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Kirja-arvio teoksesta Tomi Bergström, Mieletön häiriö. Psykiatrian ongelma ja sen ratkaisu. PS-Kustannus. 223 s.

Dysconnectivity of large-scale brain networks has been linked to major depression disorder (MDD) during resting state. Recent researches show that the temporal evolution of brain networks regulated by oscillations reveals novel mechanisms and neural characteristics of MDD. Our study applied a novel coupled tensor decomposition model to investigate the dysconnectivity networks characterized by spatio-temporal-spectral modes of covariation in MDD using resting electroencephalography. The phase lag index is used to calculate the functional connectivity within each time window at each frequency bin. Then, two adjacency tensors with the dimension of time frequency connectivity subject are constructed for the healthy group and the major depression group. We assume that the two groups share the same features for group similarity and retain individual characteristics for group differences. Considering that the constructed tensors are nonnegative and the components in spectral and adjacency modes are partially consistent among the two groups, we formulate a double-coupled nonnegative tensor decomposition model. To reduce computational complexity, we introduce the lowrank approximation. Then, the fast hierarchical alternative least squares algorithm is applied for model optimization. After clustering analysis, we summarize four oscillatory networks characterizing the healthy group and four oscillatory networks characterizing the major depression group, respectively. The proposed model may reveal novel mechanisms of pathoconnectomics in MDD during rest, and it can be easily extended to other psychiatric disorders. peerReviewed

School grades in adolescence have been linked to later psychiatric outcomes, but large-scale nationwide studies across the spectrum of mental disorders are scarce. In the present study, we examined the risk of a wide array of mental disorders in adulthood, as well as the risk of comorbidity, associated with school achievement in adolescence. We used population-based cohort data comprising all individuals born in Finland over the period 1980–2000 (N = 1,070,880) who were followed from age 15 or 16 until a diagnosis of mental disorder, emigration, death, or December 2017, whichever came first. Final grade average from comprehensive school was the exposure, and the first diagnosed mental disorder in a secondary healthcare setting was the outcome. The risks were assessed with Cox proportional hazards models, stratified Cox proportional hazard models within strata of full-siblings, and multinomial regression models. The cumulative incidence of mental disorders was estimated using competing risks regression. Better school achievement was associated with a smaller risk of all subsequent mental disorders and comorbidity, except for eating disorders, where better school achievement was associated with a higher risk. The largest associations were observed between school achievement and substance use disorders. Overall, individuals with school achievement more than two standard deviations below average had an absolute risk of 39.6% of a later mental disorder diagnosis. By contrast, for individuals with school achievement more than two standard deviations above average, the absolute risk of a later mental disorder diagnosis was 15.7%. The results show that the largest mental health burden accumulates among those with the poorest school achievement in adolescence.

BackgroundA study was undertaken to examine the association between multiple indicators of socioeconomic position (SEP) at the age of 30 and the subsequent risk of the most common mental disorders.MethodsAll persons born in Finland between 1966 and 1986 who were alive and living in Finland at the end of the year when they turned 30 were included. Educational attainment, employment status and personal total income were used as the alternative measures of SEP. Cox proportional hazards models were used to examine the association of SEP at the age of 30 with later risk of mental disorders. Additional analyses were conducted using a sibling design to account for otherwise unobserved shared family characteristics. Competing risks models were used to estimate absolute risks.ResultsThe study population included 1 268 768 persons, 26% of whom were later diagnosed with a mental disorder. Lower SEP at age 30 was consistently associated with a higher risk of being later diagnosed with a mental disorder, even after accounting for shared family characteristics and prior history of a mental disorder. Diagnosis-specific analyses showed that the associations were considerably stronger when substance misuse or schizophrenia spectrum disorders were used as an outcome. Absolute risk analyses showed that, by the age of 52 years, 58% of persons who had low educational attainment at the age of 30 were later diagnosed with a mental disorder.ConclusionsPoor SEP at the age of 30 is associated with an increased risk of being later diagnosed with a mental disorder.

Introduction: Relatively little is known about individual differences in adolescent psychological flexibility and its associations with symptoms of stress and depression. This study examined different profiles of adolescent stress and depressive symptoms and their associations with developing psychological flexibility before the critical educational transition. Methods: The data were derived from a general sample of 740 Finnish ninth-grade adolescents (Mage = 15.7 years, 57% female) who were assessed twice during the final grade of their basic education. The data were analyzed using growth mixture modeling. Results: Four profiles of stress and depressive symptoms were identified during a school year: 1) no stress and no depressive symptoms (None; 69%); 2) mild and decreasing stress and depressive symptoms (Decreasing; 15%); 3) low but increasing stress and depressive symptoms (Increasing; 6%); and 4) high and stable levels of stress and depressive symptoms (High; 10%). The adolescents in these profiles differed from each other in their initial levels and changes of psychological flexibility. The initial level of psychological flexibility was highest in the no-symptom profile group. We observed simultaneous change trends in symptoms and psychological flexibility during a school year. When symptoms decreased, psychological flexibility increased, and when symptoms increased, psychological flexibility decreased. Conclusions: A bidirectional pattern of relationships between psychological flexibility and psychological symptoms was found. Despite initially high level of skills in psychological flexibility, some adolescents, unexpectedly, experienced increased symptoms of stress and depression during the school year. The results call for further studies to explore in-depth the developmental diversity in adolescents’ well-being and its antecedents. peerReviewed

Tässä julkaisussa esitän kokonaisvaltaisen mielen hyvinvoinnin määritelmän, jota olemme empiirisesti testanneet Lapsesta aikuiseksi -pitkittäistutkimuksen aikuisikäisillä osanottajilla (Kokko ym. 2013). Kokonaisvaltaisen mielen hyvinvoinnin määritelmässä huomioidaan mielen hyvinvoinnin myönteiset ulottuvuudet. nonPeerReviewed

Kulttuurin diagnostisoituminen on diskursiivinen ilmiö ja prosessi, jossa lähtökohtaisesti lääketieteen taudinmääritteiksi tarkoitetut ja spesifit diagnoosinimikkeet saavat yhä keskeisemmän sijan kulttuurissa. Erityisesti tämä näkyy psykiatristen ja neuropsykiatristen diagnoosien leviämisenä psykiatrian ja lääketieteen piiristä osaksi muuta kulttuuria. Kulttuuri puolestaan hahmottuu tässä yhteydessä kulttuurintutkimuksen piirissä kehitettyjen kulttuuriteorioiden mukaisesti merkityksenannon järjestelmäksi. Tätä kulttuurin diagnostisoitumisen ilmiötä analysoidaan monilla humanistisilla ja yhteiskuntatieteellisillä aloilla. Tässä kirjan luvussa saatetaan yhteen aiemman tutkimuksen havaintoja ja katsotaan niitä kulttuuriteoreettisesti orientoituneen tutkimuksen näkökulmasta. Pyrkimyksenä on jäsentää, millaisiin käsitteellistyksiin ja teoreettis-metodologisiin lähtökohtiin kulttuurisesti ja erityisesti kulttuuriteoreettisesti orientoitunut, kulttuurin diagnostisoitumista kriittisesti lähestyvä tutkimus pohjaa. peerReviewed

Tässä Pro Gradu -tutkielmassa tarkastelen, millaisia tulkintarepertuaareja hyödyntäen mielenterveysongelmien ja työnhaun välistä kenttää merkityksellistetään yhdellä suomalaisella Klubitalolla. Tutkimuksen Aineisto on peräisin Suomen Akatemian ja Helsingin yliopiston rahoittamasta VOIS-hankkeesta (2017-2021), jossa tutkittiin mielenterveyskuntoutujien osallisuuden mahdollisuuksia. Käytän analyysimenetelmänä diskurssianalyysia, jonka avulla tarkastelin siirtymätyönhakuun liittyvien tapaamisten keskusteluja. Aiemman tutkimuksen pohjalta mielenterveysongelmat näyttäytyvät työmaailmassa stigmatisoituna aiheena, jonka synnyttämiä ongelmia on vasta hiljattain alettu huomaamaan. Mielenterveysongelmia omaavat yksilöt erotetaan muista ja siten heihin kohdistetaan eri odotuksia ja asenteita kuin muita kohtaan. Työnantajat eivät mielellään palkkaa mielenterveysongelmia omaavia työnhakijoita peläten heidän osoittautuvan jollain tapaa epäpäteviksi tai epätehokkaiksi. Samanaikaisesti työ esitetään vastuullisen kansalaisen velvollisuutena. Tämä tutkimus nojautuu sosiaaliseen konstruktionismiin, jossa todellisuus nähdään sosiaalisesti vuorovaikutuksen kautta rakentuvana. Sovellan tässä tutkimuksessa diskurssianalyysin alle asettuvaa kriittistä diskursiivista psykologiaa, jonka keskeisenä käsitteenä toimivat tulkintarepertuaarit ja ideologiset dilemmat. Täten mielenterveysongelmien ja työn välistä kenttää toteutetaan puheen kautta kulttuurisesti vakiintuneen kielenkäytön eli tulkintarepertuaarien kautta. Kukin tulkintarepertuaari rakentuu ominaisista ihanteistaan ja logiikoistaan. Ideologiset dilemmat voidaan hahmottaa historiallisesti muotoutuneina ja kulttuurin sisäisiä jännitteitä heijastavina ajattelun tapoina. Tutkimuksen tuloksena on kuusi tulkintarepertuaaria, jotka kuvaavat ihannetyönhakijaa: pidättyväinen, avoin, sitkeä, sensitiivinen, oppiva ja osaava työnhakija. Pidättyväinen ja avoin työnhakija -tulkintarepertuaareja käytettiin mielenterveysongelmiin liittyvien ennakkoluulojen merkityksellistämisessä. Sitkeä ja sensitiivinen työnhakija -tulkintarepertuaarit näyttäytyivät tyypillisinä työnhakuprosessin kuvailussa sen suhteen, kuinka aktiivinen työnhakijan tulee olla. Oppiva ja osaava työnhakija -tulkintarepertuaarit liittyivät työnhakijan tarvittaviin taitoihin. Ideologiset dilemmat asettuivat edellä esiteltyjen tulkintarepertuaariparien välille. Dilemma näyttäytyi erityisen vahvana mielenterveysaiheesta puhumisen tulkintarepertuaareissa. Työnhakuprosessiin ja työnhakijan taitoihin liittyen dilemmat ilmenivät osin selkeinä, mutta myös hiuksenhienoina puheen muutoksina. Tutkielma tarjoaa ymmärrystä mielenterveysongelmien ja työn välisestä suhteesta nykypäivänä Suomessa avartaen näkemystä siitä, kuinka moniulotteisesti aiheesta puhutaan.

Objectives To examine birth cohort differences in depressive symptoms and life satisfaction in older men and women and the mechanisms underpinning the possible cohort differences. Methods Two independent cohorts of Finnish men and women aged 75 and 80 were assessed in 1989–1990 ( n = 617) and 2017–2018 ( n = 794). They reported their depressive symptoms (CES-D), current life satisfaction, and evaluation of life until now. Results The later-born cohort reported fewer depressive symptoms (8.6 ± 7.1 vs. 13.9 ± 8.3) and the differences were similar for the subdomains of depressive symptoms. The later-born cohort was more often mostly satisfied with life until now (90 vs. 70%) but not with the current life than the earlier-born cohort. Better self-rated health and education of the later-born cohort partly explain the cohort differences. Discussion Older people in Finland report fewer depressive symptoms and they are more satisfied with their past life compared to their counterparts assessed 28 years ago.

Task-irrelevant threatening faces (e.g., fearful) are difficult to filter from visual working memory (VWM), but the difficulty in filtering non-threatening negative faces (e.g., sad) is not known. Depressive symptoms could also potentially affect the ability to filter different emotional faces. We tested the filtering of task-irrelevant sad and fearful faces by depressed and control participants performing a color-change detection task. The VWM storage of distractors was indicated by contralateral delay activity, a specific event-related potential index for the number of objects stored in VWM during the maintenance phase. The control group did not store sad face distractors, but they automatically stored fearful face distractors, suggesting that threatening faces are specifically difficult to filter from VWM in non-depressed individuals. By contrast, depressed participants showed no additional consumption of VWM resources for either the distractor condition or the non-distractor condition, possibly suggesting that neither fearful nor sad face distractors were maintained in VWM. Our control group results confirm previous findings of a threat-related filtering difficulty in the normal population while also suggesting that task-irrelevant non-threatening negative faces do not automatically load into VWM. The novel finding of the lack of negative distractors within VWM storage in participants with depressive symptoms may reflect a decreased overall responsiveness to negative facial stimuli. Future studies should investigate the mechanisms underlying distractor filtering in depressed populations. publishedVersion

Background Individuals with depression and depressive symptoms have a higher mortality rate than non-depressed individuals. The increased comorbidity and mortality associated with depression has remained largely unexplained. The underlying pathophysiological differences between depressive subtypes, melancholic and non-melancholic, may provide some explanation to this phenomenon. Methods 1995 participants (mean age 61 years) from the Helsinki Birth Cohort Study were recruited for this prospective study and followed up for a mean of 14.1 years. Information regarding medical history, lifestyle, and biochemical parameters were obtained. Depressive symptoms were assessed using the Beck Depression Inventory. Standardized mortality ratios were calculated. Results Participants were followed up for a total of 28 044 person-years. The melancholic depressive group had an increased adjusted risk of mortality [HR 1.49 (95% CI: 1.02-2.20)] when compared to the non-depressive group. Comparing mortality to the whole population of Finland using standardized mortality ratios (SMR) both the non-melancholic [1.11 (95% CI: 0.85-1.44)] and melancholic depressive [1.26 (95% CI: 0.87-1.81)] groups had higher mortality than the non-depressive group [ 0.82 (95% CI: 0.73-0.93)]. Conclusions Melancholic depressive symptoms are most strongly related to a higher mortality risk. peerReviewed

Toivon on todettu olevan ydinarvo hoitamisessa ja se on kytkeytynyt käsitteenä vahvasti mielenterveystyöhön. Toivo on tärkeä tekijä selviytyessä mielenterveyden häiriöistä, niiden aiheuttamista vaikutuksista ja sopeutuessa elämään sairauden kanssa. Vielä ei ole yhtäkään toivoa mittaavaa mittaria käännetty suomen kielelle, vaikka toivoa on tutkittu pitkään terveystieteissä ja muilla tieteenaloilla sekä kehitetty psykometrisesti päteviä toivoa mittaavia mittareita. Tämän tutkimuksen tarkoituksena oli kuvata mielenterveyden häiriötä sairastavien ihmisten läheisten toivoa Suomessa sekä validoida toivon tasoa mittaavaa HHI-FI-mittaria (Herth Hope Index). Tutkimustehtävinä oli 1) kuvata mielenterveyden häiriötä sairastavien ihmisten läheisten toivon tasoa ja siihen yhteydessä olevia tekijöitä ja 2) validoida suomen kielelle käännettyä HHI-FI-mittaria. Tutkimuksen avulla tuotettua tietoa voidaan hyödyntää mielenterveystyön ja toivomittarin kehittämisessä. HHI-FI-mittari tulee validoida, jotta mittari voidaan tulevaisuudessa ottaa Suomessa käyttöön kliinisessä hoitotyössä. Toivon tason mittaamisen avulla kyetään arvioimaan läheisten toivon tasoa sekä havainnoimaan mahdolliset muutokset toivon tasossa. Tutkimus toteutettiin tilastollisella tutkimusmenetelmällä ja tutkimus oli osa dosentti Jari Kylmän johtamaa HHI-FI-mittarin validointi Suomessa eri väestöryhmillä -hanketta. Aineisto (N=121) kerättiin mielenterveyden häiriötä sairastavien ihmisten läheisiltä paperisen ja sähköisen kyselylomakkeen avulla. Aineisto analysoitiin tilastollisin menetelmin. Tutkimuksen tulosten mukaan iällä, sukupuolella, koulutuksella, suhteella sairastuneeseen läheiseen, läheisen sairastamisajalla tai samassa taloudessa asumisella sairastavan läheisen kanssa ei ollut tilastollisesti merkitsevää yhteyttä toivoon. Sen sijaan kokemuksella sairastavan läheisen omaishoitajana toimimisesta havaittiin olevan tilastollisesti merkitsevä yhteys. Ne läheiset kokivat olevansa toiveikkaampia, jotka eivät kokeneet toimivansa sairaan läheisen omaishoitajina. HHI-FI-mittaria validoitaessa konfirmatorisen faktorianalyysin avulla todettiin, että yhden faktorin malli sopi paremmin tähän aineistoon kuin alkuperäinen HHI-mittarin kolmen faktorin malli. Johtopäätöksenä voidaan todeta mielenterveyden häiriötä sairastavien ihmisten läheisten toivon olevan Suomessa samalla tasolla tai heikompi kuin aiempien kansainvälisten tutkimusten tuloksissa esitetty vastaava toivon taso. HHI-FI-mittarin validoinnin johtopäätöksenä voidaan todeta, että yhden faktorin malli oli sopivampi kuin HHI-mittarin alkuperäinen kolmen faktorin malli, joka tuki HHI-FI-mittarin yksiselitteisyyttä yhden summapistemäärän muodostamisessa. HHI-FI-mittarin psykometrisiä ominaisuuksia on tutkittava tulevaisuudessa laajemmin, jotta mittari voidaan saada Suomessa kliiniseen käyttöön.

SummaryBackgroundTraumatic brain injury is associated with the future risk of depression and suicide, and this raises the possibility that former participants in sports characterised by low intensity repetitive head impact may also subsequently experience an increased burden of these mental health outcomes. Using new data from a cohort study integrated into a meta-analysis of the current evidence, we compared the occurrence of depression and suicide in former contact sports athletes against general population controls.MethodsThe cohort study comprised 2004 retired male athletes who had competed internationally on an amateur basis for Finland between 1920 and 1965, and 1385 age-equivalent male general population controls. Former contact sports participants were drawn from soccer, boxing, or Olympic-style (non-professional) wrestling. During follow-up, cases of major depressive disorder and suicide were captured via linkage to mortality and hospitalisation registries. In a PROSPERO-registered (CRD42022352780) systematic review, we searched PubMed and Embase from their inception to October 31 2022 for reports of cohort studies of contact sports participation and later risk of depression and suicide that were published in English and reported standard estimates of association and variance. Study-specific estimates were aggregated using random-effect meta-analysis. The Newcastle-Ottawa Scale was used to appraise the quality of each study.FindingsIn analyses of the Finnish cohort data, up to 45 years of health surveillance gave rise to 131 hospitalisations for major depressive disorder and 61 suicides. In survival analyses (hazard ratio [95% confidence interval]) adjusted for age and socioeconomic status, former boxers (depression: 1.43 [0.73, 2.78]; suicide: 1.75 [0.64, 4.38]), wrestlers (depression: 0.94 [0.44, 2.00]; suicide: 1.60 [0.64, 3.99]), and soccer players (depression: 0.62 [0.26, 1.48]); suicide: 0.50 [0.11, 2.16]) did not have statistically significantly different rates of major depressive disorder or suicide relative to general population controls. The systematic review identified 463 potentially eligible published articles, of which 7 met inclusion criteria. All studies sampled men and 3 were evaluated as being of high quality. After aggregating results from these retrieved studies with new data from the cohort study, we found that retired soccer players appeared to have a somewhat lower risk of depression (summary risk ratio: 0.71 [95% 0.54, 0.93]) relative to general population controls, while the rate of suicide was essentially the same (0.70 [0.40, 1.23]). Past participation in American football was associated with some protection against suicide (0.58 [0.43, 0.80]) but there were insufficient studies of depression for aggregation. All studies showed directionally consistent relationships and there was no indication of inter-study heterogeneity (I2=0%).InterpretationBased on a small cluster of studies exclusively comprising men, retired soccer players had a lower rate of later depression, and former American football players had a lower risk of suicide. Whether these findings are generalisable to women requires testing.FundingNone.Research in contextEvidence before this studyA series of cohort studies suggest that brain injury serious enough to necessitate hospitalisation is associated with elevated rates of later depression and suicide. This raises the possibility that former participants in sports characterised by low intensity repetitive head impact, who have an increased risk of other mental health disorders in later life such as dementia, may also experience an increased burden of depression and suicide. Searching PubMed and Embase using terms for specific contact sports (e.g., ‘boxing’, ‘martial’, ‘wrestling’, ‘football’, ‘soccer’, ‘hockey’, ‘rugby’), depression and suicide (e.g., depression, dysthymic; suicide) revealed relevant studies in former athletes from American football, soccer, and rugby union but no evidence for boxing, wrestling, or other contact sports. Overall, there was a suggestion of mixed results and an absence of a quantitative synthesis of findings for depression.Added value of this studyIn the first cohort study to simultaneously examine the risk of depression and suicide across multiple contact sports, there was no convincing evidence that retired boxers, wrestlers, or soccer player had a different rate of these health outcomes than the general population. After incorporating these new results into a meta-analysis, former soccer players had a lower risk of depression but there was no clear link with suicide. Retired American footballers appeared to experience lower suicide rates at follow-up.Implications of all the available evidenceCounter to the apparent impact of traumatic brain injury, a background in contact sports was not associated with elevated rates of depression or suicide. Indeed, former soccer athletes (depression) and American football players (suicide) seemed to experience some protection against these health outcomes. The existing evidence base is, however, hampered by an absence of studies of women, and is modest in scale and narrow in scope, currently not including several popular contact sports.

The group-level symptom-reduction model of mental health care emphasizes predetermined treatment guidelines for those mental and social difficulties that are diagnosable as mental health disorders on the basis of predetermined diagnostic criteria. The model have produced generalizable information to support medical decision-making for symptom reduction. However, it may have also increased the reification of diagnostic labels, and in so doing medicalized and stigmatized complex human-life experiences, with a lack of attention to a range of social determinants and existential factors associated with mental health. Since symptom-reduction model can easily lose sight of essential non-technical and contextual aspects of mental health care, including the quality of the interaction and other common factors needed to understand and treat mental health difficulties, there is doubts that the symptom-reduction model may actually decrease the effectiveness of mental health services, as compared to a holistic approach. Based on recent critiques of the group-level symptom-reduction model to mental health care, and research on common-factor perspectives on mental health treatments, holistic conceptions of humans, and naturalistic outcome studies from several holistic mental health services from different countries, I hypothesized that an ontological turn from the treatment of “mental disorders” to the treatment of “difficult life situations” will lead to a more personalized and comprehensive treatment approach, that mediates an improved effectiveness of mental health services. peerReviewed

Johdanto: Tavoitteiden asettaminen on tärkeä osa mielenterveyskuntoutusta. Nuorilla mielenterveyshäiriöt voivat vaikeuttaa kehitystehtävien saavuttamista, joten kuntoutuksen tavoitteiden tulee mukailla niitä. Aiemmat tutkimukset korostavat, että kuntoutuksessa on tärkeää huomioida kuntoutujan henkilökohtaiset tavoitteet yhteiskunnallisten resurssien lisäksi. Tavoite ja menetelmä: Tämän tutkimuksen tavoitteena oli kuvailla nuorten mielenterveyskuntoutuksen tavoitteita ja tämän myötä lisätä ymmärrystä tavoitteiden merkityksestä ja kehittää tavoitteiden asettelua. Tutkimuksen aineistona olivat 18–29-vuotiaiden nuorten (n = 16) asumiskuntoutuksessa laaditut kuntoutustiedotteet. Aineisto analysoitiin laadullisella sisällön analyysillä. Tulokset: Mielenterveyskuntoutuksen tavoitteiden pääkategoriat olivat: ikätasoiset toiminnalliset roolit, sosiaalinen osallisuus sekä sisäinen resilienssi. Yksilön toimiessa ikätasoisten toiminnallisten rooliensa mukaisesti yksilö kykenee suuntautumaan kehitystehtäviinsä. Sosiaalinen osallisuus on mahdollisuutta osallistua sosiaalisiin ympäristöihin. Sisäinen resilienssi tarkoittaa yksilön kykyä vaikeissa tilanteissa käyttää vahvuuksiaan. Aineistosta nousi esille myös nuoren ja ammattilaisen välinen vuorovaikutussuhde kuntoutusprosessin aikana. Pohdinta: Tässä tutkimuksessa löydetyt pääkategoriat ovat aiemman tutkimustiedon perusteella yhteydessä valtaistumiseen, kuntoutumiseen ja toipumiseen. Tulosten perusteella ammattilaisen ja nuoren välinen vuorovaikutussuhde on tärkeä osa kuntoutusta ja kuntoutujan osallisuutta tavoitteiden asettelussa tulee vahvistaa. Toipumisorientaation laajempi käyttö mielenterveyspalveluissa voisi mahdollistaa tätä kehitystä. Abstract Goals in Adolescents` Mental Health Rehabilitation Introduction: Goal setting is a central part of mental health rehabilitation. Especially among young people mental health disorders may delay achieving developmental tasks. Goals of rehabilitation should be in concordance with developmental tasks. According to rehabilitation impact studies, it is important to consider the rehabilitees’ goals in addition to the social and financial perspectives. Purpose and method: The purpose of this study was to increase the understanding of goals set in adolescents’ mental health rehabilitation and develop goal setting. The aim of the study was to describe the goals set in adolescent’s mental health rehabilitation. The study participants were rehabilitees between 18 - 29 years in residential rehabilitation (n=16) and the data was register information. The analyze method was content analysis. Results: The main categories of goals were: age-level occupational roles, social inclusion and inner resilience. When acting according to the age-level occupational roles, people are pursuing their developmental tasks. Social inclusion is the possibility to participate in the social environment. Inner resilience is a psychological process which helps the individual to cope with difficult situations by using their personal skills. The data shows also the importance of collaborative relationship between the professional and the young person during the process of recovery. Discussion: Prior research shows that the main categories are connected to empowerment, rehabilitation and recovery. It is important to support the collaborative relationship between the professional and the adolescent by increasing methods that supports adolescent`s participation in the process of goal setting. Wider use of recovery orientation in mental health services could support this development. Keywords: youth, young adults, adolescent`s, mental health disorders, metal health rehabilitation, goals, register information, qualitative study, retrospective study

Despite gaming disorder now being diagnosable by the International Classification of Diseases (ICD-11) as a new mental disorder due to addictive behaviors, little is known about the concrete reasons for which people seek treatment for their videogame play. As the current literature is mainly based on children and adolescents, there is a strong need for better understanding adult treatment-seekers in particular. This preregistered study responds to the gap in research by qualitatively investigating the reasons for treatment-seeking with 110 participants who had sought help for their videogame play from a Finnish treatment program. We applied template analysis to the open-ended data, which consist of the participants’ personal accounts regarding their problems. Additionally, we report the game titles that the participants had problems with, as well as Internet Gaming Disorder Test (IGDT-10) scores, which were measured from 89 participants. The template analysis suggested five themes, which cover the main reasons for treatment-seeking: social reasons, existential reasons, practical reasons, self-perceived addiction, and wish for support. Many of these themes overlap with the ICD-11 description of gaming disorder, but several issues, such as loss of meaning and financial harms, are not part of the current diagnosis. The average IGDT-10 score among participants was 3.86 (SD = 2.55) and 37 (42%) individuals met the disorder cutoff (5.00). Numerous videogames with different designs were mentioned as sources of problems, of which 26 were mentioned more than once. The study indicates that adults seek treatment for many kinds of games and gaming-related problems, including but not limited to those, which are described part of the ICD-11 gaming disorder diagnoses. We recommend both researchers and practitioners to implement an expanded perspective on gaming behaviors, acknowledging that adults may seek treatment for diverse gaming-related problems, some of which not necessarily relevant to gaming disorder or mental disorders in general. peerReviewed

Violent behaviour is known to associate with several different psychiatric disorders, and psychiatric disorders are also common consequences of exposure to violence. However, the role of psychiatric disorders in predicting later violent victimization has not been as widely studied. This study aims to investigate the predictive role of various adolescence-related clinical and socio-demographical factors for severe hospital-treated assault exposures among a population of former adolescent psychiatric inpatients, using a combination of data from clinical examination at adolescence together with comprehensive register-based follow-up data. The study participants were 508 adolescents aged between 13–17 years, treated in an acute closed ward of Unit 70 at Oulu University Hospital between 2001 and 2006. During their hospitalization, the adolescents were interviewed using the Schedule for Affective Disorder and Schizophrenia for School-Age Children Present and Lifetime, to assess DSM-IV–based psychiatric diagnoses, and to obtain information on family-related characteristics. Follow-up information on the treatment episodes for assault exposure were extracted from the national Care Register for Health Care, and the data on crimes committed from the criminal records of the Finnish Legal Register Centre. 14% of the participants had received hospital treatment for assault injury up to young adulthood. In males, anxiety disorder and non-suicidal self-injury at adolescence were identified as predictors for later assault exposure, whereas in females, being a bully or bully-victim, living in child welfare placement, and being diagnosed with personality disorder in early adulthood predicted assault exposure. Overall, a tendency to lose temper in childhood, as well as committing crimes, increased the likelihood of assault exposure. The findings of this study can be utilized in detecting vulnerable adolescents in clinical practice, and in designing relevant primary prevention interventions for these adolescents at home, school, and in primary health care. Early detection of risk factors for assault exposure is crucial in protecting adolescents’ health and welfare, but also in reducing the financial burden caused to health care systems via operative treatment of assault injuries and related episodes of hospital treatment, as well as long-term treatments for psychical traumas. Tiivistelmä Väkivaltakäyttäytymisen tiedetään olevan yhteydessä moniin eri mielenterveyden häiriöihin, ja mielenterveyden häiriöt ovat myös yleisiä seurauksia väkivallalle altistumisesta, mutta mielenterveyshäiriöiden merkitystä väkivallalle altistavina tekijöinä ei ole tutkittu yhtä laajasti. Tämän tutkimuksen tarkoituksena oli selvittää, ennustavatko erilaiset nuoruusiän kliiniset ja sosiodemografiset tekijät myöhempiä vakavia sairaalahoitoa vaativia pahoinpitelytapauksia psykiatrisessa osastohoidossa olleilla nuorilla. Tutkimukseen osallistui 508 iältään 13–17-vuotiasta nuorta, jotka olivat hoidossa psykiatrisella akuuttihoito-osastolla Oulun yliopistollisessa sairaalassa vuosina 2001–2006. Osastojakson aikana nuoret haastateltiin käyttäen Schedule for Affective Disorder and Schizophrenia for School-Age Children Present and Lifetime (K-SADS-PL) -haastattelua, jonka avulla määritettiin nuorten mielenterveyshäiriöt DSM-IV -diagnoosiluokituksen mukaisesti. Seurantatiedot pahoinpitelyistä johtuvista sairaalahoitojaksoista kerättiin sairaaloiden hoitoilmoitusrekisteristä, ja rikosrekisteritiedot poimittiin Oikeusrekisterikeskuksen rikosrekisteristä. 14 % nuorista oli joutunut sairaalahoitoon pahoinpitelyn vuoksi nuoreen aikuisuuteen mennessä. Pojilla pahoinpidellyksi joutumista ennustavia tekijöitä olivat nuoruusiän ahdistuneisuushäiriö sekä itsensä vahingoittaminen, kun taas tytöillä ennustaviksi tekijöiksi tunnistettiin kiusaaminen, lastenkodissa asuminen sekä varhaisaikuisuudessa diagnosoitu persoonallisuushäiriö. Lisäksi rikollisuus ja lapsuusajan taipumus menettää malttinsa sekä nostivat riskiä joutua pahoinpitelyn uhriksi. Tämän tutkimuksen löydöksiä voidaan käyttää hyödyksi pahoinpitelyille alttiiden nuorten tunnistamisessa kliinisessä työssä sekä suunniteltaessa heille sopivia ennaltaehkäisyinterventioita kotona, koulussa ja perusterveydenhuollossa. Pahoinpidellyksi joutumista ennakoivien tekijöiden varhainen tunnistaminen on erityisen tärkeää sekä nuorten terveyden ja hyvinvoinnin suojelemiseksi että myös pahoinpitelyistä aiheutuvien vammojen operatiivisen hoidon ja sairaalahoitojaksojen sekä pitkäaikaista hoitoa vaativien psyykkisten traumojen aiheuttaman taloudellisen kuorman vähentämiseksi.

There is an existing link between two of the most common diseases, obesity and depression. These are both of great public health concern, but little is known about the relationships between the subtypes of these conditions. We hypothesized that non-melancholic depressive symptoms have a stronger relationship with both body composition (lean mass and fat mass) and dysfunctional glucose metabolism than melancholic depression. For this cross-sectional study 1510 participants from the Helsinki Birth Cohort Study had their body composition evaluated as lean mass and fat mass (Lean Mass Index [LMI, kg/m2] + Fat Mass Index [FMI kg/m2] = Body Mass Index). Participants were evaluated for depressive symptoms utilizing the Beck depression inventory, and had laboratory assessments including an oral glucose tolerance test. Higher than average FMI was associated with a higher percentage (mean [%], 95% CI) of participants scoring in the depressive range of the Beck depression inventory (20.2, 17.2–23.2) compared to those with low FMI (16.3, 13.8–18.9; p = 0.048) when adjusted for age, sex, education, and fasting plasma glucose concentration. Higher FMI was associated with a higher likelihood of having depressive symptoms (OR per 1-SD FMI = 1.37, 95% CI 1.13–1.65), whereas higher LMI was associated with a lower likelihood of having depressive symptoms (OR per 1-SD LMI = 0.76, 95% CI 0.64–0.91). Participants with an above average FMI more frequently (mean [%], 95% CI) had non-melancholic depressive symptoms (14.7, 11.8–17.7) as compared to those with low FMI (9.7, 7.6–11.9; p = 0.008) regardless of LMI levels. There was no difference between the body composition groups in the likelihood of having melancholic depressive symptoms. The non-melancholic group had higher (mean [kg/m2], SD) FMI (9.6, 4.1) than either of the other groups (BDI p p = 0.005). As hypothesized, non-melancholic depressive symptoms are most closely related to high fat mass index and dysfunctional glucose metabolism.

BackgroundFamily caregiving-related physical and mental health problems may lead to work incapacity in employed caregivers. The aim of this study was to quantify sickness absences and disability pensions (SADP) among high-intensity family caregivers available to the labour market compared with a control population.MethodsThe study sample included all individuals in Finland, who had received caregiver’s allowance and were available to the labour market in 2012 (n=16 982) and their controls (n=35 371). Information on the number of sickness absence (spells >10 days) and disability pension (SADP) days and related diagnoses according to ICD-10 were obtained from national registers for the years 2012–2017. The analyses were adjusted for age, sex, occupational status, education, income and degree of urbanisation.ResultsDuring the follow-up, 40.9% of caregivers and 39.5% of controls had at least one sickness absence spell and 6.1% and 4.7%, respectively, received disability pension. The mean annual number of SADP days was 23.2 (95% CI 22.3 to 24.1) for caregivers and 18.5 (95% CI 18.0 to 19.0) for controls (adjusted incidence rate ratio (IRR)=1.16, 95% CI 1.10 to 1.22). The number of annual SADP days due to mental disorders was higher in caregivers (7.2, 95% CI 6.7 to 7.8) than controls (4.0, 95% CI 3.8 to 4.3; adjusted IRR 1.58, 95% CI 1.42 to 1.75). There were no differences in SADP days due to cancer, neurological, cardiovascular, respiratory, or musculoskeletal diseases, or external causes.DiscussionHigher number of SADP days due to mental disorders in caregivers suggests that family caregiving has an adverse effect on work capacity and that caregivers are at increased risk for mental disorders.

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Gaming-related health problems have been researched since the 1980s with numerous different ontologies as reference systems, from self-assessed ‘game addiction’ to ‘pathological gambling’ (in the Diagnostic and Statistical Manual of Mental Disorders [DSM]-IV), ‘internet gaming disorder’ (in the third section of the DSM-5) and most recently ‘gaming disorder’ (in the International Classification of Diseases [ICD]-11). Our goal was to investigate how screening instruments that derive from different ontologies differ in identifying associated problem groups. By using four central screening instruments, each representing a different ontological basis, we hypothesized differences and similarities in prevalence, overlap, and health. A nationally representative (N = 8217) sample of Finnish participants was collected. The screening instruments produced significantly different prevalence rates (from 0.4% to 6.9%) and the binomial probabilities of group overlap ranged from poor (0.419) to good (0.919). Expectedly, the problem groups had lower mental health than the general population, yet exploratory analyses implied equivalent or significantly higher physical health. We also found strong exploratory evidence for mischievous responding to complicate the measurement of gaming problems. Considering that several major differences were confirmed between the four gaming problem constructs, we recommend researchers to clearly define their construct of interest, i.e. whether they are studying the ICD-11 based official mental disorder, the DSM-5 proposed ‘internet gaming disorder’, or other gaming problems—especially in future meta-analyses.

Background The open dialogue (OD) approach includes the need-adapted use of psychiatric medication in treating first-episode psychosis (FEP), but there is limited information on how psychiatric medications are actually used in OD-based services. This study aims to analyse long-term medication dispensing patterns among FEP cohort treated according to the OD. Methods The OD cohort consisted of people who received treatment for FEP in the Finnish Western Lapland catchment area at a time of OD implementation (n=61). The comparison group included people whose FEP treatment commenced outside the catchment area during the mid-1990s (n=1378). Data were gathered from national registers from onset to the end of the 10-year follow-up or death. A non-confirmatory descriptive comparison was performed to evaluate the usage patterns and cumulative exposure to psychiatric medication. Results Under OD, a smaller proportion had been dispensed benzodiazepines, antidepressants, and neuroleptics. Persons who had received these medications did not differ in cumulative exposure. In both groups, most of those who received neuroleptics in the first follow-up years continued using medication throughout follow-up. Discussion OD may assist in detecting FEP patients who can manage without neuroleptics, thus minimizing iatrogenic effects. Due to the observational design, further studies are required to confirm this hypothesis. peerReviewed

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Objective This study examined the predictive ability of the Rorschach-based Ego Impairment Index (EII-2) on outcome of psychotherapy in different types and durations of therapy. Method A total of 326 outpatients suffering from depressive or anxiety disorders were randomized into receiving solution-focused (n = 97), short-term psychodynamic (n = 101), or long-term psychodynamic psychotherapy (n = 128). Psychotherapy outcome assessments during the 5-year follow-up period covered psychiatric symptoms, social functioning, and work ability. Results Lower EII-2 values, which indicate less problematic ego functioning, were found to predict faster improvement in both short-term therapies as compared to long-term psychotherapy. Conclusion The results provide preliminary support for the utility of EII-2 as a complementary measure to interview-based methods for selecting between short- and long-term therapies. peerReviewed

Koronapandemia on lisännyt vanhempien uupumusta. Varsinkin jo valmiiksi haavoittuvassa asemassa olleet vanhemmat ovat olleet erityisen suuressa vaarassa uupua. Uupumuksen on osoitettu lisäävän vanhempien päihteiden käyttöä, itsetuhoisia ajatuksia sekä lapsiin kohdistuvaa kaltoinkohtelua. Siksi uupuneiden vanhempien kriisi on vääjäämättä ollut myös lasten kriisi, sanoo Matilda Sorkkila, hyvinvoinnin psykologian dosentti Jyväskylän yliopistosta. nonPeerReviewed