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.

Self-reported depression is increasing among socio-economically disadvantaged adolescents - repeated cross-sectional surveys from Finland from 2000 to 2011.

BACKGROUND: Adolescent depression is more common in lower socio-economic groups. Whether this pattern has changed over time, is not known.We examined the prevalence of self-reported depression and its changes in socio-economic groups from 2000 to 2011 among Finnish adolescents. METHODS: Data were based on classroom surveys every second year from 2000-2001 to 2010-2011 using nationwide samples of 14-16-year old Finns (n = 618,084). Data were collected using self-administered questionnaires including questions on health, health behaviours, and school experiences. Depression was measured with a Finnish modification of the 13-item Beck Depression Inventory, and divided into no, mild, moderate and severe depression. The association between depression and the social background (parents' education and employment) over time was studied using a multinomial regression analysis. RESULTS: The prevalence of self-reported severe depression slightly increased from 2000-2001 to 2010-2011 in girls. In boys a slight increase was observed when adjusting for background variables. The differences in the prevalence of depression between the social background groups persisted over the entire study period. In both sexes, severe depression nearly doubled among those adolescents whose parents were unemployed and had a low education level; among boys, the prevalence was 6.5% in 2000-2001 and 12.8% in 2010-2011, and among girls 6.4% and 11.4% respectively. CONCLUSION: The largest increases in prevalence of severe depression are seen among socio-economically disadvantaged adolescents. This suggests that inequalities in mental health may become an increasing concern.

Consumption of special diet among Finnish adolescents in 1979-2001: repeated national cross-sectional surveys.

OBJECTIVE: To study consumption of special diet (disease-related and non disease-related) among Finnish adolescents during 1979-2001. METHODS: Self-administered questionnaires were mailed to nationally representative samples of 12- (except in 1979), 14-, 16-, and 18-year-olds in 1979, 1993, 1997, 1999 and 2001. RESULTS: The total number of respondents was 33998. The response rate declined from 78% in 1979 to 70% in 2001. Consumption of special diet increased from 1979 to 2001: in 14-year-old girls from 4% to 24%, boys from 1% to 12%; 16-year-old girls from 5% to 29%, boys from 3% to 11%; and 18-year-old girls from 9% to 30%, boys from 3% to 16%. An increase was observed both in the consumption of disease-related diets (diabetic, lactose intolerance, allergies), and in non disease-related diets (weight reducing, sports and body-building, vegetarianism, other). CONCLUSIONS: Adherence to special diet is partly explained by an increased prevalence of certain diseases (lactose intolerance, allergies, diabetes). Increase in vegetarianisms and diets related to body weight or shape are most likely explained by fads, ideals created by media, and by growing ecological awareness.

Risk of postpartum induced abortion in Finland: a register-based study.

CONTEXT: Half of Finnish abortion patients already have children, and one in 10 pregnancies ending in abortions started within 12 months of a birth. Thus, many women may not practice contraception effectively during the postpartum period. METHODS: Data from national registers were used to create ajoint data file on pregnancies occurring in Finland over the period 1987-1998. The abortion risk (the risk of a conception that leads to an induced abortion) and abortion ratio (the number of conceptions leading to abortions divided by the number leading to deliveries) were analyzed in follow-up periods after all live births to women younger than 45 (684,922), using hazard regression and logistic regression. RESULTS: Pregnancies starting within eight months postpartum were more likely to end in abortion than were those starting later. Within the first eight months, the shorter the interval to the next pregnancy, the more likely the pregnancy was to end in abortion. Abortion risk was higher 6-18 months postpartum than at later periods and was highest at 6-8 months postpartum, particularly among unmarried women and teenagers. Between 1987-1988 and 1995-1996, the abortion risk within the first eight months postpartum rose significantly among women aged 25-29 and 30-34 (relative risks, 1.5 and 1.2, respectively). The abortion risk and abortion ratio were higher among teenagers than among women in other age-groups. CONCLUSIONS: The findings are consistent with the hypothesis that contraceptive practice is less effective postpartum, suggesting room for improvement in postpartum contraceptive counseling in Finland.

Early puberty is associated with mental health problems in middle adolescence.

This study set out to assess the relationship between pubertal timing and emotional and behavioural problems in middle adolescence. The study involved a school based survey of health, health behaviour and behaviour in school as well as questions about emotional and behavioural problems (the School Health Promotion Study). Secondary schools in four regions and 13 towns in Finland participated in the study in 1998. The respondents were 36,549 adolescents aged 14-16. The study included questions on depression, bulimia nervosa, psychosomatic symptoms, anxiety, drinking, substance use, smoking, bullying and truancy. Among girls, both internalising and externalising symptoms were more common the earlier puberty occurred. Among boys, externalising symptoms only were associated with early puberty. It is concluded that early pubertal timing is associated with increased mental health problems. Professionals working with adolescents should consider the mental health needs of early maturing adolescents.

Evolution of the association between parental and child smoking in Finland between 1977 and 2005.

OBJECTIVES: To study changes in the family smoking profile and in the association between parental and child smoking from 1977 to 2005. METHODS: Data was based on biennial surveys using nationally-representative samples of 14-18-year-old Finns (n=58,279). Response rate ranged between 88% (1977) and 65% (2005). Parental smoking categories were: two smoking parents, smoking father, smoking mother, both currently non-smokers but one or both ex-smokers, and two never-smoking parents. Child smoking categories were: experimental, daily, and never. Associations between parental and child smoking were examined using multinomial logistic regression models. RESULTS: Over the study period, the proportion of never-smoking families (child and parents never-smokers) increased (9% vs. 18%). Age, sex, family structure, and survey decade adjusted odds ratios for child's daily smoking were 6.9 (95% CI: 6.4, 7.5) when both parents smoked, 4.7 (95% CI: 4.3, 5.2) when mother smoked, 3.8 (95% CI: 3.5, 4.1) when father smoked, and 2.8 (95% CI: 2.6, 2.9) when one/both were ex-smokers compared with children of never-smoking parents. Only a few non-systematic interactions between parental smoking and survey decade were found. CONCLUSIONS: The proportion of totally smoke-free families increased substantially. Association between parental and child smoking persisted strong and mainly similar over time.

The association of parental monitoring and family structure with diverse maladjustment outcomes in middle adolescent boys and girls.

The aim of this study was to study the associations between family structure, parental monitoring and maladjustment outcomes among middle adolescent girls and boys. Data was collected through a school-based survey of a nationally representative sample of 17,643 Finnish adolescents aged 14-16 years. The less the parents knew the adolescents' friends and whereabouts, the more common were all the maladjustment outcomes studied. Non-intact family structure was associated with maladjustment and had associations independent of parental monitoring. We conclude that parental involvement with adolescents is conducive to healthy development, and that adolescents need the protection provided by parental supervision. Knowing the adolescent's whereabouts and friends is a concrete and easily measurable way of assessing parents' involvement in the adolescent's life.

Delinquency and the profile of offences among depressed and non-depressed adolescents.

BACKGROUND: Depression has previously been found to be closely connected to adolescent delinquency, but little is known about how depression is related to different types of delinquency. AIM: To investigate patterns of criminal behaviour according to depression among repeatedly delinquent adolescents. METHOD: The sample was 14- to 16-year-old repeatedly delinquent adolescents (n 3679) taking part in the Finnish School Health Promotion Study, surveyed for versatility and specialization of delinquency in relation to depression. RESULTS: Patterns of criminal behaviour differed between depressed and non-depressed delinquent adolescents. The delinquent behaviour of depressed adolescents was more versatile than that of non-depressed adolescents who mainly specialized in one offence type. Non-depressed delinquent boys had most often specialized in violence. Most depressed delinquent boys had committed a variety of offences, but among those who did specialize the specialist category was violent offences. Non-depressed delinquent girls had specialized in shoplifting. Among depressed delinquent girls vandalism was the most typical offence. CONCLUSION: Differences in the delinquent behaviour of depressed and non-depressed delinquent adolescents suggest the value of including clinical assessment, and treatment for some, in an appropriately comprehensive pattern of management.

The role of school context in the increase in young people's health complaints in Finland.

According to biological indicators trends in young people's health appear favourable, but the psychosocial aspects suggest a different pattern. We studied the differences across schools in common health complaints and in three groups of factors behind them: pupils' individual characteristics, family related factors and school-related factors. Multilevel linear regression models were used to analyse repeated cross-sectional data from Finnish 8th and 9th graders (14- and 15-year-olds, n=60347) in 109 schools that were surveyed in 1996, 1998 and 2000. Common health complaints increased steadily during the follow-up for all schools and they varied across schools. Both individual and school-level factors contributed significantly to the variation in common health complaints. The study suggests that young people's psychosocial health involves a range of influences deriving from individual susceptibility and from the social and educational functioning of schools. However, none of these factors can account for the rapid decrease in young people's psychosocial health.

Brief report: delinquent behaviour and depression in middle adolescence: a Finnish community sample.

A large number (N 50,569) of 14-16 year old Finnish adolescents taking part in the School Health Promotion Study were surveyed for delinquent behaviour in relation to depression. The results indicate a robust association between delinquency and depression. Among girls risk for depression varied between 1.3 and 3.1 according to various antisocial behaviours (the equivalent risk among boys was 1.3-2.5). Depression increased according to the frequency of delinquent behaviour. The results emphasize the importance of comprehensive clinical assessment and treatment of delinquent adolescents.

Well-being in schools: a conceptual model.

Health and well-being have mostly been separated from other aspects of school life. Health services and health education have been available for school-aged children in Western societies for a long time. Recently, more comprehensive school health programmes have been developed, e.g. the WHO 'health promoting school' and 'coordinated school health programme' in the USA. They focus on how to implement health promotion and health education in school. However, a theoretically grounded model based on the sociological concept of well-being is needed for planning and evaluation of school development programmes. The School Well-being Model is based on Allardt's sociological theory of welfare and assesses well-being as an entity in school setting. Well-being is connected with teaching and education, and with learning and achievements. Indicators of well-being are divided into four categories: school conditions (having), social relationships (loving), means for self-fulfilment (being) and health status. 'Means for self-fulfilment' encompasses possibilities for each pupil to study according to his/her own resources and capabilities. 'Health status' is seen through pupils' symptoms, diseases and illnesses. Each well-being category contains several aspects of pupils' life in school. The model takes into account the important impact of pupils' homes and the surrounding community. Compared with others, The School Well-being Model's main differences are the use of the well-being concept, the definition of health and the subcategory means for self-fulfilment. Making the outline of the well-being concept facilitates the development of theoretically grounded subjective and objective well-being indicators.

Pubertal timing, sexual behaviour and self-reported depression in middle adolescence.

The associations between pubertal timing, sexual activity and self-reported depression were analysed in a population sample of 17,082 girls and 15,922 boys aged 14-16 as a par of a classroom survey. Pubertal timing was assessed by age at onset of menstruation (menarche) or ejaculations (oigarche). Sexual experiences elicited included kissing, light petting, heavy petting and intercourse. Self-reported depression was measured by the 13-item Beck Depression Inventory. Among girls, self-reported depression was associated with early puberty and intimate sexual relationship. Among boys depression was associated with very early and late puberty and experience of intercourse. Early puberty is a risk factor for self-reported depression. Intimate sexual relationships in middle adolescent are likely to indicate problems in adolescent development rather than successful adolescent passage.

Bulimia and impulsive behaviour in middle adolescence.

BACKGROUND: In clinical samples, bulimia seems to be associated with various dyscontrol behaviours suggesting weakness in impulse control. Population studies of adolescents, however, are needed. We evaluated the association between self-reported bulimic behaviour and a number of dyscontrol behaviours, namely bullying, truancy, excessive drinking and sexual disinhibition among adolescents aged 14-16. This is the first study on bulimia and impulsivity in a large non-selected adolescent population sample. METHODS: A self-report questionnaire was administered to a representative population sample of 14- to 16-year-old adolescents (pupils of the 8th and the 9th grades of secondary school in four different regions in Finland). 4,453 girls and 4,334 boys aged 14-16 participated. The participation rate was 85.5%. RESULTS: Bulimic behaviour was associated with bullying, truancy, excessive drinking and sexual disinhibition among both sexes. Odds ratios for bulimic-type eating pathology according to each of these behaviours varied between 1.7 and 4.1. The more dyscontrol behaviours occurred simultaneously, the more likely was bulimic-type eating pathology. CONCLUSIONS: There is an association between bulimic behaviour and dyscontrol behaviours in the general population of adolescent girls and boys.

Associates of obesity and weight dissatisfaction among Finnish adolescents.

OBJECTIVE: We investigated behavioural and socio-economic factors associated with obesity and weight dissatisfaction among Finnish adolescents. DESIGN: A total of 60,252 Finnish adolescents aged 14 to 16 years filled in a questionnaire about their health, health behaviour and socio-economic background. Food choices were obtained by using a short food-frequency questionnaire. Obesity was defined as a weight at least 120% of the sex- and height-specific mean weight for subjects. RESULTS: Of girls and boys, 54% and 66%, respectively, were satisfied with their weight. Among dissatisfied normal-weight adolescents, 81% of girls but only 48% of boys thought they were overweight. Of obese boys, 25% were satisfied with their weight. For both genders, obesity and weight dissatisfaction were associated with economic problems in the family. In girls, an association was also found with poor school performance, low educational level of parents and not having evening meals at home; and in boys, with physical inactivity and not eating school lunch. Smoking was more common among girls who were dissatisfied with their weight. Differences in food choices were small between different weight and weight satisfaction categories. CONCLUSIONS: Having normal weight and being satisfied with that weight are favourable for an adolescent. Obesity and weight dissatisfaction are associated mostly with disadvantageous health behaviours and low socio-economic status. Health behaviour seems to be associated more with weight satisfaction than with actual weight.

Has the adolescents' weight concern increased over 20 years?

BACKGROUND: The aim of this study is to evaluate whether the proportion of 12 to 18-year-old adolescents perceiving themselves to be overweight has increased from the late 1970s to the late 1990s, and to evaluate how self-reported weight is associated with weight concern in the different age groups among girls and boys, and how this association has changed over time. MATERIAL: A nationally representative sample of 26,700 girls and 23,346 boys, aged 12-18 years, who responded to the postal survey study Adolescent Health and Lifestyle Survey in 1979-1999. METHODS: Self-reported information about weight, height and satisfaction with one's own weight. RESULTS: Girls reported more concerns of being overweight than boys. The proportion of those perceiving themselves as being overweight decreased over time both among overweight and among normal weight adolescents. CONCLUSION: Even if the adolescent population has gained weight, they are less concerned at being overweight than earlier. It seems that adolescents compare themselves rather to the peers close to them than to ideal models provided by culture at large.

Back, neck, and shoulder pain in Finnish adolescents: national cross sectional surveys.

OBJECTIVES: To study changes in pain of the back and neck in adolescents between 1985 and 2001 and pain of the neck, shoulder, and lower back between 1991 and 2001. DESIGN: Biennial nationwide postal surveys, 1985-2001, and annual classroom surveys, 1996-2001. SETTING: Finland. PARTICIPANTS: 62 677 12, 14, 16, and 18 year olds and 127 217 14-16 year olds. MAIN OUTCOME MEASURES: Pain in the back and neck, neck and shoulder, or lower back, at least weekly. RESULTS: Prevalence of pain in the back and neck was greater in the 1990s than in the 1980s and increased steadily from 1993 to 1997. Pain of the neck and shoulder and pain of the lower back was much more common in 1999 than in 1991 and in 2001 than in 1999. Pain was more common among girls and older groups: pain of the neck and shoulder affected 24% of girls and 12% of boys in 14 year olds, 38% of girls and 16% of boys in 16 year olds, and 45% of girls and 19% of boys in 18 year olds; pain in the lower back affected 8% of girls and 7% of boys in 14 year olds, 14% of girls and 11% of boys in 16 year olds, and 17% of boys and 13% of girls in 18 year olds. CONCLUSION: Pain in the neck, shoulder, and lower back is becoming more common in Finnish adolescents. This pain suggests a new disease burden of degenerative musculoskeletal disorders in future adults.

Are adolescents with frequent pain symptoms more depressed?

OBJECTIVE: To study predicting value of pain symptoms in detecting depression among adolescents. DESIGN: A population-based classroom survey of 14-16-year-old adolescents. SETTING: Secondary schools in two regions of Finland (Vaasa and Pirkanmaa). SUBJECTS: Every secondary school in these two regions was asked to participate in the study. The final sample comprised 17,643 adolescents in 8th and 9th grades (mean age 15.3 years). MAIN OUTCOME MEASURES: The subjects were asked to rate the frequency of headache, stomach-ache, low back pain and neck or shoulder pain. Depression was measured using the Finnish modification of the short Beck Depression Inventory (R-BDI). Trait anxiety was questioned in an item formulated analogously to R-BDI questions. RESULTS: Prevalence of depression was higher among adolescents with recurrent pain symptoms. Each of the four measured pain symptoms predicted depression independently and accumulation of different pain symptoms increased the odd ratios for depression. Anxiety did not change the association between pain symptoms and depression. CONCLUSION: Recurrent pain symptoms are associated with depression among adolescents. Clinicians working with adolescents should be aware of this association and interview adolescents with recurrent pains for possible underlying depression.

Teenage pregnancies and abortions in Finland in the 1990s.

AIMS: This study analyses trends and regional variation in teenage pregnancy, abortion, and fertility rates in Finland in the 1990s, by single-year age group. METHODS: Individual-level data from Finnish abortion and birth registers maintained by the National Research and Development Centre for Welfare and Health (STAKES) were used to calculate the rates and the abortion ratio. The abortion ratio was also calculated using conception as the time reference. RESULTS: Teenage pregnancy rates and abortion rates reverted from decrease to increase in the mid-1990s. This was accompanied by an increase in the share of teenage pregnancies that ended in an abortion. The increase in abortions started first among older teenagers, and spread gradually to younger girls. Regional variation in the rates remained the same throughout the study period. CONCLUSIONS: The observed trends reflect a change towards less effective use of contraceptive methods among teenagers. There is also evidence of the earlier start of teenage sexual activity at the end of the 1990s. The possible explanations for less effective contraceptive use include cutbacks in healthcare and family planning services in the first half of the 1990s and the reduction of sex education in schools.