Effects of stricter legislation on coercive measures in child and adolescent psychiatric care: a qualitative interview study with staff.

BACKGROUND: Legislators often want to positively affect psychiatric inpatient care and reduce coercion by a stricter judicial regulation. However, staff experiences and comprehension of such legal changes are largely unknown, yet essential in obtaining the intended outcomes. We examined staff understanding and implementation of a July 1, 2020 legal change in Sweden regarding the use of coercive measures (e.g., restraint, seclusion, and forced medication) in child and adolescent psychiatric inpatient care. METHODS: During 2021, semi-structured interviews were conducted with nine child and adolescent psychiatric inpatient staff (nurses, senior consultants, and head of units). Interviews were transcribed verbatim and analysed using reflexive thematic analysis. We used an implementation outcomes framework to relate data to a wider implementation science context. RESULTS: The legislative change was viewed as both positive and negative by participating staff. They reported mixed levels of preparedness for the legislative change, with substantial challenges during the immediate introduction, including insufficient preparations and lack of clear guidelines. A knowledge hierarchy was evident, affecting various professional roles differently. While the law was positively viewed for its child-centred approach, we found notable distrust in legislators' understanding of the clinical reality, leading to practical difficulties in implementation. Care practices after the legal change varied, with some participants reporting little change in the use of coercive measures, while others noted a shift towards more seclusion and sedative medication usage. The work environment for consultants was described as more challenging due to increased bureaucratic procedures and a heightened pressure for accuracy. CONCLUSIONS: The study highlights the complexities and challenges in implementing legislative changes in psychiatric care, where stricter legislation does not necessarily entail reduced use of coercion.

All-cause and suicide mortalities among adolescents and young adults who contacted specialised gender identity services in Finland in 1996-2019: a register study.

BACKGROUND: All-cause and suicide mortalities of gender-referred adolescents compared with matched controls have not been studied, and particularly the role of psychiatric morbidity in mortality is unknown. OBJECTIVE: To examine all-cause and suicide mortalities in gender-referred adolescents and the impact of psychiatric morbidity on mortality. METHODS: Finnish nationwide cohort of all <23 year-old gender-referred adolescents in 1996-2019 (n=2083) and 16 643 matched controls. Cox regression models with HRs and 95% CIs were used to analyse all-cause and suicide mortalities. FINDINGS: Of the 55 deaths in the study population, 20 (36%) were suicides. In bivariate analyses, all-cause mortality did not statistically significantly differ between gender-referred adolescents and controls (0.5% vs 0.3%); however, the proportion of suicides was higher in the gender-referred group (0.3% vs 0.1%). The all-cause mortality rate among gender-referred adolescents (controls) was 0.81 per 1000 person-years (0.40 per 1000 person-years), and the suicide mortality rate was 0.51 per 1000 person-years (0.12 per 1000 person-years). However, when specialist-level psychiatric treatment was controlled for, neither all-cause nor suicide mortality differed between the two groups: HR for all-cause mortality among gender-referred adolescents was 1.0 (95% CI 0.5 to 2.0) and for suicide mortality was 1.8 (95% CI 0.6 to 4.8). CONCLUSIONS: Clinical gender dysphoria does not appear to be predictive of all-cause nor suicide mortality when psychiatric treatment history is accounted for. CLINICAL IMPLICATIONS: It is of utmost importance to identify and appropriately treat mental disorders in adolescents experiencing gender dysphoria to prevent suicide.

Somatic symptoms and insomnia among bereaved parents and siblings eight years after the Utøya terror attack.

Background: Levels of prolonged grief symptoms (PGS) and post-traumatic stress symptoms (PTSS) can be high, many years following bereavement after terror, but knowledge concerning somatic health is scarce. Terrorism is a serious public health challenge, and increased knowledge about long-term somatic symptoms and insomnia is essential for establishing follow-up interventions after terrorism bereavement.Objective: To study the prevalence of somatic symptoms and insomnia and their association with PGS, PTSS, and functional impairment among terrorism-bereaved parents and siblings.Methods: A cross-sectional quantitative study included 122 bereaved individuals from the Utøya terror attack in Norway in 2011. The sample comprised 88 parents and 34 siblings aged 19 years and above (Mage = 49.7 years, SDage = 13.8 years, 59.8% females). The participants completed questionnaires 8 years after the attack assessing somatic symptoms (Children's Somatic Symptoms Inventory) and insomnia (Bergen Insomnia Scale) along with measures of PGS (Inventory of Complicated Grief), PTSS (Impact of Event Scale-Revised), and functional impairment (Work and Social Adjustment Scale).Results: Fatigue was the most frequently reported somatic symptom (88% of females and 65% of males). Females reported statistically significantly more somatic symptoms than males. In total, 68% of the bereaved individuals scored above the cut-off for insomnia. There were no statistically significant gender differences for insomnia. Female gender, intrusion, and arousal were associated with somatic symptoms. Intrusion and somatic symptoms were associated with insomnia. Somatic symptoms, avoidance, and hyperarousal were associated with functional impairment.Conclusion: Many bereaved parents and siblings report somatic symptoms and insomnia eight years after the terror attack. Somatic symptoms are associated with functional impairment. Long-term follow-up and support after traumatic bereavement should focus on somatic symptoms and insomnia.

Many bereaved individuals, especially females, reported insomnia and somatic symptoms, including fatigue, pain, and other related symptoms.Somatic symptoms, avoidance, and hyperarousal were identified as being associated with functional impairment among the bereaved.Post-traumatic stress symptoms played a more significant role than prolonged grief symptoms in explaining the reduced physical health experienced by the bereaved.

Have the psychiatric needs of people seeking gender reassignment changed as their numbers increase? A register study in Finland.

BACKGROUND: The number of people seeking gender reassignment (GR) has increased everywhere and these increases particularly concern adolescents and emerging adults with female sex. It is not known whether the psychiatric needs of this population have changed alongside the demographic changes. METHODS: A register-based follow-up study of individuals who contacted the nationally centralized gender identity services (GIS) in Finland in 1996-2019 (gender dysphoria [GD] group, n = 3665), and 8:1 age and sex-matched population controls (n = 29,292). The year of contacting the GIS was categorized to 5-year intervals (index periods). Psychiatric needs were assessed by specialist-level psychiatric treatment contacts in the Finnish Care Register for Hospital Care in 1994-2019. RESULTS: The GD group had received many times more specialist-level psychiatric treatment both before and after contacting specialized GIS than had their matched controls. A marked increase over time in psychiatric needs was observed. Among the GD group, relative risk for psychiatric needs after contacting GIS increased from 3.3 among those with the first appointment in GIS during 1996-2000 to 4.6 when the first appointment in GIS was in 2016-2019. When index period and psychiatric treatment before contacting GIS were accounted for, GR patients who had and who had not proceeded to medical GR had an equal risk compared to controls of needing subsequent psychiatric treatment. CONCLUSION: Contacting specialized GIS is on the increase and occurs at ever younger ages and with more psychiatric needs. Manifold psychiatric needs persist regardless of medical GR.

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

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

Family Characteristics, Transgender Identity and Emotional Symptoms in Adolescence: A Population Survey Study.

Sociodemographic and psychosocial family factors have profound implications for adolescent development, identity formation and mental health during the adolescent years. We explored the associations of sociodemographic and psychosocial family factors with transgender identity in adolescence and the role of these factors in the associations between gender identity and emotional disorders. Data from a large adolescent population survey from Finland were analysed using logistic regression models. Reporting transgender identity was associated with mother's low level of education, accumulating family life events, lack of family cohesion, perceived lack of family economic resources and female sex. A lack of family cohesion further differentiated between adolescents reporting identifying with the opposite sex and those reporting non-binary/other gender identification. The associations between transgender identity, depression and anxiety were attenuated but did not level out when family factors were controlled for. Transgender identity in adolescence is associated with socioeconomic and psychosocial family factors that are known correlates of negative outcomes in mental health and psychosocial well-being. However, transgender identification is also associated with emotional disorders independent of these family factors.

Schizophrenia among young people first admitted to psychiatric inpatient care during early and middle adolescence.

OBJECTIVE: This study explored the incidence and stability of schizophrenia in a large national register data of all adolescents first admitted to psychiatric inpatient care at ages 13-17 in Finland 1980-2010. METHODS: The study population (N 17,112) comprised all Finnish citizens aged 13-17 receiving their first ever psychiatric inpatient treatment between 1980 and 2010 in Finland. To explore incidence and stability of schizophrenia, the diagnostic information on inpatient care or disability pension was obtained from the appropriate registers. RESULTS: The incidence of schizophrenia disorders (F20 + F25) during adolescence was higher in the study population for those admitted to psychiatric inpatient care 1980-1989 than in other decades examined. Overall, psychiatric inpatient care during adolescence was a risk factor for subsequent schizophrenia, especially if a diagnosis of F20-29 was set although a considerable share of those with psychotic disorders other than schizophrenia diagnosis did not subsequently convert to schizophrenia. The stability of adolescent onset schizophrenia diagnosis was high. CONCLUSION: Adolescents requiring psychiatric inpatient care have a higher later rate of schizophrenia diagnosis than prevalence at community level. Whereas adolescent onset schizophrenia diagnosis is a fairly stable diagnosis, there are other adolescent psychotic disorders which are more transient in nature.

Transgender identity is associated with severe suicidal ideation among Finnish adolescents.

OBJECTIVES: Emerging evidence reveals disparities in suicidal behaviour and ideation exist between transgender and cisgender youth. It has been hypothesized that certain gender minority specific risk factors, such as experiences of victimization, could partially explain the mental health disparities between transgender and cisgender youth. We set out to explore whether transgender identity is associated with severe suicidal ideation among Finnish adolescents and whether the possible association persist when a range of covariates is controlled for. METHODS: The study included 1,425 pupils (mean age (SD) = 15.59 (0.41)) who participated in the study during a school lesson. Logistic regression was used to study associations between transgender identity and severe suicidal ideation. RESULTS: Four models, each adding more covariates, were created. The final model revealed a statistically significant association between transgender identity and severe suicidal ideation, even though the association grew weaker as more covariates were added and controlled for. CONCLUSIONS: The results indicate that transgender identity is associated with severe suicidal ideation even after prominent covariates or risk factors of suicidal behaviour and ideation have been taken into account.

Educational attainment of adolescents treated in psychiatric inpatient care: a register study over 3 decades.

Mental disorders may for various reasons impair educational attainment, and with far-reaching consequences given the impact of education on subsequent employment, social life, life choices and even health and mortality. This register-based study addresses trends in educational attainment among Finnish adolescents aged 13-17 with mental disorders severe enough to necessitate inpatient treatment between 1980 and 2010. Our subjects (N = 14,435), followed up until the end of 2014, were at greater risk of discontinuing education beyond compulsory comprehensive school or of lower educational attainment than their age-peers in general population. Only 50.0% had completed any post-comprehensive education compared to 84.9% in same-aged general population. Those at highest risk were males and those with organic, intellectual disabilities and developmental, externalizing disorders or schizophrenia group diagnoses. Despite improvements in adolescent psychiatric care, school welfare services and pedagogical support, risks have remained high. Greater effort in psychiatric treatment, school welfare and pedagogy are needed to combat this severe inequality.

A Chronic Disease in Adolescence and Selection to an Educational Path-A Longitudinal Study.

Chronic disease may affect adolescents' educational success. We study whether adolescents with a somatic chronic condition have lower school performance, lower odds for academic education, and a delayed start of upper-secondary studies. Seventh graders and ninth graders in the Helsinki Metropolitan Region, Finland, were invited to participate in a school survey in 2011 and 2014, respectively. The respondents (2011, N = 8960; 2014, N = 7394) were followed using a national application registry until 2017. The chronic conditions were asthma, diabetes, and epilepsy. Outcomes were grade point average (GPA), study place in an academic school, and delayed start of secondary education. Adolescents with a chronic disease needing medication had lower GPAs in both grades. Chronic disease with medication in the seventh grade predicted higher odds for the non-academic track (OR = 1.3) and the delayed start (OR = 1.4). In the ninth grade, chronic disease predicted non-academic studies univariately (OR = 1.2) and was not associated with the delayed start. The somatic chronic condition with medication, particularly epilepsy, slightly lowers students' school performance, which is a mediator between the chronic condition and selection into educational paths. Compared to gender and parents' education, and particularly to GPA, the role of chronic conditions on educational outcomes is small.

Aspects of Gender and Sexuality in Relation to Experiences of Subjection to Sexual Harassment among Adolescents in General Population.

Subjection to sexual harassment (SH) has been reported more commonly by girls than by boys, by sexual and gender minority youth more than by mainstream youth, and by sexually active youth more than by those not yet experienced in romantic and erotic encounters. However, the research so far has not addressed these correlates simultaneously. This study aimed to explore independent associations between experiencing SH and these aspects of sex, gender and sexuality-considering all of them concurrently. A cross sectional survey with data from Finland was used, with an analyzable sample of 71,964 adolescents aged 14 to 16-years- of age, collected in 2017. The data were analysed using cross-tabulations with chi-square statistics and logistic regression analyses. The types of SH studied were gender harassment, unwelcome sexual attention, and sexual coercion. Girls, sexual and gender minority youth, and youth engaging in romantic and erotic encounters had experienced all three types of SH more commonly than boys, mainstream youth and those not sexually active. Associations between minority status and experiences of sexual harassment were stronger among boys, and being sexually active had stronger associations with subjection to sexual harassment in girls. The findings appear to support the assumption that sexual harassment serves both as a means of perpetuating heteronormativity and the sexual double standard.

Identity Integration in Adolescents With Features of Gender Dysphoria Compared to Adolescents in General Population.

Adolescence is an important period for identity formation and identity consolidation is one of the main developmental tasks. Gender identity is an essential aspect of identity but so far little is known about its development. Neither has the identity development of adolescents with features of gender dysphoria (GD) been extensively studied so far. However, adolescents with features of GD have been shown to present extensive psychiatric psychopathology and could therefore be assumed also to have more problems with identity development. We set out to compare the identity integration of adolescents with features of GD (n = 215; 186 natal females, 29 natal males) and adolescents from general population (n = 400; 244 females, 154 males and 2 who did not report their sex) using a culture-adapted Finnish version of an assessment tool for adolescents and young adults on identity in terms of personality functioning, the Assessment of Identity Development in Adolescence (AIDA). AIDA is a 58-item self-report questionnaire enabling dimensional differentiation between healthy and impaired identity development. The continuous AIDA total score (sum score) and its subscales were analyzed using MANOVA, and dichotomized T-scores differentiating identity development in impaired and healthy range using cross-tabulations with chi-square statistics. Adolescents with features of GD showed identity development similar to adolescents in general population. The slight differences seen in AIDA scores were in favor of the GD group. The proportion scoring to identity impairment was lowest among gender-referred adolescents assigned males at birth. Identity integration of the gender-referred adolescents was further compared to that of 77 adolescents in specialist level psychiatric outpatient treatment (67 females, 10 males). The adolescent psychiatric outpatients scored much higher toward impaired identity on all AIDA scales than did the adolescents with features of GD. These results suggest that features of GD are not associated with problems in identity development in adolescents at large. Adolescents with features of GD may have been required to process their identity more, thereby advancing further in their identity consolidation process than young people on average.

Sex offending among adolescents and young men with history of psychiatric inpatient care in adolescence.

BACKGROUND: Some mental disorders have been associated with increased likelihood of sexual offending in adolescents (and adults), but relevant studies tend to be of established sex offenders. AIMS: To examine relationships between adolescent mental disorders and subsequent involvement in sex offending and to explore any predictive value of primary diagnoses for subsequent interpersonal offending, whether sexual or violent. METHODS: We analyse national register-based longitudinal data on males in Finland admitted for their first psychiatric inpatient treatment between the ages of 13-17 in the period 1980-2010 (N = 6749). Cox regression was used for the analysis of multivariate associations. RESULTS: A subsequent criminal record for sex crime in the 10-year follow up was rare among former child and adolescent psychiatric (CAP) inpatient males (1.5%). Having a subsequent criminal record for non-sex-related violent crime was more common (25%). Time to either sex crimes or non-sex-related violent crimes after a first CAP inpatient treatment was 3-4 years. Whilst the risk of committing non-sex-related violent crimes was elevated in all diagnostic groups compared to those with schizophrenia spectrum disorders, the risk of committing subsequent sex crimes was elevated only in the group with substance use, conduct or personality disorders. Among those with pre-existing criminal history of sex crime, the risk of a subsequent criminal record for sex crime after CAP treatment was increased 11-fold, but the risk for later non-sex-related violent crimes was not increased compared to the rest of the male adolescent CAP population. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: In this first longitudinal study of criminal convictions for sex offending after a period of inpatient psychiatric treatment as an adolescent such convictions were rare, but the difference in post discharge risk of further convictions for sexual offending and non-sexual violent offending raises questions about whether more attention and specific treatment for aberrant sexual behaviours is needed for male adolescents with severe mental disorders.

The perceptions of different professionals on school absenteeism and the role of school health care: A focus group study conducted in Finland.

PURPOSE OF THE STUDY: School absenteeism and school dropout jeopardize the future health and wellbeing of students. Reports on the participation of school health care in absenteeism reduction are infrequent, although physical and mental health problems are the most common causes of school absenteeism. Our aim was to explore what reasons different professionals working in schools recognize for absenteeism and which factors either promote or inhibit the inclusion of school health care in absenteeism reduction. MATERIALS AND METHODS: Data for this qualitative study was gathered from ten focus groups conducted in two municipalities in southern Finland. The groups included (vice) principals, special education/resource/subject teachers, guidance counselors, school social workers, school psychologists, school nurses, school doctors, and social workers working in child protective services. Data analysis was predominantly inductive but the categorization of our results was based on existing literature. RESULTS: Study participants identified student-, family-, and school-related reasons for absenteeism but societal reasons went unmentioned. A number of reasons promoting the inclusion of school health care in absenteeism reduction arose, such as expertise in health-related issues and the confidentiality associated with health care. Inclusion of school health care was hindered by differences in work culture and differing perceptions regarding the aims of school health care. CONCLUSION: Professionals working in schools were knowledgeable about the different causes of school absenteeism. Clarifying both the aims of school health care and the work culture of different professionals could facilitate the inclusion of school health care in absenteeism reduction.

Factors behind a remarkable increase in adolescent psychiatric inpatient treatment between 1980 and 2010 - a nationwide register study.

PURPOSE: This register-based study aimed to evaluate trends in adolescent psychiatric inpatient care using nationwide data from three consecutive decades. METHODS: The study population (N 17,112) comprised all Finnish citizens aged 13-17 receiving their first-ever psychiatric inpatient treatment between 1980 and 2010 in Finland. Information on inpatient care in the psychiatric hospital was obtained from the Hospital Discharge Register and the Care Register for Health Care, which contains data on all patients discharged from all Finnish inpatient psychiatric health services. RESULTS: Inpatient admissions remained relatively stable until the early 1990s, after which a steady increase was seen, peaking in 2008 and more marked among females than males. In males, there was an increase in inpatient care episodes for externalizing disorder or mood disorder, and in females for mood disorder. Duration of first inpatient care decreased over time, but level of functioning on admission remained stable or even deteriorated. Females, patients first admitted in the 1980s or diagnosed with schizophrenia were more likely to be re-hospitalized during adolescence. CONCLUSIONS: We reported an increase in adolescent psychiatric inpatient care from the latter half of the 1990s up to 2010, which could be explained by societal and policy changes. In particular, as the study period progressed a significant increase was seen in admissions of females and a global reduction of length of stay (LOS) with no concomitant increase in re-hospitalizations.

Thinness, overweight and obesity among 6- to 17-year-old Malaysians: secular trends and sociodemographic determinants from 2006 to 2015.

OBJECTIVE: To examine secular trends and sociodemographic determinants of thinness, overweight and obesity among Malaysian children and adolescents from 2006 to 2015. DESIGN: We used cross-sectional data from the National Health and Morbidity Surveys 2006, 2011 and 2015. Individuals were classified into pre- (6-9 years), early (10-13 years) and mid- (14-17 years) adolescence. BMI status was determined according to the International Obesity Task Force (IOTF) and WHO criteria, using measured height and weight. We analysed trends using log-binomial regression, by sex-age groups, stratified by sociodemographic factors (ethnicity, residential area, household size and household income), and accounting for the complex survey design. Associations between sociodemographic factors and prevalence of thinness and overweight (obesity included) in 2015 were assessed using log-Poisson regression. SETTING: Nationwide population-based surveys, Malaysia. PARTICIPANTS: Eligible 6-17-year-olds from urban and rural residential areas (n 28 094). RESULTS: The prevalence of thinness decreased from 2006 to 2015 (IOTF: boys from 22 % to 18 %, girls from 23 % to 19 %; WHO: boys from 9 % to 7 %, girls from 8 % to 6 %), while the prevalence of overweight increased (IOTF: boys from 20 % to 26 %, girls from 19 % to 24 %; WHO: boys from 25 % to 31 %, girls from 22 % to 27 %). These changes were statistically significant in most sex-age groups. Thinness and overweight co-existed in all sociodemographic subgroups, with variation in the prevalence estimates, but similar secular changes in most subgroups. CONCLUSIONS: Malaysia is facing a double burden of malnutrition at population level with a secular increase in overweight and obesity and a gradual decrease in thinness among 6-17-year-olds from varying sociodemographic backgrounds.

Changes over time in mental health symptoms among adolescents in Tampere, Finland.

BACKGROUND: Mental health problems are common in adolescence and seeking help for them is becoming more common. Referrals to adolescent mental healthcare have recently increased in Finland. OBJECTIVE: To examine time trends in internalizing and externalizing mental health symptoms among Finnish adolescents. METHOD: A time-trend school survey was conducted among 9th graders (15-year-olds) in Tampere, Finland, in three time periods: 2002-03, 2012-13 and 2018-19 (N = 4,162). RESULTS: Compared to the period 2002-03, prevalence of externalizing symptoms decreased in the period 2012-13 and further in 2018-19. The prevalence of internalizing symptoms did not change significantly between 2002-03 and 2012-13; however, in 2018-19, depression, social anxiety, general anxiety, poor subjective health, stress symptoms among boys, and poor self-esteem increased compared to earlier time periods. The increases were more marked among girls. However, suicidal ideation did not increase in 2018-19 compared to earlier time periods. CONCLUSION: Whereas the prevalence of externalizing symptoms decreased among Finnish adolescents between 2002-03 and 2018-19, the prevalence of internalizing symptoms increased between 2012-13 and 2018-19. To help to understand the causes of these increases and to prevent internalizing problems, further research on the underlying causes is needed.

Transgender Identity Is Associated With Bullying Involvement Among Finnish Adolescents.

BACKGROUND: During adolescence, bullying often has a sexual content. Involvement in bullying as a bully, victim or both has been associated with a range of negative health outcomes. Transgender youth appear to face elevated rates of bullying in comparison to their mainstream peers. However, the involvement of transgender youth as perpetrators of bullying remains unclear in the recent literature. OBJECTIVE: The aim of this study was to compare involvement in bullying between transgender and mainstream youth and among middle and late adolescents in a general population sample. METHODS: Our study included 139,829 students in total, divided between a comprehensive school and an upper secondary education sample. Associations between gender identity and involvement in bullying were first studied using cross-tabulations with chi-square statistics. Logistic regression was used to study multivariate associations. Gender identity was used as the independent variable, with cisgender as the reference category. Subjection to and perpetration of bullying were entered each in turn as the dependent variable. Demographic factors, family characteristics, internalizing symptoms, externalizing behaviors, and involvement in bullying in the other role were added as confounding factors. Odds ratios (OR) with 95% confidence intervals (95% CI) are given. The limit for statistical significance was set at p < 0.001. RESULTS: Both experiences of being bullied and perpetrating bullying were more commonly reported by transgender youth than by cisgender youth. Among transgender youth, all involvement in bullying was more commonly reported by non-binary youth than those identifying with the opposite sex. Logistic regression revealed that non-binary identity was most strongly associated with involvement in bullying, followed by opposite sex identity and cisgender identity. Transgender identities were also more strongly associated with perpetration of bullying than subjection to bullying. CONCLUSION: Transgender identity, especially non-binary identity, is associated with both being bullied and perpetrating bullying even when a range of variables including internal stress and involvement in bullying in the opposite role are taken into account. This suggests that bullying during adolescence may serve as a mechanism of maintaining heteronormativity.

Changes in cannabis use according to socioeconomic status among Finnish adolescents from 2000 to 2015.

BACKGROUND: Despite reduced sanctions and more permissive attitudes toward cannabis use in the USA and Europe, the prevalences of adolescent cannabis use have remained rather stable in the twenty-first century. However, whether trends in adolescent cannabis use differ between socioeconomic groups is not known. The aim of this study was to examine trends in cannabis use according to socioeconomic status among Finnish adolescents from 2000 to 2015. METHODS: A population-based school survey was conducted biennially among 14-16-year-old Finns between 2000 and 2015 (n = 761,278). Distributions for any and frequent cannabis use over time according to socioeconomic adversities were calculated using crosstabs and chi-square test. Associations between any and frequent cannabis use, time, and socioeconomic adversities were studied using binomial logistic regression results shown by odds ratios with 95% confidence intervals. RESULTS: At the overall level, the prevalences of lifetime and frequent cannabis use varied only slightly between 2000 and 2015. Cannabis use was associated with socioeconomic adversities (parental unemployment in the past year, low parental education, and not living with both parents). The differences in any and frequent cannabis use between socioeconomic groups increased significantly over the study period. CONCLUSIONS: Although the overall changes in the prevalence of adolescent cannabis use were modest, cannabis use increased markedly among adolescents with the most socioeconomic adversities. Socioeconomic adversities should be considered in the prevention of adolescent cannabis use.