Reija Paananen

Cohort Profile: The 1987 Finnish Birth Cohort

There is ample evidence showing how marginalization and inequalities in well-being and health have roots in childhood. Preand perinatal factors affect childhood and adolescent outcomes—such as mortality and morbidity, behavioural problems, delinquent and criminal behaviour, cognitive and motor functioning and teenage pregnancies, but the extent to which these effects are sustained through adulthood is less clear. Epidemiological research has identified various early childhood determinants for social exclusion in adolescence and adulthood. These include preand perinatal, genetic as well as environmental risk factors across childhood years. Problems also run in families as a result of both social and biological processes. There is information about several risk factors that contribute to adolescent mental health problems. However, little is known about the protective factors. The Finnish welfare system provides many services to children in at-risk groups, yet little is known about the long-term effects of different official actions and at times reports have been unfavourable. In addition, significant health differences have been observed according to gender and region, but the reasons for these remain unknown. Most data on child and adolescent health and social coping are sample based, cross-sectional or based on short-term outcome. The increased routine collection of administrative register data has created new possibilities for life-course epidemiological research. Previously, such data have not been widely used for follow-up purposes. The Academy of Finland launched a research programme on Responding to Public Health Challenges (SALVE) in 2008. This programme is set to provide applicable information in order to respond to current and future key public health issues, and to bring together approaches applied in public health research as well as in behavioural sciences, social sciences and biosciences. The programme is divided into four thematic areas: health-protecting and health-promoting factors, life-course approaches and critical periods of life, health inequalities and clustering of ill health, and predicting future health. Follow-up of the 1987 Finnish Birth Cohort is funded by the consortium ‘Life-course Determinants of Mental Health, Marginalization and Social Coping’ through the Academy of Finland’s SALVE research programme.

Social determinants of mental health: a Finnish nationwide follow-up study on mental disorders

Background Most mental disorders start in childhood and adolescence. Risk factors are prenatal and perinatal, genetic as well as environmental and family related. Research evidence is, however, insufficient to explain the life-course development of mental disorders. This study aims to provide evidence on factors affecting mental health in childhood and adolescence. Data and methods The 1987 Finnish Birth Cohort covers all children born in Finland in 1987 (N=59 476) who were followed up until the age of 21 years. The study covers detailed health, social welfare and sociodemographic data of the cohort members and their parents from Finnish registers. Results Altogether, 7578 (12.7%) cohort members had had a diagnosed mental disorder. Several prenatal, perinatal and family-related risk factors for mental disorders were found, with sex differences. The main risk factors for mental disorders were having a young mother (OR 1.30 (1.16 to 1.47)), parents’ divorce (OR 1.33 (1.26 to1.41)), death of a parent (OR 1.27 (1.16 to 1.38)), parents’ short education (OR 1.23(1.09 to 1.38)), childhood family receiving social assistance (OR 1.61 (1.52 to 1.71)) or having a parent treated at specialised psychiatric care (OR 1.47 (1.39 to 1.55)). Perinatal problem (OR 1.11 (1.01 to 1.22)) and prenatal smoking (OR 1.09 (1.02 to 1.16)) were risk factors for mental disorders, even after controlling for background factors. Elevated risk was seen if the cohort member had only basic education (OR 3.37 (3.14 to 3.62)) or had received social assistance (OR 2.45 (2.30 to 2.60)). Conclusions Mental disorders had many social risk factors which are interlinked. Although family difficulties increased the risk for mental disorders, they were clearly determined by the cohort members low education and financial hardship. This study provides evidence for comprehensive preventative and supporting efforts. Families with social adversities and with parental mental health problems should be supported to secure childrens development.

Mental disorder diagnoses of offspring affected by parental cancer before early adulthood: the 1987 Finnish Birth Cohort study

The purpose of this study is to investigate psychiatric diagnoses given to children affected by parental cancer in psychiatric and somatic specialized health care settings.

Parents' traumatic brain injury increases their children's risk for use of psychiatric care: the 1987 Finnish Birth Cohort study

OBJECTIVE Traumatic brain injury (TBI) of a parent causes significant changes in their family life and parent-children relationships. However, the number of children affected by parental TBI and the long-term consequences for these children remain unknown. We estimated the prevalence of children affected by parental TBI and investigated whether these children had greater use of psychiatric services than their peers. METHODS This a retrospective population-based register study. All 60,069 children born in Finland in 1987 were followed up through national health and social registers from 1987 to 2008. RESULTS During the 21-year follow-up, 1532 (2.6%) children had a parent with TBI. Overall, 22.5% of those having a parent with TBI were treated in specialized psychiatric care. Use of psychiatric care was significantly increased among those cohort members with a parent with mild [odds ratio (OR) 1.80, 95% confidence interval (CI) 1.37-2.38] or severe (OR 1.49, 95% CI 1.12-1.98) TBI compared to their peers. CONCLUSIONS Parental TBI is associated with increased use of specialized psychiatric services by children. Adult health care services must have appropriate systems in place to address the psychosocial needs and support the welfare and development of children of patients with TBI.

Determinants of underage induced abortion - the 1987 Finnish Birth Cohort study

Although underage pregnancies often end in induced abortion, data on girls who undergo termination of pregnancy are lacking. Our aim was to identify determinants of underage induced abortion and compare them with those of childbirth.