The effects of mindfulness-based interventions in medical students: a systematic review.

The number of studies on the effects of mindfulness on healthcare professionals is increasing. The main aim of this study was to collate the quantitative results of original studies analyzing the effects of mindfulness-based interventions on a variety of outcomes in medical students. We also analyzed how the study design and characteristics of the intervention affect the results, and identified qualitative effects of mindfulness interventions. A literature search was performed in different databases in June 2020. Original articles meeting the following criteria were included: (1) at least 50% of the participants were medical students, (2) included a mindfulness intervention, (3) analyzed any outcome relating to mindfulness intervention, (4) peer-reviewed (5) written in English. Eventually, 31 articles including 24 different samples were included. Over half of the studies were RCTs. In over half of the studies, the intervention was 4- to 10-week original Mindfulness-Based Stress Reduction or Mindfulness-Based Cognitive Therapy or a modification of these. In general, satisfaction with the interventions was good. Based on a meta-analysis, after the intervention, the intervention group had statistically significantly fewer symptoms of stress and distress and had higher mindfulness than the controls. The beneficial effects persisted in follow-ups over months or years. Both long and shorter courses and courses with and without face-to-face sessions were effective. Both controlled and uncontrolled studies had statistically significant results. Qualitative results revealed potential factors behind the quantitative effects. The number of studies on mindfulness interventions in medical students has increased drastically. Mindfulness-based interventions seem to offer a good possibility to enhance medical students' well-being.

Visual memory and alcohol use in a middle-aged birth cohort.

Light and moderate alcohol use has been reported to be associated with both impaired and enhanced cognition. The purpose of this study was to explore whether there was a linear relationship between visual memory and alcohol consumption in males and females in a large middle-aged birth cohort population in cross-sectional and longitudinal settings. Data were collected from 5585 participants completing 31-year (1997-1998) and 46-year (2012-2014) follow-ups including Paired Associate Learning (PAL) test at 46-years follow-up. The participants were originally from 12,231 study population of the Northern Finland Birth Cohort 1966 (NFBC1966). The PAL test was conducted to assess visual memory. Reported alcohol use was measured as total daily use of alcohol, beer, wine, and spirits converted into grams and as frequency and amount of use of beer, wine, and spirits. The total daily alcohol use was not associated with reduced visual memory. The frequency of use of beer and wine in males was associated with better visual memory in cross-sectional and longitudinal settings. Using six or more servings of spirits was associated with worse visual memory in males in cross-sectional and longitudinal settings. Using six or more servings of spirits was associated with worse visual memory in males in cross-sectional and longitudinal setting. The study suggested a lack of a linear association between drinking and visual memory in the middle-aged population.

Prenatal maternal stress, breastfeeding and offspring ADHD symptoms.

There is increasing evidence to suggest that environmental factors are associated with ADHD, but results regarding prenatal maternal stress, unwanted pregnancy, breastfeeding, and ADHD in children are controversial and few prospective studies have been conducted. Using prospectively collected data from the Northern Finland Birth Cohort 1986 (n = 7,910) we studied potential risk factors for ADHD symptoms at 8 and 16 years of age, including prenatal maternal stress and unwanted pregnancy, and protective factors including the duration of breastfeeding. Prenatal stress was associated with an increased risk of ADHD symptoms at the age of 16 (OR = 1.95, 95% CI: 1.34-2.80) and an unwanted pregnancy correlated with hyperactivity symptoms in the offspring at the age of 8 (OR = 2.08, 95% CI: 1.55-2.77). We did not find an association between prenatal maternal stress and hyperactivity symptoms in the offspring at the age of 8 (OR = 0.87, 95% CI: 0.69-1.08) or with unwanted pregnancy and ADHD symptoms at the age of 16 (OR = 1.13, 95% CI: 0.57-2.02). In relation to breastfeeding, over three months of exclusive breastfeeding was associated with lower hyperactivity symptoms in the 8-year follow-up (OR = 0.65, 95% CI: 0.46-0.92) and there was evidence of same kind of relationship concerning non-exclusive breastfeeding, but the association was not statistically significant (OR = 0.76, 95% CI: 0.54-1.06). In 16-year follow-up, under six months of non-exclusive breastfeeding showed an association with ADHD symptoms (OR = 0.68, 95% CI: 0.48-0.95) while exclusive breastfeeding did not (OR = 1.00, 95% CI: 0.66-1.55). In conclusion, our findings suggest that prenatal maternal stress increases the risk of more severe forms of ADHD symptoms in the offspring and breastfeeding can protect against such symptoms at the ages of 8 and 16.

Association of temperament and character traits with ADHD and its comorbidities.

BACKGROUND: Increasing evidence suggests that personality traits may be associated with ADHD and comorbid concerns. We investigated temperament and character traits associated with internalizing and externalizing comorbidities in adolescents with or without ADHD. METHODS: The population consisted of a subsample (n = 457) of the Northern Finland Birth Cohort 1986 (NFBC1986) that comprised 16-year-old adolescents with and without symptoms of ADHD. ADHD and psychiatric comorbidities were assessed using the Kiddie-SADS-PL and temperament and character profiles were determined with TCI-125. Outcomes were examined using Pearson's chi-square test, Analyses of Covariance and Cohen's d. RESULTS: The adolescents with ADHD endorsed more novelty seeking and less persistence, self-directedness, and cooperativeness than those without. Comparison of the personality traits and psychiatric comorbidities with the ADHD cases showed that comorbidities did not particularly affect the temperament and character profiles, but rather ADHD accounted for the differences between the personality traits. However, the temperament and character traits predicted externalizing and internalizing psychiatric disorders in the control group. CONCLUSIONS: Our findings reveal unique comorbidity-related temperament factors, which may have implications for adaptive and personalizing intervention efforts.

Attention deficit hyperactivity and oppositional defiant disorder symptoms in adolescence and risk of substance use disorders-A general population-based birth cohort study.

BACKGROUND: Externalizing symptoms are associated with risk of future substance use disorder (SUD). Few longitudinal studies exist using general population-based samples which assess the spectrum of attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) symptoms. AIMS/OBJECTIVES: We aimed to study the associations between adolescent ADHD symptoms and subsequent SUD and additionally examine whether the risk of SUD is influenced by comorbid oppositional defiant disorder (ODD) symptoms. METHODS: The Northern Finland Birth Cohort 1986 was linked to nationwide health care register data for incident SUD diagnoses until age 33 years (n = 6278, 49.5% male). ADHD/ODD-case status at age 16 years was defined using parent-rated ADHD indicated by Strengths and Weaknesses of ADHD symptoms and Normal Behaviors (SWAN) questionnaire with 95% percentile cut-off. To assess the impact of ODD comorbidity on SUD risk, participants were categorized into four groups based on their ADHD/ODD case status. Cox-regression analysis with hazard ratios (HRs) and 95% confidence intervals (CIs) were used to study associations between adolescent ADHD/ODD case statuses and subsequent SUD. RESULTS: In all, 552 participants (8.8%) presented with ADHD case status at the age of 16 years, and 154/6278 (2.5%) were diagnosed with SUD during the follow-up. ADHD case status was associated with SUD during the follow-up (HR = 3.84, 95% CI 2.69-5.50). After adjustments for sex, family structure, and parental psychiatric disorder and early substance use the association with ADHD case status and SUD remained statistically significant (HR = 2.60, 95% CI 1.70-3.98). The risk of SUD remained elevated in individuals with ADHD case status irrespective of ODD symptoms. CONCLUSIONS: ADHD in adolescence was associated with incident SUD in those with and without symptoms of ODD. The association of ADHD and SUD persisted even after adjustment for a wide range of potential confounds. This emphasizes the need to identify preventative strategies for adolescents with ADHD so as to improve health outcomes.

Attention-deficit/hyperactivity disorder is not associated with overweight in adolescence but is related to unhealthy eating behavior and limited physical activity.

PURPOSE: The aim of the study was to examine the possible relation between adolescent ADHD and high BMI, studying also eating behavior and physical activity. METHODS: The data were collected from the Northern Finland Birth Cohort 1986. The follow-up at the age of 16 consisted of a self-assessment form and clinical examination where height and weight were measured and questionnaires on physical activity and eating habits was completed. ADHD diagnosis was based on a diagnostic interview with adolescents and parents according to DSM-IV-TR criteria. The participants were divided into the following study groups: individuals with adolescent ADHD (n = 90), those with only childhood ADHD (n = 40), and community controls (n = 269). RESULTS: Results showed no significant differences in BMI, but adolescents with ADHD seemed to have unhealthier eating habits than controls; they ate less often vegetables and breakfast, devoured more often, and consumed more fast food, soft drinks, sweets, and potato crisps daily. Individuals with adolescent ADHD reported light exercise more often but strenuous exercise more seldom than controls. Those with only childhood ADHD did not significantly differ from community controls regarding health behaviors. CONCLUSIONS: There was no relation between ADHD and high BMI but adolescents with ADHD had unhealthier eating habits than those without ADHD. It is conceivable that unhealthy eating behaviors in adolescence might be a risk factor for the development of later overweight; however, the longitudinal associations between ADHD, unhealthy eating behaviors and overweight have not been considered in the present study and remain to be examined further.

Military performance of men with attention-deficit/hyperactivity disorder: findings from a follow-up study in the Northern Finland birth cohort 1986.

PURPOSE: The aim of this study was to assess the military performance of men with adolescent attention-deficit/hyperactivity disorder (ADHD) and men with childhood ADHD (in remission during adolescence) as compared with controls without ADHD. METHODS: The study employs the general population-based Northern Finland Birth Cohort 1986 (NFBC1986) together with data received from the Finnish Defence Forces (FDF). A total of 38 men with childhood ADHD and 67 with adolescent ADHD were compared with 160 controls. RESULTS: The men with adolescent ADHD were more often deemed unfit for military service, had more military health care visits, more often committed at least one offence during service, received poorer evaluations for team leadership skills and indulged in more alcohol consumption and smoking than the controls, while those with childhood ADHD did not differ from the controls in their military fitness, but received poorer evaluations for team leadership skills and smoked more than did the controls. CONCLUSION: The conscripts with adolescent ADHD performed worse on many military parameters, but the men with ADHD in remission did not seem to suffer from such negative effects on military performance. The childhood ADHD group in particular was nevertheless somewhat limited in size, which might have led to a Type II error.

Association of ADHD symptoms in adolescence and mortality in Northern Finland Birth Cohort 1986.

BACKGROUND: Diagnosis of attention deficit hyperactive disorder (ADHD) has been associated with increased risk of mortality in large register samples. However, there is less known about the association between symptoms of ADHD in adolescents and risk of mortality in general population samples. METHODS: The Northern Finland Birth Cohort 1986 (n = 9432 at recruitment in early pregnancy) linked to nationwide register data for deaths was utilized to study the association between parent-rated ADHD symptoms assessed using Strengths and Weaknesses of ADHD symptoms and Normal Behaviors (SWAN) questionnaire and mortality until age 33 years. Cox-regression analysis with hazard ratios (HRs) and 95% confidence intervals (CIs) was used to study the association between SWAN inattentive, hyperactive, and combined symptom scores and risk of death. RESULTS: Sixty-three (0.9%) of the 6685 participants died during the follow-up. Higher SWAN inattentive (crude HR = 2.30, 95% CI 1.46-3.63), SWAN hyperactive (crude HR = 2.43, 95% CI 1.29-4.56), and SWAN combined (crude HR = 2.69, 95% CI 1.57-4.61) scores were associated with increased risk of death. After adjustments for sex, family structure, and lifetime parental psychiatric disorder, these associations persisted. Further adjustment for frequent alcohol intoxication, cannabis, and other substance use in adolescence attenuated these to below statistical significance. CONCLUSIONS: These results extend previous findings on the risk of mortality in adolescents who have symptoms of ADHD. Further research with larger samples are needed to determine whether the association between ADHD symptoms and mortality is independent of adolescent substance use.

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.

The association of family size and birth order in adolescence to the likelihood of developing psychotic disorders in young adulthood: A follow-up study of former adolescent inpatients.

This is a clinical follow-up study of 508 former adolescent psychiatric inpatients admitted to hospital between 2001 and 2006 in Northern Finland. The participants were interviewed using the K-SADS-PL and the EuropASI instruments. Until 2016, the national Finnish Care Register for Health Care provided data on psychiatric diagnoses. Using logistic regression analysis, we examined how birth order and childhood family size affected the incidence of schizophrenia spectrum disorder (SSD) and other psychotic disorders by young adulthood. Participants were separated into three diagnostic subgroups 1) participants with SSD (n = 76), 2) participants with a psychotic disorder other than SSD (n = 107) and 3) participants with only one nonpsychotic depressive episode (n = 118). The main conclusions were that large family size in adolescence (six or more children), male sex and father having psychiatric problems or being unemployed, were significantly associated with a higher likelihood of SSD among study participants. Large family size also associated to a higher likelihood of developing other psychotic disorders. Being the first born or an only child reduced the likelihood of psychotic disorders other than SSD. When diagnosing and treating children and teenagers with psychotic symptoms, information regarding their family size and sibling position may be relevant.

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.

Emotional neglect and parents' adverse childhood events.

INTRODUCTION: Emotional neglect means that the child's emotional and developmental needs are not fulfilled by the parents or other caregivers. Adverse childhood events (ACEs) are a risk factor for mental health problems and impaired parenting skills. The objective here was to examine whether parents' ACEs increase the child's risk of experiencing emotional neglect. METHODS: The participants in the present study were members of the Northern Finland Birth Cohort 1986 (NFBC1986). Emotional neglect experiences were measured in 190 members of this cohort by means of the Trauma and Distress Scale (TADS), and ACEs in both parents were measured with a specific questionnaire. A linear regression model was used to examine the association between parents' ACEs and the children's emotional neglect scores. RESULTS: The children's mean emotional neglect score was 8.11 on a scale from 5 to 25. There was no significant difference between males (mean 8.01) and females (mean 8.19). Only father's ACEs were associated with child's emotional neglect score. In the linear regression model, the children's emotional neglect scores increased by 0.3 points for father's ACE. CONCLUSIONS: Our findings suggest that father's ACEs may increase the child's risk of experiencing emotional neglect. It seems that childhood adversities are transferred from parents to children, but larger samples would be needed to confirm these findings.

Depressive symptoms as predictors of visual memory deficits in middle-age.

BACKGROUND: Depression has been known to affect memory and other cognitive domains. The objective of this longitudinal cohort study was to investigate longitudinal associations between depressive symptoms at age 31 years and visual memory and new learning at the age of 46 years. We investigated whether depressive symptoms at age 31 predicted visual memory deficits at age 46 years, and whether changes in depressive symptoms between 31 and 46 years predicted visual memory at age 46. METHODS: Participants were members of the Northern Finland Birth Cohort 1966. Depressive symptoms were assessed with the Symptom Checklist-25 (SCL-25) on both occasions. Visual memory and new learning were assessed using Paired Associative Learning (PAL) test at the age 46 follow-up. PAL total errors adjusted and first trial memory score were used as outcomes and basic educational level, relationship status, physical activity and diet at baseline were considered as confounding factors in linear regression analysis. RESULTS: A total of 5029 (57% female) participants were included in the main analysis. No associations were found between depressive symptoms or change in depressive symptoms and visual memory and new learning scores. The result did not change following cut-offs 1.55 and 1.75 for depression. LIMITATIONS: SCL-25 only measures symptoms during the past week. Only one cognitive domain was assessed. CONCLUSIONS: Contrary to our hypothesis, neither baseline depressive symptoms nor change in depressive symptoms predicted visual memory scores 15 years later. It appears that sub-clinical depressive symptoms do not effect this cognitive domain in the middle-aged population.