Premorbid temperament as predictor of onset of depression: 23-year follow-up.

BACKGROUND: Previously Cloninger's temperament traits have been researched as a risk factor for depression mostly in cross-sectional studies. In these studies, especially high harm avoidance has been associated with an increased risk of depression. The main objective of this study was to investigate how temperament traits affect the risk of the onset of depression in a previously mentally healthy adult population. METHODS: This study includes a follow-up period of 23 years from the age of 31 until 54 in the Northern Finland Birth Cohort 1966 Study. Temperament was measured at the 31-year follow-up using Temperament and Character Inventory (TCI). The outcome of the study was depressive disorder diagnosis during the follow-up in both sexes. To be able to take correlations between temperament traits we also did an analysis using temperament clusters. RESULTS: Our sample size was 3999 individuals, out of which 240 were diagnosed with depression. For women an increase in the TCI score for novelty seeking (NS), harm avoidance (HA) or persistence (P) increased the risk of depression during the follow-up. For men only HA was a significant predictor of depression. An increase in reward dependence (RD) was found to reduce the risk of psychotic depression. In the analysis using the temperament clusters, the cluster including shy and pessimistic individuals was associated with risk for depression diagnosis in men. CONCLUSIONS: This prospective general population-based cohort study added to previous knowledge of high HA being a risk factor for depression, but it also found new associations such as higher P and NS.

Former long-term use of combined hormonal contraception and glucose metabolism disorders in perimenopausal women: A prospective, population-based cohort study.

INTRODUCTION: Current use of combined hormonal contraceptives worsens glucose tolerance and increases the risk of type 2 diabetes mellitus at late fertile age, but the impact of their former use on the risk of glucose metabolism disorders is still controversial. MATERIAL AND METHODS: This was a prospective, longitudinal birth cohort study with long-term follow-up consisting of 5889 women. The cohort population has been followed at birth, and at ages of 1, 14, 31 and 46. In total, 3280 (55.7%) women were clinically examined and 2780 also underwent a 2-h oral glucose tolerance test at age 46. Glucose metabolism indices were analyzed in former combined hormonal contraceptive users (n = 1371) and former progestin-only contraceptive users (n = 52) and in women with no history of hormonal contraceptive use (n = 253). RESULTS: Compared with women with no history of hormonal contraceptive use, those who formerly used combined hormonal contraceptives for over 10 years had an increased risk of prediabetes (odds ratio [OR] 3.9, 95% confidence interval [CI]: 1.6-9.2) but not of type 2 diabetes mellitus. Former progestin-only contraceptive use was not associated with any glucose metabolism disorders. The results persisted after adjusting for socioeconomic status, smoking, alcohol consumption, parity, body mass index and use of cholesterol-lowering medication. CONCLUSIONS: Former long-term use of combined hormonal contraceptives was associated with a significantly increased risk of prediabetes in perimenopausal women, which potentially indicates a need of screening for glucose metabolism disorders in these women.

Temperament and longitudinal changes in physical activity - the Northern Finland Birth Cohort 1966 Study.

BACKGROUND: Insufficient physical activity is risk factor for morbidity and premature mortality. This population-based birth cohort study investigated the cross-sectional and longitudinal associations between self-reported temperament at age 31 and self-reported leisure-time moderate to vigorous physical activity (MVPA) levels and changes thereof from the age of 31 to the age of 46 years. METHODS: The study population comprised 3,084 subjects (1,359 male and 1,725 female) from the Northern Finland Birth Cohort 1966. MVPA was self-reported at ages 31 and 46 years. Novelty seeking, harm avoidance, reward dependence, and persistence and their subscales were measured using Cloninger's Temperament and Character Inventory at age 31. Four temperament clusters were used in the analyses: persistent, overactive, dependent, and passive. Logistic regression was used to evaluate the relationship between temperament and MVPA. RESULTS: The persistent and overactive temperament profiles at age 31 were positively associated with higher MVPA levels both in young adulthood and in midlife, while the passive and dependent temperament profiles were associated with lower MVPA levels. The overactive temperament profile was associated with a decrease in MVPA levels from young adulthood to midlife among males. CONCLUSION: A passive temperament profile characterized by high harm avoidance is associated with a higher risk of low MVPA level than other temperament profiles over the life cycle in females. The results suggest that temperament may play a role in determining the level and sustainability of MVPA. Individual targeting and intervention tailoring for promoting physical activity should consider temperament traits.

Employment trajectories until midlife in schizophrenia and other psychoses: the Northern Finland Birth Cohort 1966.

PURPOSE: Psychoses are associated with poor labour market attachment, but few studies have compared schizophrenia (SZ) and other psychoses (OP). Moreover, studies on long-term employment trajectories over individuals' working life courses are lacking. We compared 30 year employment trajectory patterns in a general population sample among individuals with SZ, OP, and those with no psychosis (NP). METHODS: Utilising the Northern Finland Birth Cohort 1966, we collected survey data on employment from ages 16 to 45 and detected individuals with register-based history of SZ (n = 62), OP (n = 87), or NP (n = 6464) until age 46. Through gender-specific latent class analyses on annual employment roles, we identified traditional, highly educated, self-employed, delayed and floundering employment trajectories with distinct socioeconomic characteristics. We addressed attrition by conducting weighted analyses. RESULTS: Floundering trajectories were common among individuals with SZ (79% of men, 73% of women) and OP (52% of men, 51% of women). In NP, a traditional employee trajectory was most common in men (31%), and a highly educated trajectory in women (28%). A history of psychosis was associated with heightened odds ratios (ORs; 95% confidence intervals (CIs)) for floundering trajectories in both men (SZ: 32.9 (13.3-81.4); OP: 7.4 (4.0-13.9)) and women (SZ: 9.9 (4.6-21.5); OP: 3.9 (2.1-7.1)) compared to NP. Weighted analyses produced similar results. CONCLUSION: Most individuals with SZ or OP have floundering employee trajectories reflecting an elevated risk of unemployment and part-time work until midlife. These results indicate the importance of improving labour market attachment during the early phases of psychoses.

Associations of adolescents' diet and meal patterns with school performance in the Northern Finland Birth Cohort 1986: A Mendelian randomisation study.

BACKGROUND: Several observational studies indicate that dietary habits in children and adolescents are associated with school performance. These associations are heavily confounded by socio-economic characteristics, such as household income and parents' educational attainment, amongst other factors. The objective of this study was to explore the association between diet and school performance in adolescents from the Northern Finland Birth Cohort 1986 (NFBC1986). METHODS: Dietary and school performance data were collected using self-reported questionnaires from adolescents in the NFBC1986 cross-sectional, 16-year follow-up study. In this work we derived exploratory factors for the dietary variables, frequency of skipping main meals and school performance variables, performed genome-wide association studies (GWAS) against these factors to obtain genetic association data and conducted one-sample and two-sample Mendelian randomisation (MR) analyses using individual level data for up to 9220 adolescents in NFBC1986 and GWAS results from external cohorts. We report observational and MR effects of diet on school performance and cognition-related phenotypes. RESULTS: The observational study and the one-sample Mendelian randomisation analysis showed that high fat, salt and sugar (HFSS) consumption was associated with poor school performance in general/science subjects (-0.080, -0.128 to -0.033) and staple food consumption with better school performance in general/science subjects (0.071, 0.024 to 0.119) and physical education (0.065, 0.021 to 0.110). Findings from our two-sample MR analysis identified dietary principal components described best as whole brain bread, wheat, cheese, oat cereal and red wine to be associated with higher educational attainment and other cognition-related phenotypes. CONCLUSION: Using genetics, we highlighted the potential role of HFSS food consumption and consumption of the components of a staple food diet for school performance. However, further research is required to find conclusive evidence that could support a causal role of diet on school performance.

Effect of onset age on the long-term outcome of early-onset psychoses and other mental disorders: a register-based Northern Finland Birth Cohort 1986 study.

Psychiatric illnesses can affect the social transitions of adolescence and young adulthood, such as completing education and entering working life and relationships. However, associations between earlier onset age and long-term outcomes among those with early-onset psychoses (EOP) are unclear, as are the long-term outcomes of EOP compared to non-psychotic disorders. We used national register data of the Northern Finland Birth Cohort 1986 to detect persons with EOP and other early-onset psychiatric disorders. The long-term clinical and work-family outcomes of persons with onset age before 18 years (n = 41 psychoses, n = 495 non-psychoses) or between 18-22 years (n = 61 psychoses, n = 377 non-psychoses) were compared. Individuals with the onset of psychosis between 18-22 years had significantly more unfavourable long-term outcomes when compared to those with psychosis onset before 18 years. Persons with psychosis onset before the age of 18 years had similar outcomes to those with non-psychotic psychiatric disorder onset before 18 years regarding educational level, marital status, having children, and substance use disorders. Individuals with EOP were more often on a disability pension compared to those with other early-onset mental disorders. Adjusting for sex, educational level and substance use only slightly diluted these results. Unexpectedly, later onset age of EOP was associated with worse outcomes. Those with psychosis onset between 18-22 years of age are in a critical period, which underlines the importance of investing on interventions in this age group. Further studies on the effect of the onset age on later outcomes in EOP are needed.

Effects of Symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD) on Academic Performance and Educational Attainment.

The aim of this longitudinal population-based cohort study was to examine the effects of ADHD and ODD symptoms in adolescence on academic performance at age 16, and on educational attainment by the age of 32. The population studied here was the Northern Finland Birth Cohort 1986 (NFBC1986). The participants were classified into four groups: those with symptoms of ADHD, ODD, ADHD + ODD, and a control group. Early academic performance at the age of 16 years was based on the Joint Application Register for Secondary Education, and eventual educational attainment was derived from the registers of Statistics Finland and included information recorded up to 2018. Although symptoms of pure ODD had a negative effect on academic performance at school relative to the control group, this effect was weaker than that of pure ADHD symptoms. The ADHD + ODD group, both males and females, had the greatest deficits of all in educational attainment in adulthood and failed to progress to an institution of higher education as often as the control group. Symptoms of ODD in adolescent females predicted educational attainment in adulthood that extended no further than the compulsory comprehensive school level. The results remained statistically significant after adjustment for the educational level of the parents of the subjects, family type, and any psychiatric disorders (other than ADHD or ODD). The findings provide valuable information on the pervasive effects of co-occurring symptoms of ADHD and ODD that persist into adulthood.

Characteristics and predictors of off-label use of antipsychotics in general population sample.

OBJECTIVE: Increasing number of people have been prescribed antipsychotics (APs) off-label in recent decades. This study aimed to identify the characteristics and predictors of receiving prescription of antipsychotics off-label. METHODS: The study sample was part of the Northern Finland Birth Cohort 1966 (n = 7071). Data included questionnaires and national register data. Information on prescribed medications was extracted from the national register. The sample was divided into three groups: Persons who had been prescribed APs off-label (n = 137), individuals with non-psychotic mental disorders without APs off label (n = 1478) and individuals who had been diagnosed with psychosis or bipolar disorder and who had been prescribed APs (n = 151). We compared sociodemographic, lifestyle and clinical characteristics between the off-label and the comparison groups using logistic regression. RESULTS: The most common diagnoses in the off-label group were depression (n = 96, 70.1%) and anxiety (n = 55, 40.1%). Compared with individuals with non-psychotic mental disorders who were not prescribed APs off-label, individuals with prescribed off-label APs had a lower level of education, lower socioeconomic status, were less often married, had a higher level of somatic and psychiatric morbidity, were more often smokers and more often had a substance abuse disorder and heavy alcohol consumption. When comparing the off-label group to individuals with psychosis or bipolar disorder who used APs, there were less differences, though individuals with psychosis or bipolar disorder had more markers of morbidity and a lower level of education. CONCLUSION: Individuals who had been prescribed APs off label had a higher level of mental and somatic morbidity and poorer socioeconomic status than individuals with non-psychotic mental disorders who did not use APs.

Parental separation and offspring morbidity in adulthood: a descriptive study of the Northern Finland Birth Cohort 1966.

Aims: Rates of parental separation have increased dramatically in recent decades. We evaluated the association of individuals' childhood family structure with their somatic health over 46 years of follow-up. Methods: Data were drawn from the Northern Finland Birth Cohort, an ongoing project in which 12,058 participants born in 1966 have been followed from their 24th gestational week. Based on information supplied at age 14 years, family structure was categorised as 'single-parent family' and 'two-parent family'. The anthropometric information, data from blood samples and medical history were collected from postal questionnaires and clinical examinations routinely performed at the ages of 31 and 46 years. Results: The study population comprised a total of 10,895 individuals; 85% (n=9253) were offspring of two-parent families and 15% (n=1642) of single-parent families. Type 2 diabetes (P=0.032) or prediabetes (P=0.007), psychoactive drug problems (P<0.001) and sexually transmitted diseases (P<0.001) were more common in the single-parent family group than in the participants from two-parent families. In addition, among men back diseases (P=0.002), and among women hypertension (P=0.003) and ovary infection (P=0.024) were more frequent in individuals affected by parental death than in those from two-parent families. Conclusions: Our results indicate the association of childhood family structure with offspring morbidity during 46 years' follow-up. The lifetime morbidity was observed to be higher among offspring from a single-parent family compared to two-parent family offspring. Public and scientific concern about the consequences of parental separation on the offspring' health exist, therefore support from healthcare professionals and society is warranted.

Parental death due to natural death causes during childhood abbreviates the time to a diagnosis of a psychiatric disorder in the offspring: A follow-up study.

Parental death before adulthood has been shown to increase offspring's risk of poor health and adverse social consequences. In a sample of 422 subjects with parental death (334 (79.1%) due to natural causes), and 6172 matched controls, those with parental death were given a diagnosis of a psychiatric disorder up to 28 years of age earlier than their controls (10-year survival proportions: 88.6% vs. 93.1%, p = 0.001). Our findings indicate that psychosocial support must be provided as early as when a parent falls ill, especially with those illnesses that are the most common causes of death in the population.

Return to the labour market in schizophrenia and other psychoses: a register-based Northern Finland Birth Cohort 1966 study.

PURPOSE: The prospects and predictors of returning to the labour market after long-term work disability in psychoses are unclear. Our aim was to study the proportion and characteristics of persons with schizophrenia and other psychoses who return to the labour market after receiving a disability pension. METHODS: In this 50-year follow-up study in the Northern Finland Birth Cohort 1966 (NFBC1966), national registers on demographics, care, and disability pensions were used to detect and characterize individuals who had been on a disability pension for psychiatric reasons. We compared individuals with schizophrenia (SZ, n = 223) or other psychoses (OP, n = 200) to those with non-psychotic psychiatric disorders (NP, n = 1815) regarding demographics and end of pension by cross-tabulations and logistic regression. RESULTS: Of the 170 (74%) persons with SZ who had been on disability pension for a psychiatric reason, 15 (9%) returned to the labour market. Corresponding percentages were 19% for OP and 28% for NP. In SZ, being married, a later onset age of psychosis, and better school performance, and in OP and NP, having children predicted returning to the labour market. In all groups, a shorter length of the latest disability pension associated with returning to the labour market. CONCLUSION: Although rare, it is possible to return to the labour market after a disability pension due to psychosis. Factors predicting a return to the labour market could be taken into account when planning rehabilitation.

Early childhood and adolescent risk factors for psychotic depression in a general population birth cohort sample.

BACKGROUND AND PURPOSE: In the group of severe mental disorders, psychotic depression (PD) is essentially under-researched. Knowledge about the risk factors is scarce and this applies especially to early risk factors. Our aim was to study early childhood and adolescent risk factors of PD in a representative birth cohort sample with a follow-up of up to 50 years. METHODS: The study was carried out using the Northern Finland Birth Cohort 1966 (NFBC 1966). We used non-psychotic depression (NPD) (n = 746), schizophrenia (SZ) (n = 195), psychotic bipolar disorder (PBD) (n = 27), other psychoses (PNOS) (n = 136) and healthy controls (HC) (n = 8200) as comparison groups for PD (n = 58). We analysed several potential early risk factors from time of birth until the age of 16 years. RESULTS: The main finding was that parents' psychiatric illness [HR 3.59 (1.84-7.04)] was a risk factor and a high sports grade in school was a protective factor [HR 0.29 (0.11-0.73)] for PD also after adjusting for covariates in the multivariate Cox regression model. Parental psychotic illness was an especially strong risk factor for PD. The PD subjects had a parent with psychiatric illness significantly more often (p < 0.05) than NPD subjects. Differences between PD and other disorder groups were otherwise small. CONCLUSIONS: A low sports grade in school may be a risk factor for PD. Psychiatric illnesses, especially psychoses, are common in the parents of PD subjects. A surprisingly low number of statistically significant risk factors may have resulted from the size of the PD sample and the underlying heterogeneity of the etiology of PD.

Adolescent cannabis use, baseline prodromal symptoms and the risk of psychosis.

BACKGROUND: The association between cannabis use and the risk of psychosis has been studied extensively but the temporal order still remains controversial. Aims To examine the association between cannabis use in adolescence and the risk of psychosis after adjustment for prodromal symptoms and other potential confounders. METHOD: The sample (n = 6534) was composed of the prospective general population-based Northern Finland Birth Cohort of 1986. Information on prodromal symptoms of psychosis and cannabis use was collected using questionnaires at age 15-16 years. Participants were followed up for ICD-10 psychotic disorders until age 30 years using nationwide registers. RESULTS: The risk of psychosis was elevated in individuals who had tried cannabis five times or more (hazard ratio, (HR) = 6.5, 95% CI 3.0-13.9). The association remained statistically significant even when adjusted for prodromal symptoms, other substance use and parental psychosis (HR = 3.0, 95% CI 1.1-8.0). CONCLUSIONS: Adolescent cannabis use is associated with increased risk of psychosis even after adjustment for baseline prodromal symptoms, parental psychosis and other substance use. Declaration of interest None.

Early adversity and brain response to faces in young adulthood.

Early stressors play a key role in shaping interindividual differences in vulnerability to various psychopathologies, which according to the diathesis-stress model might relate to the elevated glucocorticoid secretion and impaired responsiveness to stress. Furthermore, previous studies have shown that individuals exposed to early adversity have deficits in emotion processing from faces. This study aims to explore whether early adversities associate with brain response to faces and whether this association might associate with the regional variations in mRNA expression of the glucocorticoid receptor gene (NR3C1). A total of 104 individuals drawn from the Northern Finland Brith Cohort 1986 participated in a face-task functional magnetic resonance imaging (fMRI) study. A large independent dataset (IMAGEN, N = 1739) was utilized for reducing fMRI data-analytical space in the NFBC 1986 dataset. Early adversities were associated with deviant brain response to fearful faces (MANCOVA, P = 0.006) and with weaker performance in fearful facial expression recognition (P = 0.01). Glucocorticoid receptor gene expression (data from the Allen Human Brain Atlas) correlated with the degree of associations between early adversities and brain response to fearful faces (R2 = 0.25, P = 0.01) across different brain regions. Our results suggest that early adversities contribute to brain response to faces and that this association is mediated in part by the glucocorticoid system. Hum Brain Mapp 38:4470-4478, 2017. © 2017 Wiley Periodicals, Inc.

Serum C-reactive protein in adolescence and risk of schizophrenia in adulthood: A prospective birth cohort study.

OBJECTIVE: Meta-analyses of cross-sectional studies confirm an increase in circulating inflammatory markers during acute psychosis. Longitudinal studies are scarce but are needed to understand whether elevated inflammatory markers are a cause or consequence of illness. We report a longitudinal study of serum C-reactive protein (CRP) in adolescence and subsequent risk of schizophrenia and related psychoses in adulthood in the Northern Finland Birth Cohort 1986. METHOD: Serum high-sensitivity CRP was measured at age 15/16 years in 6362 participants. ICD-10 diagnoses of schizophrenia and related psychoses were obtained from centralised hospital inpatient and outpatient registers up to age 27 years. Logistic regression calculated odds ratios (ORs) for psychotic outcomes associated with baseline CRP levels analysed as both continuous and categorical variables using American Heart Association criteria. Age, sex, body mass index, maternal education, smoking, and alcohol use were included as potential confounders. RESULTS: By age 27years, 88 cases of non-affective psychosis (1.38%), of which 22 were schizophrenia (0.35%), were identified. Adolescent CRP was associated with subsequent schizophrenia. The adjusted OR for schizophrenia by age 27yearsfor each standard deviation (SD) increase in CRP levels at age 15/16yearswas 1.25 (95% CI, 1.07-1.46), which was consistent with a linear, dose-response relationship (P-value for quadratic term 0.23). Using CRP as a categorical variable, those with high (>3mg/L) compared with low (<1mg/L) CRP levels at baseline were more likely to develop schizophrenia; adjusted OR 4.25 (95% CI, 1.30-13.93). There was some indication that higher CRP was associated with earlier onset of schizophrenia (rs=-0.40; P=0.07). CONCLUSIONS: A longitudinal association between adolescent CRP levels and adult schizophrenia diagnosis indicates a potentially important role of inflammation in the pathogenesis of the illness, although the findings, based on a small number of cases, need to be interpreted with caution and require replication in other samples.

Smoking in pregnancy, adolescent mental health and cognitive performance in young adult offspring: results from a matched sample within a Finnish cohort.

BACKGROUND: The association between prenatal exposure to maternal cigarette smoking (PEMCS) and adult cognition is debated, including if there are differences according to sex. We aimed to determine if there are associations between PEMCS and cognition in early adulthood in men and women and examine if observed associations were mediated by adolescent mental health factors that are associated with cognition, namely psychotic-like experiences (PLEs), inattention and hyperactivity, and other externalizing behaviors. METHODS: Participants were 471 individuals drawn from the general population-based Northern Finland 1986 Birth Cohort (NFBC 1986) followed up from pregnancy and birth to early adulthood; individuals with PEMCS were matched with those without PEMCS by socioeconomic and demographic factors. Cognitive performance in adulthood was assessed with a range of tests and their association with PEMCS was measured by sex using hierarchical linear regression, unadjusted and then controlling for potential confounders, mediators and moderators, including adolescent mental health factors. RESULTS: There were no associations between PEMCS and cognitive scores in females. In males, there were associations with vocabulary (beta = -0.444, 95% CI: -0.783, -0.104) and matrix reasoning (beta = -0.379, 95% CI: -0.711, -0.047). CONCLUSIONS: While associations between PEMCS and cognition were limited, observed findings with measures of general intelligence in males contribute to suggestions of differences in response to PEMCS by sex. Furthermore, observed associations may be partly mediated by earlier inattention and hyperactivity. Findings add support to efforts aimed to eliminate smoking in pregnancy.

DTI abnormalities in adults with past history of attention deficit hyperactivity disorder: a tract-based spatial statistics study.

BACKGROUND: Diffusion tensor imaging (DTI) is a magnetic resonance imaging (MRI) technique enabling visualization and measurement of white matter tracts. Attention deficit hyperactivity disorder (ADHD) has been studied with DTI earlier with variable results, yet there is little research on remitted ADHD. PURPOSE: To compare the brain white matter between ADHD drug naïve subjects whose ADHD symptoms have mostly subsided and healthy controls. MATERIAL AND METHODS: Tract-based spatial statistics (TBSS) was used to compare 30 subjects with adolescent ADHD with control subjects at the age of 22-23 years. The study population was derived from a population-based Northern Finland Birth Cohort 1986. Fractional anisotropy (FA), mean diffusivity (MD), and measures of diffusion direction (λ1-3) were calculated. Permutation testing was used to test for differences in mean values of FA, MD, and λ1-3 between the groups. The results were corrected for multiple comparisons across the whole white matter skeleton. RESULTS: The ADHD group showed increased FA related to decreased radial diffusivity in the left forceps minor (P < 0.05). In the vicinity along the same tract, axial diffusion was significantly decreased without any significant effect on FA. No between-group difference in MD was observed. Regressor analysis revealed no gender-, IQ- or GAF-related changes. After removal of left handed subjects the statistical significance was only barely lost. CONCLUSION: In a setting with remitted ADHD, the results may represent a compensatory mechanism in the left forceps minor.

The path from childhood behavioural disorders to felony offending: Investigating the role of adolescent drinking, peer marginalisation and school failure.

BACKGROUND: Although a pathway from childhood behavioural disorders to criminal offending is well established, the aetiological processes remain poorly understood. Also, it is not clear if attention deficit hyperactivity disorder (ADHD) is predictive of crime in the absence of comorbid disruptive behaviour disorder (DBD). HYPOTHESIS: We examined two research questions: (1) Does ADHD have a unique effect on the risk of criminal offending, independently of DBD? (2) Is the effect of childhood behavioural disorders on criminal offending direct or mediated by adolescent processes related to school experience, substance misuse and peers? METHOD: Structural equation modelling, with latent variables, was applied to longitudinally collected data on 4644 men from the 1986 Northern Finland Birth Cohort Study. RESULTS: Both ADHD and DBD separately predicted felony conviction risk. Most of these effects were mediated by adolescent alcohol use and low academic performance. The effect of DBD was stronger and included a direct pathway to criminal offending. CONCLUSION: Findings were more consistent with the life course mediation hypothesis of pathways into crime than the behavioural continuity path, in that the effects of each disorder category were mediated by heavy drinking and educational failure. Preventing these adolescent risk outcomes may be an effective approach to closing pathways to criminal behaviour amongst behaviourally disordered children. However, as there was some evidence of a direct pathway from DBD, effective treatments targeting this disorder are also expected to reduce criminal offending.

Associations of Symptoms of ADHD and Oppositional Defiant Disorder (ODD) in Adolescence With Occupational Outcomes and Incomes in Adulthood.

OBJECTIVE: The purpose of this study was to examine the associations of ADHD and ODD symptoms in adolescence with occupational outcomes and incomes in adulthood within the Northern Finland Birth Cohort 1986 (NFBC1986). METHOD: ADHD symptoms were evaluated at ages 15 to 16 years using the Strengths and Weaknesses of ADHD symptoms and Normal Behaviors (SWAN) scale. ODD symptoms were assessed using a 7-point scale, like the SWAN assessment. RESULTS: Symptoms of ADHD and ADHD + ODD were associated with elevated rates of unemployment, increased sick days, and lower annual incomes compared to controls for both sexes. Symptoms of ODD were associated with higher unemployment and more sick days for males, although these associations did not reach statistical significance in their association with annual incomes. CONCLUSION: Symptoms of ADHD were associated with adverse occupational outcomes and lower incomes. Furthermore, symptoms of ODD were associated with occupational outcomes but not with incomes.