Design and subjects of a Finnish epidemiological study on psychiatric disorders in childhood

Bullying at 8 years and violent offenses by 31 years: the Finnish nationwide 1981 birth cohort study

This study explored the associations between bullying perpetration and victimization at 8 years of age and violent offenses by the age of 31. Data were obtained for subjects enrolled in a population-based longitudinal birth cohort study. In 1989, 5813 8-year-old children (attrition 3.4%), and their parents and teachers, were surveyed about bullying. When 5405 subjects (attrition 10.2%) were 15-31 years of age, violent offenses were extracted from the Finnish National Police Register. We analyzed the data by sex and categorized bullying perpetration and victimization by frequency. Violent offenses were categorized by severity. Cox regression analyses estimated the hazard ratios (HRs) and 95% confidence intervals (95% CIs). When they were compared to males who had not been bullies at 8 years of age, frequent male bullies had an increased hazard for violent offenses (adjusted HR 3.01, 95% CI 2.11-4.33) and severe violent offenses (adjusted HR 2.86, 95% CI 1.07-7.59) as adults, even when the data were controlled for them being victims, parental education level, family structure and child psychopathology. Frequent female bullies also had an increased hazard for violent offenses, compared to those who had not bullied others (adjusted HR 5.27, 95% CI 1.51-18.40). Frequent male bullying was associated with higher odds for violent offenses compared to only bullying sometimes. Being a victim was not associated with violent offenses. Preventing childhood bullying could reduce violent offenses by both sexes.

The long-term cost of childhood conduct problems: Finnish Nationwide 1981 Birth Cohort Study

BACKGROUND

Commonly recognized childhood conduct problems often lead to costly problems in adulthood. This study aimed to evaluate the long-term cumulative cost of childhood conduct problems until the age of 30. The costs included inpatient care, nervous system medicine purchases, and criminal offences.

METHODS

The study used population-based nationwide 1981 birth cohort data. Families and teachers assessed the conduct problems of the eight-year-olds based on Rutter questionnaires. We grouped 5,011 children into low-level of conduct problems (52%), intermediate-level of conduct problems (37%), and high-level of conduct problems (11%) groups, based on combined conduct symptoms scores. The analysis included the cohort data with the Care Register for Health Care, the Drug Prescription Register, and the Finnish Police Register. The cost valuation of service use applied national unit costs in 2016 prices. We used Wilcoxon rank-sum test to test the differences between groups and gender.

RESULTS

During 1989-2011, average cumulative costs of the high-level (€44,348, p < .001) and the intermediate-level (€19,405, p < .001) of conduct problems groups were higher than the low-level of conduct problems group's (€10,547) costs. In all three groups, the boys' costs were higher than girls' costs.

CONCLUSIONS

The costs associated with conduct problems in childhood are substantial, showing a clear need for cost-effective interventions. Implementation decisions of interventions benefit from long-term cost-effectiveness modelling studies. Costing studies, like this, provide cost and cost offset information for modelling studies.

Secular trends in childhood pain and comorbid psychiatric symptoms: a population-based study

PURPOSE

Pain symptoms are common in childhood. They often lead to functional impairment and co-occur with psychiatric difficulties. Although children's lives have undergone enormous changes in recent decades, long-term data on changes in pain symptoms, and in comorbid psychiatric difficulties, is lacking. This knowledge is crucial, as co-occurring psychiatric symptoms are significant predictors of long-term outcome for children who suffer from pain. The main purpose of the present study was to explore secular changes in comorbid pain and psychiatric symptoms.

METHODS

Four population-based, cross-sectional surveys of 8-9-year-old children were conducted in Southwest Finland in 1989, 1999, 2005, and 2013. Identical methodologies and questionnaire-based measures were used each study year. Participation ranged from 891 to 986 over the study period. The children were asked about the frequency of headache, abdominal pain, and other pains. Children, their parents, and teachers provided information on the child's psychiatric difficulties, including internalizing and externalizing symptoms.

RESULTS

The cumulative odds ratios and 95% confidence intervals for the overall prevalence of pain symptoms increased among both genders from 1989 to 2013 and ranged from 1.4 (1.03-1.8) for other pains to 2.4 (1.7-3.3) for abdominal pain. Comorbid internalizing symptoms increased among girls with odd ratios and 95% CIs of 1.8 (1.03-3.1) for children with any kind of pain, and 3.0 (1.4-6.2) for children with headache. No changes were found among boys.

CONCLUSION

Overall pain symptoms doubled in both genders, but the most novel finding was that comorbid emotional difficulties tripled among girls who reported headaches. Further research is needed to confirm, and explain, these findings.

Relative age is associated with bullying victimisation and perpetration among children aged eight to nine

AIM

To assess whether relative age was associated with bullying involvement and whether the associations were independent of child psychiatric symptoms.

METHODS

Bullying was assessed among 8576 children in the second grade, aged 8 years, by using four cross-sectional population-based studies with identical methodology completed by children, parents and teachers in 1989 (response rate 97%), 1999 (93%), 2005 (90%) and 2013 (86%). The main outcomes were bullying victimisation and perpetration. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated with the relatively oldest as the reference group and adjusted for child psychiatric symptoms.

RESULTS

The relatively youngest children, born September to December, were compared with the relatively oldest, born January to April. The youngest children had increased odds of being victims according to child (OR 1.2, 95% CI 1.1-1.4) and parent reports (OR 1.2 95% CI 1.008-1.4). The youngest also had decreased odds of being perpetrators according to child (OR 0.8, 95% CI 0.7-0.96) and teacher reports (OR 0.8, 95% CI 0.7-0.95). These findings were independent of psychiatric symptoms.

CONCLUSION

The relative age effects which were found in bullying involvement were independent of psychiatric symptoms. Considering this newly recognised risk factor for victimisation is important within anti-bullying practices.

The Finnish psychiatric birth cohort consortium (PSYCOHORTS) - content, plans and perspectives

Background: Psychiatric disorders tend to be developmental, and longitudinal settings are required to examine predictors of psychiatric phenomena. Replicating and combining data and results from different birth cohorts, which are a source of reliable data, can make research even more valuable. The Finnish Psychiatric Birth Cohort Consortium (PSYCOHORTS) project combines birth cohorts in Finland. Aim: The aim of this paper is to introduce content, plans and perspectives of the PSYCOHORTS project that brings together researchers from Finland. In addition, we illustrate an example of data harmonization using available data on causes of death. Content: PSYCOHORTS includes eight Finnish birth cohorts. The project has several plans: to harmonize different data from birth cohorts, to incorporate biobanks into psychiatric birth cohort research, to apply multigenerational perspectives, to integrate longitudinal patterns of marginalization and inequality in mental health, and to utilize data in health economics research. Data on causes of death, originally obtained from Finnish Cause of Death register, were harmonized across the six birth cohorts using SAS macro facility. Results: Harmonization of the cause of death data resulted in a total of 21,993 observations from 1965 to 2015. For example, the percentage of deaths due to suicide and the sequelae of intentional self-harm was 14% and alcohol-related diseases, including accidental poisoning by alcohol, was 13%. Conclusions: PSYCOHORTS lays the foundation for complex examinations of psychiatric disorders that is based on compatible datasets, use of biobanks and multigenerational approach to risk factors, and extensive data on marginalization and inequality.

Annual Research Review: The persistent and pervasive impact of being bullied in childhood and adolescence: implications for policy and practice

BACKGROUND

We have known for some time that being bullied was associated with children's and adolescents' adjustment difficulties and well-being. In recent years, we have come to recognise that the impact of childhood bullying victimisation on the development of mental health problems is more complex. This paper aims to review the evidence for an independent contribution of childhood bullying victimisation to the development of poor outcomes throughout the life span, including mental, physical and socioeconomic outcomes, and discuss the implications for policy and practice.

FINDINGS

Existing research indicates that (a) being bullied in childhood is associated with distress and symptoms of mental health problems. This large body of evidence supports actions aimed at reducing the occurrence of bullying behaviours; (b) the consequences of childhood bullying victimisation can persist up to midlife and, in addition to mental health, can impact physical and socioeconomic outcomes. These new findings indicate that interventions should also focus on supporting victims of bullying and helping them build resilience; (c) research has identified some factors that predispose children to be targeted by bullying behaviours. These studies suggest that public health interventions could aim at preventing children from becoming the target of bullying behaviours from an early age.

CONCLUSIONS

It is a truism to emphasise that further work is needed to understand why and how young people's aspirations are often cut short by this all too common adverse social experience. In parallel, we must develop effective strategies to tackle this form of abuse and its consequences for the victims. Addressing bullying in childhood could not only reduce children's and adolescents' mental health symptoms but also prevent psychiatric and socioeconomic difficulties up to adulthood and reduce considerable costs for society.

Crime and mortality in a population-based nationwide 1981 birth cohort: Results from the FinnCrime study

BACKGROUND

Offending is known to be associated with various health problems and premature death, but previous studies on associations between offending and mortality have often been only with men, convicted offenders or highly selected samples. A more sensitive measure of offending may be preferable when trying to understand the extent of health disadvantages among people who offend.

AIMS

The aim of this paper was to study the associations between investigated offending, death and causes of death in a nationally representative birth cohort.

METHODS

A broad concept of offending was used such that people who had had any contact with the police because they had been suspected of crime were included. Offending data were obtained from the National Police Register for 5405 men and women born in Finland in 1981, spanning their ages 15-30 years; mortality data were received from Statistics Finland. Offending was classified into four categories by frequency: none, 1-4 different offence contacts, 5-27 and 28 or more. Causes of death were categorised into natural, accidents, suicide or homicide. Of the cohort, 2304 (43%) had offended and 57 (1.1%) had died. Associations between offending, mortality and causes of death were analysed, controlling for parental education level and family structure in childhood.

RESULTS

The mortality rate was higher among offenders than non-offenders, increasing with rising frequency of offending. The most frequent offenders were nearly 30 times more likely to have died by age 30 than non-offenders (odds ratio 28.6, confidence interval 12.1-67.5); risk was higher for female than male offenders. Death among offenders was less likely to be from natural causes.

IMPLICATIONS

A heightened risk of premature death is the ultimate form of adverse outcome for offenders. Offenders' health is likely to need more attention as part of their overall management, for recidivists in particular. In our study, offenders' only certain criminal justice contact was with the police, so it may be that the police should take a greater role in signposting them towards health services. Offender treatment is needed not only to protect potential victims but also offenders themselves. Copyright © 2015 John Wiley & Sons, Ltd.

Bullying by peers in childhood and effects on psychopathology, suicidality, and criminality in adulthood

Bullying is shown to be associated with adverse outcomes in cross-sectional studies, but only a few studies have prospectively examined the effects of childhood bullying on adult outcomes. Our Series paper focuses on prospective longitudinal studies that used large, population-based, community samples analysed through quantitative methods and published between 1960 and 2015. We describe the results of childhood bullying in adulthood in three of the most burdensome areas: psychopathology, suicidality, and criminality. We note that the different groups involved (ie, victims, bullies, and bully-victims) are at risk of difficulties later in life, but their risk profiles differ and the contributions are probably not independent. Controlling for confounders reduces the risk and sometimes eliminates it. Victims are at a high risk of internalising disorders. Bullies seem to be at risk of later externalising disorders and criminality, mainly violent crime and illicit drug misuse. Bully-victims seem to be at risk of internalising disorders, externalising disorders, and criminality, but not all studies examined bully-victims as a separate group. Boys and girls differ in their long-term outcomes. A dose effect exists in which frequent bullying involvement in childhood is most strongly associated with adult adversities. Future studies need to control for additional factors (including genetic, psychosocial, and environmental) to account for the mechanisms behind the reported longitudinal associations.

Do headache and abdominal pain in childhood predict suicides and severe suicide attempts? Finnish nationwide 1981 birth cohort study

This study investigated associations between pain symptoms in mid-childhood and severe suicidality in adolescence and early adulthood. Severe suicidality was defined as completed suicide or suicidal attempt requiring hospital admission. In a nationwide prospective population-based study (n = 6,017), parents and children were asked about the child's headache and abdominal pain at age eight. The outcome was register-based data on suicide or suicidal attempt requiring hospital treatment by age 24. Family composition, parental educational level, and the child's psychiatric symptoms reported by the child, parents and teacher at baseline were included as covariates in statistical analyses. Boys' abdominal pain reported by the parents was associated with later severe suicidality after adjusting for family composition, parental educational level, and childhood psychiatric symptoms at baseline. In addition, the association between boys' own report of headache and later severe suicidality reached borderline significance in unadjusted analysis. Girls' pain symptoms did not predict later severe suicidality.

Self-reported experiences as predictors for onset of psychotropic medication. A prospective study of healthy draftees

BACKGROUND

Psychosis and other psychiatric disorders are often preceded by prodromal symptoms. There are few community-based studies on symptom predictors of severe mental problems in healthy people.

AIMS

We aimed to study how a new self-reported screen for prodromal symptoms (PROD) predicts onset of all psychotropic and antipsychotic medication in healthy draftees.

METHODS

In a prospective follow-up study, 2330 18-year-old Finnish draftees who at call-up in 1999 completed the PROD comprising 21 symptom items divided into positive, negative and general symptom categories were prospectively followed for 6 years. First purchases of any psychotropic and antipsychotic drugs separately between 2000 and 2005 were used as an indicator of the onset of psychiatric disorder and predicted by PROD symptoms in Cox regression analysis.

RESULTS

A majority of the PROD items significantly predicted the first purchases of any psychotropic and of antipsychotic drugs, separately. Positive, negative and general symptoms predicted purchases of any psychotropic medication, while negative and general symptoms predicted purchases of antipsychotic drugs. General symptoms, in particular anxiety, had a strong independent association with onset of psychotropic medication.

CONCLUSIONS

In young healthy men, self-reported sub-clinical psychic symptoms predict onset of psychiatric disorders requiring psychotropic, including antipsychotic, medication.

Association between childhood psychosocial factors and induced abortion

OBJECTIVE

To examine the predictive associations between psychosocial risk factors in childhood and having an abortion in adolescence or young adulthood.

STUDY DESIGN

This study is based on a nationwide cohort consisting of 2867 girls born in Finland in 1981. The baseline assessment was conducted at age eight by three informants, and it included information on psychiatric symptoms, school performance and family related risk factors. Register-based follow-up data on abortions were collected until the end of the year when the participants turned 28 years. They were available for 2694 participants. Cox proportional hazards model and logistic regression model were used for statistical analysis.

RESULTS

Altogether 357 women (13.3%) had had an abortion for other than medical reasons during the follow-up. Of the childhood factors, a high level of conduct problems, poor school performance, family structure other than two biological parents, and mother with a low level of education were independently associated with having an abortion. Comparison of the strength of associations between childhood risk factors and first abortion under the age of 20 versus first abortion at a later age, showed no significant differences. Neither did the comparison between one and more abortions.

CONCLUSIONS

At age eight there are already psychosocial factors which predict later abortion. This finding needs to be considered when targeting preventive interventions and developing sexual health services.

Psychotropic drug and polypharmacy use among adolescents and young adults: findings from the Finnish 1981 Nationwide Birth Cohort Study

BACKGROUND

Little is known about the timing of the start of psychotropic drug use and psychotropic polypharmacy use.

AIMS

This study describes these patterns in a Finnish representative cohort aged between 12 and 25.

METHODS

5525 subjects born in 1981 were followed up between 1994 and 2005 using the Finnish National Prescription Register.

RESULTS

Survival analysis revealed that the cumulative incidence of any psychotropic drug use was 1.3% by age 15, 6.1% by age 20 and 15.2% by age 25. Antidepressants and benzodiazepines were the most used drug groups, with cumulative incidences of 12.2% and 5.2%, respectively, by age 25. The cumulative incidence of polypharmacy was 0.02% by age 15, 0.9% by age 20 and 4.1% by age 25, i.e. having purchased at least two psychotropic drugs from different classes during the same day. Polypharmacy occurred among the majority of antipsychotic and benzodiazepine users, but among a minority of antidepressant users. More females than males had used any psychotropic drug, antidepressants, the antidepressant-benzodiazepine combination and the antidepressant-mood stabilizer combination.

CONCLUSIONS

Both general psychotropic drug use and psychotropic polypharmacy use was often started in late adolescence.

What is the long-term outcome of boys who steal at age eight? Findings from the Finnish nationwide "From A Boy To A Man" birth cohort study

OBJECTIVE

The aim was to study predictive associations between childhood stealing behavior at the of age 8 years with later psychiatric disorders, criminality or suicide attempts and completed suicides up to the age 25 years in a large representative population-based birth cohort.

METHOD

The sample includes 2,592 Finnish males born in 1981 with information about stealing from both parents and teachers. Information about psychiatric disorders, criminality, suicide attempts requiring hospital admission and completed suicides was gathered from four different Finnish nationwide registries until the study participants were 25 years old.

RESULTS

One out of ten boys had stealing behavior during the previous 12 months. After adjusting for parental education level and conduct problems or hyperactivity (i.e. potential confounds), stealing at eight independently predicted substance use and antisocial personality disorders, and high level of crimes. Stealing was also associated with completed suicide or severe suicide attempt requiring hospital admission. Comorbid stealing and frequent aggression had the strongest predictive association with any psychiatric diagnosis, crime and completed suicide or severe suicide attempt, while stealing without aggression was not associated with any of the negative outcomes.

CONCLUSIONS

Stealing accompanied with aggressivity at age eight is predictive of wide range of adversities. However, no increased risk was observed among the group with stealing behaviors but without aggression.

Childhood bullying and becoming a young father in a national cohort of Finnish boys

Childhood bullying is known to be associated with various adverse psychosocial outcomes in later life. No studies exist on its association with becoming a young father. The study is based on a national cohort, which included 2,946 Finnish boys at baseline in 1989. Information on bullying was collected from children, their parents and their teachers. Follow-up data on becoming a father under the age of 22 were collected from a nationwide register. The follow-up sample included 2,721 boys. Bullying other children frequently was significantly associated with becoming a young father independently of being victimized, childhood psychiatric symptoms and parental educational level. Being a victim of bullying was not associated with becoming a young father when adjusted for possible confounders. When the co-occurrence of bullying and victimization was studied, it was found that being a bully-victim, but not a pure bully or a pure victim, is significantly associated with becoming a young father. This study adds to other studies, which have shown that the risk profile and relational patterns of bully-victims differ from those of other children, and it emphasizes the importance of including peer relationships when studying young fathers.

Psychosocial factors associated with becoming a young father in Finland: a nationwide longitudinal study

Background

Little is known about the characteristics of boys who become fathers at young age. Some studies have suggested that antisocial adolescents are more likely to be young fathers. The aim of this study was to examine the associations of psychosocial factors in childhood with becoming a young father, and to assess if they are independent of criminal behavior in adolescence.

Methods

The baseline assessment in 1989 included 2,946 boys born in 1981. Information about psychiatric symptoms at age eight was collected with Rutter questionnaires from parents and teachers and with the Child Depression Inventory from the children themselves. Data on criminal offenses at age 16–20 was collected from a police register. Register-based follow-up data on becoming a father under the age of 22 was available for 2,721 boys.

Results

The factors measured at age eight, which were associated with becoming a young father independently of adolescent criminality, were conduct problems, being born to a young father and having a mother with a low educational level. Having repeatedly committed criminal offences in adolescence was associated with becoming a young father independently of psychosocial factors in childhood.

Conclusions

Antisocial tendencies both in childhood and adolescence are associated with becoming a young father. They should be taken into consideration when designing preventive or supportive interventions.

Pain at age eight as a predictor of antidepressant medication use by age 24: findings from the Finnish nationwide 1981 birth cohort study

BACKGROUND

The existing knowledge about long-term psychosocial consequences of childhood pain is scarce. The current study investigated childhood pain symptoms as potential risk factors for antidepressant use in adolescence and early adulthood.

METHODS

A representative sample of eight-year-old children (n=6017) and their parents were asked about the prevalence of the child's headache, abdominal pain, and unspecified pain symptoms. The associations with antidepressant purchases by age 24, based on the nationwide prescription register, were analyzed separately for each symptom and each reporter. Sex, parental educational level, and child-, parent- and teacher-reported child's psychiatric symptoms at baseline were included as confounding variables.

RESULTS

In the sex-adjusted model, the child's own report of headache and other pains, and the parents' report of their child's abdominal pain, predicted antidepressant purchases. When confounding variables were included in the final model, only the child's own report of headache predicted antidepressant use with a dose-response relationship. The hazard ratios and 95% confidence intervals for frequent and for almost daily headache were 1.6 (1.3-2.0) and 2.1 (1.5-2.9), respectively, in the sex-adjusted model, and 1.5 (1.2-1.8) and 1.7 (1.2-2.5) in the final model.

LIMITATIONS

The assessment of each pain symptom was based on one question for each reporter. The specific indications for the described medication could not be defined.

CONCLUSIONS

Health care professionals should also ask children themselves about the pain symptoms. They should be aware that children with pain are at increased risk of suffering later from conditions that require antidepressant treatment.

Bullying at age eight and criminality in adulthood: findings from the Finnish Nationwide 1981 Birth Cohort Study

CONTEXT

There are no prospective population-based studies examining predictive associations between childhood bullying behavior and adult criminality.

OBJECTIVE

To study predictive associations between bullying and victimization at age eight and adult criminal offenses.

DESIGN

Nationwide birth cohort study from age 8 to 26 years.

PARTICIPANTS

The sample consists of 5,351 Finnish children born in 1981 with information about bullying and victimization at age eight from parents, teachers, and the children themselves.

MAIN OUTCOME MEASURES

National police register information about criminal offenses at age 23-26 years.

RESULTS

When controlled for the parental education level and psychopathology score, bullying sometimes and frequently independently predicted violent (OR 3.9, 95% CI 1.9-7.9, p < 0.001; OR 2.5, 95% CI 1.6-4.1, p < 0.001, respectively), property (OR 2.3, 95% CI 1.2-4.7, p < 0.05; OR 1.7, 95% CI 1.1-2.7, p < 0.05), and traffic (OR 2.8, 95% CI 1.8-4.4, p < 0.001; OR 1.6, 95% CI 1.3-2.1, p < 0.001) offenses. The strongest predictive association was between bullying frequently and more than five crimes during the 4-year period (OR 6.6, 95% CI 2.8-15.3, p < 0.001) in adjusted analyses. When different informants were compared, teacher reports of bullying were the strongest predictor of adult criminality. In adjusted analyses, male victimization did not independently predict adult crime. Among girls, bullying or victimization at age eight were not associated with adult criminality.

CONCLUSIONS

Bullying among boys signals an elevated risk of adult criminality.

Generic and crime type specific correlates of youth crime: a Finnish population-based study

OBJECTIVE

The aim of this study was to examine the psychosocial correlates of various crime types among adolescent males born in Finland in 1981.

METHODS

Data on crime registered in the Finnish National Police Register between 1998 and 2001 were received for 2,866 boys, of whom 81% (n = 2,330) filled in a questionnaire at obligatory military call-up at age 18 in 1999. Crime was divided into five types: drug, violent, property, traffic, and drunk driving offences.

RESULTS

Of the 2,866 boys, 23% had been registered for offending; 4% for drug, 7% for violent, 11% for property, 11% for traffic, and 5% for drunk driving offences during the 4-year period in late adolescence. All the crime types correlated with each other and shared many of the psychosocial problems. Small community size, parents' divorce, aggressiveness, daily smoking, and weekly drunkenness were generic correlates of crime, being independently related to various crime types.

CONCLUSIONS

The results support general rather than specific accounts of youth crime. In particular, measures moderating the adverse effects of divorce, alleviating parental adversities and supporting parenthood, and tackling substance abuse seem relevant in social and criminal policy because they address psychosocial problems characterizing youth crime in general.

Childhood predictors of use and costs of antidepressant medication by age 24 years: findings from the Finnish Nationwide 1981 Birth Cohort Study

OBJECTIVE

Prior studies on antidepressant use in late adolescence and young adulthood have been cross-sectional, and prospective associations with childhood psychiatric problems have not been examined. The objective was to study the association between childhood problems and lifetime prevalence and costs of antidepressant medication by age 24 years.

METHOD

A total of 5,547 subjects from a nation-wide birth cohort were linked to the National Prescription Register. Information about parent- and teacher-reported conduct, hyperkinetic and emotional symptoms, and self-reported depressive symptoms was gathered at age 8 years. The main outcome measure was national register-based lifetime information about purchases of antidepressants between ages 8 and 24 years. In addition, antidepressant costs were analyzed using a Heckman maximum likelihood model.

RESULTS

In all, 8.8% of males and 13.8% of females had used antidepressants between age 13 and 24 years. Among males, conduct problems independently predicted later antidepressant use. In both genders, self-reported depressive symptoms and living in other than a family with two biological parent at age 8 years independently predicted later antidepressant use. Significant gender interactions were found for conduct and hyperkinetic problems, indicating that more males who had these problems at age 8 have used antidepressants compared with females with the same problems.

CONCLUSIONS

Childhood psychopathology predicts use of antidepressants, but the type of childhood psychopathology predicting antidepressant use is different among males and females.

Factors associated with reported childhood depressive symptoms at age 8 and later self-reported depressive symptoms among boys at age 18

AIMS

This study aimed to study conditions associated with depressive symptoms at ages 8 and 18 in a representative birth cohort of Finnish males.

METHODS

The participants in this community-based 10-year follow-up study consisted of 2,348 boys born in 1981. At age 8, three informant sources were used: parents, teachers, and the children themselves. Depressive symptoms were established using the Children's Depression Inventory (CDI). At age 18, self-report questionnaires were used to study the boys' family factors, life events, adaptive functioning, and substance use. Depressive symptoms at age 18 were established using Beck's Depression Inventory (BDI).

RESULTS

Poor adaptive functioning at age 18 was independently associated with both child and late adolescent depressive symptoms. Use of illicit drugs and somatic health problems were independently associated with later depressive symptoms. Parental divorce in early childhood independently predicted depressive symptoms both in childhood and in late adolescence. Teacher reports of child's total problems at age 8 independently predicted depressive symptoms at age 18.

CONCLUSIONS

Depression in males at ages 8 and 18 is particularly associated with stressful life events in childhood, whereas late depression is associated with somatic health problems and substance use. Further population-based studies comparing conditions associated with childhood and adolescent depression are needed.

Childhood bullying behaviors at age eight and substance use at age 18 among males. A nationwide prospective study

Childhood bullying behaviors (bullying and victimization) were studied as risk factors for substance use among Finnish males. The study design was a nationwide prospective general population study, where information was collected in 1989 and 1999. Bullying behaviors and childhood psychopathology at age eight were collected from teachers, parents and boys themselves. At age 18, self-reports of frequent drunkenness (once a week or more often), daily heavy smoking (10 cigarettes or more per day), and illicit drug use during the past six months were obtained from 78% of the boys attending the study at age eight (n=2946). Being frequently victimized at age eight predicted daily heavy smoking, and this was evident even after adjusting for childhood family background, psychopathology at age eight and at age 18, and other forms of substance use. In multivariate analysis, bullying others frequently predicted illicit drug use, while being a victim of bullying associated with a lower occurrence of illicit drug use. Bullying behaviors had no association with frequent drunkenness independent of other factors. Accordingly, being a victim of bullying predisposes in particular to subsequent smoking. Bullying others in childhood can be regarded as an early indicator to illicit drug use later in life. The screening and intervention possibilities in order to recognize the risk group for later health compromising behaviors are emphasized.

Childhood bullying as a predictor for becoming a teenage mother in Finland

The aim of this study is to examine the association between bullying behaviour at the age of 8 and becoming a mother under the age of 20. This birth cohort study included 2,867 Finnish girls at baseline in 1989. Register-based follow-up data on births was collected until the end of 2001. Information, both on the main exposure and outcome, was available for 2,507 girls. Both bullies and victims had an increased risk of becoming a teenage mother independent of family-related risk factors. When controlled for childhood psychopathology, however, the association remained significant for bullies (OR 2.2, 95% CI 1.2-4.1) and bully-victims (OR 1.8, 95% CI 1.05-3.2), but not for pure victims. Reports of bullying and victimisation from the girls themselves, their parents and their teachers were all associated with becoming a teenage mother independent of each other. There is a predictive association between being a bully in childhood and becoming a mother in adolescence. It may be useful to target bullies for teenage pregnancy prevention.

Childhood predictors of later psychiatric hospital treatment: findings from the Finnish 1981 birth cohort study

Psychiatric hospital treatment (PHT) is expensive and indicates a severe disorder. Investigation of the early identification of this small patient group has though been hindered by small samples or unsatisfactory assessment in childhood. The present study aims to study the predictive association between psychopathology at age 8 using multi-informant assessment and later PHT. A nationwide birth cohort of Finnish children (n = 5,346) was assessed at age 8 to obtain information about psychopathology using the Rutter parent and teacher reports and self-reports of depressive symptoms. The main outcome was admission to any hospital with a primary diagnosis of any psychiatric disorder according to the Finnish National Hospital Discharge Register between age 13 and 24. Between age 13 and 24, 6.2% of the males and 4.1% of the females had been admitted for PHT. Among males, PHT was independently predicted by non-intact family and adult reports of conduct and of emotional symptoms, while among females by self-reported depressive symptoms. However, the combination of conduct and emotional problems was the strongest predictor for PHT in both sexes. Admission due to psychosis among males was associated with childhood conduct, attention, and emotional problems, but with emotional problems among females. Psychopathology at age 8 can be seen as a long-lasting increased risk of severe psychiatric disorders requiring hospital treatment in adolescence or early adulthood. Attention should be paid to self-reports among females and of comorbid conduct and emotional problems in both sexes in the early identification of this patient group.

The association of suicide and bullying in childhood to young adulthood: a review of cross-sectional and longitudinal research findings

OBJECTIVE

To review the research addressing the association of suicide and bullying, from childhood to young adulthood, including cross-sectional and longitudinal research findings.

METHOD

Relevant publications were identified via electronic searches of PsycNet and MEDLINE without date specification, in addition to perusing the reference lists of relevant articles.

RESULTS

Cross-sectional findings indicate that there is an increased risk of suicidal ideation and (or) suicide attempts associated with bullying behaviour and cyberbullying. The few longitudinal findings available indicate that bullying and peer victimization lead to suicidality but that this association varies by sex. Discrepancies between the studies available may be due to differences in the studies' participants and methods.

CONCLUSIONS

Bullying and peer victimization constitute more than correlates of suicidality. Future research with long-term follow-up should continue to identify specific causal paths between bullying and suicide.

Child mental health problems and obesity in early adulthood

OBJECTIVE

To examine whether mental health problems in childhood increase the likelihood of overweight or obesity during early adulthood among male subjects.

STUDY DESIGN

In a national prospective population-based study conducted in Finland, child mental health, including depression, emotional problems, conduct problems, and hyperactivity (determined on the basis of child, parent, and teacher information), was assessed at age 8 years. Body mass index (BMI) was obtained from military examination records (n = 2209) conducted in early adulthood (age range, 18-23 years).

RESULTS

Both moderate (50th-90th percentile) and high (>90th percentile) levels of conduct problems at age 8 years were prospectively associated with a young adult being obese (BMI > or = 30; odds ratio [OR], 2.0; 95% CI, 1.2-3.2; and OR, 2.9; 95% Confidence interval [CI], 1.5-5.9; respectively). Conduct problems were also prospectively associated with a young adult being overweight (25 < or = BMI < 30; OR, 1.5; 95% CI, 1.1-1.9 for moderate levels of conduct problems, and OR, 1.9; 95% CI, 1.2-2.8 for high levels), after controlling for hyperactive problems and sociodemographic factors.

CONCLUSIONS

Conduct problems in childhood are prospectively associated with overweight and obese in young adulthood. Future studies should address the potential for interventions to reduce obesity risk in young adulthood for boys who manifest conduct problems early in life.

Childhood psychopathology and sense of coherence at age 18: findings from the Finnish from a boy to a man study

OBJECTIVE

To examine associations between childhood psychopathology and family factors at age 8, and sense of coherence (SOC) at age 18.

METHODS

The sample includes 2,314 Finnish boys born 1981 with information about psychopathology from parents and teachers using Rutter scales, and self-reports of depressive symptoms using Child Depression Inventory (CDI), and self-reports of SOC at age 18.

RESULTS

Low parental education level and living in other than two biological parent family at age 8 were associated with low SOC 10 years later. Boys with internalizing symptoms based on parent/teacher reports, and depressive symptoms based on self-reports at age 8 were at risk for lower SOC at follow-up. Comorbidity of internalizing and conduct problems had the strongest association with low SOC.

CONCLUSION

The study shows that internalizing symptoms, comorbid conduct and emotional problems, low parental education level and nonintact family at age 8 predict low SOC at age 18. Future research whether universal, selective or indicated early interventions targeted on risk factors of childhood mental health problems may result in promotion of well-being (including good SOC) in early adulthood is warranted.

Childhood bullying behaviors as a risk for suicide attempts and completed suicides: a population-based birth cohort study

OBJECTIVE

There are no previous studies about the association of childhood bullying behavior with later suicide attempts and completed suicides among both sexes. The aim was to study associations between childhood bullying behaviors at age 8 years and suicide attempts and completed suicides up to age 25 years in a large representative population-based birth cohort.

METHOD

The sample includes 5,302 Finnish children born in 1981. Information about bullying was gathered at age 8 years from self-report, as well as parent and teacher reports. Information about suicide attempts requiring hospital admission and completed suicides was gathered from three different Finnish registries until the study participants were 25 years old. Regression analyses were conducted to determine whether children who experience childhood bullying behaviors are at risk for later suicide attempts and completed suicides after controlling for baseline conduct and depression symptoms.

RESULTS

The association between bullying behavior at age 8 years and later suicide attempts and completed suicides varies by sex. Among boys, frequent bullying and victimization are associated with later suicide attempts and completed suicides but not after controlling for conduct and depression symptoms; frequent victimization among girls is associated with later suicide attempts and completed suicides, even after controlling for conduct and depression symptoms.

CONCLUSIONS

When examining childhood bullying behavior as a risk factor for later suicide attempts and completed suicides, each sex has a different risk profile.

Childhood antecedents of being a cigarette smoker in early adulthood. The Finnish 'From a Boy to a Man' Study

OBJECTIVE

To identify childhood psychiatric symptoms as antecedents of cigarette smoking at age 18.

METHODS

In 1989, a general population sample of 2946 8-year-old boys born in Finland in 1981 was assessed using the Rutter's parent and teacher questionnaires, and the Child Depression Inventory. This birth cohort was followed up in 1999, when the subjects reported for their obligatory military service at age 18. Information about cigarette smoking frequency was obtained from 78% (n = 2307) of the boys attending the study in 1989.

RESULTS

Childhood hyperactivity and self-reported depressive symptoms correlated with moderate daily (1-10 cigarettes), and heavy daily (>10 cigarettes) smoking at age 18. Conduct problems correlated with heavy daily smoking. A high level of childhood depressive symptoms, particularly in conjunction with a low educational level of the father, increased the risk of daily smoking. Emotional problems decreased the risk of smoking at age 18. In general, teacher reports had a better predictive power than parent reports for subsequent smoking.

CONCLUSION

Future developmental studies with special focus on interaction between individual and environmental factors are warranted to reveal the mechanisms underlying the association between childhood psychopathology and adult smoking. In particular, the associations between childhood depression and future smoking need more clarification.

Do mental health problems in childhood predict chronic physical conditions among males in early adulthood? Evidence from a community-based prospective study

BACKGROUND

Previous studies have documented associations between mental and physical health problems in cross-sectional studies, yet little is known about these relationships over time or the specificity of these associations. The aim of the current study was to examine the relationship between mental health problems in childhood at age 8 years and physical disorders in adulthood at ages 18-23 years.

METHOD

Multiple logistic regression analyses were used to examine the relationship between childhood mental health problems, reported by child, parent and teacher, and physical disorders diagnosed by a physician in early adulthood.

RESULTS

Significant linkages emerged between childhood mental health problems and obesity, atopic eczema, epilepsy and asthma in early adulthood. Specifically, conduct problems in childhood were associated with a significantly increased likelihood of obesity and atopic eczema; emotional problems were associated with an increased likelihood of epilepsy and asthma; and depression symptoms at age 8 were associated with an increased risk of asthma in early adulthood.

CONCLUSIONS

Our findings provide the first evidence of an association between mental health problems during childhood and increased risk of specific physical health problems, mainly asthma and obesity, during early adulthood, in a representative sample of males over time. These data suggest that behavioral and emotional problems in childhood may signal vulnerability to chronic physical health problems during early adulthood.

Cross-informant agreement about bullying and victimization among eight-year-olds: whose information best predicts psychiatric caseness 10-15 years later?

OBJECTIVE

To examine cross-informant agreement and whose information (parents, teachers, children) about childhood bullying and victimization carry the strongest weight to late adolescent psychiatric outcome. The importance of frequency of bullying in such predictions is addressed.

METHODS

Information from 2,713 boys about bullying and victimization at the age of eight was correlated with information about psychiatric disorder at 18-23.

RESULTS

Agreement between informants was poor. Teachers reported higher levels of frequent bullying than others, whereas children reported the highest percentage of victimization. All three informant groups' reports of "frequent bullying" predicted later psychiatric disorder. Teachers' reports of "frequent victimization" was the strongest predictor of later psychiatric disorder. Informants' report about "infrequent bullying" showed at most a rather low risk of adverse outcome. When the associations between bullying/victimization and psychiatric outcome were adjusted with total psychopathology score at age 8, none of the associations remained significant.

CONCLUSION

"Frequent bullying" behaviour of boys is a marker of present and later psychopathology. The education system and school health-care service in mid- childhood are of great importance for the early detection of bullying and prevention of later adverse outcomes. A closer integration of these systems in the context of school should be promoted.

Psychosocial correlates of police-registered youth crime. A Finnish population-based study

This study is focused on psychosocial correlates of youth crime in a sample of 2330 Finnish boys born in 1981. Two kinds of data were combined: questionnaires completed by the boys at call-up in 1999 and crime registered in the Finnish National Police Register between 1998 and 2001. One-fifth of the boys were registered to offending during the 4-year period in late adolescence; 14% were registered for one or two offences, 4% for three to five offences, and 3% for more than five offences. Crime accumulated heavily in those with more than five offences, as they accounted for 68% of all crime. Independent correlates of crime were living in a small community, parents' low educational level and divorce, having a regular relationship, self-reported delinquency, daily smoking, and weekly drunkenness, whereas anxious-depressiveness was reversely associated with crime. Most psychosocial problems covaried linearly with offending frequency, being particularly manifested by multiple recidivists. However, recidivists had very rarely used mental health services. The results indicate that offending and various psychosocial problems accumulate in a small minority of boys not reached by mental health services.

Victimization and bullying among 8-year-old Finnish children: a 10-year comparison of rates

OBJECTIVE

There are only few population-based time-trend studies on changes in prevalence of bullying and victimization among children. The main aim of this study was to find out whether changes have occurred in prevalence rates of bullying and victimization from 1989 to 1999 among eight-year-old children. The associations between victimization and bullying and psychiatric symptoms and their possible differences in the statistical strengths of associations between the years 1989 and 1999 were also studied.

METHOD

Two cross-sectional, representative samples from southern Finland were compared. All children born in 1981 (1989 sample, n = 985, response rate 95%) and 1991 (1999 sample, n = 962, response rate 86%) and living in the selected school district were included in the study samples. Children, parents and teachers were asked about bullying and victimization. The Children's Depression Inventory and Rutter's parent and teacher scales were used to study psychiatric symptoms.

RESULTS

In 1999, fewer 8-year-old children were victims of bullying than in 1989. There was a decrease in the number of bullies but the change was statistically significant only in the parental reports. The statistical strengths of associations of victimization and bullying with psychiatric symptoms were mainly the same in 1989 as in 1999.

CONCLUSIONS

Slightly decreased levels of victimization among 8-year-old Finnish children is a promising result, but further time-trend studies are needed, as well as qualitative studies, to obtain a deeper understanding of the bullying phenomenon and the factors reducing it. It might be that especially young children are suspectible to influences diminishing victimisation and bullying.

What predicts illicit drug use versus police-registered drug offending? Findings from the Finnish "From a Boy to a Man" birth cohort study

AIMS

To study whether drug offenders differ in childhood and in early adulthood from those who only report using illicit drugs.

DESIGN

Prospective nationwide birth cohort study. Baseline survey in 1989, follow-up data collection from self-reports, police and military registers in late adolescence and early adulthood.

PARTICIPANTS

Two-thousand nine hundred and forty six Finnish boys born in 1981. Information about self-reported drug use at age 18 or police-registered drug offending at age 17-20 was available from 79.3% (n = 2,336) of the subjects.

MEASUREMENTS

At age 8, psychopathology was assessed using the parent and teacher Rutter scales and child self-reports (Child Depression Inventory). ICD-10 psychiatric diagnoses at early adulthood according to the military register were based on a medical examination.

FINDINGS

Childhood psychopathology did not predict self-reported drug use at age 18. Both conduct and hyperactivity problems at age 8 predicted drug offences at age 16-20. The predictive association with drug offences was strongest with severe level (over 90th percentile cut-off point) of conduct (OR 5.5, 95% CI 2.9-10.5) and hyperactivity problems (OR 5.0, 95% CI 2.7-9.3). Also moderate level of conduct (OR 2.9, 95% CI 1.7-4.9) and hyperactivity problems (OR 3.1, 95% CI 1.9-5.1) predicted drug offending. Having a psychiatric diagnosis in early adulthood associated with both self-reported use (OR 4.1, 95% CI 2.4-6.8) and drug offending (OR 13.2, 95% CI 8.3-21.2).

CONCLUSIONS

Drug offending is part of a life-course-persistent deviance, whereas for self-reporters, psychiatric problems arise later in life. Accordingly, the preventive needs, and the age period for intervention are different for boys with divergent illicit drug use involvement.

Childhood bullying as a risk for later depression and suicidal ideation among Finnish males

BACKGROUND

Little is known about the predictive association between childhood bullying behavior with depression and suicidal ideation at age 18.

METHODS

The sample included 2348 boys born in 1981. Information about bullying was gathered at the age of 8 from self, parent and teacher's reports. Depression and suicidal ideation were assessed during the Finnish military call-up examination.

RESULTS

Based on regression models, boys who were bullies frequently, but not merely sometimes, were more likely to be severely depressed and to report suicidal ideation compared to boys who were not bullies. When controlling for depression at age 8 the association between frequent bullying and severe depression was maintained but the association with suicidal ideation became non-significant. Boys who were only victimized were not more likely to be depressed or to report suicidal ideation at age 18. Boys who were frequently both bullies and victims were found to be at risk for later depression.

LIMITATIONS

Our finding can only be generalized to boys who were involved in bullying at elementary school age. Data at age 18 was based only on self-reports and the bullying/victimization questions were very general.

CONCLUSIONS

Childhood bullying behavior is a risk factor for later depression. Screening and intervention for bullying behavior in the early school years is recommended to avoid subsequent internalizing problem in late adolescence.

Children's Depression Inventory in Estonia. Single items and factor structure by age and gender

The aim of study was to estimate the score of symptoms of depression with the Children's Depression Inventory (CDI) among Estonian schoolchildren aged 7-13-year-old, according to age and gender differences, and to identify the components in factor analysis characterising self-reported childhood symptoms of depression. The applicability of the CDI in 7-year-old children was also estimated. The number of subjects in the study was 725 (342 girls and 383 boys), and the mean age was 10.2 (SD 1.7). The mean total score of the CDI for the whole sample was 9.96 (SD = 6.3, range 0-39, median 9.0). The mean scores of symptoms of depression among children did not differ by gender or age. There were no significant differences in the CDI mean scores between 7-year-old compared to older schoolchildren in the present study. Factor analysis obtained five factors: anhedonia, ineffectiveness, negative self-esteem, negative mood and interpersonal problems. Significant gender and age differences were found: girls reported more symptoms of anhedonia and negative self-esteem, and boys reported more symptoms of ineffectiveness. Younger children reported more symptoms of anhedonia and ineffectiveness, and older children negative self-esteem. The study serves as baseline data before intervention of the EC project "European Alliance Against Depression".

Life events, self-reported psychopathology and sense of coherence among young men--a population-based study

The aim is to study the associations between sense of coherence (SOC), and psychopathology and major life events among adolescent boys. The study population consisted of 2314 Finnish boys born during 1981 who attended military call-up (79% of the original sample). At military call-up in 1999, the boys filled in the Young Adult Self-Report (YASR) and Antonovsky's Orientation to Life Questionnaire (SOC-13), which measure SOC. In univariate analysis, low parental education level, death and serious illness of parent, parental divorce and high symptom level in all YASR scales were associated with poor SOC. In multivariate analysis, most YASR syndrome scales and father's education level were independently associated with SOC. The study demonstrates the sensitivity of the SOC-13 scale to a wide range of mental health problems. The results offer additional support to the argument that SOC may be an important global measure for use in both clinical and research purposes in adolescent psychiatry.

Who is at greatest risk of adverse long-term outcomes? The Finnish From a Boy to a Man study

OBJECTIVE

To study associations between comorbid psychopathology and long-term outcomes in a large birth cohort sample from age 8 to early adulthood.

METHOD

The sample included long-term outcome data on 2,556 Finnish boys born in 1981. The aim was to study the impact of early childhood psychopathology types (externalizing versus internalizing versus both) and informant sources (self-report versus parent/teacher reports) on young adult outcomes, based on data from a military registry of psychiatric diagnosis, a police registry on criminal and drug offenses, and self-reported problems in late adolescence and early adulthood.

RESULTS

Children with combined conduct and internalizing problems at age 8 had the worst outcomes and highest risk of subsequent psychiatric disorders, criminal offenses, and self-reported problems at follow-up, with 62% of these boys manifesting psychiatric disorders, committing criminal offenses, or both at follow-up. Although these children included only 4% of the sample, they were responsible for 26% of all criminal offenses at follow-up. In contrast, children with conduct problems without internalizing problems and those with attention problems had much less severe but nonetheless elevated levels of risk of antisocial personality disorder and criminal offenses. Long-term outcomes for these two groups were substantially better than for children with combined conduct and internalizing problems. Children with "pure" emotional problems had an elevated risk only of similar emotional problems at follow-up.

CONCLUSIONS

The subjective suffering and long-term burden to society is especially high among children with comorbid conduct and internalizing problems in childhood. A major challenge for child and adolescent psychiatric, education, and social services is to develop effective intervention strategies focusing on these children. Additional longitudinal epidemiological studies of this comorbidity group are needed, and, if replicated, such findings will have important implications for future diagnostic classification systems (DSM-V).

What is the early adulthood outcome of boys who bully or are bullied in childhood? The Finnish "From a Boy to a Man" study

OBJECTIVE

Our goal was to study predictive associations between bullying and victimization at age 8 years and psychiatric disorders in early adulthood.

METHODS

The sample comprised 2540 boys born in 1981. Information about bullying and victimization was gathered in 1989 when the boys were 8 years old from parents, teachers, and children. Information about psychiatric disorders was based on military call-up examination and army registry when the subjects were 18 to 23 years old.

RESULTS

In univariate logistic regression analysis, frequent bullying-only status predicted antisocial personality, substance abuse, and depressive and anxiety disorders; frequent victimization-only status predicted anxiety disorder, whereas frequent bully-victim status predicted antisocial personality and anxiety disorder. When controlled against the effects of parental education level and parent and teacher reports of emotional and behavioral symptoms by using Rutter scales, frequent victimization-only status predicted anxiety disorders, and frequent bullying-only predicted antisocial personality disorder, whereas frequent bully-victimization predicted both anxiety and antisocial personality disorder. Information about frequent bullying and victimization as primary screening for children at risk identified approximately 28% of those with a psychiatric disorder 10 to 15 years later.

CONCLUSIONS

Both bullying and victimization during early school years are public health signs that identify boys who are at risk of suffering psychiatric disorders in early adulthood. The school health and educational system has a central role to play in detecting these boys at risk.

Police-registered offenses and psychiatric disorders among young males : the Finnish "From a boy to a man" birth cohort study

OBJECTIVE

To study associations between crime and psychiatric disorders among adolescent males in a representative population-based cohort study.

METHOD

The sample includes 2,712 Finnish boys born in 1981. Information on criminality consists of offenses registered in the Finnish National Police Register 1998-2001. Crime was classified according to frequency and type (drug, violent, property, traffic, and drunk driving offenses). Information on psychiatric diagnoses between 1999 and 2004 was collected from the Finnish National Military Register.

RESULTS

Of the 2,712 boys, 22% had a crime registration during the 4-year period, and 10% had at least one psychiatric disorder according to the Military Register. Those with psychiatric disorders accounted for 49% of all crimes. Of those with more than five crimes (n = 98), 59% had psychiatric diagnoses. After adjusting for other crime types and childhood socio-economic status, property crime was independently associated with several diagnoses: antisocial personality (APD), substance use (SUD), psychotic, anxiety, and adjustment disorders. Drug offending was independently associated with APD, SUD, and psychotic disorder, and traffic offenses with APD.

CONCLUSIONS

Youth crime is predominantly associated with antisocial personality and substance use disorders. Crime prevention efforts should focus on boys showing a risk for antisocial and substance use problems. In particular, property, drug, and repeat offenders need mental health and substance use assessment. There is a need to develop integrated mental health and substance use treatment services for young offenders within or alongside the criminal justice system.

Infertility treatment and marital relationships: a 1-year prospective study among successfully treated ART couples and their controls

BACKGROUND

Evidence about the effects of infertility and assisted reproduction technique (ART) on marital relationships is discrepant. Here, we examined the impact of ART on marital relationships. The roles of life stressors, infertility and treatment characteristics in predicting marital relations were also evaluated.

METHODS

SUBJECTS

367 couples with singleton IVF/ICSI pregnancies.

CONTROLS

379 couples with spontaneous singleton pregnancies. Women and men were assessed when the child was 2 months (T2) and 12 months old (T3). They further reported stressful life events at T2 and depression in pregnancy.

RESULTS

No between-group differences were found in marital satisfaction and dyadic cohesion. Dyadic consensus deteriorated from T2 to T3 only among control women. Sexual affection was low among control men at T2 and stressful life events decreased it further. Depression during pregnancy predicted deteriorated marital relations only in control couples. Several unsuccessful treatment attempts were associated with good dyadic consensus and cohesion among ART women. Spontaneous abortions and multiple parity predicted poor marital satisfaction in ART women, whereas long duration of infertility and multiple parity predicted poor marital relations in ART men.

CONCLUSIONS

Successful ART does not constitute a risk for marital adjustment. The shared stress of infertility may even stabilize marital relationships.

Self-reported psychopathology, adaptive functioning and sense of coherence, and psychiatric diagnosis among young men--a population-based study

OBJECTIVE

To study the associations between psychiatric disorders and self-perceived problems among adolescent boys.

METHOD

The study population consisted of 2348 Finnish boys born during 1981 attending obligatory military call-up (79.7% of the original sample). At military call-up in 1999, the boys filled in the Young Adult Self-Report (YASR) and Orientation of Life Questionnaire (SOC-13). Information about psychiatric disorders was obtained from the national military register during the years 1999-2004.

RESULTS

Most of the psychopathology, adaptive functioning and SOC scales were associated with a variety of psychiatric disorders at follow-up. However, when the effects of scales were controlled in multivariate analysis, only YASR somatic problems and SOC-13 showed an independent association with a wide range of psychiatric disorders at follow-up. Poor SOC-13 predicted anxiety, depression, antisocial personality and substance use disorders. The YASR somatic problems scale predicted anxiety, depression, substance use, psychotic, and adjustment disorders. Self-reported delinquency and poor competence at school predicted substance use and antisocial personality disorders.

CONCLUSIONS

Self-reports of poor sense of coherence and somatic complaints have a non-specific association with a wide range of psychiatric disorders. Clinical and theoretical implications of these findings are discussed.

Childhood predictors of male criminality: a prospective population-based follow-up study from age 8 to late adolescence

OBJECTIVE

To study childhood predictors for late adolescence criminality.

METHOD

The follow-up sample included 2,713 Finnish boys born in 1981. Information about the 8-year-old boy' problem behavior was obtained from parents, teachers, and the children themselves. The follow-up information about criminal offenses was based on the national police register between the years 1998 and 2001 when the subjects were 16 to 20 years old.

RESULTS

According to the national police register, 22.2% of boys had at least one criminal offense other than a minor traffic violation during the 4-year study period. Living in nonintact family, low parental education level, parent reports of conduct problems, and teacher reports of hyperkinetic problems when the child was 8 independently predicted a high level (more than five) of offenses. Living in nonintact family at age 8 predicted all types of criminal offenses. Low parental education level and parent or teacher reports of conduct problems independently predicted violence, property, traffic, and drunk driving offenses. Teacher reports of hyperkinetic problems independently predicted all types of criminal offenses except drunk driving. Self-reports of bullying others independently predicted violent offenses.

CONCLUSIONS

Living in a broken home, low parental education level, conduct problems, and hyperactivity in middle childhood predict criminal offenses in late adolescence. Efforts to prevent later criminality already in childhood are emphasized.

Childhood predictors of drunkenness in late adolescence among males: a 10-year population-based follow-up study

AIMS

To study childhood precursors of drunkenness frequency among 18-year-old boys in a representative, nation-wide 10-year follow-up study.

DESIGN

In 1989, a general population sample of 2,946 8-year-old boys was collected. Three different informant sources were used: parents, teachers and the boys themselves. The follow-up was 10 years later in 1999, when the boys were called up for their obligatory military service at age 18. Information about drunkenness frequency was obtained from 78.3% (n=2306) of the original sample.

SETTING

Finland, nation-wide; in 1989 at schools, in 1999 at the obligatory military call-up.

PARTICIPANTS

General population sample of Finnish boys born in 1981.

MEASUREMENTS

At age 8, the Rutter A2 scale, Rutter B2 scale and Child Depression Inventory (CDI) were used. At age 18, self-reported drunkenness frequency during the previous 6 months was determined.

FINDINGS

Of the subjects, 15.0% reported never being drunk from alcohol, 74.6% reported being occasionally drunk and 10.4% reported being drunk at least once a week during the previous 6 months. After adjusting for other variables, teacher's estimate of the child's problem behaviour at age 8 predicted frequent drunkenness in late adolescence. Hyperactive problems predicted both occasional and frequent drunkenness. Conduct problems at age 8 predicted only frequent drunkenness. High teacher-reported scores of emotional problems predicted lower occurrence of drunkenness-orientated alcohol use.

CONCLUSIONS

The educational system has a potential role in detecting boys at risk of later risk-taking behaviours, such as frequent drunkenness. Early interventions in children with conduct problems and hyperactivity are called for.

ADAPTIVE FUNCTIONING, PSYCHOPATHOLOGY AND SERVICE USE AMONG 18-YEAR-OLD BOYS WITH DRUNKENNESS-RELATED ALCOHOL USE

AIMS

To study the associations between drunkenness frequency and adaptive functioning, psychopathology and service use among 18-year-old Finnish boys in a nation-wide population-based study.

METHODS

Information about drunkenness frequency within the previous six months was collected from the Finnish boys born in 1981 (n = 2306) at the boys' obligatory military call-up in 1999. Self-report questionnaires were used to study demographic factors, adaptive functioning, risk behaviour, life events, and mental health service use. Psychopathology and adaptive functioning was assessed with the Young Adult Self-Report (YASR) questionnaire.

RESULTS

Of the boys, 85% reported drunkenness within the previous 6 months. Most of the subjects were occasionally drunk: 39% reported drunkenness less than a month, and 35% less than once a week, while 10% reported being frequently drunk once a week or more often. Occasional drunkenness was associated with better adaptive functioning and psychosocial well-being in general. Refraining from drunkenness was associated with suicidal ideation and internalizing problems in the YASR scale. Frequent drunkenness associated with daily smoking, illicit drug use, and externalizing problems in the YASR scale, especially delinquent behaviour. In the multivariate analysis, number of friends, having a regular relationship and cigarette smoking had a linear association with frequency of drunkenness, while drunkenness-related alcohol use was less common among those with poor friendship quality. Among the participants, entering substance use treatment was rare (0.2%). Frequent drunkenness was found to be common among mental health service users.

CONCLUSIONS

Among late-adolescent boys, occasional drunkenness is a normative alcohol use pattern and associates with social competence and good psychosocial functioning. Late-adolescent boys refraining from drunkenness in addition to those with frequent drunkenness may be in a need of mental health assessment. As entering substance use treatment is infrequent, establishing integrated services with multi-professional co-operation for late-adolescent males with frequent drunkenness is emphasized.