Symptomatic behaviour in childhood strongly predicts psychiatric treatment as a young adult

"The early detection of children who are showing psychiatric symptoms or are at the risk of a mental disorder is crucial, but introducing "mental health checkups" as part of health care in schools is not altogether simple," says David Gyllenberg, MD, whose doctoral dissertation "Childhood Predictors of Later Psychotropic Medication Use and Psychiatric Hospital Treatment -- Findings from the Finnish Nationwide 1981 Birth Cohort Study" was publicly examined at the University of Helsinki on 13 April 2012.

In Gyllenberg's study, the mental wellbeing of nearly 6,000 Finnish children of the age of eight was charted through a survey carried out in 1989. After this, the use of psychotropic medication and psychiatric hospital periods of the same children from the age of 12 to 25 was followed up.

Both the use of psychotropic drugs and need for psychiatric hospital treatment were linked with symptoms reported in the survey carried out at the age of eight. Symptoms of depression at this age were linked to later treatment of depression both with boys and girls, while a non-intact family background was linked with a range of psychiatric care required in the teens or early adulthood for both sexes.

However, the predictive value of many factors differ between girls and boys. While the strongest factor for girls to predict later use of psychotropic medication and need for psychiatric care were symptoms of depression and anxiety shown in childhood, for boys, the most salient predictors were behavioural problems such as acting out, aggressive behaviour and stealing.

"Boys showed symptoms directed towards their environment while girls showed more introverted symptoms," says Gyllenberg.

Gyllenberg's study also showed that by the age of 25, 15 per cent of those participating in the survey had taken some kind of psychotropic drug, and 12 per cent had taken antidepressants.

The strong link between psychiatric symptoms displayed in childhood and later use of psychotropic drugs and psychiatric care supports the findings of previous research. A new finding in this particular study was how predictive factors differ between boys and girls.

"If future research supports these findings and an element of mental health screening is made part of health checkups at school, employing sex-specific criteria should be considered," Gyllenberg says.

Gyllenberg stresses that a systematic mental health screening at schools is something that has to be very carefully considered and they should be strictly based only on solid scientific research. It is crucial that such screenings do not lead to stigmatisation or become a self-fulfilling prophecy.

"However, in order to prevent children's and young people's severe mental disorders, we should be able to identify those at risk in time. This, again, would naturally necessitate a functioning support and care system to take care of them," Gyllenberg adds.

The study involved approximately 10% of children who turned eight in 1989, in total 5,817 children. The parents and the teacher completed questionnaires with items concerning family structure, parental education level, conduct problems, hyperactive problems, emotional symptoms, bullying, and victimisation of bullying behaviour. The children themselves completed questions regarding depressive symptoms, bullying, and victimization of bullying behaviour.

At the follow-up stage, the personal identification numbers of 5,525 subjects who had participated in the survey at age eight were linked to data in the nationwide Drug Prescription Register and the nationwide Finnish Hospital Discharge Register which gives information about medication use and psychiatric hospital treatment between age 12 and 25.

The dissertation forms part of the Finnish Nationwide 1981 Birth Cohort Study multicentral research, including all five children's university psychiatric units in Finland.

The thesis is based on the following original publications:

I. Gyllenberg D, Sourander A. Psychotropic drug and polypharmacy use among adolescents and young adults: Findings from the Finnish 1981 Nationwide Birth Cohort Study. Nord J Psychiatry, 2012; Epub ahead of print Jan 3. DOI: 10.3109/08039488.2011.644809

II. Gyllenberg D, Sourander A, Helenius H, Sillanmäki L, Huttunen J, Piha J, Kumpulainen K, Tamminen T, Moilanen I, Almqvist F. Childhood Predictors of Antipsychotic Medication Use among Young People in Finland. Pharmacoepidemiol Druf Saf, in press. DOI: 10.1002/pds.3265

III. Gyllenberg D, Sourander A, Niemelä S, Helenius H, Sillanmäki L, Piha J, Kumpulainen K, Tamminen T, Moilanen I, Almqvist F. Childhood Predictors of Use and Costs of Antidepressant Medication by Age 24 years: Findings From the Finnish Nationwide 1981 Birth Cohort Study. J Amer Acad Child Adolsc Psychiatry, 2011;50(4):406-415. DOI: 10.1016/j.jaac.2010.12.016

IV. Gyllenberg D, Sourander A, Niemelä S, Helenius H, Sillanmäki L, Ristkari T, Piha J, Kumpulainen K, Tamminen T, Moilanen I, Almqvist F. Childhood Predictors of Later Psychiatric Hospital Treatment. Findings from the Finnish 1981 Birth Cohort Study. Eur Child Adolsc Psychiatry, 2010;19(11):823-833. DOI: 10.1007/s00787-010-0129-1

V. Sourander A, Rønning J, Brunstein-Klomek A, Gyllenberg D, Kumpulainen K, Niemelä S, Helenius H, Sillanmäki L, Tamminen T, Moilanen I, Piha J, Almqvist F. Childhood bullying behavior and later psychiatric hospital and psychopharmacological treatment. Arch Gen Psychiatry, 2009;66(9):1005-1012. DOI: 10.1001/archgenpsychiatry.2009.122