Olli Kiviruusu

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.

Antidepressant utilisation patterns and determinants of short-term and non-psychiatric use in the Finnish general adult population

BACKGROUND The aim was to study utilisation patterns and determinants of antidepressant use in the general population >30 years, especially short-term use or use not related to known psychiatric morbidity. METHODS Participants from a cross-sectional population-based Finnish Health 2000 Study (2000--2001) were linked with the National Prescription Register and National Care Register for Health Care. Within a representative sample (N=7112) of the adult population (>30 years), 12-month DSM-IV depressive, anxiety, and alcohol use disorders were assessed with the M-CIDI. Utilisation patterns of antidepressants were categorised to short-term, intermittent and continuous use. Factors predicting short-term use or use not related to known psychiatric morbidity were investigated. RESULTS Of Finnish adults 7.1% had used antidepressants in 2000, of which two-thirds reported a physician-diagnosed mental disorder; a third (35%) had major depressive or anxiety disorder during the previous 12 months. In terms of utilisation pattern, 43% were long-term users, 32% intermittent users and 26% short-term users. Short-term use was related to care by a general practitioner and having no known mental disorder. A quarter of all users had no known psychiatric morbidity. This type of user was most common among the older age groups, and inversely related to being single, on disability pension and using mental health services. LIMITATIONS Not all psychiatric indications for antidepressant use could be explored. CONCLUSIONS Depression remains the main indication for antidepressant use. About a quarter of users had no known psychiatric indication and the indication remained unclear. Short-term and non-psychiatric use are more commonly prescribed for the elderly.

Suicidal ideation, deliberate self-harm behaviour and suicide attempts among adolescent outpatients with depressive mood disorders and comorbid axis I disorders

ObjectiveWe aimed to analyse and compare prevalence and associated clinical features of suicidal ideation, self-harm behaviour with no suicidal intent and suicide attempts among adolescent outpatients with depressive mood disorders with or without comorbidity.MethodA sample of 218 consecutive adolescent outpatients aged 13–19 years with depressive mood disorders was interviewed using K-SADS-PL for DSM-IV Axis I diagnoses. They filled out self-report questionnaires assessing depressive and anxiety symptoms. Suicidal behaviour was assessed by K-SADS-PL suicidality items.ResultsHalf of the subjects reported suicidal ideation or behaviour. There was no difference in prevalence of suicidal behaviour between non-comorbid and comorbid mood disorder groups. Multivariate logistic regression analyses produced the following associations: (1) suicidal ideation with self-reported depressive symptoms and poor psychosocial functioning, (2) deliberate self-harm behaviour with younger age and poor psychosocial functioning, and (3) suicide attempts with self-reported depressive symptoms and poor psychosocial functioning. ConclusionsDepressed mood disorders, whether comorbid or not, are associated with suicidal ideation and suicide attempts. Diagnostic assessment should be supplemented by self-report methods when assessing suicidal behaviour in depressed adolescents.

Depressed adolescents as young adults - Predictors of suicide attempt and non-suicidal self-injury during an 8-year follow-up

BACKGROUND Clinically derived follow-up studies examining the predictors of suicide attempts (SA) and non-suicidal self-injury (NSSI) among adolescents are scarce. The aims were to study SA and NSSI as predictors of future NSSI and SA, and to study the role of other risk and protective factors, especially alcohol use, and perceived social support from family and peers during a 1-year follow-up and between the 1-year and 8-year follow-ups among consecutively referred depressed adolescent outpatients. METHODS The Adolescent Depression Study (ADS) is a longitudinal study of depressed adolescent outpatients (mean age at baseline 16.5 years, 81.8% females). The subjects of the present study (n=139, 63.8% of the original study population) were assessed at baseline, at 1-year and 8-year follow-ups using semi-structured diagnostic interviews (K-SADS-PL) for DSM-IV diagnoses, and structured self-report scales for clinical risk factors. RESULTS In multivariate comparisons, SAs were predicted both in the 1-year follow-up and in the period between the 1- and 8-year follow-ups by alcohol use and low perceived peer support. NSSI in the 1-year of follow-up was predicted by baseline NSSI, younger age and alcohol use, whereas the only significant predictor for NSSI between the 1- and 8-year follow-ups was NSSI. LIMITATIONS A large majority of the sample were females, limiting the possibility to analyze gender differences. CONCLUSIONS Among depressed outpatients NSSI is a strong predictor of suicidal behavior, and other factors beyond depression, such as alcohol use and availability of social support, must also be addressed to prevent the recurrence of suicidal behavior.

Treatment of major depressive disorder in the Finnish general population

Background: Few general population studies of the treatment of major depressive disorder (MDD) have included the whole spectrum of treatments. We estimated the rates of different treatments and the effect of individual and disorder characteristics plus provider type on treatment received. Methods: In the Health 2000 Study, a representative sample (n=6,005) from the adult Finnish population (≥30 years) were interviewed (CIDI) in 2000–2001 for the presence of DSM‐IV mental disorders during the past 12 months. Logistic regression models were used to examine factors influencing the type of treatment: either pharmacotherapies (antidepressants, anxiolytics, sedatives/hypnotics, antipsychotics) or psychological treatment. Results: Of the individuals with MDD (n=288), currently 24% used antidepressants, 11% anxiolytics, 16% sedatives/hypnotics, 5% antipsychotics, and 17% reported having received psychological treatment. Overall, 31% received antidepressants or psychological treatment or both; 18% received minimally adequate treatment. Of those 33% (n=94) using health care services for mental reasons, 76% received antidepressants or psychological treatment or both; 54% received minimal adequate treatment. In logistic regression models, the use of antidepressants was associated with female sex, being single, severe MDD, perceived disability, and comorbid dysthymic disorder; psychological treatment with being divorced, perceived disability, and comorbid anxiety disorder. Conclusions: Due to the low use of health services for mental reasons, only one‐third of subjects with MDD use antidepressants, and less than one‐fifth receives psychological treatment. The treatments provided are determined mostly by clinical factors such as severity and comorbidity, in part by sex and marital status, but not education or income. Depression and Anxiety 26:1049–1059, 2009.

Moclobemide and fluoxetine in atypical depression : a double-blind trial

The effectiveness of moclobemide or fluoxetine in the treatment of atypical (n = 53) and other depressive patients (n = 156) was compared in a 6-week double-blind randomized trial. HDRS, MARDS, GCI and the Atypical Depression Diagnostic Scale were used in clinical assessment. Significant differences were seen in MADRS and GCI scores in favour of moclobemide in the treatment of atypical depression, but not with HDRS. No major differences were seen between the two drugs in the treatment of other depressive patients. A positive response, defined by a > 50% decrease in HDRS score and a GCI Improvement Score of 1 or 2, was seen among 67% of atypical patients treated with moclobemide and among 55% treated with fluoxetine and in 60 and 48% of other depressive patients, respectively. Both drugs gave results with atypical patients at least as good as with other depressive patients. Our results suggest that patients suffering from atypical depression may respond more favourably to moclobemide than to fluoxetine treatment.

Current comorbidity among consecutive adolescent psychiatric outpatients with DSM-IV mood disorders

ObjectiveTo compare selected characteristics (age, sex, age of onset for depression, impairment, severity of depression, somatic comorbidity, and treatment status) of adolescents with currently comorbid and non-comorbid depression.MethodA sample of 218 consecutive adolescent (13–19 years) psychiatric outpatients with depressive disorders, and 200 age- and sex-matched school-attending controls were interviewed for DSM-IV Axis I and Axis II diagnoses.ResultsCurrent comorbidity, most commonly with anxiety disorders, was equally frequent (>70%) in outpatients and depressed controls. Younger age (OR 0.20; 95% CI 0.08, 0.51) and male gender (OR 0.02; 95% CI 0.09, 0.55) were associated with concurrent disruptive disorders. Current comorbidity with substance use disorders (SUD) was independent of age (OR 1.13; 95% CI 0.51, 2.49) and sex (OR 0.51; 95% CI 0.22, 1.17). Personality disorders associated with older age (OR 2.06; 95% CI 1.10, 3.86). In multivariable logistic regression analysis, impairment (GAF ≤60) was associated with current comorbidity (OR 3.13; 95% CI 1.53, 6.45), while severity of depression and lifetime age of onset for depression were not.ConclusionsAdolescent depression presents with age- and sex-dependent patterns of multiple co-occurring problem areas. While many clinical characteristics of adolescent depression are not affected by comorbidity, comorbidity associates with increased impairment.

Psychometric properties and clinical utility of the Scale for Suicidal Ideation (SSI) in adolescents

BackgroundAccurate assessment of suicidality is of major importance in both clinical and research settings. The Scale for Suicidal Ideation (SSI) is a well-established clinician-rating scale but its suitability to adolescents has not been studied. The aim of this study was to evaluate the reliability and validity, and to test an appropriate cutoff threshold for the SSI in a depressed adolescent outpatient population and controls.Methods218 adolescent psychiatric outpatient clinic patients suffering from depressive disorders and 200 age- and sex-matched school-attending controls were evaluated by the SSI for presence and severity of suicidal ideation. Internal consistency, discriminative-, concurrent-, and construct validity as well as the screening properties of the SSI were evaluated.ResultsCronbachs α for the whole SSI was 0.95. The SSI total score differentiated patients and controls, and increased statistically significantly in classes with increasing severity of suicidality derived from the suicidality items of the K-SADS-PL diagnostic interview. Varimax-rotated principal component analysis of the SSI items yielded three theoretically coherent factors suggesting construct validity. Area under the receiver operating characteristic (ROC) curve was 0.84 for the whole sample and 0.80 for the patient sample. The optimal cutoff threshold for the SSI total score was 3/4 yielding sensitivity of 75% and specificity of 88.9% in this population.ConclusionsSSI appears to be a reliable and a valid measure of suicidal ideation for depressed adolescents.

Factors associated with deliberate self-harm behaviour among depressed adolescent outpatients

This study examined whether depressed adolescent outpatients with deliberate self-harm behaviour (DSH) differed from non-suicidal depressed adolescent outpatients in depressive and anxiety symptoms, alcohol use, perceived social support and number of negative life-events. Depressed adolescent outpatients (n=155) aged 13-19 years were interviewed using K-SADS-PL for DSM-IV Axis I diagnoses and completed self-report questionnaires. Suicidal behaviour was assessed by K-SADS-PL suicidality items. Depressed adolescents with DSH were younger, perceived less support from the family, had more severe depressive symptoms and used more alcohol than non-suicidal depressed adolescents. Adolescents with DSH and suicidal ideation or suicide attempts had more depressive and anxiety symptoms than adolescents with DSH only. Adolescents with severe internalizing distress symptoms are at risk not only for DSH, but also additional suicidal behaviour. Family interventions may be needed in the treatment of depressed adolescents with DSH.

Use of mental health services and complementary and alternative medicine in persons with common mental disorders

Objective:  Few studies investigated the use of complementary and alternative medicine (CAM) by subjects with mental disorders. We examined the relationship between depressive, anxiety and alcohol‐use disorders and their comorbidity, as well as the relationship between use of CAM and use of mental health services.