Erkki Komulainen

The influence of adversity and perceived social support on the outcome of major depressive disorder in subjects with different levels of depressive symptoms.

BACKGROUND Adverse life events and social support may influence the outcome of major depressive disorder (MDD). We hypothesized that outcome would depend on the level of depressive symptoms present at the outset, with those in partial remission being particularly vulnerable. METHOD In the Vantaa Depression Study (VDS), patients with DSM-IV MDD were interviewed at baseline, and at 6 and 18 months. Life events were investigated with the Interview for Recent Life Events (IRLE) and social support with the Interview Measure of Social Relationships (IMSR) and the Perceived Social Support Scale - Revised (PSSS-R). The patients were divided into three subgroups at 6 months, those in full remission (n = 68), partial remission (n = 75) or major depressive episode (MDE) (n = 50). The influence of social support and negative life events during the next 12 months on the level of depressive symptoms, measured by the Hamilton Rating Scale for Depression (HAMD), was investigated at endpoint. RESULTS The severity of life events and perceived social support influenced the outcome of depression overall, even after adjusting for baseline level of depression and neuroticism. In the full remission subgroup, both severity of life events and subjective social support significantly predicted outcome. However, in the partial remission group, only the severity of events, and in the MDE group, the level of social support were significant predictors. CONCLUSIONS Adverse life events and/or poor perceived social support influence the medium-term outcome of all psychiatric patients with MDD. These factors appear to have the strongest predictive value in the subgroup of patients currently in full remission.

Comparing two self-report measures of coping—the Sense of Coherence Scale and the Defense Style Questionnaire

Antonovskys Sense of Coherence Scale (SOC) and Bonds Defense Style Questionnaire (DSQ) were compared in a sample of 334 community controls and 122 psychiatric outpatients. The major question was, whether the two coping inventories with different theoretical backgrounds-stress research vs. psycho-analysis-tap similar phenomena. The affinity of the two coping measures was evident: in multiple regression analysis defenses explained 68% of the variance in sense of coherence. Not surprisingly, the SOC scale-emerging out of the salutogenic orientation-showed more expertise in measuring how people manage when they do well, whereas the DSQ-with its theoretical roots deep in psychopathology-was most sensitive to how people manage when they do rather poorly.

Health, lifestyle, family and school factors in adolescence: predicting adult educational level

Background Education fundamentally shapes an individuals life chances and social status. Duration and level of education are associated with peoples incomes, socio-economic status, living standard, lifestyle and the respect and esteem they enjoy. Failure to fulfil educational potential may have long-term consequences for later occupational and social life, as well as creating problems for society at large. Purpose The aim of this prospective follow-up study was to investigate which health, lifestyle, family and school factors in adolescence had the strongest impact on educational level attained in adulthood. Sample The original study population included all 9th-grade school pupils aged 16 years attending secondary school in spring 1983 in Tampere, Finland (n = 2269). Subjects were followed up at 32 years of age in 1999 (n = 1471). Design and methods In 1983, 2194 pupils (96.7%) with a mean age of 15.9 years (SD 0.3 years) completed questionnaires during school hours. The questionnaire included questions about psychological and somatic health, lifestyle, family background, school factors and life events. In 1999, postal questionnaires were sent to the same study population when they were 32 years old. The follow-up questionnaire included basically the same questions about health and lifestyle as in adolescence and age-appropriate versions of questions about social relations and life events. Education was measured by the highest level of attained education. The follow-up cohort totalled 2091 persons (92%), and the response rate was 70.3% (n = 1471). The univariate associations between independent variables in adolescence and attained educational level in adulthood were analysed using the χ2 test, and Students t-test where appropriate. Multivariate logistic regression analyses using forward stepwise procedure were used to determine which factors in adolescence had the strongest impact on adult educational level. Results Several health, lifestyle, family and school factors in adolescence were univariately associated with educational attainment in adulthood. Multivariate analyses showed that, in both genders, low school achievement and manual class of origin were the strongest predictors of low educational level in adulthood. Additional significant predictors among females were poor perceived health status, spending less leisure-time on hobbies and more on dating, and among males, poor relationships with teachers and heavy drinking. Conclusions Mid-adolescence is an important period for future educational life trajectory. Based on our study results, more attention should be paid to adolescents with school difficulties, unhealthy lifestyle and poor perceived health. It is also important to promote educational equality in relation to family background.

Academic self‐beliefs and prior knowledge as predictors of student achievement in Mathematics: a structural model

The aim of this study was to explore the relationships between prior knowledge, academic self‐beliefs, and previous study success in predicting the achievement of 139 students on a university mathematics course. Structural equation modelling was used to explore the interplay of these variables in predicting student achievement. The results revealed that domain‐specific prior knowledge was the strongest predictor of student achievement over and above other variables included in the model and, together with previous study success, explained 55% of the variance. Academic self‐beliefs strongly correlated with previous study success and had a strong direct influence on prior knowledge test performance. However, self‐beliefs predicted student achievement only indirectly via prior knowledge. The results imply that both prior knowledge and self‐beliefs should be taken into account when considering instructional support issues, because they can provide valuable insights about the future performance of the students.

Socioeconomic status as a cause and consequence of psychosomatic symptoms from adolescence to adulthood

BackgroundFew follow-up studies have investigated psychosomatic health and socioeconomic status (SES) and associations between them at different life stages. The aim of this study was to investigate differences in psychosomatic symptoms by SES in adolescence, early adulthood and adulthood and to examine whether lower SES leads to higher levels of symptoms (social causation) or higher levels of symptoms to lower SES (health selection) or both.MethodsAll 16-year-old ninth-grade school pupils of one Finnish city completed questionnaires at school. Subjects were followed up using postal questionnaires when aged 22 and 32 years.ResultsFemales reported significantly higher scores of psychosomatic symptoms than males at 16, 22 and 32 years of age. Higher rates of psychosomatic symptoms were found among females of manual class origin at 16 years. In addition, at 22 years, both females and males with only comprehensive school education and, at 32 years, those who worked in manual jobs had higher scores of symptoms. When low SES both as a cause and consequence of symptoms was investigated, the findings supported both these paths among females and more the health selection among males. In both genders, especially the path from psychosomatic symptoms in adolescence to lower education in early adulthood was strong.ConclusionsThe results highlight the need of greater consideration of psychosomatic symptoms, particularly in adolescence, in later socioeconomic outcomes.

Female homicide offenders have greatly increased mortality from unnatural deaths

The mortality of female homicidal offenders has scarcely been studied. Our aim was to examine the mortality of homicidal women in Finland using a representative nation-wide material. The data consisted of all 132 women who underwent forensic psychiatric examinations after committing homicide or attempted homicide in 1982-1992. We analysed their rate and cause of death during follow-up using standardised mortality ratios (SMRs) and the official classification of death. The mean follow-up time for dead subjects was 7 years (S.D. 4), and for the rest 11 years (S.D. 3). There were 22 observed deaths, the expected value being 1.3 (SMR 17.4). The SMR for unnatural deaths was 226 and for suicides 425. The SMRs for women below 40 years were over 220. In conclusion, homicidal women have an over 200-fold risk of unnatural death, rising to over 400-fold for suicide. This should be taken into consideration in planning discharge programmes for homicidal offenders.

The development of teachers’ responses to challenging situations during interaction training

The qualitative changes in teachers’ responses in challenging situations were analysed during a four-day Teacher Effectiveness Training (TET) course, which aimed at improving teachers’ interpersonal dynamics with pupils, parents and colleagues. The participants were 21 teachers from one elementary and 23 teachers from one secondary school attending a TET course in Finland. Qualitative abductive content analysis was used to classify the data. Frequencies based on this analysis were also looked at. After TET the teachers described the behaviour of their pupils and expressed their feelings and the actual consequences of that behaviour, instead of using generalized labels and subjective interpretations of the pupils’ behaviour. They were also more likely to support pupils’ autonomy and agency by acknowledging pupils more, by increased listening or by asking pupils to participate actively in problem solving. This study deepens our understanding of the nature of the qualitative shift in teachers’ thinking during interaction training.

Spoken Language Skills and Educational Placement in Finnish Children with Cochlear Implants

Objective: This study reports the demographics, and the auditory and spoken language development as well as educational settings, for a total of 164 Finnish children with cochlear implants. Methods: Two questionnaires were employed: the first, concerning day care and educational placement, was filled in by professionals for rehabilitation guidance, and the second, evaluating language development (categories of auditory performance, spoken language skills, and main mode of communication), by speech and language therapists in audiology departments. Results: Nearly half of the children were enrolled in normal kindergartens and 43% of school-aged children in mainstream schools. Categories of auditory performance were observed to grow in relation to age at cochlear implantation (p < 0.001) as well as in relation to proportional hearing age (p < 0.001). The composite scores for language development moved to more diversified ones in relation to increasing age at cochlear implantation and proportional hearing age (p < 0.001). Children without additional disorders outperformed those with additional disorders. Conclusion: The results indicate that the most favorable age for cochlear implantation could be earlier than 2. Compared to other children, spoken language evaluation scores of those with additional disabilities were significantly lower; however, these children showed gradual improvements in their auditory perception and language scores.

Parents and children as agents of disease management in JIA

*Department of Rheumatology, Rheumatism Foundation Hospital, Heinola †Department of Pediatric Rheumatology, Hospital for Children and Adolescents, Helsinki University Central Hospital ‡Department of Pediatric Rheumatology, Hospital for Children and Adolescents §Department of Education, Helsinki University ¶Department of Medicine/invärtes medicin, Helsinki University Central Hospital **ORTON Orthopaedic Hospital of the Invalid Foundation, Helsinki, and ††COXA, the Joint Replacement Hospital, Tampere, Finlandcch_981 578..585

Development of self-image and its components during a one-year follow-up in non-referred adolescents with excess and normal weight

BackgroundThe proportion of overweight and obese youths is high. The present study aimed to investigate the development of self-image and its components during a one-year follow-up among non-referred adolescents with excess and normal weight. Furthermore, we separately analyzed the data for girls and boys.MethodsAltogether 86 8th grades (41 girls and 45 boys) with a relative weight of 26% or more above the median and 91 controls (43 girls and 48 boys) with normal weight participated the follow-up. The Offer Self-Image Questionnaire, Revised (OSIQ-R) was used to assess self-image at baseline and on follow-up. In the OSIQ-R, a low total raw score implies positive adjustment, while a high raw score implies poor adjustment and a negative self-image. The study design was doubly correlated (pairs and time), and a linear mixed model was used in the statistical analysis.ResultsIn OSIQ-R total scores, a comparative improvement was observed in girls with normal weight. Among these girls, significant change scores compared to zero were seen in impulse control, social functioning, vocational attitudes, self-confidence, self-reliance, body image, sexuality, and ethical values. In girls with excess weight, none of the change scores compared to zero were statistically significant. When the girls with normal and excess weight were compared, the difference in change scores was largest in sexuality and vocational attitudes. Change scores compared to zero were significant in sexuality and idealism for boys with excess weight, and in impulse control, mental health, self-reliance, and sexuality for normal weight boys. When the boys with excess and normal weight were compared, no statistically significant differences emerged in change scores.ConclusionIn mid-adolescent girls, the influence of overweight and obesity on the development of self-image is substantial. Weight management programs directed at overweight adolescent girls should include psychological interventions aiming to diminish self-image distress, especially that associated with feelings, attitudes, and behavior towards the opposite sex, as well as future career plans.