Päivi Rantanen

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

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.

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.

Are adolescents with frequent pain symptoms more depressed

Objective - To study predicting value of pain symptoms in detecting depression among adolescents. Design - A population-based classroom survey of 14-16-year-old adolescents. Setting - Secondary schools in two regions of Finland (Vaasa and Pirkanmaa). Subjects - Every secondary school in these two regions was asked to participate in the study. The final sample comprised 17 643 adolescents in 8th and 9th grades (mean age 15.3 years). Main outcome measures - The subjects were asked to rate the frequency of headache, stomach-ache, low back pain and neck or shoulder pain. Depression was measured using the Finnish modification of the short Beck Depression Inventory (R-BDI). Trait anxiety was questioned in an item formulated analogously to R-BDI questions. Results - Prevalence of depression was higher among adolescents with recurrent pain symptoms. Each of the four measured pain symptoms predicted depression independently and accumulation of different pain symptoms increased the odd ratios for depression. Anxiety did not change the association between pain symptoms and depression. Conclusion - Recurrent pain symptoms are associated with depression among adolescents. Clinicians working with adolescents should be aware of this association and interview adolescents with recurrent pains for possible underlying depression.

Social phobia in Finnish general adolescent population: prevalence, comorbidity, individual and family correlates, and service use.

Background: Few studies have investigated the epidemiology of social phobia (SP) among early to middle adolescents, at the time of suggested mean onset of the disorder. The objective of this study was to investigate the prevalence, comorbidity, individual and familial correlates, and service use associated with SP among Finnish 12–17‐year‐old adolescents in general population. Methods: A sample of 784 adolescents was screened with the Social Phobia Inventory, and a sub‐sample (n=350) was interviewed with a semi‐structured clinical interview to identify SP, sub‐clinical SP (SSP), and a range of other axis I DSM‐IV disorders. Individual and familial correlates, and service use associated with SP were also inquired. Results: We found a 12‐month prevalence of 3.2% for SP, and 4.6% for SSP. The prevalence rose and the gender ratio shifted to female preponderance as age increased. SP was frequently comorbid with other anxiety disorders (41%) and depressive disorders (41%). Adolescents with SP/SSP were impaired in their academic and global functioning, and reported more parental psychiatric treatment contacts. Two thirds (68%) of adolescents with SP reported having been bullied by peers. Only one fifth of adolescents with non‐comorbid SP had been in contact with a mental health professional. Conclusions: We conclude that adolescent SP is a relatively frequent, undertreated and highly comorbid condition, associated with educational impairment, depression and anxiety in parents, and peer victimization. Depression and Anxiety, 2009.

Bulimia and bulimic behaviour in middle adolescence: more common than thought?

Kaltiala‐Heino R, Rissanen A, Rimpelä M, Rantanen P. Bulimia and bulimic behaviour in middle adolescence: more common than thought? Acta Psychiatr Scand 1999: 100: 33–39.

Depression, drinking, and substance use among 14- to 16-year-old Finnish adolescents.

Our aim was to assess the relationship between self-reported depression, alcohol consumption, and substance use among 14- to 16-year-olds. A school survey was conducted of 16,464 14- to 16-year-olds in two regions of Finland. Alcohol and other substance use were found to be significantly associated with depression. Of girls (boys) who reported drinking weekly, 24% (13%) scored as depressed, compared with 7% (4%) of those not drinking. Of girls (boys) who reported having experimented with substances five times or more, 37% (28%) scored as depressed compared with 8% (5%) of those who reported never having experimented with substances. These associations persisted in multivariate analyses controlling for sociodemographic background. In conclusion, frequent drinking and experimenting with substances indicate a risk for adolescent depressive disorders, and depressive adolescents are at risk for substance use. Health services should pay attention to the identified depressive adolescents to prevent the possibly subsequent substance use problems among them and also pay attention to frequently drinking adolescents and substance experimenters, to increase identification of depressive disorder and possibilities for early interventions.

Puberty, sexual development and eating disorders in adolescent outpatients

Abstract.This study examined puberty and psychosexual state in a clinical sample of adolescents attending for assessment because of eating disorders (ED). A total of 57 adolescents (girls) aged 14–21 years (mean age 16.9 years) having either anorexia nervosa (AN) or bulimia nervosa (BN) were studied by semi-structured interviews and structured self-report questionnaires considering the timing of menarche, dating and attitudes to sexuality. The age at menarche did not differ statistically significantly between AN and BN. It was significantly lower in the BN group than in the normal population, but no statistically significant difference was found between the AN group and normal population. The general attitudes to sexuality were more negative in the AN group than in the BN group. In the AN group, there were also fewer dating experiences and interest in dating than in the BN group. After controlling for the effect of age, age at menarche and duration of ED, negative attitudes to sexuality and no dating experiences were still best predicted by AN. The results suggest different ways of coping with the developmental challenges in sexuality in AN and BN during adolescence.

Psychopathological distress predicts suicidal ideation and self-harm in adolescent eating disorder outpatients.

ObjectiveThis study evaluated the differences in suicidal behaviour between adolescent anorexia nervosa (AN) and bulimia nervosa (BN), and the association of age, menarche timing, duration of eating disorder (ED), depression and general psychopathological symptoms (GSI) with suicidal behaviour in adolescent ED.MethodsThe study group comprised 57 adolescent outpatients (girls) attending for assessment because of eating disorders. Suicidal ideation, deliberate self-harm and suicidal attempts were assessed in self-report questionnaires.ResultsIn both ED groups, one adolescent had attempted suicide before assessment. Suicidal ideation and/or deliberate self-harm were reported in over half of the cases. Bulimics had significantly more suicidal ideation and deliberate self-harm than anorectics. In multivariate analysis, BN and depression predicted suicidal ideation, but only GSI persisted as predicting deliberate self-harm.ConclusionsSuicidal behaviour is common in adolescent ED. Type of ED (BN), depression and higher GSI are strongly associated with suicidal ideation and deliberate self-harm. Our results point to the need to evaluate psychopathological symptoms in adolescent ED, especially in BN, in the initial assessment to prevent severe suicidal behaviour.