Matti Rimpelä

Bullying, depression, and suicidal ideation in Finnish adolescents: school survey.

Abstract Objective: To assess the relation between being bullied or being a bully at school, depression, and severe suicidal ideation. Design: A school based survey of health, health behaviour, and behaviour in school which included questions about bullying and the Beck depression inventory, which includes items asking about suicidal ideation. Setting: Secondary schools in two regions of Finland. Participants: 16410 adolescents aged 14-16. Results: There was an increased prevalence of depression and severe suicidal ideation among both those who were bullied and those who were bullies. Depression was equally likely to occur among those who were bullied and those who were bullies. It was most common among those students who were both bullied by others and who were also bullies themselves. When symptoms of depression were controlled for, suicidal ideation occurred most often among adolescents who were bullies. Conclusion: Adolescents who are being bullied and those who are bullies are at an increased risk of depression and suicide. The need for psychiatric intervention should be considered not only for victims of bullying but also for bullies. Key messages About 1 in 10 schoolchildren report being bullied weekly at school Adolescents who are bullied or who are bullies have an increased risk of depression and suicidal ideation Bullies are often as depressed as those who are bullied, and suicidal ideation is even more common among bullies Interventions aimed at reducing bullying in schools, as well as psychiatric assessment and treatment of bullies and those who are bullied, might also prevent depression and suicidal ideation

Back, neck, and shoulder pain in Finnish adolescents: national cross sectional surveys

Abstract Objectives: To study changes in pain of the back and neck in adolescents between 1985 and 2001 and pain of the neck, shoulder, and lower back between 1991 and2001. Design: Biennial nationwide postal surveys, 1985-2001, and annual classroom surveys, 1996-2001. Setting: Finland. Participants: 62 677 12, 14, 16, and 18 year olds and 127 217 14-16 year olds. Main outcome measures: Pain in the back and neck, neck and shoulder, or lower back, at least weekly. Results: Prevalence of pain in the back and neck was greater in the 1990s than in the 1980s and increased steadily from 1993 to 1997. Pain of the neck and shoulder and pain of the lower back was much more common in 1999 than in 1991 and in 2001 than in 1999. Pain was more common among girls and older groups: pain of the neck and shoulder affected 24% of girls and 12% of boys in 14 year olds, 38% of girls and 16% of boys in 16 year olds, and 45% of girls and 19% of boys in 18 year olds; pain in the lower back affected 8% of girls and 7% of boys in 14 year olds, 14% of girls and 11% of boys in 16 year olds, and 17% of boysand 13% of girls in 18 year olds. Conclusion: Pain in the neck, shoulder, and lower back is becoming morecommon in Finnish adolescents. This pain suggests a new disease burden of degenerativemusculoskeletal disorders in future adults.

Early puberty is associated with mental health problems in middle adolescence.

This study set out to assess the relationship between pubertal timing and emotional and behavioural problems in middle adolescence. The study involved a school based survey of health, health behaviour and behaviour in school as well as questions about emotional and behavioural problems (the School Health Promotion Study). Secondary schools in four regions and 13 towns in Finland participated in the study in 1998. The respondents were 36,549 adolescents aged 14-16. The study included questions on depression, bulimia nervosa, psychosomatic symptoms, anxiety, drinking, substance use, smoking, bullying and truancy. Among girls, both internalising and externalising symptoms were more common the earlier puberty occurred. Among boys, externalising symptoms only were associated with early puberty. It is concluded that early pubertal timing is associated with increased mental health problems. Professionals working with adolescents should consider the mental health needs of early maturing adolescents.

Pubertal timing, sexual behaviour and self-reported depression in middle adolescence

The associations between pubertal timing, sexual activity and self-reported depression were analysed in a population sample of 17,082 girls and 15,922 boys aged 14-16 as a par of a classroom survey. Pubertal timing was assessed by age at onset of menstruation (menarche) or ejaculations (oigarche). Sexual experiences elicited included kissing, light petting, heavy petting and intercourse. Self-reported depression was measured by the 13-item Beck Depression Inventory. Among girls, self-reported depression was associated with early puberty and intimate sexual relationship. Among boys depression was associated with very early and late puberty and experience of intercourse. Early puberty is a risk factor for self-reported depression. Intimate sexual relationships in middle adolescent are likely to indicate problems in adolescent development rather than successful adolescent passage.

Neck or shoulder pain and low back pain in Finnish adolescents.

The aim of this study was to investigate the prevalence and determinants of self-reported neck or shoulder pain (NSP) and low back pain (LBP) among 12-18-year-olds. A questionnaire was mailed to a nationally representative sample of 11,276 12-, 14-, 16- and 18-year-olds in 1991. The response rate was 77%. NSP was perceived at least once a week by 15% of 12-18-year-olds and LBP by 8%. Both symptoms were more prevalent among girls than among boys, and the prevalence increased with age. Among the determinants investigated, the number of perceived psychosomatic symptoms had the strongest association with NSP and LBP. Our study confirmed the co-morbidity of NSP and LBP, and indicated that NSP is more frequent than believed among 16-18-year-old girls. The strong association of psychosomatic symptoms with NSP and LBP suggests that the latter two pain states could be more psychosomatic than nosiceptive in character.

Adolescent depression: the role of discontinuities in life course and social support.

OBJECTIVE To study sociodemographic determinants of depression among 14-16 years old girls and boys, and the role of perceived social support in mediating the effects of the background variables. METHOD 16464 adolescents aged 14-16 participated the School Health Promotion Study, a survey about health, health behaviour and school behaviour. Depression was measured by the Finnish modification of the 13-item Beck Depression Inventory. Moderate to severe symptoms in this scale were recorded as depression. RESULTS Depression was associated with family structure in both sexes. Among girls, having moved recently and low parental education increased the risk for depression, among boys, unemployment in the family. Accumulating number of discontinuities in life course increased the proportion of the depressed among both girls and boys. Perceived lack of social support had the same effect. Lack of support did not explain the effect on depression of the discontinuities in life course. CONCLUSION To detect risk groups for adolescent depressive disorders, health services should pay attention to adolescents who have experienced life changes. Perceived social support should be enquired.

Finnish modification of the 13-item Beck Depression Inventory in screening an adolescent population for depressiveness and positive mood

The functioning of a Finnish modification of the 13-item Beck Depression Inventory (R-BDI) in measuring the mood of an adolescent population was studied in a large population sample of 14- to 16-year-old adolescents (n =17,643) who participated in the 1997 School Health Study. Adolescents were well able to answer the items of the R-BDI. Dropout due to incomplete scale response was 6.7%. Of the individual items, girls had omitted 2.5%-3.7%, and boys 4.1%-4.9%. Factor analyses yielded a two-factor solution for both sexes. The factors were psychologically meaningful. The internal consistency of the scale was good. Cronbachs alpha was 0.84 for girls and 0.87 for boys. In the R-BDI the original 13-item BDI is supplemented with a positive-mood scale. The positive-mood scale appeared functional and meaningful in factor analysis and reliability test.

Associates of obesity and weight dissatisfaction among Finnish adolescents.

OBJECTIVE We investigated behavioural and socio-economic factors associated with obesity and weight dissatisfaction among Finnish adolescents. DESIGN A total of 60,252 Finnish adolescents aged 14 to 16 years filled in a questionnaire about their health, health behaviour and socio-economic background. Food choices were obtained by using a short food-frequency questionnaire. Obesity was defined as a weight at least 120% of the sex- and height-specific mean weight for subjects. RESULTS Of girls and boys, 54% and 66%, respectively, were satisfied with their weight. Among dissatisfied normal-weight adolescents, 81% of girls but only 48% of boys thought they were overweight. Of obese boys, 25% were satisfied with their weight. For both genders, obesity and weight dissatisfaction were associated with economic problems in the family. In girls, an association was also found with poor school performance, low educational level of parents and not having evening meals at home; and in boys, with physical inactivity and not eating school lunch. Smoking was more common among girls who were dissatisfied with their weight. Differences in food choices were small between different weight and weight satisfaction categories. CONCLUSIONS Having normal weight and being satisfied with that weight are favourable for an adolescent. Obesity and weight dissatisfaction are associated mostly with disadvantageous health behaviours and low socio-economic status. Health behaviour seems to be associated more with weight satisfaction than with actual weight.

Social mobility and health related behaviours in young people.

STUDY OBJECTIVE: To assess the influences related to social mobility, particularly health related behaviours, as one potential explanation for the social class variation in health among adults. DESIGN: The study is based on questionnaire data from the Adolescent Health and Lifestyle Surveys of 1985, 1987, and 1989. SETTING: The whole of Finland. PARTICIPANTS: A representative sample of 8355 adolescents. The response rate was 79%. MEASUREMENT AND MAIN RESULTS: The relation between social mobility and health related behaviours among 16 and 18 year old young people was studied. The measure of social mobility was based on a combination of the social class of origin and achieved social position measured by the present educational status, educational attainment, and labour market position. Three mobility groups were constructed: the downwardly mobile, the upwardly mobile and the stable. Health related behaviours in an upwardly or downwardly mobile group were compared with a stable group from the same social class of origin by calculating relative risks (RR). RRs were assessed by calculating age and sex adjusted rate ratios approximating a Mantel-Haenszel estimate. In logistic regression analyses the independent effects of the social class of origin and the achieved social position were investigated. Most of the nine behaviours studied (smoking, alcohol use, heavy intoxication, coffee drinking, tooth brushing, consumption of sweets, lack of physical exercise, choice of bread spread, and consumption of milk) were related to the direction of mobility so that health compromising behaviours were more frequent among downwardly mobile and less frequent among upwardly mobile young people than their stable peers. Achieved social position proved to determine health related behaviours more strongly than class of origin, thus emphasising the way education facilitates both health values and behaviours as well as the future social position. CONCLUSIONS: The close relation between social mobility and health related behaviours is concluded to be a part of an explanation of social class differences in health observed among adults.

Menstrual pain, health and behaviour in girls.

Prevalence of menstrual pain, use of medication and school absenteeism due to the pain were studied by means of a mailed questionnaire in a sample representing 12-18-year-old girls in Finland (n = 3370, response rate 87%). Prevalence of menstrual pain was 48% among 12-year-old post-menarcheal girls and 79% among 18-year-olds. Thirty percent of the 16-year-old girls had used medication and 21% had stayed at home due to menstrual pain in the last 6 months; 3% had both been absent and used medication several times. Three types of factors were associated with menstrual pain: (1) physiological (gynaecological age, duration of menstrual flow); (2) indicators of poor self-rated health (not feeling active in the morning, bad physical condition, number of common colds); (3) unhealthy practices (consumption of alcohol, low physical activity, smoking). The prevalence of menstrual pain did not correlate with the variables describing the place of residence or the socio-economic status of the family. The determinants of menstrual pain are supposed to lie more in the biological construct and micro-environment of the girls than in macro-level structures of the society. The experience of pain seems to be related to self-rated health as a whole and to lifestyle rather than to specific disorders and health practices.