Riittakerttu Kaltiala-Heino

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.

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.

INTERNET ADDICTION? POTENTIALLY PROBLEMATIC USE OF THE INTERNET IN A POPULATION OF 12-18 YEAR-OLD ADOLESCENTS

On-line surveys indicate harmful excessive use of the Internet resulting in psychosocial problems (Internet addiction). Population studies are scarce, particularly on adolescents who are a vulnerable group in the middle of their personality development. The prevalence of features suggesting harmful use of the Internet is studied in a representative sample of 12–18 year-old Finns (N = 7292) in a postal survey in 2001. Criteria were tailored analogously to the criteria of pathological gambling, fulfilling four of the seven criteria operationalised as Internet addiction. Eighty five percent used the Internet. Among daily users 4.6% of boys and 4.7% of girls fulfilled the four criteria, infrequent users 0.3 and 0.5%, and all respondents 1.7 and 1.4%, respectively. The “addicts” spent more hours (mean = 2.7) in the Internet daily than the “non-addicts” (mean = 1.3). Some adolescents reported a potentially harmful relationship with the Internet comparable to addictive disorders. Although not common now, it will most likely increase with the increasing Internet use.

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.

Early puberty and early sexual activity are associated with bulimic type eating pathology in middle adolescence.

PURPOSE To examine the associations between early pubertal timing and early advanced sexual development with bulimic-type eating pathology in middle adolescents. METHODS A total of 19,321 boys and 19,196 girls aged 14-16 years (mean age 15.3 years, standard deviation 0.59) responded to the School Health Promotion Study, a class-room survey among Finnish adolescents about health, health behavior, and school experiences. Bulimic-type eating pathology was assessed with a questionnaire formulated according to the fourth edition of the Diagnostic and Statistical Manual for Mental Disorders IV (DSM-IV) criteria. Pubertal timing was assessed by self-reported age at menarche or oigarche. Statistical methods were used chi-square and logistic regression. RESULTS Bulimic-type eating pathology among girls was associated with early menarche, early sexual experiences, and increasing age. Among boys, onset of ejaculations at the normative age was protective for bulimic-type eating pathology, and the risk was elevated among very early and late maturers. Early sexual experience was associated with bulimic-type eating pathology. CONCLUSION To prevent bulimia nervosa and to create opportunities for early intervention, attention should be paid to early maturing girls and off-time maturing boys, as well as those with early onset of sexual activity.

Reasons for using seclusion and restraint in psychiatric inpatient care

R. Kaltiala-Heino*, C. Tuohimaki, J. Korkeila, V. Lehtinen Professor of Social Psychiatry, Tampere School of Public Health, University of Tampere, Tampere, Finland MD DrMedSci, Department of Psychiatry, Tampere University Hospital, Tampere, Finland MD, Department of Psychiatry, Oulu University Hospital, Oulu, Finland Professor, Kupittaa Hospital, Turku, Finland Professor, National Research and Development Centre for Welfare and Health (STAKES), Helsinki, Finland

Coercion and restrictions in psychiatric inpatient treatment.

To find out to what extent coercion and restrictions are used in psychiatric inpatient treatment and with which patient characteristics the use of coercion is associated. To this end, the hospital records of 1,543 admissions (six-month admission samples) to the psychiatric clinics in three Finnish university towns were evaluated by retrospective chart review. The study clinics provide all psychiatric inpatient treatment for the working-age population in their catchment areas. Use of coercion and restrictions was recorded in a structured form. Coercion and restrictions were applied to 32% of the patients. Mechanical restraints were used on 10% of the patients, and forced medication on 8%. Compared to international statistics the figures in the current study are high.

Associations between peer victimization, self-reported depression and social phobia among adolescents: the role of comorbidity.

Associations of peer victimization with adolescent depression and social phobia (SP), while controlling for comorbidity between them, have not been sufficiently explored in earlier research. A total of 3156 Finnish adolescents aged 15-16 years participated in a survey study. Self-reported peer victimization, as well as self-reported depression (Beck Depression Inventory), SP (Social Phobia Inventory), and selected background variables were assessed. Frequency of overt and covert peer victimization was examined among four groups: (1) adolescents with depression non-comorbid with SP (DEP), (2) those with SP non-comorbid with depression (SP), (3) those with both SP and depression (SP+DEP), and (4) controls, with neither. A logistic regression analysis controlling for confounding familial (family moving, parental unemployment), and psychopathology (delinquency, aggressiveness, general anxiety) covariates was conducted to confirm the associations between peer victimization and the four groups. Among boys the comorbid SP+DEP group reported the highest rates of both overt and covert victimization, these being significantly higher than among both DEP and SP groups. Among girls covert victimization was again most frequent in the SP+DEP group, but overt victimization was not more frequent in the comorbid group than it was in the DEP and SP groups. In the logistic regression analysis depression without SP did not maintain an independent association with either type of victimization. Instead, SP without depression with ORs from 2.8 to 4.3, and SP comorbid with depression, with ORs between 3.2 and 11.4 had independent associations with peer victimization. In conclusion, overt and covert peer victimization seem to be associated with SP, rather than depression, among adolescents.