Time trends of Finnish adolescents' mental health and use of alcohol and cigarettes from 1998 to 2014

The youth mental health crisis: analysis and solutions

Background

Since the mid-20th century, mental illness has become a leading cause of health burden, particularly among adolescents and emerging adults, with most disorders emerging before the age of 25. Over the past two decades, mental ill health has surged to alarming levels, with evidence confirming that the increase is not just due to better awareness or diagnosis but reflects a genuine public health crisis.

Study design/method

We explore the evolving landscape of youth mental health and its contributing factors, including family dynamics, educational pressures, climate change, social media, and socio-economic challenges, potentially linked to neoliberal policies. A narrative review methodology was employed to analyze these factors and their role in the trends of mental ill-health among young people.

Study results

We document mental health trends since the mid-1990s, focusing on mental and substance use disorders among young people and their current needs. Potential new explanatory factors and megatrends, potentially flowing from a paradigm shift in the global political economy which has largely passed under the radar, yet which has produced fragmentation and inequality, are identified, with the COVID-19 pandemic further intensifying these trends. We discuss methodologies to estimate the contribution of these megatrends and outline potential barriers to implementation, along with strategies to overcome them.

Conclusion

This review calls for a comprehensive global action plan, emphasizing prevention, early intervention, and improved treatment strategies. In addition to strengthening prevention, which may take time and be elusive, immediate action is needed to innovate and expand services, which are currently under-resourced and overwhelmed.

Secular trends in mental health problems among young people in Norway: a review and meta-analysis

There is a growing concern that the mental health of recent generations of youth is deteriorating, yet the etiology of these secular changes is not fully understood. We aimed to review the evidence on trends in mental health problems among young people in Norway. Seven large-scale repeated cross-sectional studies were included in this study, comprising 35 cross-sectional data collections between 1992 and 2019, with a total sample of 776,606 young people. Our study found a clear increase in mental health problems among young females in Norway over the past few decades, while the trends were less marked for males. The proportion of individuals scoring above the problematic symptom score threshold increased on average by 11.2% (range 2.2% to 21.9%) for females and 5.2% (range - 0.9% to 11.1%) for males, based on data from the individual studies. The results from a meta-regression analysis showed that across all surveys, mean symptom scores increased by 17% (95% CI 12 to 21%) among females and 5% (95% CI 1 to 9%) among males from 1992 to 2019. Overall, mental health problems have increased continually since the early 1990s among young people, especially among young females. The cause of these secular changes remains unknown but likely reflect the interplay of several factors at the individual and societal level.Protocol registration: Open science framework, November 8, 2021 ( https://osf.io/g7w3v ).

Depressive symptoms, conduct problems and alcohol use from age 13 to 19 in Norway: evidence from the MyLife longitudinal study

BACKGROUND

Even though mental health problems and alcohol use remain major challenges facing adolescents, our understanding of their developmental progressions primarily stems from cohorts coming 1 of age in the early 2000's. We aimed to examine and describe normative developmental trajectories of depression, conduct problems, and alcohol use across adolescent years among more recent cohorts of Norwegian youth born in the 21st century.

METHODS

Multilevel mixed linear models for symptoms of depression and conduct disorder, and multilevel mixed logistic models for depressive disorder, conduct problems, any alcohol use, and risky drinking, were estimated with longitudinal data from a nationwide sample N = 3436 (55% girls) of Norwegian adolescents (mean age 14.3 [SD = 0.85] in 2017). We compared models with linear, quadratic, and cubic change with age, and models that tested moderation by sex and centrality (rural vs. urban communities).

RESULTS

Average symptoms and the rate of depressive disorder increased sharply from age 13 to age 19, but both the initial levels and the rates of change were greater for girls than for boys. Average symptoms of conduct disorder and the rate of conduct problems increased in early adolescence and were greater for boys than girls. The rates of any alcohol use and risky drinking both increased sharply from age 14, but there were no notable sex differences either in the initial levels or rates of change over time. Adolescents from more rural communities had greater rates of any drinking in mid-adolescence, but there were no other effects of centrality.

CONCLUSIONS

This study provides a much-needed update concerning normative developmental trajectories of depression, conduct problems, and alcohol use among millennium cohorts. Consistent with prior studies, we observed significant increases in all outcomes across adolescence, with depression being both greater and more prevalent among girls and conduct problems being both greater and more prevalent among boys. Consistent with the emerging evidence, we observed no sex differences in alcohol use. Finally, there were no differences in the examined developmental trajectories as a function of centrality. These findings underscore the importance of early prevention and treatment of mental health and substance use problems.

The relationship between online communication and adolescents' mental health: Long-term evaluation between genders

AIMS

In a relatively short time, online communication has become an important part of adolescents' lives, and concerns have been raised about its potential effects on mental health. The first aim was to compare mental health status and online communication in 15-year-old Icelanders born in 1988 and in 1994. The second aim was to assess whether the relationship between online communication and mental health has changed among 15-year-old Icelanders from 2003 to 2015 across genders.

METHODS

Analysis used data from self-reports from 2003 (N=385, 51% males) and 2015 (N=302, 42% males). Mental health was assessed with subscales of Symptom Checklist 90 and online communications with self-reports. To evaluate the difference in anxiety and depression, a factorial analysis of variance was conducted between gender and years. Multigroup structural equation modelling was used to assess the change in the relationship between years.

RESULTS

Symptoms of anxiety and depression remained unchanged for males. Symptoms of depression increased for females, while anxiety was stable between 2003 and 2015. In 2003, there was no relationship between online communication and mental health. However, in 2015, an association was found for females.

CONCLUSIONS

Depression is getting worse for adolescent females, and an association between time spent online communicating and mental health emerged for them in 2015, which did not exist in 2003. These findings add to the possibility that online communication is harmful for mental health, but more detailed studies are still needed.

Temporal changes in the associations between diagnosed psychiatric disorders and dropping out of school early

Psychiatric problems are risk markers for poor educational attainment. The number of adolescents receiving treatment has increased. We investigated whether the association between psychiatric problems in early adolescence and dropping out of school had changed. We used the register-based 1987 and 1997 Finnish Birth Cohort studies, which include all live births in Finland. Hospital districts with incomplete records were excluded, leaving 25,421 participants born in 1987 and 32,025 born in 1997. The main outcome was not having applied for secondary education by the year the cohort members turned 18. Our main predictors were psychiatric and neurodevelopmental disorders diagnosed by specialized services during 1998-2003 and 2008-2013, when the cohort members were 10-16 years old. We found that 511 (2.0) of subjects born in 1987 and 499 (1.6%) born in 1997 dropped out of school. Having any diagnosis at 10-16 of age was associated with dropping out of school early in both cohorts: 3.9% in 1987 and 4.8% in 1997. The highest proportions were in the subgroup with autism spectrum disorders (ASD), 19.4% in 1987 and 16.2% in 1997. Dropping out early increased among adolescents diagnosed with any psychiatric or neurodevelopmental disorder, from 3.9 to 4.8%, with the clearest increase for learning disabilities, from 3.4 to 9.0%. Dropping out decreased for those with depression, from 4.5 to 2.1%. Adolescents with psychiatric and especially neurodevelopmental disorders, need effective interventions to prevent them dropping out of school early. Increased detection of psychopathology did not result in decreased dropout rates.

Multi-center nationwide study on pediatric psychiatric inpatients 2000-2018: length of stay, recurrent hospitalization, functioning level, suicidality, violence and diagnostic profiles

Inpatient treatment is an important part of child and adolescent psychiatric (CAP) care. This nationwide study explores the changes in length of stay, recurrent hospitalization, functioning level, suicidality, violence and diagnoses of CAP inpatients in Finland in 2000, 2011 and 2018. We obtained comprehensive questionnaire data on each study year from 93 to 95% of all CAP wards in Finland. We split the 1276 inpatients into two age groups in each study year: under 13 and 13-18. The median length of stay in inpatient treatment decreased from 82.0 days in 2000 to 20.5 days in 2018 (p < 0.001) and recurrent hospitalization increased from 38 to 46%. General functioning, which was evaluated by the Children's Global Assessment Scale, deteriorated by an average of six points between 2000 and 2018. Violent threats decreased from 21.5 to 16.6% and violent acts decreased from 26.9 to 20.3%. Suicidal threats decreased from 42.6 to 23.3% in those aged under 13 and remained stable among those aged 13-18. In the 13-18 group, there was an increase in the diagnoses of ADHD, from 5.0 to 16.9% and depression, from 25.1 to 41.7%. However, psychosis decreased from 23.2 to 12.6% in the older age group. In the whole cohort, anxiety disorders increased from 7.6 to 15.6%. The overall picture does not show that CAP inpatients have become more disturbed. While the general functioning of CAP inpatients deteriorated somewhat over the 2000-2018 study period, symptoms of suicidality and violence remained stable or decreased. There was also a continuous increase in short-term treatment.

Generalized anxiety among Finnish youth from 2013 to 2021-Trend and the impact of COVID-19

BACKGROUND

Alarming levels of emotional symptoms among youth were reported during the COVID-19 pandemic. Studies assessing these figures against the pre-pandemic developments are rare. We examined the trend of generalized anxiety (GA) in adolescents in the 2010s and the effect of the COVID-19 pandemic against this trend.

METHODS

Data from the Finnish School Health Promotion study with 750,000 participants aged 13-20 between 2013 and 2021 was analyzed using GAD-7 to measure self-reported GA (cut-off ≥10). Inquiries were made about remote learning arrangements. Effects of time and COVID-19 were analyzed with logistic regression.

RESULTS

Among females, an increasing trend in GA between 2013 and 2019 was found (OR per year 1.05), and the prevalence increased from 15.5 % to 19.7 %. Among males, the trend was decreasing (OR = 0.98), with prevalence from 6.0 % to 5.5 %. Increase in GA from 2019 to 2021 was stronger in females (19.7 % to 30.2 %) than males (5.5 % to 7.8 %), while the effect of COVID-19 on GA was equally strong (OR = 1.59 vs. OR = 1.60) against the pre-pandemic trends. Remote learning was associated with elevated levels of GA, especially among those with unmet needs for learning support.

LIMITATIONS

The design of repeated cross-sectional surveys doesn't allow analyses of within individual changes.

CONCLUSIONS

Given the pre-pandemic trends of GA, the COVID-19 effect on it appeared equal in both sexes. The increasing pre-pandemic trend among adolescent females and the strong effect of COVID-19 on GA among both sexes warrants constant monitoring of mental health of the youth in the aftermath of the COVID-19 pandemic.

Associations of leisure-time physical activity and active school transport with mental health outcomes: A population-based study

Promoting physical activity can improve population health. This study aimed to examine associations of leisure-time moderate-to-vigorous physical activity and active school transport with mental health, that is, symptoms of depression and anxiety, among 15- to 16-year-old adolescents. We also assessed the relationships with less-studied outcomes, such as chronic stress and visits to school psychologist. A nationwide Finnish cohort of eighth and ninth graders from the School Health Promotion study (32 829 participants; mean age 15.4 years; 53% girls) was studied. We used logistic regression to estimate odds ratios (OR), with models adjusted for major sociodemographic, health behavior, and physical activity variables. Key findings suggest that leisure-time moderate-to-vigorous physical activity is associated with better mental health in a dose-response manner. Even the smallest dose, 30 weekly minutes, was linked to 17% lower odds of chronic stress symptoms compared to inactivity (OR 0.83, 95% CI 0.71-0.96). Compared to non-active transportation, more than 30 min of daily active school transport yielded 19% (OR 1.19, 95% CI 1.07-1.31) and 33% (OR 1.33, 95% CI 1.12-1.58) higher odds of depression symptoms and school psychologist visits, respectively. However, no associations were found for low-to-moderate daily active school transport levels (<30 min). This large-scale study further highlights a positive association between leisure-time physical activity and mental health among youth. Future research should explore what factors might explain the potential adverse mental health outcomes of active school transport.

The Mental Well-Being of Italian Adolescents in the Last Decade through the Lens of the Dual Factor Model

(1) Background: In Italy, the components of adolescents' mental well-being (psychological symptomatology and cognitive perception of life satisfaction) showed different temporal trends, suggesting the adoption of a multidimensional conceptualization. We aimed to assess temporal patterns and provide additional insights into Italian adolescents' mental well-being in the last decade by adopting the Dual Factor Model; (2) Methods: We used nationally representative samples of Italian students (n = 165,000) aged 11, 13, and 15 years across the three more recent Italian Health Behaviour in School-aged Children (HBSC) surveys. Two measures of mental well-being were used: life satisfaction (LS, indicator of positive subjective well-being) and psychological health complaints (PHC, indicator of mental illness); (3) Results: Our study showed that the overall sample has been moving from a Complete Mental Health (Flourishing) to an Incomplete Mental Illness (Struggling) condition. Among 13- and 15-year-old girls, a jump from one to the other mental condition was observed in the 2014-2018 and 2010-2014 time periods, respectively; (4) Conclusions: Our findings suggest that Italian adolescents, especially older girls, have been shifting from Complete Mental Health to Incomplete Mental Illness in the last decade. Further research is needed to investigate this breaking up of the connection between psychological symptomatology and cognitive perception of life satisfaction.

Time trends in treated incidence, sociodemographic risk factors and comorbidities: a Finnish nationwide study on anxiety disorders

BACKGROUND

There has been a lack of research about the time trends and socio-demographic risk factors for children and adolescents who receive treatment for anxiety disorders. This study aimed to fill these gaps in our knowledge by examining a nationwide sample of Finnish children and adolescents diagnosed in specialized healthcare settings.

METHODS

This study comprised national register data of all singleton children born in Finland from 1992-2006 who were diagnosed with anxiety disorders from 1998-2012. The changes in time trends in incidence were studied by dividing the study sample into three cohorts by birth years: 1992-1996, 1997-2001 and 2002-2006, who were followed up until the age of 20, 15 and 10 years, respectively. The 22,388 individuals with anxiety disorders were age and gender matched with 76,139 controls from the general population. Logistic regression was used to examine the socio-demographic risk factors and anxiety disorders in the entire sample. Comorbid disorders were examined in the oldest birth cohort (1992-1996 born).

RESULTS

Comparing the 1992-1996 and 2002-2006 cohorts showed that the cumulative incidence of treated anxiety disorders at the age of 10 increased from 0.3 to 1.2% among females and 0.46 to 1.9% among males. Subjects had higher likelihood for being diagnosed with an anxiety disorder if their mothers had low maternal socio-economic status class at birth (OR 1.53, 95% CI 1.45-1.61) compared to higher SES class, and marital status was single at the time of birth (OR 2.02, 95% CI 1.87-2.17) compared to married or in a relationship. They had lower risk of anxiety disorders diagnosis if born in rural (OR 0.82, 95% CI 0.79-0.86) or semi-urban areas (OR 0.79, 95% CI 0.76-0.82) when compared to urban residence. There was a wide range of psychiatric comorbidities, and unipolar depression was the most common (31.2%).

CONCLUSION

Anxiety disorders diagnosed by specialized Finnish services increased from 1998-2012 in both genders. This could indicate a real increase in overall anxiety disorders or an increase in treatment seeking. The findings on maternal socioeconomic status and single parenting improve the recognition of the environmental risk factors for anxiety disorders among children and adolescents.

Time trends in adolescent mental wellbeing in the Czech Republic between 2002 and 2018: gender, age and socioeconomic differences

OBJECTIVES

Recent literature indicates a decline over time in adolescent mental wellbeing but results are inconsistent and rely mainly on data from Western societies. This study investigates time trends in adolescent mental wellbeing (psychological and somatic complaints, life satisfaction) among Czech adolescents and explores the moderating role of gender, age and socioeconomic status.

METHODS

Nationally representative data from 29,376 Czech adolescents (50.8% girls, mean age = 13.43; SD = 1.65) across five Health Behaviour in School-aged Children (HBSC) surveys (2002, 2006, 2010, 2014, 2018) were used. Hierarchical regression models estimated national trends in adolescent mental wellbeing and established the moderating role of gender, age and socioeconomic status.

RESULTS

From 2002 to 2018, an increase in the psychological complaints was observed. Life satisfaction decreased over time up to 2014 only, whereas somatic symptoms increased until 2010, followed by a decline in 2014 and 2018. Girls, older adolescents and those from low family affluence reported poorer mental wellbeing. Gender gap increased over time for psychological complaints and life satisfaction. Socioeconomic inequalities gap remained stable over the investigated timeframe.

CONCLUSIONS

Our findings do not provide evidence for substantial temporal changes in mental wellbeing among adolescents in the Czech Republic. Yet, the increase in psychological complaints has been consistent which is an indicator of a small decline over time in adolescent mental wellbeing. Furthermore, the gender gap in mental wellbeing increased over time, whereas the age and socioeconomic differences remained relatively stable. This calls for the attention of public health professionals and policy makers from the Czech Republic.

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.

Changes in referral patterns to outpatient child and adolescent psychiatric services from 2005-2018

INTRODUCTION

There has been a steep increase in referrals to child and adolescent psychiatric (CAP) services across Western countries. To fit CAP services to the increasing demand, it is important to gain more knowledge about the background for the increase in referrals and to investigate changes in referral patterns over time.

METHODS

Cross-sectional observational study comparing referrals to outpatient CAP services from 2005, 2010 and 2018 to the only CAP center in the North Denmark Region.

RESULTS

There was a 3.9 times increase in referrals from 2005 to 2018. Referrals for disorders with onset in early childhood (primarily autism and ADHD/ADD) increased from 2005 to 2010 but decreased from 2010 to 2018. There was an increase in the proportion of referrals for emotional disorders from 2010 to 2018. The proportion of girls referred for disorders with onset in early childhood increased from 2005 to 2018. The referral age for these disorders remained relatively high, and this was most pronounced for girls.

CONCLUSIONS

There has been significant changes in the referral pattern to outpatient CAP services. The increasing referral rates for girls for disorders with onset in early childhood could indicate improved ability in primary settings to recognize these symptoms in girls. However, late referral to CAP services for these disorders remains an issue. Educational services play an increasing role in referring children for these disorders, and it is important to ensure that they have the competences to identify children in need of assessment by CAP services.

Trends in alcohol intoxication among native and immigrant youth in Sweden, 1999-2017: A comparison across family structure and parental employment status

BACKGROUND

Developing a better understanding of drinking patterns across immigrant generations and how these change over time is important for the development of effective alcohol polices. This study investigates the direction and rate of change in youth alcohol intoxication over time, based on immigrant status, and by family structure and parental employment status.

METHOD

The study is based on eight nationally representative school surveys conducted by the Swedish National Council for Crime Prevention between 1999 and 2017, with a combined sample of 50,657 adolescents. Group by time interactions were examined to compare rates of change of alcohol intoxication over time across immigrant generations.

RESULTS

The results show a decreasing trend in alcohol intoxication among both first and second generation immigrant youth, and also among immigrant youth across different family structures and parental employment statuses. The results also show that the decrease in alcohol intoxication over time is greater for youths born abroad and for youths with two immigrant parents than for native Swedes, and that the decrease over time is greater for youths from intact families than for native Swedish youths from non-intact families and youths with one immigrant parent.

CONCLUSION

Native and first- and second-generation immigrant youth may differ substantially from one another in many ways, and may therefore manifest different patterns of drinking behaviours. From a policy and prevention perspective, the data in this study imply that native youths and youths with one immigrant parent should be a central target group for alcohol prevention policy in Sweden.

A Global Decline in Adolescents' Subjective Well-Being: a Comparative Study Exploring Patterns of Change in the Life Satisfaction of 15-Year-Old Students in 46 Countries

There is a growing body of research that demonstrates declines in subjective well-being and increases in mental health problems among children and young people in recent decades. However, there is little comparative research examining changes in adolescents' life satisfaction (LS) across a large number of countries, and critically, how this differs across sociodemographic groups. This study addresses this question by investigating changes in the LS of 15-year-old students between 2015 and 2018, with particular attention given to differences by gender, socio-economic status, immigrant background and urbanity. Data for this study come from the Programme for International Student Assessment (PISA). Due to the skewed nature of LS scale variables, the current study includes both mean levels of LS in a 0 to 10 scale, and the proportion of students reporting low LS (5 points or less). Linear regression models were used. Results demonstrate a global decline in mean levels of LS in 39 out of the 46 countries. In most countries, mean LS declined more among girls than among boys. Mean LS declined more, and the proportion of students reporting low LS increased more, among non-immigrant students and those of higher SES in the majority of countries. Findings regarding rural or urban communities were mixed. We advise that heterogeneity across all sociodemographic groups needs to be accounted for in public policy efforts to increase LS among young people.

Good interaction skills are not enough - competency in mental health issues in child health clinics and school health services

BACKGROUND

Mental health problems among children and adolescents are a worldwide issue of concern. Health professionals who have sufficient competency in mental health issues are crucial for responding to this situation.

AIM

The aim of the study was to describe the competency in mental health issues required by the work of public health nurses in child health clinics and school health services.

METHODS

This qualitative, descriptive study was conducted with focus group interviews in March 2018. The sample consisted of public health nurses (n = 24) who were working in child health clinics or school health services in Finland. The data were analysed using inductive and deductive content analysis.

RESULTS

The competency in mental health issues required by the work of public health nurses was formulated from the identified strengths and topics required in continuing education. In total, 18 competencies were identified as covering mental health promotion, as well as the alleviation and treatment of symptoms and disorders. Intuitive and interpersonal competency was identified as the main strength of public health nurses. The theoretical and evidence-based competency regarding mental health issues was identified as a main topic needed in continuing education.

CONCLUSION

Public health nurses in child health clinics and school health services need competency in mental health issues for the promotion of mental health, the alleviation of symptoms and treatment of disorders. The results indicate that good interactional skills are not enough: the current competency of public health nurses in mental health issues is insufficient and does not meet the requirements of the work. The results were consistent with existing knowledge, but also provide a more comprehensive and precise insight into the current situation. In the future, the results should be verified with more studies. There is also a need for intervention studies aiming to improve competency in mental health issues.

Ten-year changes in the psychosocial well-being, psychopathology, substance use, suicidality, bullying, and sense of coherence of 18-year-old males: a Finnish population-based time-trend study

We studied Finnish 18-year-old males attending obligatory military call-up assessments in 1999 (n = 2340) and 2009 (n = 4309) on time-trend changes in psychosocial well-being, psychopathology, substance use, suicidality, bullying, and sense of coherence. Subjects filled in questionnaires, including the Young Adult Self-Report (YASR) for psychopathology and the Orientation to Life Questionnaire (SOC-13) for sense of coherence. The prevalence of minor mental health problems in the last 6 months decreased from 22.3% in 1999 to 18.6% in 2009 (OR 0.8, 95% CI 0.7-0.9), whereas severe mental health problems remained stable. Suicidal thoughts decreased from 5.7 to 3.7% (OR 0.6, 95% CI 0.5-0.8). The use of illicit drugs decreased from 6.0 to 4.7% (OR 0.8, 95% CI 0.6-0.95), but being drunk at least once a week increased from 10.3 to 13.4% (OR 1.3, 95% CI 1.0-1.5). Attention problems increased in YASR syndrome domains (mean score 2.9 vs 3.2, p < 0.001) and so did somatic complains (mean score 1.7 vs 1.9, p = 0.005). The SOC-13 scores remained stable. The percentage of males who had studied during the past 6 months increased from 91.4 to 93.4% (OR 1.3, 95% CI 1.1-1.6), while being employed decreased from 64.9 to 49.4% (OR 0.5, 95% CI 0.5-0.6). The positive findings included reductions in the prevalence of suicidal thoughts and the use of illicit drugs, but being drunk at least once a week increased. Self-reported somatic problems and attention problems increased. Despite changes in society and family structures, there were only minor overall changes in psychopathology.

Trends in the psychosocial characteristics of 11-15-year-olds who still drink, smoke, take drugs and engage in poly-substance use in England

INTRODUCTION AND AIMS

Youth substance use is declining in many high-income countries. As adolescent substance use becomes less common, it may concentrate in higher-risk groups. This paper aims to examine how the psychosocial characteristics of young substance users in England have changed over time.

DESIGN AND METHODS

Annual cross-sectional data from the 2001-2014 Smoking, Drinking and Drug Use Among Young People in England survey are analysed (n = 112 792, age: 11-15). Logistic and Poisson regression analyses are used to test whether the sex, socioeconomic status (SES) and prevalence of truancy and exclusion from school of those who drink alcohol, smoke cigarettes, take cannabis, take other drugs and engage in poly-substance use changed across the study period.

RESULTS

Use of all substances decreased and there were shifts in the psychosocial characteristics of young smokers, illicit drug users and poly-substance users. The proportion of current smokers and ever-users of cannabis of low SES and who had been excluded increased significantly between 2001/2003-2014. The proportion of last month drug users who had been excluded from school also increased significantly and there were increases in the proportion of polysubstance-users who had truanted and been excluded. The proportion of low SES alcohol users who had been excluded also increased significantly, but this change was very small. There was no evidence of substance use becoming more or less concentrated in one gender.

DISCUSSION AND CONCLUSIONS

There is some evidence that smoking, illicit drug use and poly-substance use are becoming more concentrated in potentially at risk populations. There is limited evidence of concentration amongst young drinkers.

Cross-National Time Trends in Adolescent Mental Well-Being From 2002 to 2018 and the Explanatory Role of Schoolwork Pressure

PURPOSE

Previous research has shown inconsistent time trends in adolescent mental well-being, but potential underlying mechanisms for such trends are yet to be examined. This study investigates cross-national time trends in adolescent mental well-being (psychosomatic health complaints and life satisfaction) in mainly European countries and the extent to which time trends in schoolwork pressure explain these trends.

METHODS

Data from 915,054 adolescents from 36 countries (50.8% girls; mean_age = 13.54; standard deviation_age = 1.63) across five Health Behaviour in School-aged Children surveys (2002, 2006, 2010, 2014, and 2018) were included in the analyses. Hierarchical multilevel models estimated cross-national trends in adolescent mental well-being and schoolwork pressure. We also tested whether schoolwork pressure could explain these trends in mental well-being.

RESULTS

A small linear increase over time in psychosomatic complaints and schoolwork pressure was found. No change in life satisfaction emerged. Furthermore, there was large cross-country variation in the prevalence of, and trends over time in, adolescent mental well-being and schoolwork pressure. Overall, declines in well-being and increases in schoolwork pressure were apparent in the higher income countries. Across countries, the small increase in schoolwork pressure over time partly explained the decline in psychosomatic health complaints.

CONCLUSIONS

Our findings do not provide evidence for substantial declines in mental well-being among adolescents. Yet, the small declines in mental well-being and increases in schoolwork pressure appear to be quite consistent across high-income countries. This calls for the attention of public health professionals and policy-makers. Country differences in trends in both adolescent mental well-being outcomes and schoolwork pressure were considerable, which requires caution regarding the cross-national generalization of national trends.

A growing need for youth mental health services in Canada: examining trends in youth mental health from 2011 to 2018

AIMS

The mental health of youth is continually changing and requires reliable monitoring to ensure that adequate social and economic resources are allocated. This study assessed trends in mental health among Canadian youth, 12-24 years old. Specifically, we examined the prevalence of poor/fair perceived mental health, diagnosis of mood and anxiety disorders, suicidality, perceived stress and sleep problems, substance use, and mental health consultations.

METHODS

Data were collected from eight cycles of the annual Canadian Community Health Survey (2011-2018). Prevalence of mental health outcomes was calculated from each survey, and meta-regression was used to assess trends over time. In the absence of a significant trend over time, the eight cycles were pooled together using meta-analysis techniques to gain precision. Trends in prevalence were assessed for the overall sample of youth (12-24 years) and separately for male and female adolescents (12-18 years) and young adults (19-24 years).

RESULTS

The prevalence of poor/fair perceived mental health, diagnosed mood and anxiety disorders, and past-year mental health consultations increased from 2011 to 2018, most strongly among young adult females. Past-year suicidality increased among young adult females but did not change for other age and sex groups. Notably, the prevalence of binge drinking decreased by 2.4% per year for young adult males, 1.0% for young adult females and 0.7% per year for adolescent males, while staying relatively stable for adolescent females. Prevalence of cannabis use declined among adolescents before legalisation (2011-2017); however, this trend did not persist in 2018. Instead, the 2018 prevalence was 5.6% higher than the 2017 prevalence (16.3 v. 10.7%). The combined prevalence of other illicit drug use was stable at 4.6%; however, cocaine use and hallucinogens increased by approximately 0.2% per year.

CONCLUSIONS

Our findings highlight a growing need for youth mental health services, as indicated by a rise in the prevalence of diagnosed mood and anxiety disorders and past-year mental health consultations. The reason for these observed increases is less apparent - it may represent a true rise in the prevalence of mental illness, or be an artefact of change in diagnostic practices, mental health literacy or diminishing stigma. Nonetheless, the findings indicate a need for the health care system to respond to the rising demand for mental health services among youth.

Bidirectional Relationship of Sleep with Emotional and Behavioral Difficulties: A Five-year Follow-up of Finnish Adolescents

The long-term effects of sleep on adolescent psychosocial well-being are mostly unknown, although insufficient sleep has been associated with emotional and behavioral difficulties in cross-sectional studies. With a five-year follow-up of Finnish adolescents (Time 1: n = 8834; Mean age = 13 years, 51.1% female, Time 2: n = 5315, Mean age = 15 years, 51.6% female, Time 3: n = 3712; Mean age = 17 years; 50.2% female), the purpose of this longitudinal study was to investigate the relations between self-reported sleep duration, sleep problems, and emotional and behavioral difficulties during adolescence. Emotional and behavioral difficulties were assessed using The Strengths and Difficulties Questionnaire (SDQ) measuring emotional symptoms, conduct problems, hyperactivity, peer problems and total difficulties. Sleep duration was calculated by counting the hours between self-reported bedtime and wake-up time. Sleep problems were assessed with a single question about the general sleep problems. According to the cross-lagged models for sleep and emotional and behavioral difficulties, the findings of this study indicate a developmental process during adolescence where, firstly, short sleep duration is a stronger predictor for current and prospective emotional and behavioral difficulties than vice versa. Secondly, increased emotional and behavioral difficulties expose adolescents to current and later sleep problems more strongly than reverse. Thus, the results show that short sleep duration predisposed to emotional and behavioral difficulties across adolescence, which then led to more prospective sleep problems. These findings suggest a developmental process where sleep and emotional and behavioral difficulties are intertwined in shaping adolescents' health.

New Users of Antipsychotics Among Children and Adolescents in 2008-2017: A Nationwide Register Study

INTRODUCTION

Recently, prescribing antipsychotics for children and adolescents has been increasing in many countries. These drugs are often prescribed off-label, although antipsychotics have been associated with adverse effects. We determined the recent incidence of antipsychotic use among children and adolescents in Finland.

METHODS

Finnish National Prescription Register including all Finnish inhabitants receiving reimbursement for pharmaceuticals was searched for subjects of 1 to 17 years of age who had started an antipsychotic drug between January 1, 2008, and December 31, 2017 (n = 26,353). Between 2008 and 2017, the range of number of Finnish children and adolescents aged 1 to 17 years was 1.01 to 1.03 million/year. The incidence was calculated by dividing the number of new users by all age- and sex-matched Finnish inhabitants in the year.

RESULTS

Between 2008 and 2017, the incidence of antipsychotic use among children and adolescents increased from 2.1 to 3.8 per 1000 individuals, respectively. In children aged 7 to 12 years, the incidence of antipsychotic use 1.4-folded (from 1.9 (95% CI: 1.8-2.0) to 2.7 (95% CI: 2.5-2.9) per 1000) with a cumulative increase of 0.2% per year (χ² = 51.0, p < 0.0001). In adolescents aged 13 to 17 years, the incidence 2.2-folded (from 4.3 (95% CI: 4.1-4.5) to 9.4 (95% CI: 9.1-9.8) per 1000) with a cumulative increase of 0.6% per year (χ² = 590.3, p < 0.0001). The increase in the incidence of use was steeper in girls (2.3-fold) than in boys (1.4-fold) (χ² = 85.6, p < 0.0001), especially between 2015 and 2017 (1.6-fold and 1.2-fold, respectively) (χ² = 151.7, p < 0.0001). The year 2011 was the turning point when the incidence in girls exceeded the incidence in boys, and the incidence of quetiapine use exceeded that of risperidone use.

CONCLUSIONS

The incidence of antipsychotic use increased between 2008 and 2017, especially in adolescent girls. The use of quetiapine increased, although it has few official indications in children and adolescents. Future studies should investigate the reasons for increasing use of antipsychotics, especially quetiapine, in children and adolescents.

Time trends in the incidence of diagnosed depression among people aged 5-25 years living in Finland 1995-2012

Background: Knowledge of time trends for depression is important for disease prevention and healthcare planning. Only a few studies have addressed these questions regarding the incidence and cumulative incidence of diagnosed depression from childhood to early adulthood and findings have been inconclusive. Aim: The aim of this national register-based Finnish study was to report the time trends of the age-specific and gender-specific incidence and cumulative incidence of diagnosed depression. Methods: The study sample included all 1,245,502 singletons born in Finland between 1 January 1987 and 31 December 2007 and still living in Finland at the end of 2012. The participants were divided into three cohorts by birth year: 1987-1993, 1994-2000 and 2001-2007. Depression diagnoses (ICD-9: 2961; ICD-10: F32, F33) given in 1995-2012 were available and identified from the Care Register for Health Care. Results: Ten percent of the females and five percent of the males were diagnosed with depression in specialized services by age 25 years. The cumulative incidence of depression by age 15 years rose from 1.8% (95% CI 1.8-1.9) to 2.9% (95% CI 2.8-3.0) in females and from 1.0% (95% CI 1.1-1.2) to 1.6% (95% CI 1.6-1.7) in males when the cohorts born 1987-1993 and 1994-2000 were compared. Conclusions: A larger proportion of young people in Finland are diagnosed with depression in specialized services than before. This can be due to better identification, more positive attitudes to mental health problems and increased availability of the services.

Analysis of the Relationship between Emotional Intelligence, Resilience, and Family Functioning in Adolescents’ Sustainable Use of Alcohol and Tobacco

The use of alcohol and tobacco is related to several variables, which act as risk or protective factors depending on the circumstances. The objectives of this study were to analyze the relationship between emotional intelligence, resilience, and family functioning in adolescent use of alcohol and tobacco, and to find emotional profiles for their use with regard to self-concept. The sample was made up of 317 high school students aged 13 to 18, who filled out the Brief Emotional Intelligence Inventory, the Resilience Scale for Adolescents, the APGAR Scale, the Alcohol Expectancy Questionnaire–Adolescents, and the Five-Factor Self-Concept Questionnaire. The results revealed that emotional intelligence and resilience, specifically stress management and family cohesion, were significant in the group of non-users. Family functioning acts as a predictor for the onset of use of tobacco and alcohol. Positive expectancies about drinking alcohol were found to be a risk factor, and the intrapersonal factor was found to be protective. Both stress management and family cohesion were protective factors against smoking. Furthermore, cluster analysis revealed the emotional profiles for users of both substances based on self-concept. Finally, the importance of the direction of the relationship between the variables studied for intervention in this problem should be mentioned. Responsible use by improving adolescent decision-making is one of the results expected from this type of intervention.

Finnish schoolchildren's perceived health-related quality of life deteriorates remarkably with age

Background

Information on individuals' functioning and disability is needed for numerous purposes in social and health care.

Objective

The purpose of the study was to assess the perceived health-related quality of life of Finnish schoolchildren aged from 7 to 17 years. We were interested to ascertain if changes of health-related quality of life with age could be discovered.

Method

The quality of life data (N = 4,776) were collected using Revidierter KINDer Lebensqualitätsfragebogen (KINDL-R). The survey was conducted in several comprehensive schools using tablet computers. The response rate was 95%. The quality of life data are presented as means and standard deviations. The rating scale was 0 to 100 points.

Results

The mean of respondents' (N = 4,776) health-related quality of life points was 72.1 (SD 11.0). Family as a factor impacting on the quality of life scored the highest points 78.2 (SD 16.1), while self-esteem got the lowest points 62.5 (SD 17.9). Adolescent girls' school-related quality of life points were 60.2 (SD 15.0) and adolescent boys' points were 61.7 (SD 14.4). Lower graders' and upper graders' quality of life differed very significantly so that the ratings of the lower graders were higher than the ratings of the upper graders. Finnish girls' quality of life as a whole was poorer than that of Finnish boys. The physical and emotional welfare as well as the self-esteem of young Finnish girls were poorer than those of their male peers.

Conclusions

The poor well-being of adolescents is recognized and accepted as a development-related phenomenon. Poor health-related quality of life experienced by adolescents may be interpreted as a symptom of a disease. Deterioration in health-related quality of life among adolescents should not be accepted as a development-related factor; that phenomenon should be further investigated and necessary measures taken to improve the quality of adolescent's life.

Cross-cultural, population-based study on adolescent body image and eating distress in Japan and Finland

This cross-sectional population-based survey compares the prevalence of self-reported body image and eating distress symptoms among adolescents in Japan and Finland, and associations between emotional/behavioral problems, body image and eating distress from a cross-cultural perspective. The study included 1,840 Japanese and 1,135 Finnish 8th grade students. The self-reported questionnaire included the Body Image and Eating Distress Scale and Strengths and Difficulties Questionnaire (SDQ). The female adolescents from both Finland and Japan reported much greater dissatisfaction with, and concern about, their bodies than the males and Japanese females expressed even higher distress than Finnish females. High levels of body image and eating distress were associated with psychiatric problems measured with the SDQ. There was a significant three-way interaction effect of body image and eating distress, gender and country with SDQ peer problems and prosocial behavior.