Interpersonal Conflicts and Development of Self-Esteem from Adolescence to Mid-Adulthood. A 26-Year Follow-Up.

This study investigated the association between interpersonal conflicts and the trajectory of self-esteem from adolescence to mid-adulthood. The directionality of effects between self-esteem and interpersonal conflicts was also studied. 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) using postal questionnaires. Measures covered self-esteem and interpersonal conflicts including, conflicts with parents, friends, colleagues, superiors, partners, break-ups with girl/boyfriends, and divorces. Participants were grouped using latent profile analysis to those having "consistently low", "decreasing", or "increasing" number of interpersonal conflicts from adolescence to adulthood. Analyses were done using latent growth curve models and autoregressive cross-lagged models. Among both females and males the self-esteem growth trajectory was most favorable in the group with a consistently low number of interpersonal conflicts. Compared to the low group, the group with a decreasing number of interpersonal conflicts had a self-esteem trajectory that started and remained at a lower level throughout the study period. The group with an increasing number of interpersonal conflicts had a significantly slower self-esteem growth rate compared to the other groups, and also the lowest self-esteem level at the end of the study period. Cross-lagged autoregressive models indicated small, but significant lagged effects from low self-esteem to later interpersonal conflicts, although only among males. There were no effects to the opposite direction among either gender. Our results show that those reporting more and an increasing number of interpersonal conflicts have a lower and more slowly developing self-esteem trajectory from adolescence to mid-adulthood. While the result was expected, it does not seem to imply an effect from interpersonal conflicts to low self-esteem. Rather, if anything, our results seem to suggest that those with low self-esteem are more prone to later interpersonal conflicts.

Self-esteem and Body Mass Index from Adolescence to Mid-adulthood. A 26-year Follow-up.

PURPOSE: This study examined the developmental trajectories of self-esteem and body mass index (BMI) from adolescence to mid-adulthood and the way the association between self-esteem and BMI changed during a 26-year follow-up. METHODS: Participants of a Finnish cohort study in 1983 at 16 years (N = 2194) were followed up at ages 22 (N = 1656), 32 (N = 1471), and 42 (N = 1334) using postal questionnaires. Measures at each time point covered self-esteem and self-reported weight and height. Analyses were done using latent growth curve models (LGM) and difference scores. RESULTS: In LGM analyses among females both the initial levels (r = -0.13) and slopes (r = -0.26) of the self-esteem and BMI trajectories correlated negatively. Among males, there were no significant correlations between self-esteem and BMI growth factors. The association between increasing BMI and decreasing self-esteem among females was strongest between ages 22 and 32 (r = -0.16), while among males, increases in BMI and self-esteem correlated positively (r = 0.11) during that period. Among females, cross-sectional correlations between self-esteem and BMI showed an increasing trend (p < 0.001) from age 16 (r = -0.07) to age 42 (r = -0.17), whereas among males negative correlation (r = -0.08) emerged only in mid-adulthood at age 42. CONCLUSION: Among females, higher and increasing BMI is associated with lower and more slowly increasing self-esteem. This association is not restricted to adolescent years but persists and gets stronger in mid-adulthood. Among males, associations are weaker but indicate more age-related differences. The results highlight the need for interventions that tackle weight-related stigma and discrimination, especially among women with higher body weight and size.

Self-esteem growth trajectory from adolescence to mid-adulthood and its predictors in adolescence.

The present study examined the trajectory of self-esteem from adolescence to mid-adulthood and its predictors in adolescence in a prospective cohort sample with a 26-year follow-up. Participants of a Finnish cohort study in 1983 at 16 years (N = 2194) were followed up at ages 22 (N = 1656), 32 (N = 1471) and 42 (N = 1334) years. Self-esteem development was analyzed using latent growth curve models with parental socioeconomic status (SES), parental divorce, school achievement, daily smoking, and heavy drinking as time invariant covariates. Self-esteem grew linearly from 16 to 32 years, but stabilized after that with no growth between 32 and 42 years. Males had significantly higher self-esteem throughout the follow-up, although females had a faster growth rate. Better school performance and higher parental SES were associated with a higher initial level of self-esteem among both genders, while parental divorce among females and daily smoking among males were associated with a lower initial level of self-esteem. Among females the growth rate of self-esteem was practically unaffected by the studied covariates. Among males, however, the initial differences in self-esteem favouring those from a higher SES background were indicated to diminish, while the differences between non-smokers and smokers were indicated to increase. The studied adolescent covariates combined had only limited predictive value for the later self-esteem development. However, the effects of any covariate on the level and slope of the self-esteem trajectory, even if small, should be assessed in combination in order to identify whether they lead to converging, diverging or constantly equidistant self-esteem trajectories. The findings highlight the variety of roles that adolescent behaviours and social environments may have in the developmental process of self-esteem from adolescence into mid-adulthood.

Changes in psychological resources moderate the effect of socioeconomic status on distress symptoms: a 10-year follow-up among young adults.

OBJECTIVE: This study examined the impact of socioeconomic status (SES) on changes in psychological resources and whether these changes in turn moderate the effect of SES on distress symptoms in a prospective 10-year follow-up among young adults. METHOD: Subjects (N = 1239) were participants in two phases (1989, 22 years; 1999, 32 years) of a Finnish cohort study. The measurements were SES (basic education at 22 years, occupation at 32 years), distress symptoms (index of 17 somatic and mental complaints), and psychological resources (self-esteem, meaningfulness, locus of control). RESULTS: The results showed that lower SES is associated with poorer psychological resources both concurrently and prospectively. Lower SES at age 22 also predicted slower resource development, but only among females. In prospective analyses among both genders, changes in psychological resources moderated the effect of SES on distress symptoms: for those with losses in psychological resources, lower SES was associated with greater increases in distress between 22 and 32 years of age, whereas for those with stable or increasing resources, no effects of SES on distress were found. CONCLUSION: The results indicate that higher SES is associated with more favorable changes in psychological resources. In a longitudinal setting, SES differences in health seem to increase only when psychological resources decrease during the same period. The results emphasize the importance of dynamic conceptualizations of psychological resources in SES-health research.

Long-term impact of parental divorce on intimate relationship quality in adulthood and the mediating role of psychosocial resources.

The purpose of this 16-year prospective follow-up study was to investigate the association between parental divorce in childhood and intimate relationship quality in adulthood. The mediating role of psychosocial resources (parent-child relationships at 16 years, self-esteem and social support at 32 years) in this association was also studied. All 16 year olds of one Finnish city completed questionnaires at school and were followed up by postal questionnaires at 32 years of age (n = 1,471). Results showed that women and men from divorced families were more often divorced or separated at the age of 32 years than those from nondivorced families. However, parental divorce was associated with poorer intimate relationship quality only among women. Women from divorced families also had poorer relationships with their father and mother in adolescence, and they had lower self-esteem and satisfaction with social support in adulthood than women from intact families. No such associations were found among men. The impact of parental divorce on intimate relationship quality among women was partially mediated by mother-daughter relationship, self-esteem, and satisfaction with social support. The mediating role of mother-daughter relationship was not direct, however, but was mediated via self-esteem and satisfaction with social support. Our findings indicate that parental divorce affects daughters more than sons. In the context of parental divorce, the mother-daughter relationship in adolescence is important for the development of later psychosocial resources and, via them, for intimate relationship quality.

Social capital as a determinant of self-rated health and psychological well-being.

OBJECTIVE: To examine whether specific dimensions of social capital are related to self-rated health and psychological well-being. METHODS: Cross-sectional data from a health survey representing the adult Finnish population (N = 8,028) were used. Logistic regression analysis was used to reveal and quantify the possible associations between three dimensions of social capital (social support; social participation and networks; trust and reciprocity) and two general health indicators (self-rated health and psychological well-being). The roles of age, gender, education, living arrangements, income, type of region, functional capacity, and long-standing illness were also assessed. RESULTS: Good self-rated health was associated with high levels of social participation and networks and trust and reciprocity, but social support did not remain statistically significant after adjustment for socio-demographic factors, long-standing illness, and functional capacity. The association between social support and psychological well-being was explained by the other two dimensions of social capital. The strong positive association between trust and psychological well-being persisted after controlling for all the other factors in our model. CONCLUSIONS: Our findings suggest that trust and reciprocity and social participation and networks contribute to good self-rated health and psychological well-being.

Adolescent risk factors for excessive alcohol use at age 32 years. A 16-year prospective follow-up study.

AIMS: To examine which socioeconomic, family, personal and lifestyle risk factors in adolescence were the strongest independent predictors of excessive alcohol use in adulthood. METHODS: In a prospective longitudinal study, all 16-year-olds of one Finnish city completed questionnaires at school, and were followed up by postal questionnaires at 32 years of age [n = 1,471, (females n = 805, males n = 666); response rate 70.3%). The alcohol use disorders identification test (AUDIT) was used to assess alcohol use in adulthood. AUDIT scores of 8 or more for females and 10 or more for males were classified as excessive alcohol use. Adolescent risk factors examined were parental social class, school performance, depressive symptoms, self-esteem, impulsiveness, parental divorce, relationships with parents, parental trust, health behaviour, leisure-time spent with friends, dating, and problems with the law. RESULTS: All the socioeconomic, family, personal, and lifestyle variables in adolescence, except parental social class in both genders and self-esteem among females, showed significant univariate associations with excessive alcohol use at age 32 years. Multivariate logistic regression analysis showed that among adolescent males, parental divorce, moderate and high level of depressive symptoms, leisure-time spent daily among friends and moderate and drunkenness-orientated drinking were the strongest predictors of excessive alcohol use in adulthood. Among females, the strongest adolescent predictors of excessive alcohol use in adulthood were drunkenness-orientated drinking and frequent smoking. CONCLUSIONS: Early interventions for adolescent substance use and a set of specific psychosocial risk factors should be tailored and evaluated as methods for identifying those at high risk of and preventing excessive alcohol use in adulthood.

Prevalence and correlates of alcohol and other substance use disorders in young adulthood: A population-based study.

BACKGROUND: Several risk factors for alcohol and other substance use disorders (SUDs) have been identified, but it is not well understood whether their associations with SUD are independent of each other. In particular, it is not well known, whether the associations between behavioral and affective factors and SUDs are independent of other risk factors. The incidence of SUDs peaks by young adulthood making epidemiological studies of SUDs in young adults informative. METHODS: In a comprehensive population-based survey of mental health in Finnish young adults (aged 21-35 years, n = 605), structured clinical interview (SCID-I) complemented by medical record data from all lifetime hospital and outpatient treatments were used to diagnose SUDs. We estimated the prevalences of lifetime DSM-IV SUDs, and investigated their associations with correlates from four domains representing: (1) behavioral and affective factors, (2) parental factors, (3) early initiation of substance use, and (4) educational factors. Independence of the association of behavioral and affective factors with SUD was investigated. RESULTS: Lifetime prevalences of abuse or dependence of any substance, alcohol, and any illicit substance were 14.2%, 13.1%, and 4.4%, respectively. Correlates from all four domains were associated with SUD. The associations between behavioral and affective factors (attention or behavior problems at school, aggression, anxiousness) and SUD were largely independent of other correlates, whereas only daily smoking and low education associated with SUD after adjustment for behavioral and affective factors. CONCLUSION: Alcohol use disorders are common in Finnish young adults, whereas other SUDs are less common than in many other developed countries. Our cross-sectional analyses suggested that the association between behavioral and affective factors and SUD was only partly accounted for by other correlates, such as early initiation of substance use and parental alcohol problems. In contrast, associations between many other factors and SUD were non-significant when adjusted for behavioral and affective factors.

Validation of the Finnish version of the SCOFF questionnaire among young adults aged 20 to 35 years.

BACKGROUND: We tested the validity of the SCOFF, a five-question screening instrument for eating disorders, in a general population sample. METHODS: A random sample of 1863 Finnish young adults was approached with a questionnaire that contained several screens for mental health interview, including the SCOFF. The questionnaire was returned by 1316 persons. All screen positives and a random sample of screen negatives were invited to SCID interview. Altogether 541 subjects participated in the SCID interview and had filled in the SCOFF questionnaire. We investigated the validity of the SCOFF in detecting current eating disorders by calculating sensitivity, specificity, and positive and negative predictive values (PPV and NPV) for different cut-off scores. We also performed a ROC analysis based on these 541 persons, of whom nine had current eating disorder. RESULTS: The threshold of two positive answers presented the best ability to detect eating disorders, with a sensitivity of 77.8%, a specificity of 87.6%, a PPV of 9.7%, and a NPV of 99.6%. None of the subjects with current eating disorder scored zero points in the SCOFF. CONCLUSION: Due to its low PPV, there are limitations in using the SCOFF as a screening instrument in unselected population samples. However, it might be used for ruling out the possibility of eating disorders.

Trends in socio-economic differences in self-reported depression during the years 1979-2002 in Finland.

BACKGROUND: Socio-economic differences in depressive symptoms are well reported, but there are only few studies concerning changes in these differences over time. The aim of this study was to assess trends in socio-economic differences in self-reported depression over the time period 1979-2002 in Finland. METHODS: The data source was a representative repeated cross sectional survey "Health Behaviour and Health among the Finnish Adult Population" (AVTK) linked with socio-economic register data from Statistics Finland, for the period 1979-2002. The age group of 25-64 years was included in this study (N = 71,290; average annual response rate 75%). Outcome measure was a single question of self-reported depression. Socio-economic factors included education, employment status and household income. The main analyses were conducted by multiple logistic regression. RESULTS: The prevalence of self-reported depression fluctuated in both men and women but remained higher in women compared to men over the past 24 years. After adjusting for age, socio-economic differences in self-reported depression were clear in regard to education, employment status and household income over the time period 1979-2002. When all socio-economic factors were mutually adjusted for, the association with self-reported depression remained significant in the unemployed, the retired and in those in the lowest household income categories in both genders. The effect of education on self-reported depression was mediated by the other socio-economic factors. Based on a time trend analysis, the socio-economic differences in self-reported depression remained stable over the time period 1979-2002. CONCLUSIONS: Socio-economic inequalities in self-reported depression were confirmed, and they have persisted with approximately the same magnitude over the past 24 years.

Adolescent risk factors for episodic and persistent depression in adulthood. A 16-year prospective follow-up study of adolescents.

BACKGROUND: We examined mid-adolescent psychosocial problems as risk factors for subsequent depression up to adulthood proper, and differences in these for episodic and persistent depression. METHODS: In a 16-year follow-up of an urban Finnish community cohort (547 males and 714 females) from age 16 years risk factors for subsequent depression (S-BDI) were studied. Data were collected with a classroom questionnaire at 16 years and a postal questionnaire at 22 and 32 years. Differences in predictors for episodic depression (only at age of 22 or 32 y) and persistent depression (both at 22 and 32 y) were studied using logistic and multinomial regression analyses. RESULTS: Mid-adolescent depressive symptoms predicted persistent and female sex episodic depression. Low self-esteem, dissatisfaction with academic achievement, problems with the law, having no dating experiences, and parental divorce all predicted both episodic and persistent depression. LIMITATIONS: We had two assessment points in adulthood, but no information about depression between these. CONCLUSIONS: The associations between mid-adolescent psychosocial problems and subsequent depression extended up to adulthood proper, somewhat differently for episodic and persistent depression. Preventive efforts should be focused towards young people at risk.

Psychosocial resources and depression among chronically ill young adults: are males more vulnerable?

This population-based study examined the association between chronic illness and depression and the role of psychosocial resources (coping styles, locus of control (LOC) and social support) in this association, among young Finnish adults aged 32. Gender differences in these phenomena were also investigated. The study was based on questionnaire data from a Finnish cohort study. Participants with self-reported chronic illness (e.g. diabetes, asthma, migraine) were grouped together (n=257) and compared to healthy controls (n=664). The results showed that the chronically ill males were more depressed than healthy control males. They also used more emotion-focused coping, had a more external LOC and were less often married or cohabiting than healthy males. The association between chronic illness and depression among males attenuated when the effects of emotion-focused coping disposition and LOC were taken into account, indicating a possible mediating role for these resources. Among females no differences were found in depression or psychosocial resources between the chronically ill and healthy control groups. Psychosocial resources, especially LOC, explained the gender difference in the association between chronic illness and depression. Only a few buffering effects of psychosocial resources emerged: an active problem-solving coping disposition among the chronically ill males and perceived social support among the chronically ill females seemed to act as buffers against depression. The results indicated a significant gender disparity in the association between chronic illness and depression among young adults and emphasised the role of psychosocial resources in this context. With regard to prevention we suggest that, chronically ill young adult males should be recognised as a risk group for depression that would probably benefit from guidance in learning more active coping skills and maintaining a sense of personal control in facing chronic physical illness.

Does social support affect the relationship between socioeconomic status and depression? A longitudinal study from adolescence to adulthood.

BACKGROUND: The aim of this prospective longitudinal study of adolescents was to investigate socioeconomic differences in adult depression and in the domain of social support from adolescence to adulthood. We also studied the modifying effect of social support on the relationship between socioeconomic status (SES) and depression. METHODS: All 16-year-old ninth-grade school pupils of one Finnish city completed questionnaires at school (n=2194). Subjects were followed up using postal questionnaires when aged 22 and 32 years. RESULTS: At 32 years of age there was a social gradient in depression, with a substantially higher prevalence among subjects with lower SES. Low parental SES during adolescence did not affect the risk of depression at 32 years of age, but the person's lower level of education at 22 years did. Lower level of support among subjects with lower SES was found particularly in females. Some evidence indicated that low level of social support had a greater impact on depression among lower SES group subjects. However, this relationship varied depending on the domain of social support, life stage and gender. On the other hand, the results did not support the hypothesis that social support would substantially account for the variation in depression across SES groups. LIMITATIONS: The assessments and classifications of social support were rather brief and crude, particularly in adolescence and early adulthood. CONCLUSIONS: It is important to pay attention to social support resources in preventive programs and also in the treatment settings, with a special focus on lower SES group persons.

Long-term psychosocial effects of parental divorce: a follow-up study from adolescence to adulthood.

OBJECTIVE: The purpose of this 16-year follow-up study was to investigate whether 32-year-old adults who had experienced parental divorce before 16 years of age (n = 317) differed in psychosocial well-being or life trajectories from those from non-divorced two-parent families (n = 1069). METHOD: The data were obtained from a follow-up survey of a Finnish urban age cohort from the age of 16 till 32 years (n = 1471). The long-term impact of parental divorce on a variety of outcomes in adulthood, including psychological well-being, life situation, health behaviour, social networks and support, negative life events and interpersonal problems, was assessed. RESULTS: Females from divorced compared to non-divorced families reported more psychological problems (higher scores in the Beck Depression Inventory, General Health Questionnaire and Psychosomatic Symptoms Score) and more problems in their interpersonal relationships. These differences were not found among males. Shorter education,unemployment, divorce, negative life events and more risky health behaviour were more common among subjects of both genders with a background of parental divorce. CONCLUSIONS: The study revealed that parental divorce is an indicator of sufficient stress in childhood for its influences to persist well into adulthood, possibly with wider scope among females. It is important to recognise specific needs of children in the divorce process in order to prevent or minimize negative consequences and chain reactions during their subsequent life.

Determinants of health in early adulthood: what is the role of parental education, childhood adversities and own education?

BACKGROUND: Of the many studies assessing the impact of childhood living conditions on health and health inequalities in adulthood, only few have combined information on current determinants of health with detailed individual level data on different aspects of childhood living conditions and adversities. This study aims (i) to assess the role of parental education, self-reported childhood adversities and family structure as determinants of different dimensions of health in early adulthood, and (ii) to identify the role of the respondent's own education as a modifier of the association between childhood living conditions and health. METHODS: The study is based on a representative sample (n = 3669; participation rate 83%) of young adults aged 18-39 years in 2000 in Finland. The main outcome measures were poor self-rated health (SRH), psychological distress (by GHQ12) and somatic morbidity. RESULTS: Parental education, problems in childhood and the respondent's own education were independently related to SRH and psychological distress. The impact of childhood living conditions on health varied by gender and according to the measure of health. Childhood conditions were strongly associated with poor SRH and psychological distress, whereas the connection with somatic morbidity was weaker. The associations remained relatively unchanged after controlling for the respondent's own education. CONCLUSIONS: Childhood living conditions and adversities are strongly associated with poor SRH and psychological distress in early adulthood. Early recognition of childhood adversities followed by relevant support measures may play an important role in preventing health problems in adulthood.

Major depressive episode related to long unemployment and frequent alcohol intoxication.

We studied the association between two major problems--unemployment and major depressive episode--and the impact of different timing of periods of unemployment and risk factors, especially alcohol intoxication, for major depressive episode among the unemployed. Major depressive episode during the last 12 months, plus current and past employment status and frequency of alcohol intoxication, were assessed within the nationally representative, cross-sectional 1996 Finnish Health Care Survey, in which non-institutionalized individuals aged 15-75 years were interviewed by using the Short Form of the University of Michigan version of the Composite International Diagnostic Interview (the UM-CIDI Short Form). Of the 5993 subjects interviewed, 3818 (64%) were occupationally active and included in the logistic regression analysis, showing that even after adjusting for other potentially confounding variables, current unemployment was associated with major depressive episode (odds ratio, OR=1.78, 95% confidence interval, CI, 1.38-2.29). Further analysis revealed that the increased risk of major depressive episode was only related to long-term unemployment. Frequent alcohol intoxication (at least once a week) increased the risk of major depressive episode remarkably. Compared with the group "Constantly employed, no frequent alcohol intoxication", long-term unemployment with no frequent alcohol intoxication had moderately increased risk of major depressive episode (OR=1.72 (95% CI 1.29-2.30) and those with frequent alcohol intoxication had highly increased risk [OR=11.27 (95% CI 5.51-23.09) vs. OR=1.72 (95% CI 1.29-2.30]. Long-term unemployment is associated with increased risk of major depressive episode. Frequent alcohol intoxication among long-term unemployed individuals greatly increases the risk of depression.

Childhood adversities as risk factors for adult mental disorders: results from the Health 2000 study.

BACKGROUND: The sex-specific role of stressful or traumatic childhood experiences and adverse circumstances in developing adulthood mental disorders is complex and still in need of comprehensive research. METHODS: Within the Health 2000 project in Finland, a representative sample of 4,076 subjects aged 30-64 years were investigated to examine associations between a set of retrospectively self-reported adverse environmental factors during childhood (0-16 years) and mental disorders diagnosed in the past 12 months by the Munich Composite International Diagnostic Interview. RESULTS: Of the 60% of adults reporting at least one childhood adversity, 17% had a current (past 12 months) mental disorder, compared to 10% of the non-reporters. A moderate dose-response relationship between the total number of adversities and current disorders was observed. Paternal mental health problems associated particularly strongly with male depressive disorders (OR 4.46), and maternal mental health problems with female depressive disorders (OR 3.20). Although seldom reported, maternal alcohol problems associated with alcohol use disorders in both sexes. Being bullied at school and childhood family discord predicted a variety of adulthood disorders in both sexes. All these four adversity items were more typical for depressive disorders with an earlier onset. Among females, more adversities were associated with mental disorders and their statistical significance was greater than among males. CONCLUSIONS: There are marked sex differences and several diagnosis-related patterns in the associations between reported childhood experiences and environmental circumstances and adulthood mental disorders. The impact of adversities is probably composed of a wide range of factors from direct causal associations to complex, interacting environmental effects. Variations in the reported associations reflect the differing genetic and environmental transmission mechanisms of mental disorders.

Major depressive episode and physical health in adolescents and young adults: results from a population-based interview survey.

BACKGROUND: This paper aimed to investigate associations between major depressive episode (MDE) and chronic illness, disability, self-perceived health and number of sick-days among adolescents and young adults in the general population. METHODS: The Finnish Health Care Survey 1996 was a cross-sectional nationwide epidemiological study. A random sample of 509 adolescents and 433 young adults was interviewed in 1996. DSM-III-R MDE during the past 12 months was defined using The University of Michigan Composite International Diagnostic Interview Short-Form algorithm. Data on physical health were gathered in the interview. RESULTS: In multivariable logistic regression, chronic illness [odds ratio (OR) 1.78; 95% confidence interval (CI) 1.03, 3.05], poor self-rated health (OR 2.26; 95% CI 1.01, 5.07), more than three sick-days in the past 6 months (OR 1.72; 95% CI 1.02, 2.92) and respiratory allergies (OR 2.40; 95% CI 1.00, 5.75) were associated with MDE. Among 15- to 19-year-olds, disabling chronic illness was related to MDE (OR 2.59; 95% CI 1.06, 6.36), and thoughts of death were more prevalent in the presence of chronic illness among those with MDE [35.2% versus 65.7%; F(1,67) P = 0.024]. Migraine was associated with MDE among young adults (OR 6.18; 95% CI 1.14, 30.8). CONCLUSIONS: Symptoms of depression should be investigated among adolescents with chronic illness or frequent sick-days. The degree of reported disability should be noted. Young people with both chronic illness and depressive symptoms should be assessed for thoughts of death and possible suicidality.

Socioeconomic status as a cause and consequence of psychosomatic symptoms from adolescence to adulthood.

BACKGROUND: Few follow-up studies have investigated psychosomatic health and socioeconomic status (SES) and associations between them at different life stages. The aim of this study was to investigate differences in psychosomatic symptoms by SES in adolescence, early adulthood and adulthood and to examine whether lower SES leads to higher levels of symptoms (social causation) or higher levels of symptoms to lower SES (health selection) or both. METHODS: All 16-year-old ninth-grade school pupils of one Finnish city completed questionnaires at school. Subjects were followed up using postal questionnaires when aged 22 and 32 years. RESULTS: Females reported significantly higher scores of psychosomatic symptoms than males at 16, 22 and 32 years of age. Higher rates of psychosomatic symptoms were found among females of manual class origin at 16 years. In addition, at 22 years, both females and males with only comprehensive school education and, at 32 years, those who worked in manual jobs had higher scores of symptoms. When low SES both as a cause and consequence of symptoms was investigated, the findings supported both these paths among females and more the health selection among males. In both genders, especially the path from psychosomatic symptoms in adolescence to lower education in early adulthood was strong. CONCLUSIONS: The results highlight the need of greater consideration of psychosomatic symptoms, particularly in adolescence, in later socioeconomic outcomes.

The problem of attrition in a Finnish longitudinal survey on depression.

A cohort of all school children aged 16 years in 1983 (n = 2194, 96.7%) in Tampere, Finland were studied at 16, 22 and 32 years of age by self-reported questionnaires. The non-response pattern was considered by modelling the individual response probability by panel year and gender. Gender and school performance at age 16 years were the most important predictors of non-response. They explained away the effect of all other variables at 16 and 22 years, except for earlier non-response at age 22. However, the ability of the models to predict non-respondents was very poor. The effect of attrition for the estimation of depression prevalence was evaluated first by longitudinal weighting methods used commonly in survey studies and then by Markov chain Monte Carlo (MCMC) simulation of the missing depression status. Under the missing-at-random assumption (MAR), both applied correction methods gave estimates of roughly the same size and did not significantly differ from the observed prevalence of depression. No indication of informative missingness was found. We therefore conclude that attrition does not seriously bias the estimation of depression prevalence in the data. In general, non-response models, which are needed to correct for informative missingness, are likely to have poor ability to predict non-response. Therefore, the plausibility of the MAR assumption is important in the presence of attrition.