Kaisa Riala

Adverse childhood experiences and suicidal behavior of adolescent psychiatric inpatients

The present study examines the association of adverse childhood experiences (ACEs) to suicidal behavior and mortality in 508 Finnish adolescents (aged 12–17xa0years) who required acute psychiatric hospitalization between April 2001 and March 2006. The Schedule for Affective Disorder and Schizophrenia for School-Age Children Present and Lifetime (K-SADS-PL) and the European Addiction Severity Index (EuropASI) were used to obtain information about ACEs, adolescents’ suicidal behavior and psychiatric diagnoses. The cases of death were obtained from Statistics Finland. The results of our study indicated that, among girls, exposure to sexual abuse statistically significantly increased the risk of non-suicidal self-injury (NSSI) (OR, 1.8; 95xa0% CI, 1.0–3.2) and suicide attempts (OR, 2.3; 95xa0% CI, 1.0–4.5). The cumulative number of ACEs was also associated with an increased risk of NSSI (OR, 1.2; 95xa0% CI, 1.0- 1.4) and suicide attempts (OR, 1.2; 95xa0% CI, 1.0–1.4) in girls. Among all deceased adolescents, ACEs were most notable among those who had died due to accidents and injuries. Gender differences in the types of ACEs were noted and discussed.

Suicide in children and young adolescents: a 25-year database on suicides from Northern Finland.

Despite the large amount of research on adolescent suicidality, there are few detailed studies illustrating the characteristics of child and adolescent completed suicide. Our study presents the characteristics of child and adolescent suicides occurring over a period of 25 years within a large geographical area in Northern Finland, with a special focus on gender differences. The study sample included all 58 suicides among children and adolescents (<18 years) occurring in the province of Oulu in Finland between 1988 and 2012. The data is based on documents pertaining to establish the cause of death from forensic autopsy investigations. A register linkage to the data from the Finnish Hospital Discharge Register (FHDR) was also made. 79% of the suicide victims were male. Violent suicide methods predominated in both genders (males 98%, females 83%). While symptoms of mental illness were common, only a minority (15% of males and 17% of females) had a previous history of psychiatric hospitalization. 17% of females but none of the males had been hospitalized previously due to self-poisoning. A greater proportion of females than males had a history of self-cutting (33% vs. 7%) and previous suicide attempts (25% vs. 4%). 48% of males and 58% of females were under the influence of alcohol at the time of their suicide, and alcohol intoxication was related to suicides during the night. One fifth of the adolescents screened positive for substances other than alcohol. The results of this study indicate that there are similarities but also some differences in the characteristics of male and female suicides in adolescents.

Association of traumatic brain injury with criminality in adolescent psychiatric inpatients from Northern Finland

The association of traumatic brain injuries (TBI) with criminality, substance-related disorders and conduct disorders has mainly been studied in adult populations. In our study we examine the association in an adolescent population. We used a population-based clinical sample of 508 psychiatric inpatient adolescents from Northern Finland. The prevalences of TBI and criminality were 26 (5.1%) and 85 (16.7%), respectively. The information on TBI was acquired from the Finnish Hospital Discharge Register and on criminality from the Legal Register Center. DSM-IV diagnoses were obtained by interviewing the subjects using the semi-structured Schedule for Affective Disorder and Schizophrenia for School-Age Children, Present and Lifetime (K-SADS-PL). Adolescents with TBI had significantly more often committed crimes compared to adolescents without TBI (53.8% vs. 14.7%, respectively). Prevalences of both violent crimes (42.9% vs. 9.1%) and non-violent crimes (29.4% vs. 6.8%) were also higher in the TBI group. TBI during childhood and adolescence increased the risk of any criminality 6.8-fold (95% 3.0-15.2), conduct disorder 5.7-fold (95% 2.1-15.4) and concomitant criminality and conduct disorder 18.7-fold (95% 4.3-80.1). Our results suggest that clinicians working with mentally ill adolescents who have experienced head injuries should be aware of the increased risk for delinquency and violent tendencies occurring later in the adolescents lives.

The relationship between childhood family background and educational performance, with special reference to single-parent families: a longitudinal study

Aims: Education is an important indicator of health and well-being. We studied the relationship between childhood family background and later educational achievements. Methods: A total of 10,581 subjects from the Northern Finland 1966 Birth Cohort were studied prospectively covering the period from pregnancy to 31 years of age. The association between family background (two-parent family and three types of single-parent families, wantedness of pregnancy, mothers education, family size, social class and its change between 1966 and 1980) and educational achievements (school performance and highest attained education by age 31) was examined using two-way tables and logistic regression analysis. Results: Low maternal education and large family size were the most powerful predictors for low education in adulthood. Single-parent family background seemed to be less important compared with other family background variables in predicting low school performance or low educational level in adulthood. Conclusions: Single-parent family background and other adverse family features may increase the risk of educational underachievement. However, in a welfare state with well-educated population the effect of single-parent family background seems to be relatively small. Health care professionals, teachers and parents should pay attention to the specific educational needs and counselling of young adults from disadvantaged families.

The impact of adverse childhood experiences on obesity and unhealthy weight control behaviors among adolescents.

BACKGROUNDnChildhood abuse and other early-life stressors associate with being overweight or obese later in life. In addition to being overweight, unhealthy weight control behaviors (e.g., vomiting, using diet pills, fasting, and skipping meals) have been shown to be common among adolescents. To our knowledge, the association between these behaviors and adverse childhood experiences (ACEs) remains unexamined.nnnMETHODSnWe examined the association of ACEs to body mass index (BMI) and unhealthy weight control behaviors among 449 Finnish adolescents aged 12 to 17years admitted to an acute psychiatric hospital unit between April 2001 and March 2006. We used the Schedule for Affective Disorders and Schizophrenia for School-Age Children Present and Lifetime (K-SADS-PL) and the European Addiction Severity Index (EuropASI) to obtain information about ACEs, psychiatric diagnoses and weight control behaviors. BMI was calculated using the weight and height measured for each adolescent upon admission.nnnRESULTSnGirls who experienced sexual abuse were more likely to be obese (OR: 2.6; 95% CI: 1.1-6.4) and demonstrate extreme weight loss behaviors (EWLB) (OR: 2.2; 95% CI: 1.0-4.7). Among girls, parental unemployment is associated with an increased likelihood of obesity (OR: 3.5; 95% CI: 1.2-9.6) and of being underweight (OR: 3.6; 95% CI: 1.1-11.6). A proneness for excessively exercising was found among girls who had witnessed domestic violence (OR: 3.5; 95% CI: 1.4-9.2) and whose parent(s) had died (OR: 5.4; 95% CI: 1.1-27.7).nnnCONCLUSIONnThis study showed that female adolescents with a history of traumatic experiences or difficult family circumstances exhibited an elevated likelihood of being obese and engaging in unhealthy weight control behaviors.

Suicidality and unhealthy weight control behaviors among female underaged psychiatric inpatients

OBJECTIVEnThe aim of this study was to investigate whether unhealthy weight control behaviors, fear of becoming obese, binge eating, impulsivity, and body mass index are associated with suicide ideation, repetitive self-mutilative behavior (SMB), suicide attempts, or both suicide attempts and SMB among female adolescent psychiatric inpatients.nnnMETHODSnData were drawn from a clinical inpatient cohort of female adolescents (N = 300, aged 12-17 years) consecutively admitted for psychiatric hospitalization between April 2001 and March 2006. Information on adolescents suicidal behavior, psychiatric Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), diagnoses and weight control behaviors was obtained using the Schedule for Affective Disorder and Schizophrenia for School-Age Children Present and Lifetime (K-SADS-PL).nnnRESULTSnEven after adjustment with DSM-IV, affective, anxiety and eating disorders self-induced vomiting was significantly associated with SMB and suicide attempts with SMB. Impulsivity was related to suicide attempts with SMB. Excessive exercising was a significant finding only in those girls who had attempted suicide. Girls who had attempted suicide were more often overweight compared with girls without suicidal behavior.nnnCONCLUSIONnUnhealthy weight control behaviors among adolescent girls were found to be strongly associated with suicidal behavior. Girls with a history of both suicide attempts and SMB seem to be the most disturbed group, with multiple weight loss methods and impulsivity. Girls who are overweight or exercise excessively may represent risk groups for attempted suicide.

Northern excess in adolescent male firearm suicides: a register-based regional study from Finland, 1972–2009

There are more firearms in Northern Finland as compared to Southern Finland, and a positive association between suicide rates and the number of firearms in a given region has been demonstrated in previous literature. Accordingly, the authors compared firearm suicide rates of Finnish adolescent (under 18xa0years) males in the two geographic regions. Young adult (18–24xa0years) and adult (25–44xa0years) males were used as reference groups. National data on cases of suicide in Northern and Southern Finland between 1972 and 2009 were obtained from Statistics Finland. Firearm suicides (nxa0=xa05,423) were extracted according to ICD-classification (ICD-8/9: E955, ICD-10: X72-X75). The distribution of types of firearms (hunting gun, handgun, other) employed in suicides was also investigated. The adolescent male firearm suicide rate in Northern Finland was almost three times higher than that observed in Southern Finland, while there was no difference in rates of suicide by other methods. A northern excess in firearm suicide rates was also found among young adult and adult males. Hunting guns were the most common type of firearms employed in young male suicides, and their use was especially common in Northern Finland. Our results indicate that the use of firearms plays a major role in explaining the northern excess in young Finnish male suicide rates, and emphasize a need to advance suicide prevention according to specific regional characteristics.

Exposure to Obstetric Complications in Relation to Subsequent Psychiatric Disorders of Adolescent Inpatients: Specific Focus on Gender Differences

Background: Exposure to obstetric complications is known to be associated with subsequent development of psychiatric disorders. However, earlier findings are mainly based on adult populations having a long follow-up time for onset of psychiatric illness. We examined whether the association of obstetric complications with severe mental disorders is already seen in a population of underage adolescents admitted to psychiatric inpatient care. Method: The study population was a clinical sample of adolescents (n = 508) aged 12–17 years admitted to psychiatric hospital. DSM-IV diagnoses of the psychiatric disorders of the adolescents as well as information on obstetric (i.e., pregnancy, delivery and perinatal) complications and substance use during pregnancy reported by the mothers of the adolescents were based on the semi-structured Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime. Results: A total of 96 (19%) adolescents had been exposed to obstetric complications. The prevalence of pregnancy, delivery or perinatal complications reported by the mothers of the offspring was 55 (57%), 57 (59%) and 13 (14%), respectively. Among adolescents with conduct disorder, exposure to delivery complications was more common among males compared to females (16 vs. 5%, p = 0.006); this was particularly true for section delivery (7 vs. 1%, p = 0.023). A trend towards a significant gender difference was also found among adolescents with anxiety disorder (21 vs. 8%, p = 0.085). Conclusions: Boys seem to be more vulnerable to the exposure of delivery complications than girls. Exposure to obstetric complication may be associated with development of subsequent psychiatric disorder; particularly conduct disorder of adolescent boys.

Poor premorbid school performance is associated with later cigarette smoking among schizophrenia patients

Schizophrenia patients who smoke have been postulated to have genetically mediated dysfunctional nicotinic neurotransmission. We hypothesized that this nicotinic dysfunction would manifest as poorer school performance in adolescence, before the onset of illness, in smoking compared with non-smoking schizophrenia patients. Over a 31-year follow-up period, 100 (65 men) cohort members of the Northern Finland 1966 Birth Cohort were hospitalized and diagnosed with DSM-III-R schizophrenia. The information on school performance was obtained at the end of compulsory schooling at age 16 years. The information on smoking habits was gathered from a questionnaire mailed to cohort members at the age of 31 years. Compared with non-smoking schizophrenia patients, schizophrenia patients who smoked in adulthood had lower overall mean grades, lower mean grades in combined mathematical subjects, and lower grades in music. Poor school performance might represent premorbid nicotinergic dysfunction associated with cognitive deficits in future smokers among schizophrenia patients compared with those who remained non-smokers.

Borderline personality disorder associates with violent criminality in women: A population based follow-up study of adolescent psychiatric inpatients in Northern Finland

Various psychiatric problems in adolescence and early adulthood have been shown to associate with criminal behaviour. In this study the association of personality disorders (PDs) with criminal behaviour was examined in adolescents treated in psychiatric hospitals. The study sample consisted of 508 adolescents (age 13-17) admitted to acute psychiatric impatient care between April 2001 and March 2006. Crime data was obtained from the Finnish Legal Register Centre on September 2013. The Schedule for Affective Disorder and Schizophrenia for School-Age Children Present and Lifetime (K-SADS-PL) was used to assess psychiatric diagnoses in adolescence. The information on PDs in early adulthood was based on follow-up information on psychiatric treatments in either out- or inpatient settings until the end of 2012, and was extracted from the National Care Register for Health Care provided by the Finnish National Institute for Health and Welfare. A total of 22 (39%) of the 57 subjects with PD had committed a crime. In women, the likelihood for violent criminality was significantly increased in those with Borderline PD (OR 6.09, CI 1.24-29.84, p=0.009) and was also associated with conduct disorder (OR 4.26, CI 1.38-13.19, p=0.012), child welfare placement (OR 11.82, CI 3.61-38.76, p<0.001) and parents substance use disorder (OR 7.74, CI 2.30-26.10, p=0.001). In men, no association was observed between PD and any kind of criminal behaviour. Significant predictors for violent criminality in males were conduct disorder (OR 4.05, CI 1.75-9.38, p=0.001), substance use disorder (OR 2.51, CI 1.22-5.17, p=0.012) and special services at school (OR 2.58, CI 1.16-5.76, p=0.021). Females with Borderline PD showed an increased risk for violent offending. This suggests Borderline PD as a potential explanatory factor for violent assaults by females and highlights the importance of recognizing the risk for violence in young women with a Borderline PD.