Increasing numbers of adolescents are seeking treatment at gender identity services in Western countries. An increasingly accepted treatment model that includes puberty suppression with ...gonadotropin-releasing hormone analogs starting during the early stages of puberty, cross-sex hormonal treatment starting at ~16 years of age and possibly surgical treatments in legal adulthood, is often indicated for adolescents with childhood gender dysphoria (GD) that intensifies during puberty. However, virtually nothing is known regarding adolescent-onset GD, its progression and factors that influence the completion of the developmental tasks of adolescence among young people with GD and/or transgender identity. Consolidation of identity development is a central developmental goal of adolescence, but we still do not know enough about how gender identity and gender variance actually evolve. Treatment-seeking adolescents with GD present with considerable psychiatric comorbidity. There is little research on how GD and/or transgender identity are associated with completion of developmental tasks of adolescence.
A number of 14–16 year old Finnish adolescents taking part in the School Health Promotion Study (n=8787 in 1995, n=17643 in 1997) were surveyed about bullying and victimization in relation to ...psychosomatic symptoms, depression, anxiety, eating disorders and substance use. A total of 9 per cent of girls and 17 per cent of boys were involved in bullying on a weekly basis. Anxiety, depression and psychosomatic symptoms were most frequent among bully-victims and equally common among bullies and victims. Frequent excessive drinking and use of any other substance were most common among bullies and thereafter among bully-victims. Among girls, eating disorders were associated with involvement in bullying in any role, among boys with being bully-victims. Bullying should be seen as an indicator of risk of various mental disorders in adolescence.
Abstract Background Aggressive and disruptive behaviors often precede the onset of schizophrenia. In this register-based follow-up study with a case-control design, we wanted to investigate if ...serious delinquency was associated with future diagnoses of schizophrenia or schizoaffective disorder (here, broadly defined schizophrenia) among a nationwide consecutive sample of 15- to 19-year-old Finnish delinquents sent for a forensic psychiatric examination in 1989–2010. Methods The sample comprised 313 delinquents with no past or current psychotic disorder. For each delinquent, four age-, gender- and place of birth -matched controls were randomly selected from the Central Population Register. Five controls (0.4%) had been treated for schizophrenia before their respective index-dates and were thus excluded from further analysis, leaving us with a control population of 1247 individuals. The subjects were followed till death, emigration or the end of 2015, whichever occurred first. Diagnoses were obtained from the Care Register for Health Care. Results Forty (12.8%) of the delinquents and 11 (0.9%) of the controls were diagnosed with schizophrenia later in life (HR 16.6, 95% CI 8.53–32.39, P < 0.001). Almost half of the pretrial adolescents with later schizophrenia were diagnosed within 5 years of the forensic psychiatric examination, but latency was longer among the other half of the sample, reaching up to 20.5 years. Conclusions The study supports the previous research indicating a potential link between serious delinquency and later schizophrenia. Accurate psychiatric assessments should be made in correctional services but also later in life so that any possible psychotic symptoms can be detected in individuals with a history of serious delinquency even if there were no signs of psychosis before or at the time of the crime. Future research should explore which factors influence the delinquent's risk of developing later schizophrenia.
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
Abstract
Background
Serious long-term diseases like asthma, diabetes or epilepsy in adolescence means extra efforts to cope everyday life in school, hobbies or at home. These also set extra ...challenges on adolescents to go through the developmental tasks of that age. We study here, if adolescents with a long-term disease have lower chances for an academic education compared to those without a long-term disease.
Methods
In 2011, all 7th graders in the Helsinki Metropolitan area, Finland were invited to the MetLoFin survey (8946 students from 128 schools answered). In 2014, all 9th graders, representing the same cohort were invited in the end of the lower secondary school (7629; 127). The data were linked with the national Joint Application Registry for the upper secondary schools. Serious diseases were asthma, diabetes, epilepsy and some other individual diseases (6%).
Results
At the 7th grade, the OR for continuing in vocational track or not having got a study place instead of academic track was 1.2 for those with the long-term disease. The difference stayed after adjusting for parents' education and sex but disappeared after adjusting for GPA. At 9th grade, results were similar, but the association disappeared after adjusting for parents' education and sex.
Conclusions
Even in a country like Finland, with high quality health services for children, a long-term disease can compromise educational career, even if the effect is small. The effect mediates mainly through GPA, which is the main selection criteria for upper secondary school.
Key messages
A long-term disease in adolescence can lower chances for academic educational career, even though the effect is small. The effect is mainly mediating through poorer GPA.
Accessible summary
•
This study explores staff perception of management of adolescent aggressive behaviour in forensic units in four European countries. For staff, adolescent aggressive behaviour ...poses a management challenge because of its frequent occurrence.
•
Staff preferred using verbal interventions to manage adolescent aggressive behaviour. They perceived the use of coercive measures as the last option to resolve challenging situations.
•
Differences between countries were reported in the use of restrictive methods. Countries with a longer history of treatment experience of the adolescents tended to use less physical restraints and less often. However, the principles of aggression management were fairly similar.
•
Awareness of aggression management practices would help to manage aggressive situations effectively. This affects the safety of the unit and the occupational safety of the staff. In addition, exploring aggression management across cultures helps in finding good practices when managing challenging situations.
Management of aggressive behaviour is a challenge in adolescent forensic units. Aggressive behaviour endangers the safety of the treatment milieu for patients and nursing and multidisciplinary staff. However, there is a paucity of literature about how the staff manage aggressive behaviour among patients in adolescent forensic settings, and whether the nursing practices are similar across countries. The purpose of this study was to explore nursing practices used to manage adolescent aggressive behaviour in adolescent forensic units in four European countries. An exploratory, descriptive research approach was adopted for the study. A convenience sampling was used by selecting the staff members working in adolescent forensic units (Belgium n= 15, Finland n= 18, the Netherlands n= 16, the UK n= 9). Personal thematic interviews were used to collect the data; and for data analysis, qualitative content analysis was applied. Staff members preferred using verbal and less restrictive interventions when intervening in escalated situations and perceived the use of coercive measures as the last option. Differences between countries were found in the use of restrictive methods. The principles of aggression management were fairly similar across Europe, even if differences were reported in practical solutions.
Background Little is known about use of coercion on minors in psychiatric care. Questions of coercion, self-determination and competence are more complicated in minors than in adults. Choice between ...psychiatric and child welfare care is not always clear. Objective To present findings in Finnish studies on involuntary treatment of adolescents. Methods Register data, medical file data and interviews with the young people, their parents, and professionals participating in decision-making are used in an ongoing series of studies. Results Involuntary psychiatric treatment and taking into care of adolescents has vastly increased since mid 1990's. Their use varies greattly within the same legislation. Involuntary care is more common in socially deprived ares. Involuntary treatment takes place justified by paternalistic motivations. Girls are more easily committed due to disruptive behaviours than boys. Conclusion Involuntary care of minors is a sizeable and ignored ethical problem.
Background Early sexual activity has been widely studied in the context of pregnancies, substance use and antisocial behaviour, but the aspects of psychosexual health have received less attention.
...Aim To study the associations of early sexual activity and self‐reported depression.
Setting A school survey in Finland in 1999 and 2000 in the eighth and ninth grades.
Methods Adolescents with experience of sexual intercourse were studied (11 793 girls and 10 443 boys, mean age 15.5 years). Scores of 8 or more in the Beck Depression Inventory were regarded as indicative of self‐reported depression. Associations with sexual behaviour variables were analysed using logistic regression models.
Results In both genders, self‐reported depression increased in proportion to the number of sexual partners and with the non‐use of contraception. A higher number of coital experiences correlated with depression only among boys. Adjusting for age and age at menarche/oigarche did not affect the associations detected. In stepwise logistic regression, an increasing number of partners increased the risk for self‐reported depression for boys with at least five partners odds ratio (OR) 2.5, 95% confidence intervals (CI) 2.2–3.0, and for girls OR 2.7, 95% CI 2.3–3.2. Boys and girls who did not use contraception showed roughly twice as high a risk as contraceptive users. However, girls with five or more coital experiences had a significantly lower risk for depression compared to girls with only one sexual intercourse.
Conclusions Multiple sexual partners and non‐use of contraception may reflect a depressive disorder in both genders. While adolescent health service providers should be aware of the risk for depression among sexually active adolescents, the sexual health of depressed adolescents also warrants special attention.
Nurses' ethical perceptions about coercion LIND, M.; KALTIALA-HEINO, R.; SUOMINEN, T. ...
Journal of psychiatric and mental health nursing,
08/2004, Letnik:
11, Številka:
4
Journal Article
Recenzirano
Purpose of the study: The purpose of this study was to describe Finnish psychiatric nurses’ ethical perceptions about coercive measures in acute psychiatric setting. Methods: The data were collected ...with a questionnaire developed for this study. The sample included 170 Finnish psychiatric nurses on acute wards in five psychiatric hospitals. The data were analysed using frequency and percentage distributions, mean and standard deviations. The internal consistency of the instrument was explored with Cronbach's alpha. The association between the background variables and the sum score of the items of the questionnaire was tested with Mann–Whitney U‐test and Kruskal–Wallis test. The open‐ended question was analysed with content analysis. Results: Some psychiatric nurses perceived coercive measures as ethically problematic. In particular, the implementation of forced medication (18%), four‐point restraints (16%) and patient seclusion (11%) were perceived as ethically problematic. Female nurses and nurses who worked on closed wards perceived the measures to be more problematic than male nurses and nurses who did not work on closed wards. Conclusion: In Finland, special attention has been paid to ethical questions related to the care of psychiatric patients and to the enhancement of patients’ rights, yet the majority of the nurses participating in the survey did not perceive coercive measures as ethically problematic. More research on this issue as well as further education of the personnel and more extensive teaching of ethics in nursing schools are needed to support the ability of the psychiatric personnel to identify ethically problematic situations. In addition, it is important to consider new measures for generating genuine moral reflection among the personnel on the usage of coercive measures as well as on their effectiveness and legitimacy in the psychiatric care.
PDF
