Does Family Structure Play a Role in Depression in Adolescents Admitted to Psychiatric Inpatient Care?

We examined whether adolescents' family structure associate with depression in a clinical sample of 508 adolescents (age 13-17 years) treated in psychiatric hospital between April 2001 and March 2006. Psychiatric disorders of adolescents were based on the K-SADS-PL-interview. Adolescents with depression were characterized by a single parent family background (58 %), but less commonly by a child welfare placement (37 %). Depression in adolescents was significantly related to female gender and a single parent family background, but less significantly related to comorbid psychotic or conducts disorders. The association between family structure and depression presents a challenge to mental health services. Early screening for depression in adolescents admitted for psychiatric treatment from "at risk" family types is important to enhance their future wellbeing and coping strategies.Peer reviewe

Seasonal variation of suicides and homicides in Finland : With special attention to statistical techniques used in seasonality studies

AbstractSeasonal variations of events are apparently playing an important part in various psychiatric conditions. To study the seasonal variation of a condition appears to be one useful approach to clarify the aetiology of a mental disorder and phenomena to which mental disorders are associated. In the present study the seasonal variations of suicides during the period of 1980–95 (n=21279) and homicides during the years 1957–95 (n=4553) in Finland were analysed. In addition, the use of statistical techniques for seasonality and some important characteristics of study samples were evaluated from 44 original suicide seasonality studies published between 1970–97. Special attention was paid to statistical methods for seasonality and these were reviewed in the summary part of this dissertation.A statistically significant spring peak of suicides was found in both genders, in all age groups (aged 39 years or below, 40–64 years, and 65 years or more) and in violent (hanging, drowning, shooting, wrist-cutting, jumping from a height) and non-violent suicides (poisoning, gas, other methods). A secondary autumn peak of suicides was present in females and also associated with non-violent methods. The rate of violent suicides had increased significantly during 1980–90 and decreased thereafter, while the non-violent suicides had kept steadily increasing over the whole 16-year study period. The seasonal variation of violent suicides had remained stable and statistically significant over the whole study period, but the seasonality in non-violent suicides has diminished over time.The seasonal pattern of homicides showed a statistically significant peak in summer and a trough in winter. The observed rate of homicides was about 6% higher in summer and 6% lower in winter than expected under the null hypothesis of a uniform distribution. Both the crude numbers of homicide and the rate of homicides per 100 000 population increased significantly over the 39-year study period. The increasing rate of homicides in Finland was accompanied by decreasing homicide seasonality. The seasonal trends in homicides correlated significantly (positive correlation) with the seasonal trends in the violent suicides over the period of 1980–95.The use of particular statistical techniques was specified in the majority of the 44 reviewed suicide seasonality articles. This was considered as satisfactory, although in subgroup analyses and in comparisons of the seasonal pattern of suicides with phenomena other than suicides, researchers tended to interpret their study findings without a statistical significance test. In those 37 articles, which had actually examined the seasonal pattern of suicides with a statistical test, statistical methods varied from simple standard tests like the chi-square test (14 articles, 38%) to sophisticated time series analyses such as a spectral analysis (4 articles, 11%). The calendar effect (i.e. effect due to the unequal lengths of months and leap years) was reported to have been taken into account in only 10 out of 44 (22%) reviewed studies. The lack of reporting the size of a sample (12 articles, 27%) or monthly values of suicides (17 articles, 54%) was found to be a major deficit in the reviewed studies. On the basis of these findings it is recommended to carry out further surveys, which evaluate statistical content and use of statistical methods in published medical articles. These kinds of surveys remind researchers to consider more thoroughly methodological and statistical issues in their investigations.Academic dissertation to be presented with the assent of the Faculty of Medicine, University of Oulu, for public discussion in the Väinö Pääkkönen Hall of the Department of Psychiatry (Peltolantie 5), on April 28th, 2000, at 12 noon.Abstract Seasonal variations of events are apparently playing an important part in various psychiatric conditions. To study the seasonal variation of a condition appears to be one useful approach to clarify the aetiology of a mental disorder and phenomena to which mental disorders are associated. In the present study the seasonal variations of suicides during the period of 1980–95 (n=21279) and homicides during the years 1957–95 (n=4553) in Finland were analysed. In addition, the use of statistical techniques for seasonality and some important characteristics of study samples were evaluated from 44 original suicide seasonality studies published between 1970–97. Special attention was paid to statistical methods for seasonality and these were reviewed in the summary part of this dissertation. A statistically significant spring peak of suicides was found in both genders, in all age groups (aged 39 years or below, 40–64 years, and 65 years or more) and in violent (hanging, drowning, shooting, wrist-cutting, jumping from a height) and non-violent suicides (poisoning, gas, other methods). A secondary autumn peak of suicides was present in females and also associated with non-violent methods. The rate of violent suicides had increased significantly during 1980–90 and decreased thereafter, while the non-violent suicides had kept steadily increasing over the whole 16-year study period. The seasonal variation of violent suicides had remained stable and statistically significant over the whole study period, but the seasonality in non-violent suicides has diminished over time. The seasonal pattern of homicides showed a statistically significant peak in summer and a trough in winter. The observed rate of homicides was about 6% higher in summer and 6% lower in winter than expected under the null hypothesis of a uniform distribution. Both the crude numbers of homicide and the rate of homicides per 100 000 population increased significantly over the 39-year study period. The increasing rate of homicides in Finland was accompanied by decreasing homicide seasonality. The seasonal trends in homicides correlated significantly (positive correlation) with the seasonal trends in the violent suicides over the period of 1980–95. The use of particular statistical techniques was specified in the majority of the 44 reviewed suicide seasonality articles. This was considered as satisfactory, although in subgroup analyses and in comparisons of the seasonal pattern of suicides with phenomena other than suicides, researchers tended to interpret their study findings without a statistical significance test. In those 37 articles, which had actually examined the seasonal pattern of suicides with a statistical test, statistical methods varied from simple standard tests like the chi-square test (14 articles, 38%) to sophisticated time series analyses such as a spectral analysis (4 articles, 11%). The calendar effect (i.e. effect due to the unequal lengths of months and leap years) was reported to have been taken into account in only 10 out of 44 (22%) reviewed studies. The lack of reporting the size of a sample (12 articles, 27%) or monthly values of suicides (17 articles, 54%) was found to be a major deficit in the reviewed studies. On the basis of these findings it is recommended to carry out further surveys, which evaluate statistical content and use of statistical methods in published medical articles. These kinds of surveys remind researchers to consider more thoroughly methodological and statistical issues in their investigations

Vanhemman kohtaaminen lastensuojelun perheohjauksessa

Tutkimuksen tavoitteena oli selvittää lastensuojelun perheohjauksen asiakkaina olevien vanhempien kokemuksia kohtaamisesta, eli miten vanhemmat olivat kokeneet tulleensa kohdatuiksi ja miten he toivoisivat jatkossa tulevansa kohdatuiksi. Kohtaamisella tarkoitetaan sitä, miten henkilö on otettu vastaan, miten hänet on huomioitu ja miten häntä on kohdeltu. Tutkimus toteutettiin kyselylomakkeilla jotka jaettiin Etelä-Pohjanmaalla toimivan lastensuojelun perheohjauksen yksikön asiakkaina oleville vanhemmille. Vastauksia saatiin 12 kappaletta. Tutkimus on sekä kvalitatiivinen että kvantitatiivinen ja se analysoitiin aineistolähtöisen sisällönanalyysin avulla. Teoreettisessa viitekehyksessä käsitellään perhettä ja vanhemmuutta, lastensuojelua ja lastensuojelun tukimuotoja sekä kohtaamista. Tutkimus osoittaa, että perheohjauksen asiakkaat kokivat hyvän kohtaamisen olevan tärkeää perheohjauksen onnistumisen kannalta. Kysyttäessä konkreettisia esimerkkejä hyvästä kohtaamisesta vastaajat nostivat esille eniten termejä liittyen kuuntelemiseen, auttamiseen ja tukemiseen. Tutkimuksen mukaan kyseisen yksikön perheohjaajat olivat onnistuneet kohtaamisessa pääosin hyvin.The purpose of this research was to study the experiences of the parents on how they have been encountered during family councelling in child welfare i.e. how the parents felt they had been encountered and how they would like to be encountered in the future. Encounter in this context means how a person has been greeted, taken into account and treated. The study was carried out with questionnaires to the parents that were the clients of one child welfare unit in the area of Southern-Ostrobothnia. There were 12 responses. This study is qualitative and quantitative and the material was analysed with data based content analysis. The theoretical frame of the study deals with encountering, families and parenthood, child welfare and different forms of support offered in child welfare. The study concludes that the clients of family councelling felt that an encounter of good a quality is essential for successful family councelling. When asked about examples of good encounter, the parents brought up terms related to listening, helping and supporting. The results also show that the employees of the family work unit have in most cases succeeded well in encountering the clients

High occurrence of cyclosporiasis in Istanbul, Turkey, during a dry and warm summer

We evaluated the incidence of Cyclospora cayetanensis in immunocompetent, diarrheic patients during the summers of 2006-2009 in Istanbul. Stools from 1876 patients were examined using microscopic techniques. Cyclospora oocysts were observed in wet preparations by light and epifluorescence microscopy and in fecal smears that were stained by Kinyoun's modified acid-fast stain. Characteristic Cyclospora oocysts were observed in 2 patients in 2006, 17 in 2007, and one in 2009. Samples positive for Cyclospora were further analyzed by a single step polymerase chain reaction (PCR) with Cyclospora-specific primers from the ITS-1 region of the genome

Kvanttipisteet lääketieteellisessä kuvantamisessa

Kvanttipisteet ovat Louis E. Brusin vuonna 1986 löytämiä puolijohdenanopartikkeleita, joiden halkaisija on vain muutamia nanometrejä. Hyvin pienen kokonsa vuoksi kvanttipisteet käyttäytyvät yllättävällä tavalla. Kvanttipisteiden kokoa muuttamalla niiden energiarakenne muuttuu. Energiarakenteen muuttuminen puolestaan muuttaa materiaalin havaittavia sähköisiä ja optisia ominaisuuksia. Kvanttipisteiden säädettävyys tekee niistä kiinnostavia useilla eri tieteenaloilla. Kvanttipisteiden toiminnan fysikaaliseen ymmärtämiseen tarvitaan kvanttimekaniikkaa, mistä kvanttipisteet ovat luultavasti saaneet nimensä. Kvanttipisteiden myrkyllisyys on rajoittanut niiden käyttöä laboratorioiden ulkopuolella. Kyky valmistaa myrkyttömiä kvanttipisteitä on tuonut ensimmäiset kvanttipisteet kuluttajakäyttöön kvanttipisteitä hyödyntävässä näyttötekniikassa. Tutkielmassani käsittelen kvanttipisteiden valmistusta, tarkastelen kvanttipisteitä fysiikan näkökulmasta sekä esitän kvanttipisteiden lääketieteellisiä sovellutuksia

One-year prevalence and psychiatric comorbidity of borderline personality disorder in a medical certificate population: a registry study of psychiatric outpatients in community mental health care in the city of Oulu

Abstract Objective: Borderline personality disorder (BPD) is a common disorder in healthcare settings but estimates of BPD prevalence vary greatly. This study aimed to estimate the one-year prevalence of BPD in psychiatric outpatients and analyze the psychiatric comorbidity presented with BPD. Method: The data comprised 18–60-year-old patients who had a BPD diagnosis recorded in their medical certificate B (mcB) and were treated in specialized psychiatric outpatient services in the city of Oulu, northern Finland, in 2014. An mcB is a comprehensive summary of a patient’s medical history written by a doctor, and patients need it in the Finnish healthcare system when applying for social benefits and rehabilitation measures. Results: The prevalence of BPD was 12.8% among patients with an mcB treated in the psychiatric outpatient services. BPD was 3.0 times more common in female than male psychiatric outpatients with an mcB. The most common comorbid psychiatric disorders written in mcBs of BPD patients were mood (81.0%) and anxiety (39.2%) disorders. The only statistically significant gender difference was found in behavioral and emotional disorders (16.7% in men, 1.6% in women). Conclusions: The mcB-based BPD prevalence estimate and psychiatric comorbidity was consistent with previous studies researching psychiatric outpatients with BPD. McBs appear to be a reliable and comprehensive data source for diagnostic information in research.Abstract Objective: Borderline personality disorder (BPD) is a common disorder in healthcare settings but estimates of BPD prevalence vary greatly. This study aimed to estimate the one-year prevalence of BPD in psychiatric outpatients and analyze the psychiatric comorbidity presented with BPD. Method: The data comprised 18–60-year-old patients who had a BPD diagnosis recorded in their medical certificate B (mcB) and were treated in specialized psychiatric outpatient services in the city of Oulu, northern Finland, in 2014. An mcB is a comprehensive summary of a patient’s medical history written by a doctor, and patients need it in the Finnish healthcare system when applying for social benefits and rehabilitation measures. Results: The prevalence of BPD was 12.8% among patients with an mcB treated in the psychiatric outpatient services. BPD was 3.0 times more common in female than male psychiatric outpatients with an mcB. The most common comorbid psychiatric disorders written in mcBs of BPD patients were mood (81.0%) and anxiety (39.2%) disorders. The only statistically significant gender difference was found in behavioral and emotional disorders (16.7% in men, 1.6% in women). Conclusions: The mcB-based BPD prevalence estimate and psychiatric comorbidity was consistent with previous studies researching psychiatric outpatients with BPD. McBs appear to be a reliable and comprehensive data source for diagnostic information in research

Profile of Substance Misuse among Adolescent and Young Adult Gabapentinoid Users : A Register-Based Follow-up Study of Former Adolescent Psychiatric Inpatients

AbstractAims: Our study examined characteristics of adolescent and young adult study participants using gabapentinoids (gabapentin, pregabalin), with previous history of adolescent psychiatric inpatient hospitalization. Particular focus was on temporal association of age, at first prescription for gabapentinoids, to age at tobacco smoking initiation, regular alcohol use, diagnosis of substance dependence and prescriptions for benzodiazepines and opioids. Methods: The initial study population contained 508 adolescents (300 females, 208 males) admitted to psychiatric inpatient care in Oulu University hospital between the ages 13–17 years. Register-based follow-up information on prescriptions for gabapentinoids, benzodiazepines and opioids, as well as ICD-10 diagnosis for hospital-treated substance dependence, was obtained from the Finnish national health care registers. Results: The users of gabapentinoids accounted for 9.1% of the initial study population. Of adolescence-related characteristics, suicidal ideation, suicide attempts and non-suicidal self-injury was emphasized in females using gabapentinoids. The majority of participants using gabapentinoids had benzodiazepines (80.4%) and opioids (71.7%) as comorbid drugs. Initiation of tobacco smoking and alcohol use and first prescriptions for of benzodiazepines and opioids, and a diagnosis of substance dependence commonly predated first prescriptions for gabapentinoids. Conclusions: In clinical practice, the decision to prescribe gabapentinoids to adolescents or young adults must be made with caution, particularly for those with substance use problems and/or without a clinically approved indication.Abstract Aims: Our study examined characteristics of adolescent and young adult study participants using gabapentinoids (gabapentin, pregabalin), with previous history of adolescent psychiatric inpatient hospitalization. Particular focus was on temporal association of age, at first prescription for gabapentinoids, to age at tobacco smoking initiation, regular alcohol use, diagnosis of substance dependence and prescriptions for benzodiazepines and opioids. Methods: The initial study population contained 508 adolescents (300 females, 208 males) admitted to psychiatric inpatient care in Oulu University hospital between the ages 13–17 years. Register-based follow-up information on prescriptions for gabapentinoids, benzodiazepines and opioids, as well as ICD-10 diagnosis for hospital-treated substance dependence, was obtained from the Finnish national health care registers. Results: The users of gabapentinoids accounted for 9.1% of the initial study population. Of adolescence-related characteristics, suicidal ideation, suicide attempts and non-suicidal self-injury was emphasized in females using gabapentinoids. The majority of participants using gabapentinoids had benzodiazepines (80.4%) and opioids (71.7%) as comorbid drugs. Initiation of tobacco smoking and alcohol use and first prescriptions for of benzodiazepines and opioids, and a diagnosis of substance dependence commonly predated first prescriptions for gabapentinoids. Conclusions: In clinical practice, the decision to prescribe gabapentinoids to adolescents or young adults must be made with caution, particularly for those with substance use problems and/or without a clinically approved indication

Associations of adolescent psychosocial factors to later benzodiazepine use : a population-based follow-up study of adolescent psychiatric inpatients in Northern Finland

AbstractWe investigated factors associated with benzodiazepine (BZD) use during late adolescence and early adulthood. The study population consisted of 508 adolescents admitted to psychiatric inpatient care between April 2001 and March 2006. Information on adolescents’ family- and school-related factors, suicidality and psychiatric disorders were obtained by semistructured interviews. Data on BZD prescriptions from 1999 to 2012 were collected from the Social Insurance Institution of Finland. In males heavy BZD use associated with adolescent substance-use disorder (OR, 3.5; P P = 0.029). Among females, conduct disorder (OR, 3.3; P = 0.016), being a bully/bully-victim (OR, 3.3; P = 0.019) and parental substance-use problems (OR, 2.6; P = 0.024) were related to heavy BZD use. The mean (±SD) age of first BZD prescription was significantly lower in heavy, compared with mild users (men: 19.3 ± 2.5 vs. 21.0 ± 2.5 years, P = 0.027; women: 19.7 ± 2.6 vs. 21.5 ± 3.4 years, P = 0.027). Heavy, compared with mild, BZD use is associated with female suicide attempts (OR, 5.0; P = 0.049). Physicians should be cautious when prescribing BZDs to young adults and must allocate treatment to those with carefully evaluated clinical indications.Abstract We investigated factors associated with benzodiazepine (BZD) use during late adolescence and early adulthood. The study population consisted of 508 adolescents admitted to psychiatric inpatient care between April 2001 and March 2006. Information on adolescents’ family- and school-related factors, suicidality and psychiatric disorders were obtained by semistructured interviews. Data on BZD prescriptions from 1999 to 2012 were collected from the Social Insurance Institution of Finland. In males heavy BZD use associated with adolescent substance-use disorder (OR, 3.5; P < 0.004) and parents’ psychiatric problems (OR, 3.5; P = 0.029). Among females, conduct disorder (OR, 3.3; P = 0.016), being a bully/bully-victim (OR, 3.3; P = 0.019) and parental substance-use problems (OR, 2.6; P = 0.024) were related to heavy BZD use. The mean (±SD) age of first BZD prescription was significantly lower in heavy, compared with mild users (men: 19.3 ± 2.5 vs. 21.0 ± 2.5 years, P = 0.027; women: 19.7 ± 2.6 vs. 21.5 ± 3.4 years, P = 0.027). Heavy, compared with mild, BZD use is associated with female suicide attempts (OR, 5.0; P = 0.049). Physicians should be cautious when prescribing BZDs to young adults and must allocate treatment to those with carefully evaluated clinical indications

Factors that Affect Adolescent Adherence to Mental Health and Psychiatric Treatment: a Systematic Integrative Review of the Literature

Although adherence to somatic treatment has been studied extensively, adherence to mental health treatment has not. In this study, the term treatment adherence is used to refer to adherence to medication regimes and other non-pharmacological recommended treatments as part of mental health and psychiatric care. Knowledge of factors connected to adolescents' adherence to such treatment is fairly fragmented. Although treatment staff members are broadly aware of the factors that influence adherence, it would be desirable to develop formalized treatment assessment and planning approaches that specifically take these factors into account.The purpose of this article is to review the available data related to factors that affect adolescents' adherence to both medication and non-pharmacological treatments in mental health and psychiatric care.A systematic literature search that involved four databases was undertaken. A thematic analysis was conducted on 17 studies to extract relevant information.It appears that an adolescent's own positive beliefs toward his or her treatment are the main factor that improves his or her adherence to that treatment. Good cohesion with close supportive people appears to be positively related to adherence, whereas sociodemographic characteristics (e.g., race, gender) were not related.By identifying the factors related to the treatment adherence of adolescents, this review article can provide guidance to help improve the quality of care and thus further increase adolescents' satisfaction with their mental health and psychiatric treatment

Season, weather, and suicide:Further evidence for ecological complexity

Background: easonality in suicide is reported worldwide, and peaks in late spring. Despite the potential connection to the weather, associations between meteorological variables and suicide does not explain seasonality. Studies testing for seasonality while controlling for the weather show patterns that are more complex than a straightforward link between spring-like weather and suicide. Methods: We tested whether seasonality in suicide was due to meteorological variation (hours of sunshine, rainfall, or temperature) in a novel population (Scotland; 2003–2013). We also sought to further explore the ecological complexity demonstrated in previous work by testing associations at a single location (Tay Road Bridge; 1968–2017). RESULTS: We found peaks in suicidal behavior in June at the bridge, but no seasonality for Scotland as a whole. Seasonality was reduced when we controlled for maximum temperature and hours of sunshine. We found patterns to be dependent upon sex, with stronger seasonal and meteorological effects amongst men. Limitations: Our study was exploratory and relies on population-level data. Conclusions: Seasonal and meteorological effects on suicide are dependent upon local and individual context, with significant effects apparent at the Tay Road Bridge and not across Scotland as a whole. Men may be more sensitive to season and weather. In order to determine whether seasonality in suicide is due to meteorological variation, future research should test patterns in small geographical units, in men and women, and for different suicide methods, and seek to identify the social and physical factors which predict variation in patterns