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Background: Mental health disorders are one of the leading causes of the disease burden globally. Aim: The aim of this population-based study was to investigate the relationship between life satisfaction and mental health by taking into account its less studied areas, such as personality disorders and childhood adversities. Methods: The sample of this cross-sectional study was derived from a population-based Kuopio Depression Study performed in Eastern Finland. Health questionnaires were mailed in 1998, 1999, 2001 and 2005 including questions on several clinical factors. Questions on childhood home were asked in 1999. The inclusion criteria for the final study sample in 2005 were based on previously repeatedly (1998, 1999, 2001) reported life satisfaction, depression or alexithymic features (with/without). Psychiatric diagnoses of major depressive disorder and personality disorder were confirmed by structured clinical interview I and II for DSM-IV in 2005. Logistic regression analyses were performed to assess the studied relationships. Results: In general, the broad spectrum of poor mental health indicators was associated with concurrent life dissatisfaction. After multiple adjustments, major depressive disorder (MDD), hopelessness and mental distress remained independent correlates of life dissatisfaction, while personality disorder or self-reported childhood adversities lost their significance when these other factors were included in the model. Conclusions: Mental health is closely interwoven with life satisfaction. Even if personality disorder and childhood adversities were significant correlates of life dissatisfaction, adverse concurrent mental symptoms and features and MDD were its strongest correlates [ABSTRACT FROM AUTHOR]

Abstract: This study investigated the relationship between alexithymia, depressive symptoms, and Youth Self-Report (YSR) self-image profiles among 13 to 18-year-old adolescents (n = 7087) attending school in Kuopio, Finland. The final sample consisted of 3936 adolescents (1801 boys, 2135 girls) who completed structured self-rating questionnaires (Toronto Alexithymia Scale [TAS] 20, Beck Depression Inventory [BDI], and YSR) during class periods at school. The overall prevalence of alexithymia was 7.3%. However, girls in all age groups were more frequently alexithymic than boys. Regardless of sex, alexithymic youths reported more depressive symptoms as well as internalizing and externalizing problems than the others. A YSR total score of more than 70 was recorded among 33.4% of alexithymic compared with 3.7% of nonalexithymic adolescents. The TAS-20 correlated significantly with the BDI score, YSR total score, and with internalizing problems. This study revealed alexithymia among adolescents to be associated with various complications such as depressive symptoms, high scores in YSR problem scales, and difficulties in social relationships. Our findings indicate that these adolescents are at high risk of mental disorders and require treatment interventions. [Copyright &y& Elsevier]

Purpose: Self-cutting as a form of self-harm is common in general population adolescents. The aim of this study was to investigate the prevalence of mental disorders and associated factors among self-cutting community-dwelling adolescents. Methods: A sample of adolescents who reported current self-cutting (n = 80) was drawn from a large sample of community adolescents (n = 4205). Of these 80 individuals, 44 consented to further detailed assessment. An age- and gender-matched control subject was selected for each study subject. Data collection included Structured Clinical Interviews for DSM-IV-TR, the Beck Depression Inventory, the Alcohol Use Disorders Identification Test (AUDIT), and the Youth Self-Report for adolescents aged 11–18 years (YSR). Results: Major depressive disorder (63% vs. 5%), anxiety disorders (37% vs. 12%), and eating disorders (15% vs. 0%) were more common among self-cutting girls (n = 41) than among controls. None of the self-cutting boys (n = 3) had a DSM-IV-TR Axis I mental disorder. In multivariate model, the presence of major depressive disorder, the AUDIT score and the YSR internalizing subscale score were the factors that were independently associated with the presence of self-cutting in girls. Conclusions: Major depressive disorder, signs of alcohol misuse, and internalizing behavior strongly associate with self-cutting in community-dwelling adolescents, especially in girls. [Copyright &y& Elsevier]

Adverse life events or the commencement of adverse lifestyles associate with suicidal ideation, but most associations only have been identified in cross-sectional studies. More information is needed about whether they are true risk factors and independently predict the development of suicidal ideation. A sample of the general population from Eastern Finland ( n = 1,339) was followed-up for three-years with baseline and two follow-up assessments using postal questionnaires. The main adverse life events and changes in lifestyles were screened at baseline and on one- and three-year follow-up. The Beck Depression Inventory was used to assess the level of depression and the presence of suicidal ideation. Suicidal ideation was common in the sample (annual incidence 4.3%). At baseline it associated with a cluster of adverse life events and lifestyles, as well as depression. Nevertheless, only the Beck Depression Inventory score on 3-year follow-up (OR 1.33, 95% CI 1.22–1.45) and the onset of daily smoking during the follow-up period (OR 5.38, 95% CI 1.41–20.62) independently predicted the presence of suicidal ideation on 3-year follow-up among those who had been non-suicidal at baseline and on 1-year follow-up. Depressive mood appears to be a necessary precondition for the occurrence of suicidal ideation even after adverse life events. [ABSTRACT FROM AUTHOR]

Deliberate self-harm has become more prevalent among adolescents. To investigate the prevalence and the associated background factors of self-cutting and other self-harming behaviour. The study sample included 4,205 adolescents aged 13–18 years. Background factors, social relationships, alcohol and substance abuse, self-harm and self-cutting were assessed by a structured questionnaire including the Youth Self Report and Beck Depression Inventory. The life-time prevalence of self-cutting was 11.5% and of other self-harm 10.2%, while the prevalence of current self-cutting was 1.8%. Self-cutting was associated with female gender and a very wide range of adverse psychosocial background variables. Parents living together were an independent protective factor. By contrast, there was no gender difference in the risk of other self-harm. Independent risk factors were depressive mood, somatic complaints, drug abuse, poor school performance and poor family relationships. No protective factors were found for other self-harm. During adolescence, self-cutting and other self-harm are common. Adolescents who have self-cutting or harm themselves have wide-ranging problems in their lives. The specific characteristics of these phenomena need further investigation. [ABSTRACT FROM AUTHOR]

Background: Psychiatric patients have the right to strive for well-being and not only be confined to symptom reduction. Studies are needed to assess global well-being during recovery from depression by comparing the assessments of patients and clinicians.Method: A 6-year natural follow-up of 185 depressive out-patients was carried out with health questionnaires at baseline, 0.5, 1, 2 and 6 years, including scales on depression (BDI, HDRS), general psychopathology (SCL), functional capacity (GAF, SOFAS) and life satisfaction (LS). A structured diagnostic interview was carried out at baseline, 2 and 6 years. Complete follow-up data were obtained from 121 patients.Results: In general, depressive patients mainly attained a normal mood, adequate functional capacity and life satisfaction. Those with a slow recovery improved with successive treatment contacts, eventually reaching levels of mental health not significantly different from the others. Throughout the follow-up, recovery was similarly shown with the self-reported BDI-21, SCL-90 and LS-4, while intercorrelations between clinician ratings were low at baseline.Conclusions: Adequate mental health and global well-being can be reached among depressive patients, but it may take time in treatment. Subjective assessments are reliable. The 4-item life satisfaction scale is a global well-being indicator and a valid treatment outcome measure. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess the dopamine function of the temporal cortex in major depressive disorder using [123I]epidepride to image D2/3 receptor binding sites. Ten major depressives and 10 healthy controls were selected from a general population sample for single-photon emission computed tomography imaging. Among the major depressives there was a strong bilateral correlation between the scores on the 21-item Hamilton Depression Rating Scale and D2/3 receptor binding. Dopaminergic abnormalities may be present in the temporal cortices of major depressives. [ABSTRACT FROM AUTHOR]

Abstract: Objective: There have been no previous general population studies on the stability of dissociative symptoms. The aim of this study was to examine the course of and the changes in dissociative symptoms and factors associated with these changes during a 3-year follow-up of a Finnish general population sample. Methods: The general population sample included a cohort of 1497 subjects. Dissociative symptoms were assessed with the Dissociative Experiences Scale (DES) and the DES-taxon (DES-T). Depressive symptoms and suicidal ideation were measured with the Beck Depression Inventory (BDI). The sample was categorized into low dissociators with DES scores less than 20 and high dissociators with DES scores of 20 or more. Results: At baseline, 98 subjects were high dissociators. On follow-up, 28 of them were still high dissociators, whereas among 70 subjects, the DES score declined below the cutoff score. During the follow-up period, 28 of 1399 subjects became new high dissociators, and constantly low dissociators consisted of 1371 of 1399 subjects. Dissociative taxon membership was detected in 39 subjects either at baseline or at follow-up, but only 4 of them met the criteria at both assessments. Stable high dissociation was associated with an increase in the BDI score on follow-up, baseline suicidal ideation, a younger age, a reduced working ability, and smoking. Risk factors for becoming a new high dissociator were an increase in the BDI score, a younger age at baseline, and a reduced working ability. Among the baseline high dissociators, recovery from high dissociation was associated with a decline in the BDI score at follow-up and with no suicidal thoughts, older age, and a good working ability at baseline. Conclusions: Only a small proportion of the general population had constantly high levels of dissociative symptoms. The stability of dissociative taxon membership was weaker than the stability of the continuous variables of dissociation. The dissociative experiences had a tendency to change, and these changes were associated with changes in the BDI scores. Further studies are needed to reveal the factors associated with the changes in dissociative symptoms. [Copyright &y& Elsevier]

Introduction: Schizophrenia occurs worldwide but the prevalence varies markedly. In Finland, schizophrenia is most prevalent in the northeastern region. Our aims were to reassess the register-, case record- and interview-based lifetime prevalence in a genetically homogeneous birth cohort from an isolate population with earlier reported high prevalence of schizophrenia and a chromosome linkage to chromosome 1q.Methods: We identified all patients with a diagnosis of schizophrenia [International Classification of Diseases (ICD)-8, ICD-9 or ICD-10 codes], born 1940-1969 in the isolate (n=282) and alive (n=237) in 1998 using the Hospital Discharge, Disability Pension and Free Medicine Registers. The corresponding birth cohort of 14,817 persons and 12,368 alive in 1998 was identified from the National Population Register. We validated 69% of the register diagnosis by making DSM-IV consensus diagnoses, and interviewed 131 (55%) of the 237 patients with SCID-I and SCID-II.Results: The register-based lifetime prevalence was 1.5% for schizophrenia and 1.9% for schizophrenia spectrum psychotic disorders: in birth cohorts born 1945 to 1959, the latter prevalence was especially high (2.4%). Of those with a register diagnosis of schizophrenia spectrum psychotic disorder, 69% or 63% also received a record-based consensus diagnosis or SCID interview diagnosis of schizophrenia, and the prevalence was 0.9-1.3 and 0.7-1.2%, respectively, when we reassessed most of the register-based cases. The cumulative incidence of schizophrenia spectrum psychotic disorders in the total birth cohort was 1.9%.Conclusion: In this isolate, the register, DSM-IV consensus and SCID interview-based lifetime prevalence of schizophrenia was internationally high. For genetic research work, the register diagnosis should be reassessed using either structured interview or the best estimate consensus diagnosis. [ABSTRACT FROM AUTHOR]

Background: Several cross-sectional studies have focused on the low blood folate levels of depressive patients. Nevertheless, no prospective studies have been published on the association between dietary folate and depression.Methods: We studied the association between dietary folate and cobalamin and receiving a discharge diagnosis of depression in a prospective follow-up setting. Our cohort was recruited between 1984 and 1989 and followed until the end of 2000, and it consisted of 2,313 men aged between 42 and 60 years from eastern Finland.Results: The mean intake of folate in the whole cohort was 256 microg/day (SD=76). Those below the median of energy-adjusted folate intake had higher risk of getting discharge diagnosis of depression (RR 3.04, 95% CI: 1.58, 5.86) during the follow-up period than those who had a folate intake above the median. This excess risk remained significant after adjustment for current socioeconomic status, the baseline HPL depression score, the energy-adjusted daily intake of fibre and vitamin C, and the total fat intake.Conclusions: A low dietary intake of folate may be a risk factor for severe depression. This also indicates that nutrition may have a role in the prevention of depression. [ABSTRACT FROM AUTHOR]

Background: Despite of an increasing body of research the associations between vitamin B12 and folate levels and the treatment outcome in depressive disorders are still unsolved. We therefore conducted this naturalistic prospective follow-up study. Our aim was to determine whether there were any associations between the vitamin B12 and folate level and the six-month treatment outcome in patients with major depressive disorder. Because vitamin B12 and folate deficiency may result in changes in haematological indices, including mean corpuscular volume, red blood cell count and hematocrit, we also examined whether these indices were associated with the treatment outcome. Methods: Haematological indices, erythrocyte folate and serum vitamin B12 levels were determined in 115 outpatients with DSM-III-R major depressive disorder at baseline and serum vitamin B12 level again on six-month follow-up. The 17-item Hamilton Depression Rating Scale was also compiled, respectively. In the statistical analysis we used chi-squared test, Pearson's correlation coefficient, the Student's t-test, analysis of variance (ANOVA), and univariate and multivariate linear regression analysis. Results: Higher vitamin B12 levels significantly associated with a better outcome. The association between the folate level and treatment outcome was weak and probably not independent. No relationship was found between haematological indices and the six-month outcome. Conclusion: The vitamin B12 level and the probability of recovery from major depression may be positively associated. Nevertheless, further studies are suggested to confirm this finding. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate mental health and social isolation in surviving family members (n=56) 10 years after a suicide as compared to sex and age matched general population controls. Minor mental disorders were more common among suicide survivors than among general population controls (30% vs. 16%), especially in surviving spouses (39% vs. 11%). Suicide survivors had fewer close friends than their controls. According to multivariate logistic regression analyses adjusted for several socioeconomic factors and the number of close friends, surviving spouses, but not relatives by blood, had a significantly increased risk of having minor mental disorder as compared to general population controls. Our conclusion is that suicide may be associated with mental symptoms and lack of social relationships in surviving spouses even 10 years later. [ABSTRACT FROM AUTHOR]

Aims: To investigate urban-rural differences in male suicide mortality between 1988 and 1997 in the province of Kuopio in eastern Finland. Methods: Male suicide mortality between 1988 and 1997 was studied in eastern Finland. The data were collected from official autopsy reports. Age, marital status, household type, place of death, method of suicide and the region within the county were analysed. Results: The age-adjusted male suicide mortality remained quite constant at 67 and 65/100,000 (> 15 years of age) in 1988 and 1997, respectively. In urban areas, a decline in suicide rates was noted in all age groups of men, whereas in rural areas, after an initial decline, a marked increase took place during the last years of the study period, especially among middle-aged and elderly men. This coincided with the time of recovery from an economic recession in Finland that particularly affected rural areas. Conclusion: Male suicide mortality may be regionally diverging in Finland. [ABSTRACT FROM AUTHOR]

Objective - To investigate whether depression was associated with cardiac status and socio-demographic factors in patients with coronary heart disease (CHD). Methods - The sample consisted of 144 symptomatic patients with CHD. For screening depression the Beck Depression Inventory was administered on the day before elective coronary angiography. Results - Twenty-four per cent of patients had probable depressive disorder, but none of them had been previously identified as suffering from depression, or been treated for depression. Alexithymia and dissatisfaction with life were common in depressed patients. Logistic regression analysis showed that neither the cardiac status nor sociodemographic factors were associated with depression. Conclusion - Depression is a common finding and should be looked for independently of other risk factors in patients with CHD. [ABSTRACT FROM AUTHOR]

Discusses several issues related to psychiatry. Association of leptin with alcohol craving; Analysis of age at onset in bipolar I affective disorder; Relationship between fish consumption and risk of depression.

The aim of this study was to investigate the prevalence of mental disorder and associated factors during an economic recession. Random samples of Finnish general population were collected in 3 consecutive years, 1993-95. The prevalence of mental disorders was assessed by means of the 12-item General Health Questionnaire (GHQ). The prevalence of mental disorders varied among Finnish men from 15.6% to 19.2% and among women from 21 to 24.5%. Mental disorder was more common among women than among men in every study year. Mental disorder was more common among the unemployed than among other respondents both in women and men in every year. Subjective poor health, suicidal thoughts and poor economic situation were constantly associated with mental disorder in both sexes every year. Using logistic regression analyses, problems with a partner, uncertain future orientation and use of psychoactive drugs, in particular, were found to be fairly permanent independent risk factors in relation to mental disorder. As studied by gender no major changes occurred in the mental health status of Finns during economic recession, although in many specific groups mental disorder was markedly more common than in the general population. [ABSTRACT FROM AUTHOR]

This is a study on associations between suicide mortality, unemployment, divorce rate and mean alcohol consumption during an economic cycle in Finland, from 1985 to 1995. Data on annual suicide mortality, gross domestic product, unemployment, divorce rate and mean alcohol consumption were collected from official Finnish statistics. Regression analyses using a correction for serial autocorrelation were performed. Suicide mortality in both males and females increased during an economic upswing from 1985 to 1990, and decreased during an economic recession from 1990 to 1995. Suicide mortality was not associated with unemployment or divorce rate. These results are opposed to those of many previous studies. However, a significant association was found between male suicide mortality and mean alcohol consumption, in accord with other studies. In conclusion, the results suggest diversity in associations between suicide mortality, socio-economic factors and alcohol consumption. [ABSTRACT FROM AUTHOR]

This study investigated the association between the quality of marriage as manifested by subjective happiness and common mental disorders in a national sample of the Finnish population. Mental disorders were screened by means of the 12-item General Health Questionnaire. Marriage per se was not found to be associated with common mental disorders. However, men in general, but not those in an unhappy marriage, suffered from mental disorders less frequently than did women. Men and women who were unhappy in their marriages suffered from common mental disorders more often than others who were not. Both men and women in unhappy marriages were found to be at significantly higher risk of common mental disorders as compared with the unmarried and to those in a happy marriage, after adjusting for several confounding factors. [ABSTRACT FROM AUTHOR]

The present study examined the relationship between smoking and depression among patients with different psychiatric diagnoses according to DSM-III-R criteria. The study sample of 1217 consecutive in- and outpatients, treated at the Department of Psychiatry, Kuopio University Hospital, in eastern Finland, was interviewed with two sets of questions during May 1993. The prevalence of smoking was higher among severely depressive than among mildly or moderately depressive patients in all diagnostic categories, except in male schizophrenics. However, this difference in rate of smoking was statistically significant only among men with major depression and women with personality disorder. The best determinants of severe depression in a multiple logistic model were diagnosis of major depression, personality disorder, and dysthymia. According to the model, current smokers had a 40% higher risk of severe depression than nonsmokers. Because both smoking and depression are major public health problems, the observed association deserves more thorough research, especially by psychiatric specialists. [ABSTRACT FROM AUTHOR]

Five suicides committed within a day of discharge from a psychiatric hospital between 1991 and 1994 in the province of Kuopio, Finland, are described. The suicides occurred when psychiatric services in the region were being reorganized and when there also was great pressure for reductions in the number of psychiatric beds and for changes in the nature of psychiatric inpatient treatment. Common to all cases was a possible neglect of individual clinical assessment and consequent underestimation of the severity of the patients' symptoms. The case histories also suggest that internal and external pressures on treatment communities and staff can result in problems relating to basic clinical tasks. Careful individual examination and appropriate treatment based on the results of such examination continue to be of the utmost importance in preventing suicides among psychiatric patients. [ABSTRACT FROM AUTHOR]

Postpartum depression (PPD) is detrimental to the mother and the family as a whole. Early initiation of appropriate treatment is important. The aim of this pilot study was to evaluate the efficacy and adverse effects of oestradiol treatment. We performed a pilot double-blind, randomized, placebo-controlled study. Major depression was diagnosed using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), and the severity of depression was evaluated using the Edinburgh Postnatal Depression Scale (EPDS). The duration of treatment with sublingual oestradiol hemihydrate (1–3 mg/day) was 12 weeks. The treatment group consisted of 16 mothers and the placebo group of 14 mothers. Thirteen mothers in the treatment group and ten in the placebo group recovered from depression during the treatment period as measured with the EPDS (<10). There was no evidence to suggest that oestradiol was more effective than placebo. More mothers in the treatment group than in the placebo group (eight vs. one) received gestagen treatment for irregular bleeding. Oestradiol did not disturb breastfeeding. The mean number of other adverse effects per mother was lower in the treatment group, and these were mostly somatic symptoms. Our findings warrant further studies on oestrogen therapy for PPD with and without antidepressant and gestagen therapy, and on adverse effects (including effects on vaginal bleeding and breastfeeding). [ABSTRACT FROM AUTHOR]

Objective: Pain is known to be a major factor decreasing the quality of life in the elderly¹. Yet, the overall consensus among professionals has for long highlighted under-assessment and undertreatment/mistreatment of persistent pain in the elderly². The aim of this public-based study was to examine Finnish seniors' selfreported pain severity and interference and their association with demographic factors, life habits, obesity and morbidity. Methods: This cross-sectional sub-study of the Good Ageing in Lahti region (GOAL) cohort study, in which questionnaire-provided data from aged citizens were collected in a 10-year follow up (2002-2012), focused on the end-point data from year 2012. 1420 seniors aged 62-86 years answered questions regarding intensity and interference of experienced pain during the previous month. Additional questionnaire-provided, clinical and blood sample data were scrutinized. Results: Over three of four seniors had reported endured pain. Four groups were formed based on both pain intensity and interference (group I [moderate to very severe pain, moderate to extreme harm caused by pain] - group IV [no pain at all, no harm at all]). Cohabiting was reported 12 percentage points more likely in group IV vs. in group I. Years of education and household income were significantly the lowest in group I. Obesity (especially BMI over 30 and wide waist circumference), diagnosed psychiatric illnesses and depressive symptoms markedly increased with pain. Conclusions: Low socio-economic status, obesity and depression were found to independently associate with pain. Increasing attention should be paid to pain prevention, assessment and management considering these risk groups. [ABSTRACT FROM AUTHOR]

Background: Dietary habits have a great influence on physiological health. Even though this fact is generally recognized, people do not eat as healthily as they know they should. The factors that support a healthy diet, on the other hand, are not well known. It is supposed that there is a link between personal traits and dietary habits. Personal traits may also partially explain why some people manage to make healthy dietary changes while some fail to do so or are not able to try to make changes even when they desire to do so. There is some information suggesting that dispositional optimism plays a role in succeeding in improving dietary habits. The aim of this study was to determine the role of optimism and pessimism in the process of dietary changes.Methods: Dispositional optimism and pessimism were determined using the revised Life Orientation Test in 2815 individuals (aged 52-76 years) participating in the GOAL study in the region of Lahti, Finland. The dietary habits of the study subjects were analysed. After 3 years, the subjects' dietary habits and their possible improvements were registered. The associations between dispositional optimism and pessimism, dietary habits at baseline, and possible changes in dietary habits during the follow-up were studied with logistic regression. We also studied if the dietary habits or certain lifestyle factors (e.g. physical exercising and smoking) at baseline predicted success in improving the diet.Results: Pessimism seemed to correlate clearly negatively with the healthiness of the dietary habits at baseline - i.e. the higher the level of pessimism, the unhealthier the diet. Optimism also showed a correlation with dietary habits at baseline, although to a lesser extent. Those who managed to improve their dietary habits during follow-up or regarded their dietary habits as healthy enough even without a change were less pessimistic at baseline than those who failed in their attempts to improve their diet or did not even try, even when they recognized the need for a change.Conclusions: Pessimistic people are more likely to eat an unhealthy diet than others. Pessimism reduces independently the possibilities to improve dietary patterns. [ABSTRACT FROM AUTHOR]

Objectives: To explore myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) patients' experiences of a health psychological group intervention and its usefulness, non‐usefulness or harmfulness for illness management and adjustment. Design: A qualitative longitudinal study using inductive content analysis. Methods: Semistructured interviews were conducted with 10 adults. Interviews were conducted before the 16‐week intervention, immediately after its completion, and at 3 months after completion. Results: Participants reported that the intervention was useful and not harmful. The model improved their ability to cope with ME/CFS by providing them with useful information about the illness along with peer support and professional guidance. Participants reported improved illness management and adjustment, which they perceived as an outcome of achieving new ways of thinking, feeling and acting. Conclusions: Participants viewed the health psychological approach to group intervention as meeting their needs. To achieve better illness management and adjustment, more consideration should be given to supportive interactional processes with peers and healthcare professionals. Patient or Public Contribution: The intervention was developed to meet patients' needs of finding ways to manage their illness. The research team consulted eight patients with ME/CFS and three clinical centres working with ME/CFS treatment and rehabilitation at the intervention planning stage. Their comments influenced the planning and content of the intervention as well as ethical issues that should be considered, such as potential harm to participants. All participants were informed about the theoretical foundations of the study and the principles guiding the intervention. Participants were not involved in the data analysis. Clinical Trial Registration: NCT04151693 [ABSTRACT FROM AUTHOR]

Objective: With the intention of understanding the dynamics of psychiatric interviews, we investigated the usual (DSM/ICD-based) psychiatric assessment process and an alternative assessment process based on a case formulation method. We compared the two different approaches in terms of the clinicians' practices for offering patients opportunities to reveal their subjective experiences.Methods: Using qualitative and quantitative applications of conversation analysis, we compared patient-clinician interaction in five usual psychiatric assessments (AAU) with five assessment interviews based on dialogical sequence analysis (DSA).Results: The frequency of conversational sequences where the patient described his/her problematic experiences was higher in the DSA interviews than in the AAU interviews. In DSA, the clinicians typically facilitated the patient's subjective experience talk by experience-focused questions and formulations, whereas in AAU, such talk typically occurred in environments where the clinicians' questions and formulations focused on non-experiential, medical matters.Conclusion: Interaction in DSA was organized to provide for the patient's experience-focused talk, whereas in AAU, the patient needed to go against the conversational grain to produce such talk.Practice Implications: By facilitating patients' opportunities to uncover subjective experiences, it is possible to promote their individualized care planning in psychiatry. [ABSTRACT FROM AUTHOR]

Investigates the prevalence and risk of common mental disorders in Finland during an upswing in the national economy. Compilation of study material through telephone interviews; Use of the general health questionnaire to screen for the presence of mental symptoms; Increase in the prevalence of mental disorders in accordance with unemployment rate.

Bullying victimization is experienced by more than 10% of children and adolescents worldwide and has been associated with numerous negative mental health consequences, such as depression and dissociation. We investigated the association between bullying victimization and self-cutting in a Finnish adolescent population and whether depression and dissociation act as mediators in this association. We used cross-sectional questionnaire data from Finnish students (age 13–18; N = 3345; boys n = 1454; girls n = 1891). Logistic regression and mediation analyses were performed. Bullying victimized adolescents were younger, more likely to be afraid to go to school, had fewer friends, felt lonelier, and had a poorer relationship with family members, as well as higher level of depressive and dissociative symptoms compared to non-bullied adolescents. According to logistic regression analysis, the association between bullying and self-cutting remained significant despite all other adjustments besides those for depressive symptoms. In serial mediation analysis, depressive and dissociative symptoms mediated the effect of bullying victimization on self-cutting, regardless of their order in the model. Self-cutting is more common among bullying victimized adolescents than their peers. The association is mediated by depressive and dissociative symptoms. More studies are needed to clarify the exact mechanisms via which depressive and dissociative symptoms interact with the association between bullying and self-harm. [ABSTRACT FROM AUTHOR]

Background Disorganized speech, manifested as derailment, tangentiality, incoherence and loss of goal, occurs commonly in schizophrenia. Studies of language processing have demonstrated that semantic activation in schizophrenia is often disordered and, moreover, the ability to use contextual cues is impaired. Aims To reconstruct the origins and most plausible intended meanings of disorganized discourse sequences in a clinical interview with a patient with thought-disordered schizophrenia. Methods & Procedures We assessed the so-called pragmatic felicity of every turn using a novel tool called the Overall Comprehensibility of Turn (OCT) Scale. In addition to felicity analysis, all topics and referents of turns were registered. Three most disorganized discourse sequences from the transcribed interview were chosen for the thematic and semantic analysis, in which we attempted to reconstruct the structure and meaning of those sequences utilizing (1) the notion of discourse model extending up to contextual background knowledge, (2) the (re)occurrence of topical items, together with (3) the knowledge from findings of disordered semantic activation in schizophrenia. Outcomes & Results The linguistic analyses showed that the disrupted sequences were characterized by (1) unexpected, seemingly irrelevant topic intrusion, (2) pragmatically inappropriate chain of topic extensions, and (3) fuzzy reference together with disturbed ordering of propositions. The underlying causes seemed to be, respectively, (1) long-term semantic activation of topics, which popped out sporadically along the conversation, (2) overreliance on lexical-semantic associations, and (3) the inability to sequence the utterances and link them together using explicit or implicit bridging assumptions necessary to a coherent and cohesive message. All scrutinized passages violated the expectations of the addressee in on-line conversation. However, the post-hoc analysis showed that they contained items which were relevant to the global topic. Conclusions & Implications Latent sources, motivations and even meanings, at least to some extent, of seemingly disorganized utterances can become analysable through linguistic analyses. The results suggest that continuity in the treatment is essential, because a practitioner who shares background knowledge with the patient has better opportunities to capture the relevance of the superficially disorganized utterances. Moreover, especially the most disorganized sequences should warrant thorough attention because they can convey, beneath their unexpected or obscure surface structure, items which are psychologically important to the patient. The results of this study should be taken into account in the training of interactional skills of professionals who work with schizophrenia patients. [ABSTRACT FROM AUTHOR]

Abstract: Findings on the association between dissociation and alexithymia in adult populations are inconsistent. Dissociation has also been related to other types of psychopathology. Few studies have been published on these connections among adolescents. We examined the association between Adolescent Dissociative Experiences Scale (A-DES) scores and those for the Toronto Alexithymia Scale (TAS), the 21-item Beck Depression Inventory (BDI-21) and the Youth Self-Report (YSR), as well as subscales of the TAS and the YSR, in a sample of Finnish adolescents aged 13 to 18 years (n =4019). Factor analysis suggested that dissociation can be considered distinctive from other psychopathology. A-DES scores, however, associated strongly with several other scales and subscales measuring psychiatric symptoms. In logistic regression models the strongest associations were observable between the A-DES and TAS subscale ‘difficulty identifying feelings’ (DIF) and the YSR subscale ‘thought problems’. Thus, dissociation and alexithymia can be considered distinctive but overlapping phenomena. [Copyright &y& Elsevier]

Background: The aims of this study were to investigate the stability of alexithymia from adolescence to young adulthood, as well as the association between alexithymia, peer relationships, and symptoms of depression and dissociation.Methods: The participants (n = 755, aged 13-18 years) were assessed with self-rated questionnaires and the 20-item Toronto Alexithymia Scale (TAS-20) at baseline in 2005 and on follow-up in 2011.Results: The changes in the TAS-20 total score (t = -12.26) and the scores for its subscales, difficulty identifying feelings (DIF) (t = -4.04), difficulty describing feelings (DDF) (t = -5.10), and externally oriented thinking (EOT) (t = -18.23), were statistically significant (p < 0.001). Effect sizes (Cohen's d) for the change indicating absolute stability were small for DIF (-0.15) and DDF (-0.19), medium for TAS-20 total (-0.45), and large for EOT (-0.66) scores. Moderate correlations in test-retests with Spearman's ρ (TAS-20 total 0.46, DIF 0.41, DDF 0.39, EOT 0.43) indicated relative stability, whereas low intraclass correlation coefficients (ICCs) (respectively 0.41, 0.39, 0.37, 0.37) indicated poor reliability of test-retests. In regression analyses, poor relationships with peers, loneliness, and symptoms of depression and dissociation at baseline associated with alexithymia at baseline and on follow-up. Unlike EOT, increases in the TAS-20 total, DIF, and DDF scores during the 6-year follow-up associated with baseline symptoms of depression and dissociation.Conclusions: Alexithymia in adolescence is not always a reliable predictor of alexithymia in young adulthood. Mental health symptoms appear to affect the consistency of alexithymia during adolescent development. [ABSTRACT FROM AUTHOR]

Self-cutting is common among adolescents. However, studies examining protective factors are rare. It has been suggested that social support may protect against self-cutting in adolescence. The aim of this study was to investigate the possible association of social relationships with the initiation of self-cutting. Methods: The participants were community-dwelling Finnish adolescents (N = 4171) aged 13-18 years at baseline. The follow-up assessment was conducted 5 years later (N = 794). Those adolescents who had self-cut before the baseline assessment (N = 134) were excluded from the analysis, leaving a total of 660 participants to be analyzed. In this group, 37 adolescents initiated self-cutting during the 5-year follow-up period and 623 did not. Cox's proportional hazards models were used with several adjustments for possible confounding factors. Findings: A higher age, male gender, good relationships with siblings, weekly meetings with friends, and personal experience of not being lonely associated with the noninitiation of self-cutting during the follow-up period. Good relationships with parents or peers had no association with the initiation of self-cutting. Depressive symptoms mediated the effect of subjective loneliness on initiating self-cutting. Conclusions: Social support produced by friends may have a protective effect against self-cutting. [ABSTRACT FROM AUTHOR]

Background: Pain is a frequent and inevitable factor affecting the quality of life among older people. Several studies have highlighted the ineffectiveness of treating chronic pain among the aged population, and little is known about the prevalence of analgesics administration among community-dwelling older adults. The objective was to examine older adults' prescription analgesic purchases in relation to SF-36 pain in a population-based setting.Methods: One thousand four hundred twenty community-dwelling citizens aged 62-86 years self-reported SF-36 bodily pain (pain intensity and pain-related interference) scores for the previous 4 weeks. The Social Insurance Institution of Finland register data on analgesic purchases for 6 months prior to and 6 months after the questionnaire data collection were considered. Special interest was focused on factors related to opioid purchases.Results: Of all participants, 84% had purchased prescription analgesics during 1 year. NSAIDs were most frequently purchased (77%), while 41% had purchased paracetamol, 32% opioids, 17% gabapentinoids, and 7% tricyclic antidepressants. Age made no marked difference in purchasing prevalence. The number of morbidities was independently associated with analgesic purchases in all subjects and metabolic syndrome also with opioid purchases in subjects who had not reported any pain.Discussion: Substantial NSAID and opioid purchases emerged. The importance of proper pain assessment and individual deliberation in terms of analgesic contraindications and pain quality, as well as non-pharmacological pain management, need to be highlighted in order to optimize older adults' pain management. [ABSTRACT FROM AUTHOR]

Diagnosis is integral part of the way medicine organises illness: it is important for identifying treatment options, predicting outcomes and providing an explanatory framework for clinicians. Previous research has shown that during a medical visit not only the clinician but also patients provide explanations for the causes of their symptoms and health problems. Patients’ lifeworld explanations are often differentiated from the diagnostic explanations provided by clinicians. However, while previous conversation analytic research has elaborated the ways in which diagnostic and lifeworld explanations are interactionally structured in somatic medicine, there is little research on how these explanations are organised in psychiatry. Psychiatric diagnosis is particularly interesting because in mental disorders illness itself is not determined by any objective measurement. Understanding of the patient's problem is constructed in interaction between the patient and clinician. The focus of this research will be patients ' references to diagnosis in psychiatry and the functions of these references. The findings are based on conversation analysis of 29 audio-recorded diagnostic interviews in a psychiatric outpatient clinic. Our results demonstrate that patients can utilise diagnostic categories in several ways: disavowing a category to distance their symptoms from it, accounting for their life experiences being rooted in psychiatric illnesses and explaining their illnesses as being caused by certain life experiences. We argue that these explanations are important in patients' face-work – in constructing and maintaining a coherent and meaningful view of the patient's self. [ABSTRACT FROM AUTHOR]

Background. The prevalence of somatic, mental and behavioural problems increases in puberty. Nevertheless, compared to adults, health service utilization by adolescents, and associated factors such as risky health behaviours, have been poorly explored. In order to improve health care services, there is a need for further research on adolescents frequently using primary health care. Objectives. We aimed to investigate adolescents who seek help for health issues, and examine whether particular socio-economic or psychological factors predict frequent primary health care use. Methods. Finnish adolescents aged 13-18 years (N = 793) attending comprehensive, upper secondary and vocational schools participated in the study in 2005. Data were collected using a questionnaire that included the Youth Self Report (YSR), as well as questions on the psychosocial background of the adolescents and substance use. Data regarding the frequency of use of health services were gathered from medical records of the local public health care services. Results. Altogether, 288 in the sample had used primary health care services making a combined total of 1411 health care visits. Female gender associated with frequent primary health care use. Furthermore, a high level of alcohol consumption and mental health symptoms in girls, and increased self-reported somatic complaints in the YSR in boys were associated with frequent primary health care use. Attending upper secondary school was related to less frequent primary health care use. Conclusion. Few adolescents frequently use primary health care, but they account for a considerable proportion of all adolescent health care visits. There are higher levels of alcohol consumption, as well as socio-economic, educational and gender differences among adolescent frequent primary health care users. [ABSTRACT FROM AUTHOR]