Multi-center nationwide study on pediatric psychiatric inpatients 2000-2018: length of stay, recurrent hospitalization, functioning level, suicidality, violence and diagnostic profiles.

Inpatient treatment is an important part of child and adolescent psychiatric (CAP) care. This nationwide study explores the changes in length of stay, recurrent hospitalization, functioning level, suicidality, violence and diagnoses of CAP inpatients in Finland in 2000, 2011 and 2018. We obtained comprehensive questionnaire data on each study year from 93 to 95% of all CAP wards in Finland. We split the 1276 inpatients into two age groups in each study year: under 13 and 13-18. The median length of stay in inpatient treatment decreased from 82.0 days in 2000 to 20.5 days in 2018 (p < 0.001) and recurrent hospitalization increased from 38 to 46%. General functioning, which was evaluated by the Children's Global Assessment Scale, deteriorated by an average of six points between 2000 and 2018. Violent threats decreased from 21.5 to 16.6% and violent acts decreased from 26.9 to 20.3%. Suicidal threats decreased from 42.6 to 23.3% in those aged under 13 and remained stable among those aged 13-18. In the 13-18 group, there was an increase in the diagnoses of ADHD, from 5.0 to 16.9% and depression, from 25.1 to 41.7%. However, psychosis decreased from 23.2 to 12.6% in the older age group. In the whole cohort, anxiety disorders increased from 7.6 to 15.6%. The overall picture does not show that CAP inpatients have become more disturbed. While the general functioning of CAP inpatients deteriorated somewhat over the 2000-2018 study period, symptoms of suicidality and violence remained stable or decreased. There was also a continuous increase in short-term treatment.

Bullying at 8 years and violent offenses by 31 years: the Finnish nationwide 1981 birth cohort study.

This study explored the associations between bullying perpetration and victimization at 8 years of age and violent offenses by the age of 31. Data were obtained for subjects enrolled in a population-based longitudinal birth cohort study. In 1989, 5813 8-year-old children (attrition 3.4%), and their parents and teachers, were surveyed about bullying. When 5405 subjects (attrition 10.2%) were 15-31 years of age, violent offenses were extracted from the Finnish National Police Register. We analyzed the data by sex and categorized bullying perpetration and victimization by frequency. Violent offenses were categorized by severity. Cox regression analyses estimated the hazard ratios (HRs) and 95% confidence intervals (95% CIs). When they were compared to males who had not been bullies at 8 years of age, frequent male bullies had an increased hazard for violent offenses (adjusted HR 3.01, 95% CI 2.11-4.33) and severe violent offenses (adjusted HR 2.86, 95% CI 1.07-7.59) as adults, even when the data were controlled for them being victims, parental education level, family structure and child psychopathology. Frequent female bullies also had an increased hazard for violent offenses, compared to those who had not bullied others (adjusted HR 5.27, 95% CI 1.51-18.40). Frequent male bullying was associated with higher odds for violent offenses compared to only bullying sometimes. Being a victim was not associated with violent offenses. Preventing childhood bullying could reduce violent offenses by both sexes.

Feeling Unsafe at School Among Adolescents in 13 Asian and European Countries: Occurrence and Associated Factors.

Background: Research on perceived school safety has been largely limited to studies conducted in Western countries and there has been a lack of large-scale cross-national studies on the topic. Methods: The present study examined the occurrence of adolescents who felt unsafe at school and the associated factors of perceived school safety in 13 Asian and European countries. The data were based on 21,688 adolescents aged 13-15 (11,028 girls, 10,660 boys) who completed self-administered surveys between 2011 and 2017. Logistic regression analyses were used to estimate odds ratios and 95% confidence intervals. Findings: The number of adolescents who felt unsafe at school varied widely across countries, with a mean occurrence of 31.4% for the total sample: 31.3% for girls, and 31.1% for boys. The findings revealed strong independent associations between feeling unsafe and individual and school-related factors, such as being bullied, emotional and behavioral problems and feeling that teachers did not care. The study also found large variations in perceived school safety between schools in many countries. Conclusion: The findings emphasize the need to create safe educational environments for all students, based on positive relationships with teachers and peers. School-based interventions to prevent bullying and promote mental health should be a natural part of school safety promotion.

Victimization by traditional bullying and cyberbullying and the combination of these among adolescents in 13 European and Asian countries.

There has been a lack of studies on bullying in non-western low-income and middle-income countries. This study reported the prevalence of traditional victimization, cybervictimization, and the combination of these, in 13 European and Asian countries, and explored how psychiatric symptoms were associated with victimization. The data for this cross-sectional, school-based study of 21,688 adolescents aged 13-15 were collected from 2011 to 2017. The main outcomes were traditional and cybervictimization obtained from student self-reports. The Strengths and Difficulties Questionnaire was used to assess psychiatric symptoms. Generalized estimating equation and logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs). The mean prevalence of any victimization was 28.9%, of traditional victimization only, this was 17.7%, and for cybervictimization only this was 5.1%. Cybervictimization occurred both independently, and in combination with, traditional victimization. The mean prevalence of combined victimization was 6.1%. The mean proportion of those who were cyberbullied only among those who were either cyberbullied only or bullied both traditionally and in cyber was 45.1%. The rates of prevalence varied widely between countries. In the total sample, those who experienced combined victimization, reported the highest internalizing symptoms (girls, OR 1.25, 95% CI 1.22-1.29; boys, OR 1.29, 95% CI 1.25-1.33). The study findings suggest that anti-bullying interventions should include mental health components and target both traditional and cyberbullying. Due to the overlap between these, targeting bullying should primarily focus on how to reduce bullying behavior rather than just focusing on where bullying takes place.

Feeling Unsafe at School and Associated Mental Health Difficulties among Children and Adolescents: A Systematic Review.

This study systematically reviewed the literature on perceived school safety. We investigated the prevalence, factors and associated mental health difficulties, as well as cross-cultural findings. Five databases were searched up to 9 February 2021 for peer-reviewed papers published in English. We included quantitative studies that explored the perception of school safety among children and adolescents. The reference lists of the selected papers were also searched. We conducted a narrative synthesis of the included studies. The review included 43 papers. The mean prevalence of the students who felt unsafe at school was 19.4% and ranged from 6.1% to 69.1%. Their perceived safety was associated with a wide range of personal, school, and social factors. Not feeling safe at school was related to being victimized and mental health difficulties, including depressive symptoms and suicidal behavior. Higher perceived school safety was associated with measures such as the presence of a security officer and fair school rule enforcement. The results showed the lack of cross-cultural studies on perceived school safety. Empirical studies are needed that examine the mechanisms of school safety, using valid measures. A clear definition of school safety should be considered a key aspect of future studies.

Relative age and specific learning disorder diagnoses: A Finnish population-based cohort study.

Background: Being among the youngest in class has previously been associated with attention-deficit/hyperactivity disorder (ADHD) and academic disadvantage, but the relative age effect on learning disorders is less well understood. This study examined whether relatively young children are more likely to be diagnosed with specific learning disorders than their older peers. Methods: The setting included all 388,650 children born singleton in Finland from 1996 to 2002. Cases diagnosed with specific learning disorders in specialized health care by the age of 10 were identified from national registers. Cumulative incidences of specific learning disorders and the corresponding incidence rate ratios (IRRs) and 95% confidence intervals (CIs) were calculated for each birth month compared to January. Results: During follow-up, 3162 (0.8% of 388,650) children were diagnosed with a specific learning disorder. Children born in December displayed higher cumulative incidences for specific learning disorders than children born in January (IRR: 1.77, 95% CI: 1.50-2.11). The findings were similar for girls (IRR: 2.01, 1.44-2.83) and boys (IRR: 1.70, 1.39-2.08). ADHD did not explain the association, as the IRR for the youngest children with specific learning disorders and ADHD was 1.59 (1.13-2.26) compared to those without ADHD (IRR: 1.84, 1.51-2.24). Conclusions: Relatively younger children in Finnish schools were more likely to be diagnosed with a specific learning disorder by the age of 10. Increased awareness of how relative age differences affect the likelihood for children to be diagnosed with specific learning disorders is needed among parents, clinicians, and teachers.

Relative age is associated with bullying victimisation and perpetration among children aged eight to nine.

AIM: To assess whether relative age was associated with bullying involvement and whether the associations were independent of child psychiatric symptoms. METHODS: Bullying was assessed among 8576 children in the second grade, aged 8 years, by using four cross-sectional population-based studies with identical methodology completed by children, parents and teachers in 1989 (response rate 97%), 1999 (93%), 2005 (90%) and 2013 (86%). The main outcomes were bullying victimisation and perpetration. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated with the relatively oldest as the reference group and adjusted for child psychiatric symptoms. RESULTS: The relatively youngest children, born September to December, were compared with the relatively oldest, born January to April. The youngest children had increased odds of being victims according to child (OR 1.2, 95% CI 1.1-1.4) and parent reports (OR 1.2 95% CI 1.008-1.4). The youngest also had decreased odds of being perpetrators according to child (OR 0.8, 95% CI 0.7-0.96) and teacher reports (OR 0.8, 95% CI 0.7-0.95). These findings were independent of psychiatric symptoms. CONCLUSION: The relative age effects which were found in bullying involvement were independent of psychiatric symptoms. Considering this newly recognised risk factor for victimisation is important within anti-bullying practices.

Did Bullying Victimization Decrease After Nationwide School-Based Antibullying Program? A Time-Trend Study.

OBJECTIVE: We assessed changes in traditional and cyberbullying victimization, and their associations with mental health, before and after the introduction of a nationwide antibullying program in Finnish schools in 2009. METHOD: This time-trend assessment comprised two methodologically identical cross-sectional survey studies, with 2,061 adolescents in 2008 (response rate 90.2%) and 1,936 in 2014 (91.8%). Their mean age was 14.4 years. They completed questionnaires about traditional and cyberbullying, mental health, and perceptions of school safety. Odds ratios (OR) and 95% CIs are presented with 2008 as the reference year. RESULTS: From 2008 to 2014, traditional victimization decreased from 28.9% to 19.1% (odds ratio [OR] = 0.5, 95% CI = 0.4-0.7) among boys and from 23.2% to 17.4% (OR = 0.7, 95% CI = 0.6-0.9) among girls. Cyberbullying victimization remained fairly stable at 3.3% and 3.0% (OR = 0.7, 95% CI = 0.4-1.2) for boys and at 2.7% and 4.1% (OR = 1.4, 95% CI = 0.9-2.4) for girls. Combined traditional and cyberbullying victimization decreased from 6.1% to 3.9% (OR = 0.5, 95% CI = 0.4-0.8) among boys and from 7.5% to 6.7% (OR = 0.8, 95% CI = 0.6-1.2) among girls. Those experiencing both traditional and cyberbullying reported the highest mental health problems. Perceived school safety improved among boys, but not among girls. Both boys and girls reported greater efforts by teachers and fellow students to stop bullying. CONCLUSION: Combined traditional and cyberbullying victimization was an indicator of comorbid mental health problems. Interventions that target both types of bullying, and that are integrated with mental health promotion, are needed.

Suicidality among child and adolescent psychiatric inpatients: time trend study comparing 2000 and 2011.

Child and adolescent inpatient treatment has faced major changes since the year 2000, including shorter inpatient stays and a greater use of psychotropic drugs. This study explored changes and correlates of suicidal threats and suicide acts among inpatients, by comparing Finnish cross-sectional surveys from 2000 to 2011. A questionnaire that explored the background, diagnosis and treatment characteristics of inpatients was sent to all child and psychiatric wards in Finland. The data collection was carried out on specified days in 2000 and 2011. We received comprehensive data on 504 patients from 64/69 (93%) wards in 2000 and on 412 patients from 75/79 (95%) wards in 2011. The Spectrum of Suicidal Behaviour Scale was used to explore suicidality. The prevalence of suicidality did not change in this nationwide study: suicidal threat rates were 38% in 2000 and 37% in 2011, and suicide attempts in both years were 11%. The prevalence of suicidal acts was higher among girls and teenagers, while low general functioning, defined as Children's Global Assessment Scale scores of under 30, was associated with both suicidal threats and acts. Violent acts were associated with both suicidal threats and acts in 2000, but not in 2011. Despite changes in treatment practices and shorter inpatient stays, the prevalence of suicidality in child and adolescent inpatient treatment remained unchanged in Finland in 2000 and 2011.

Time trends of Finnish adolescents' mental health and use of alcohol and cigarettes from 1998 to 2014.

This study reports time-trend changes in self-reported mental health problems, smoking, and alcohol habits among Finnish adolescents over a 16-year period using three cross-sectional studies with similar designs, methodologies, and geographical recruitment areas. There were 4508 participants with a mean age of 14.4 years (range 13-18) in 1998 (n = 1449), 2008 (n = 1560), and 2014 (n = 1499). The information they provided on their mental health was measured with the Strengths and Difficulties Questionnaire and they were also asked questions about their alcohol and smoking habits. The findings showed that from 1998 to 2014 females reported less hyperactivity and conduct problems and males reported fewer peer problems and better prosocial skills. The only mental health problem that showed a significant increase was emotional symptoms among females. Smoking and alcohol use consistently decreased in males and females during the 16-year period. Our findings suggest that overall adolescent's self-reported mental health problems were either stable or falling, indicating increased well-being. The decreased smoking indicates that anti-smoking campaigns have been successfully changing teenagers' attitudes towards smoking. The important finding is that self-reported emotional symptoms had increased in females. This may indicate an increase or earlier onset of affective disorders.