Hillevi Aro

DSM-IV mood-, anxiety- and alcohol use disorders and their comorbidity in the Finnish general population--results from the Health 2000 Study.

BackgroundInformation on prevalence, accumulation and variation of common mental disorders is essential for both etiological research and development of mental health service systems.MethodsA representative sample (6005) of Finland’s general adult (≥ 30 years) population was interviewed in the period 2000–2001 with the CIDI for presence of DSM-IV mental disorders during the last 12 months in the comprehensive, multidisciplinary Health 2000 project.ResultsDepressive-, alcohol use- and anxiety disorders were found in 6.5%, 4.5 % and 4.1% of the subjects, respectively. A comorbid disorder was present in 19% of those with any disorder. Males had more alcohol use disorders (7.3 % vs. 1.4 %) and females more depressive disorders (8.3 % vs. 4.6 %). Older age, marriage and employment predicted lower prevalence of mental disorders and their comorbidity. Prevalences of alcohol use- and comorbid disorders were higher in the Helsinki metropolitan area, and depressive disorders in northern Finland.ConclusionsMental disorders and their comorbidities are distributed unevenly between sexes and age groups, are particularly associated with marital and employment status, and vary by region. There appears to be no single population subgroup at high risk for all mental disorders, but rather several different subgroups at risk for particular disorders or comorbidity patterns.

Recent life events, Social support and suicide

The occurrence of recent life events during the last 3 months, and Social support received were studied in a nationwide suicide population (N = 1,067) in Finland. Recent life events were reported in 80 % of the suicides. Job problems (28 %), family discord (23 %), somatic illness (22 %), financial trouble (18 %), unemployment (16 %), separation (14 %), death (13 %) and illness in family (12 %) were the most common life events. Sex differences were found in recent life events: any life event, separation, financial trouble, job problems and unemployment were more common among males. The mean number of life events was also higher among males.

The 12‐month prevalence and risk factors for major depressive episode in Finland: representative sample of 5993 adults

Objective: This study reports the 12‐month prevalence of major depressive episode and its risk factors in a representative nationwide sample.

Mental disorders in cancer suicides

Mental disorders among suicide victims who had suffered from cancer were investigated using psychological autopsy data on all suicides in Finland over 1 year. Retrospective DSM-III-R consensus diagnoses were assigned to all 60 cancer suicides and to 60 age- and sex-matched comparison suicides without a cancer history. Depressive syndromes were equally common along cancer suicides (80%) and others (82%). Alcohol dependence and personality disorders were more frequent among noncancer suicides. Major depression and substance abuse were more common among victims with cancer in remission than in terminal stages. Only a small minority of cancer suicides seem to occur in the absence of mental disorders.

Mental disorders in elderly suicide.

The purpose of this study was to investigate the prevalence and comorbidity of current mental disorders defined by DSM-III-R among elderly suicide victims and to compare them with the mental disorders among younger victims. Using a psychological autopsy method, we collected comprehensive data on all suicides in Finland during 1 year. Retrospective Axis I-III consensus diagnoses were assigned to a random sample consisting of 43 victims aged 60 years or over and 186 victims aged under 60 from the nationwide suicide population. At least one Axis I diagnosis was made for 91% of the elderly victims. Major depression as the principal diagnosis was more common among the elderly victims. Almost all elderly female victims were major depressives. Psychiatric comorbidity was more common among elderly male than among elderly female victims. More of the elderly victims (88%) than the younger (36%) received Axis III diagnoses. Suicide among the elderly without a diagnosable mental disorder and somatopsychiatric comorbidity seems to be rare.

Long-term psychosocial effects of parental divorce: a follow-up study from adolescence to adulthood.

ObjectiveThe purpose of this 16–year follow–up study was to investigate whether 32–year–old adults who had experienced parental divorce before 16 years of age (n = 317) differed in psychosocial well–being or life trajectories from those from non–divorced two–parent families (n = 1069).MethodThe data were obtained from a follow–up survey of a Finnish urban age cohort from the age of 16 till 32 years (n = 1471). The long–term impact of parental divorce on a variety of outcomes in adulthood, including psychological well–being, life situation, health behaviour, social networks and support, negative life events and interpersonal problems, was assessed.ResultsFemales from divorced compared to non–divorced families reported more psychological problems (higher scores in the Beck Depression Inventory, General Health Questionnaire and Psychosomatic Symptoms Score) and more problems in their interpersonal relationships. These differences were not found among males. Shorter education,unemployment, divorce, negative life events and more risky health behaviour were more common among subjects of both genders with a background of parental divorce.ConclusionsThe study revealed that parental divorce is an indicator of sufficient stress in childhood for its influences to persist well into adulthood, possibly with wider scope among females. It is important to recognise specific needs of children in the divorce process in order to prevent or minimize negative consequences and chain reactions during their subsequent life.

Childhood adversities as risk factors for adult mental disorders : Results from the health 2000 study

BackgroundThe sex-specific role of stressful or traumatic childhood experiences and adverse circumstances in developing adulthood mental disorders is complex and still in need of comprehensive research.MethodsWithin the Health 2000 project in Finland, a representative sample of 4,076 subjects aged 30–64 years were investigated to examine associations between a set of retrospectively self-reported adverse environmental factors during childhood (0–16 years) and mental disorders diagnosed in the past 12 months by the Munich Composite International Diagnostic Interview.ResultsOf the 60% of adults reporting at least one childhood adversity, 17% had a current (past 12 months) mental disorder, compared to 10% of the non-reporters. A moderate dose–response relationship between the total number of adversities and current disorders was observed. Paternal mental health problems associated particularly strongly with male depressive disorders (OR 4.46), and maternal mental health problems with female depressive disorders (OR 3.20). Although seldom reported, maternal alcohol problems associated with alcohol use disorders in both sexes. Being bullied at school and childhood family discord predicted a variety of adulthood disorders in both sexes. All these four adversity items were more typical for depressive disorders with an earlier onset. Among females, more adversities were associated with mental disorders and their statistical significance was greater than among males.ConclusionsThere are marked sex differences and several diagnosis-related patterns in the associations between reported childhood experiences and environmental circumstances and adulthood mental disorders. The impact of adversities is probably composed of a wide range of factors from direct causal associations to complex, interacting environmental effects. Variations in the reported associations reflect the differing genetic and environmental transmission mechanisms of mental disorders.

Social support, life events and psychosomatic symptoms among 14-16-year-old adolescents

The role of family, friends and confidants in mediating the impact of adverse life events on psychosomatic symptoms in mid-adolescence was studied. School children (n = 2013) completed questionnaires in class on three occasions during 17 months. Data about social support and life events for 12 months were gathered retrospectively in the final questionnaire. The differences in symptoms by life events and social support were already present at the beginning of the study. Those adolescents who had experienced adverse life events and reported a poor relationship with one or both parents had the highest levels of symptoms and the greatest increase in symptoms during the follow-up. Lack of friends was also associated with psychosomatic symptoms, especially among those who had experienced adverse life events. The results suggest that adolescents who lack parental or peer support are at risk for psychosomatic symptoms in general, and especially in the face of stressful life events.

Mental disorders in young adulthood

BACKGROUND The effect of mental disorders may be particularly detrimental in early adulthood, and information on mental disorders and their correlates in this age group is important. METHOD A questionnaire focusing on mental health was sent to a nationally representative two-stage cluster sample of 1863 Finns aged 19 to 34 years. Based on a mental health screen, all screen-positives and a random sample of screen-negatives were asked to participate in a mental health assessment, consisting of the Structured Clinical Interview for DSM-IV (SCID-I) interview and neuropsychological assessment. We also obtained case-notes from all lifetime mental health treatments. This paper presents prevalences, sociodemographic associations and treatment contacts for current and lifetime mental disorders. RESULTS Forty percent of these young Finnish adults had at least one lifetime DSM-IV Axis I disorder, and 15% had a current disorder. The most common lifetime disorders were depressive disorders (17.7%) followed by substance abuse or dependence (14.2%) and anxiety disorders (12.6%). Of persons with any lifetime Axis I disorder, 59.2% had more than one disorder. Lower education and unemployment were strongly associated with current and lifetime disorders, particularly involving substance use. Although 58.3% of persons with a current Axis I disorder had received treatment at some point, only 24.2% had current treatment contact. However, 77.1% of persons with a current Axis I disorder who felt in need of treatment for mental health problems had current treatment contact. CONCLUSIONS Mental disorders in young adulthood are common and often co-morbid, and they may be particularly harmful for education and employment in this age group.

Sex differences in coping and depression among young adults.

The main purpose of the study was to evaluate the notion that the association between sex and depression is partly mediated by differences in coping styles. The study is based on questionnaire data from 890 female and 766 male Finnish 22-year-old young adults. Of the 12 ways of coping presented, self-blame, venting anger on others, seeking comfort in sweets and drinking beer were positively, and the others negatively, associated with depression; these were called dysfunctional and functional ways of coping, respectively. Women resorted much more often than men to dysfunctional ways of coping, except drinking. They also scored lower on personal resilience and showed more depressive symptoms. The sex difference in depressiveness was eliminated when dysfunctional coping was taken into account.