were high dissociators. On follow-up, 28 of them were still high dissociators, whereas among 70 subjects, the DES score declined below the cutoff score. During the follow-up period, 28 of 1399 subjects became new high dissociators, and constantly low dissociators consisted of 1371 of 1399 subjects. Dissociative taxon membership was detected in 39 subjects either at baseline or at follow-up, but only 4 of them met the criteria at both assessments. Stable high dissociation was associated with an increase in the BDI score on follow-up, baseline suicidal ideation, a younger age, a reduced working ability, and smoking. Risk factors for becoming a new high dissociator were an increase in the BDI score, a younger age at baseline, and a reduced working ability. Among the baseline high dissociators, recovery from high dissociation was associated with a decline in the BDI score at follow-up and with no suicidal thoughts, older age, and a good working ability at baseline. CONCLUSIONS: Only a small proportion of the general population had constantly high levels of dissociative symptoms. The stability of dissociative taxon membership was weaker than the stability of the continuous variables of dissociation. The dissociative experiences had a tendency to change, and these changes were associated with changes in the BDI scores. Further studies are needed to reveal the factors associated with the changes in dissociative symptoms.

Dissociation in a general population of Finnish adolescents.

Only a few studies have been published concerning dissociation in general population adolescents. We assessed dissociation using the Adolescent Dissociative Experiences Scale (A-DES) in a sample of Finnish adolescents aged 13 to 18 years (n = 4019). The A-DES had good internal reliability and factor analysis suggested a 1-factor solution to be optimal. The younger participants had somewhat higher A-DES scores, but there were no differences between the genders. The mean A-DES score of 0.88 in the whole sample was lower than that in previous studies in other countries. A high level of dissociation was associated with an age of 15 or less, daily smoking, frequent use of alcohol, abuse of legal drugs, cannabis use, social isolation, and poor school performance in mathematics.