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Childhood predictors of later psychiatric hospital treatment: findings from the Finnish 1981 birth cohort study

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Abstract

Psychiatric hospital treatment (PHT) is expensive and indicates a severe disorder. Investigation of the early identification of this small patient group has though been hindered by small samples or unsatisfactory assessment in childhood. The present study aims to study the predictive association between psychopathology at age 8 using multi-informant assessment and later PHT. A nationwide birth cohort of Finnish children (n = 5,346) was assessed at age 8 to obtain information about psychopathology using the Rutter parent and teacher reports and self-reports of depressive symptoms. The main outcome was admission to any hospital with a primary diagnosis of any psychiatric disorder according to the Finnish National Hospital Discharge Register between age 13 and 24. Between age 13 and 24, 6.2% of the males and 4.1% of the females had been admitted for PHT. Among males, PHT was independently predicted by non-intact family and adult reports of conduct and of emotional symptoms, while among females by self-reported depressive symptoms. However, the combination of conduct and emotional problems was the strongest predictor for PHT in both sexes. Admission due to psychosis among males was associated with childhood conduct, attention, and emotional problems, but with emotional problems among females. Psychopathology at age 8 can be seen as a long-lasting increased risk of severe psychiatric disorders requiring hospital treatment in adolescence or early adulthood. Attention should be paid to self-reports among females and of comorbid conduct and emotional problems in both sexes in the early identification of this patient group.

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References

  1. Almqvist F, Ikäheimo K, Kumpulainen K et al (1999) Design and subjects of a Finnish epidemiological study on psychiatric disorders in childhood. Eur Child Adolesc Psychiatry 8(Suppl 4):3–6

    Article  PubMed  Google Scholar 

  2. Almqvist F, Kumpulainen K, Ikäheimo K et al (1999) Behavioural and emotional symptoms in 8–9-year-old children. Eur Child Adolesc Psychiatry 8(Suppl 4):7–16

    Article  PubMed  Google Scholar 

  3. AmericanPsychiatric Association (2000) Appendix H. DSM-IV classification with ICD-10 codes. In: American Psychiatric Association (ed) Diagnostic and statistical manual of mental disorders, fourth edition, text revision (DSM-IV-TR). American Psychiatric Association, Washington, DC, pp 829–841

    Chapter  Google Scholar 

  4. Best KM, Hauser ST, Gralinski-Bakker JH, Allen JP, Crowell J (2004) Adolescent psychiatric hospitalization and mortality, distress levels, and educational attainment: follow-up after 11 and 20 years. Arch Pediatr Adolesc Med 158:749–752

    Article  PubMed  Google Scholar 

  5. Blanz B, Schmidt MH (2000) Preconditions and outcome of inpatient treatment in child and adolescent psychiatry. J Child Psychol Psychiatry 41:703–712

    Article  CAS  PubMed  Google Scholar 

  6. Cannon M, Caspi A, Moffitt TE, Harrington H, Taylor A, Murray RM, Poulton R (2002) Evidence for early-childhood, pan-developmental impairment specific to schizophreniform disorder: Results from a longitudinal birth cohort. Arch Gen Psychiatry 59:449–456

    Article  PubMed  Google Scholar 

  7. Costello EJ, Egger H, Angold A (2005) 10-year research update review: the epidemiology of child and adolescent psychiatric disorders. I. Methods and public health burden. J Am Acad Child Adolesc Psychiatry 44:972–986

    Article  PubMed  Google Scholar 

  8. Done DJ, Crow TJ, Johnstone EC, Sacker A (1994) Childhood antecedents of schizophrenia and affective illness: social adjustment at ages 7 and 11. BMJ 309:699–703

    CAS  PubMed  Google Scholar 

  9. Elkins IJ, McGue M, Iacono WG (2007) Prospective effects of attention-deficit/hyperactivity disorder, conduct disorder, and sex on adolescent substance use and abuse. Arch Gen Psychiatry 64:1145–1152

    Article  PubMed  Google Scholar 

  10. Ensminger ME, Juon HS, Fothergill KE (2002) Childhood and adolescent antecedents of substance use in adulthood. Addiction 97:833–844

    Article  PubMed  Google Scholar 

  11. Fergusson DM, Boden JM, Horwood LJ (2007) Exposure to single parenthood in childhood and later mental health, educational, economic, and criminal behavior outcomes. Arch Gen Psychiatry 64:1089–1095

    Article  PubMed  Google Scholar 

  12. Foley DL, Goldston DB, Costello EJ, Angold A (2006) Proximal psychiatric risk factors for suicidality in youth: the great smoky mountains study. Arch Gen Psychiatry 63:1017–1024

    Article  PubMed  Google Scholar 

  13. Gissler M, Haukka J (2004) Finnish health and social welfare registers in epidemiological research. Norsk Epidemiologi 14:113–120

    Google Scholar 

  14. Gowers SG, Rowlands L (2005) Inpatient services. Curr Opin Psychiatry 18:445–448

    Article  PubMed  Google Scholar 

  15. Hankin BL, Abramson LY (2001) Development of gender differences in depression: an elaborated cognitive vulnerability-transactional stress theory. Psychol Bull 127:773–796

    Article  CAS  PubMed  Google Scholar 

  16. Hoshmer DW, Lemenshow S (1999) Applied survival analysis, regression modeling of time to event data. John Wiley & Sons, New York

    Google Scholar 

  17. Jensen PS, Rubio-Stipec M, Canino G, Bird HR, Dulcan MK, Schwab-Stone ME, Lahey BB (1999) Parent and child contributions to diagnosis of mental disorder: are both informants always necessary? J Am Acad Child Adolesc Psychiatry 38:1569–1579

    Article  CAS  PubMed  Google Scholar 

  18. Jones P, Rodgers B, Murray R, Marmot M (1994) Child development risk factors for adult schizophrenia in the British 1946 birth cohort. Lancet 344:1398–1402

    Article  CAS  PubMed  Google Scholar 

  19. Keskimäki I, Aro S (1991) Accuracy of data on diagnoses, procedures and accidents in the Finnish hospital discharge register. Int J Health Sci 2:15–21

    Google Scholar 

  20. Kim-Cohen J, Caspi A, Moffitt TE, Harrington H, Milne BJ, Poulton R (2003) Prior juvenile diagnoses in adults with mental disorder: developmental follow-back of a prospective-longitudinal cohort. Arch Gen Psychiatry 60:709–717

    Article  PubMed  Google Scholar 

  21. Knapp M, McCrone P, Fombonne E, Beecham J, Wostear G (2002) The Maudsley long-term follow-up of child and adolescent depression. 3. Impact of comorbid conduct disorder on service use and costs in adulthood. Br J Psychiatry 180:19–23

    Article  PubMed  Google Scholar 

  22. Kovacs M (1992) Children’s Depression Inventory, CDI, Manual. Multi-Health Systems, Ontario

    Google Scholar 

  23. Kresanov K, Tuominen J, Piha J, Almqvist F (1998) Validity of child psychiatric screening methods. Eur Child Adolesc Psychiatry 7:85–95

    Article  CAS  PubMed  Google Scholar 

  24. Mechanic D, McAlpine DD, Olfson M (1998) Changing patterns of psychiatric inpatient care in the United States, 1988–1994. Arch Gen Psychiatry 55:785–791

    Article  CAS  PubMed  Google Scholar 

  25. Official Statistics of Finland/Stakes (2008) Psykiatrian erikoisalan laitoshoito 2007-tilastotiedote 36/2008. http://www.stakes.fi/tilastot/tilastotiedotteet/2008/Tt36_08.pdf. Accessed 04/20/2009

  26. Olfson M, Gameroff MJ, Marcus SC, Greenberg T, Shaffer D (2005) National trends in hospitalization of youth with intentional self-inflicted injuries. Am J Psychiatry 162:1328–1335

    Article  PubMed  Google Scholar 

  27. Olin SS, John RS, Mednick SA (1995) Assessing the predictive value of teacher reports in a high risk sample for schizophrenia: a ROC analysis. Schizophr Res 16:53–66

    Article  CAS  PubMed  Google Scholar 

  28. Perälä J, Suvisaari J, Saarni SI et al (2007) Lifetime prevalence of psychotic and bipolar I disorders in a general population. Arch Gen Psychiatry 64:19–28

    Article  PubMed  Google Scholar 

  29. Pottick K, Hansell S, Gutterman E, White HR (1995) Factors associated with inpatient and outpatient treatment for children and adolescents with serious mental illness. J Am Acad Child Adolesc Psychiatry 34:425–433

    Article  CAS  PubMed  Google Scholar 

  30. Reef J, Diamantopoulou S, van Meurs I, Verhulst F, van der Ende J (2009) Child to adult continuities of psychopathology: a 24-year follow-up. Acta Psychiatr Scand 120:230–238

    Article  CAS  PubMed  Google Scholar 

  31. Rutter M (1967) A children’s behaviour questionnaire for completion by teachers: preliminary findings. J Child Psychol Psychiatry 8:1–11

    Article  CAS  PubMed  Google Scholar 

  32. Rutter M, Caspi A, Moffitt TE (2003) Using sex differences in psychopathology to study causal mechanisms: unifying issues and research strategies. J Child Psychol Psychiatry 44:1092–1115

    Article  PubMed  Google Scholar 

  33. Rutter M, Tizard J, Whitmore K (eds) (1970) Education, health and behaviour. Longman, London

    Google Scholar 

  34. Simonoff E, Pickles A, Meyer JM et al (1997) The Virginia twin study of adolescent behavioral development. Influences of age, sex, and impairment on rates of disorder. Arch Gen Psychiatry 54:801–808

    CAS  PubMed  Google Scholar 

  35. Sourander A, Helstelä L, Helenius H (1999) Parent-adolescent agreement on emotional and behavioral problems. Soc Psychiatry Psychiatr Epidemiol 34:657–663

    Article  CAS  PubMed  Google Scholar 

  36. Sourander A, Jensen P, Davies M et al (2007) Who is at greatest risk of adverse long-term outcomes? The Finnish from a boy to a man study. J Am Acad Child Adolesc Psychiatry 46:1148–1161

    Article  PubMed  Google Scholar 

  37. Sourander A, Klomek AB, Niemelä S et al (2009) Childhood predictors of completed and severe suicide attempts: Findings from the Finnish 1981 birth cohort study. Arch Gen Psychiatry 66:398–406

    Article  PubMed  Google Scholar 

  38. Tiihonen J, Haukka J, Henriksson M et al (2005) Premorbid intellectual functioning in bipolar disorder and schizophrenia: results from a cohort study of male conscripts. Am J Psychiatry 162:1904–1910

    Article  PubMed  Google Scholar 

  39. Timbremont B, Braet C, Dreessen L (2004) Assessing depression in youth: relation between the children’s depression inventory and a structured interview. J Clin Child Adolesc Psychol 33:149–157

    Article  PubMed  Google Scholar 

  40. Verhulst FC, Dekker MC, van der Ende J (1997) Parent, teacher and self-reports as predictors of signs of disturbance in adolescents: whose information carries the most weight? Acta Psychiatr Scand 96:75–81

    Article  CAS  PubMed  Google Scholar 

  41. Weissman MM, Wolk S, Wickramaratne P et al (1999) Children with prepubertal-onset major depressive disorder and anxiety grown up. Arch Gen Psychiatry 56:794–801

    Article  CAS  PubMed  Google Scholar 

  42. Weitoft GR, Hjern A, Haglund B, Rosen M (2003) Mortality, severe morbidity, and injury in children living with single parents in Sweden: a population-based study. Lancet 361:289–295

    Article  PubMed  Google Scholar 

  43. Welham J, Isohanni M, Jones P, McGrath J (2009) The antecedents of schizophrenia: a review of birth cohort studies. Schizophr Bull 35:603–623

    Article  PubMed  Google Scholar 

  44. Youngstrom EA, Findling RL, Calabrese JR (2003) Who are the comorbid adolescents? Agreement between psychiatric diagnosis, youth, parent, and teacher report. J Abnorm Child Psychol 31:231–245

    Article  PubMed  Google Scholar 

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Acknowledgments

The study has been supported by the Medical Society of Finland (Finska Läkaresällskapet), the Finnish Foundation for Paediatric Research (Lastentautien tutkimussäätiö) and the Wilhelm and Else Stockmann Foundation. The authors wish to thank Ms Jarna Lindroos for secretarial assistance. The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Child Psychiatry, University of Helsinki, PO.BOX 22, Lastenlinnantie 2, 00014, University of Helsinki, Finland

    David Gyllenberg & Fredrik Almqvist

  2. Department of Child Psychiatry, University of Turku, Turku, Finland

    Andre Sourander, Lauri Sillanmäki & Jorma Piha

  3. RBUP, Institute of Clinical Medicine, Tromsø University, Tromsø, Norway

    Andre Sourander

  4. Department of Psychiatry, University of Turku, Turku, Finland

    Solja Niemelä

  5. Department of Biostatistics, University of Turku, Turku, Finland

    Hans Helenius

  6. Department of Child Psychiatry, University of Kuopio, Kuopio, Finland

    Kirsti Kumpulainen

  7. Department of Child Psychiatry, University of Tampere, Tampere, Finland

    Tuula Tamminen

  8. Department of Child Psychiatry, University of Oulu, Oulu, Finland

    Irma Moilanen

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  1. David Gyllenberg
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  2. Andre Sourander
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  10. Fredrik Almqvist
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Correspondence to David Gyllenberg.

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Gyllenberg, D., Sourander, A., Niemelä, S. et al. Childhood predictors of later psychiatric hospital treatment: findings from the Finnish 1981 birth cohort study. Eur Child Adolesc Psychiatry 19, 823–833 (2010). https://doi.org/10.1007/s00787-010-0129-1

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  • DOI: https://doi.org/10.1007/s00787-010-0129-1

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