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Biomedical subjects

R Kaltiala-Heino

Publications and source records attributed to R Kaltiala-Heino.

At least 19 recordsLinked to original sources
PubMed2005

Are there differences in the attitudinal body image between adolescent anorexia nervosa and bulimia nervosa?

OBJECTIVE: Body image dissatisfaction is as well a risk factor for eating disorders (ED) and a central feature of ED. The exact nature of body image in adolescent ED is still debated. This study examined attitudinal body image in adolescent anorexia nervosa (AN) and bulimia nervosa (BN), and the association of age, maturational timing, duration of eating disorder, actual weight and general psychological distress with the attitudinal body image in ED. METHODS: The study group consisted of an outpatient clinical sample of adolescents attending for assessment because of eating disorders. The attitudinal body image of 57 adolescents (girls) aged 14-21 years was studied at the beginning of the treatment. The attitudes to body shape, body size, appearance, tone and femininity were studied by a Likert format scale and by the body dissatisfaction (BD) and drive for thinness scales (DT) from EDI-2 inventory. RESULTS: Bulimics reported more body image dissatisfaction than anorectics. In multivariate analyses BN and higher general psychological distress had strong associations with body image dissatisfaction. Longer duration of ED and earlier menarche were also associated with negative body image. DISCUSSION: Attitudinal body image differs between adolescent AN and BN. The psychological distress has a great impact on body image in ED, which should be taken into account in assessment and in treatment interventions.

Adolescent↗
PubMed2004

Psychiatric treatment and research unit for adolescent intensive care: the first adolescent forensic psychiatric service in Finland.

Finland does not have a history of providing forensic adolescent psychiatric units although the need for this kind of service has been established. According to legislation patients who are minors have to be treated separately from adults, however, this has not been possible in practice. Also, adolescent psychiatric wards have not always been able to admit the most severely ill patients, those with impulsive and aggressive behaviours, because of lack of staff resources, problems associated with protecting other vulnerable patients and a shortage of secure environments. A previous report demonstrated the significant increase in adolescent's involuntary treatment within adult psychiatric wards. Data from this report were acknowledged as an important starting point in the planning process for the psychiatric treatment and research unit for adolescent intensive care. This paper describes the background, development process, plan of action, tailor-made education programme and supporting evidence for the first Finnish adolescent forensic service opened in April 2003 in the Department of Psychiatry, Tampere University Hospital. The tool used for planning the unit's activities and staff education programme was the Balanced Score Card approach, the structure and development of which is also outlined within the paper.

Adolescent↗
PubMed2004

Nurses' ethical perceptions about coercion.

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.

Adult↗
PubMed2003

Involuntary medication in psychiatric inpatient treatment.

The aim of this study was to examine involuntary medication in psychiatric inpatient treatment. A retrospective chart review of 1543 consecutive admissions of working aged civil patients from well-defined catchment areas to three psychiatric centres were evaluated regarding events of involuntary medication. 8.2% of the admissions included involuntary medication episode(s). Involuntary medication was associated with a diagnosis of schizophrenia, involuntary legal status and having previously been committed. One of the studied centres used less involuntary medication than the other two, even if patients with schizophrenia were over-represented in that centre. Although involuntary medication mainly takes places in the treatment of patients who are conceptualised most ill and perhaps resist treatment most, treatment culture obviously also plays a role. In future, it is important to study the aspects of treatment culture to fully understand the use of involuntary medication in psychiatry.

Adolescent↗
PubMed2003

Inpatient treatment of mood disorders in the era of de-institutionalisation, depression awareness campaigns and development of new antidepressants.

OBJECTIVE: To analyse changes in inpatient treatment for mood disorders during the period of de-institutionalisation, de-centralisation of service planning, economic recession, attempts to increase depression awareness and increasing biological treatment possibilities. A special interest is paid to whether de-institutionalisation at specialist level psychiatric care results in transfer of inpatient care into non-specialised institutions. METHOD: A register study of all inpatient treatment due to psychiatric disorders from four health care districts in Northern Finland, with a population of more than 600,000. Treatment undertaken by psychiatric hospitals and wards, primary care wards and medical and surgical wards in general hospitals are distinguished. RESULTS: Inpatient treatment for mood disorders increased vastly in all kinds of health care institutions. The increase was due to growing inpatient treatment of depression. LIMITATIONS: The National Discharge Register does not include treatment episodes in private nursing homes or details about the contents of the treatment. CONCLUSION: Even during explicit active de-institutionalisation, other policies may have a greater impact on hospital use, resulting in unexpected changes in patient populations and service utilisation. In Finland, de-institutionalisation failed concerning mood disorders. The depression awareness policies during the 1990s increased inpatient use of depression across institutions.

Antidepressive Agents↗
PubMed2003

Risk-taking sexual behaviour and self-reported depression in middle adolescence--a school-based survey.

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.

Adolescent↗
PubMed2003

The use of harmful to others-criterion for involuntary treatment in Finland.

During the past decades the Western countries have paid attention to their Mental Health legislation, in particular, by making changes concerning involuntary treatment. In Western countries legislation allows involuntary treatment of the mentally ill. Involuntary psychiatric treatment is motivated by either potential harm to others (for the good of society) or by need for treatment and/or potential self-harm (for the good of the patient). The aims of this study were to describe to what extent the danger to others criterion is used as a motivation for involuntary hospitalization and detainment in Finland, and to what kind of patients this criterion is applied. The study involves a retrospective chart review of all the treatment periods of a six month admission sample in three Finnish university hospitals. We found that potential harm to others has been rarely used as a motivation for involuntary referral or detainment together with other motivations, and virtually never as the sole motivation. With the exception of gender, which was most often male, patients with potential harm to others did not differ significantly from other involuntarily treated patients. Coercion (defined as seclusion, the use of restraints, forced medication, physical restraint or restrictions in leaving the ward) was not used with these patients more regularly than with the patients motivated by the other criteria. Length of stay (LOS) in a psychiatric hospital did not differ between the patients determined harmful to others and the other involuntarily treated patients.

Adolescent↗
PubMed2001

Adolescent depression: the role of discontinuities in life course and social support.

OBJECTIVE: To study sociodemographic determinants of depression among 14-16 years old girls and boys, and the role of perceived social support in mediating the effects of the background variables. METHOD: 16464 adolescents aged 14-16 participated the School Health Promotion Study, a survey about health, health behaviour and school behaviour. Depression was measured by the Finnish modification of the 13-item Beck Depression Inventory. Moderate to severe symptoms in this scale were recorded as depression. RESULTS: Depression was associated with family structure in both sexes. Among girls, having moved recently and low parental education increased the risk for depression, among boys, unemployment in the family. Accumulating number of discontinuities in life course increased the proportion of the depressed among both girls and boys. Perceived lack of social support had the same effect. Lack of support did not explain the effect on depression of the discontinuities in life course. CONCLUSION: To detect risk groups for adolescent depressive disorders, health services should pay attention to adolescents who have experienced life changes. Perceived social support should be enquired.

Adolescent↗
PubMed2001

Has the attempt to reduce psychiatric inpatient treatment been successful in Finland?

The deinstitutionalisation process in Finland's psychiatric healthcare did not start until the late 1980s. Our aim is to evaluate how the use of psychiatric inpatient treatment was associated with deinstitutionalisation given the changes in the modality of treatment ideology (years 1987--1991) as well as being due to economic pressures (years 1991--1995). Special emphasis is given on the inpatient treatment of schizophrenia and other psychotic disorders. Data was retrieved using the national hospital discharge register of all treatment periods in psychiatric hospitals and treatment periods due to psychiatric disorders in other hospitals. Three years (1987, 1991, and 1995) were compared. Four healthcare districts in northern Finland were studied. Resource use was measured by number of treatment periods and inpatient days in relation to population. Psychiatric inpatient treatment was reduced in 1987--1991, when resources in community care increased. During the period of economic pressures (1991--1995), when community care resources no longer increased, inpatient treatment started to rise again. Over the whole period, psychiatric treatment in primary care institutions increased. Reduction of psychiatric beds results in increasing inpatient treatment in non-specialist institutions, especially when community care fails to serve the patients. In the future it is important to evaluate whether the quality of care remains in the standard of specialised services when treatment shifts away from the specialist level.

Adult↗
PubMed2001

Early puberty and early sexual activity are associated with bulimic-type eating pathology in middle adolescence.

PURPOSE: To examine the associations between early pubertal timing and early advanced sexual development with bulimic-type eating pathology in middle adolescents. METHODS: A total of 19,321 boys and 19,196 girls aged 14-16 years (mean age 15.3 years, standard deviation 0.59) responded to the School Health Promotion Study, a class-room survey among Finnish adolescents about health, health behavior, and school experiences. Bulimic-type eating pathology was assessed with a questionnaire formulated according to the fourth edition of the Diagnostic and Statistical Manual for Mental Disorders IV (DSM-IV) criteria. Pubertal timing was assessed by self-reported age at menarche or oigarche. Statistical methods were used chi-square and logistic regression. RESULTS: Bulimic-type eating pathology among girls was associated with early menarche, early sexual experiences, and increasing age. Among boys, onset of ejaculations at the normative age was protective for bulimic-type eating pathology, and the risk was elevated among very early and late maturers. Early sexual experience was associated with bulimic-type eating pathology. CONCLUSION: To prevent bulimia nervosa and to create opportunities for early intervention, attention should be paid to early maturing girls and off-time maturing boys, as well as those with early onset of sexual activity.

Adolescent↗
PubMed2001

Depression, drinking, and substance use among 14- to 16-year-old Finnish adolescents.

Our aim was to assess the relationship between self-reported depression, alcohol consumption, and substance use among 14- to 16-year-olds. A school survey was conducted of 16,464 14- to 16-year-olds in two regions of Finland. Alcohol and other substance use were found to be significantly associated with depression. Of girls (boys) who reported drinking weekly, 24% (13%) scored as depressed, compared with 7% (4%) of those not drinking. Of girls (boys) who reported having experimented with substances five times or more, 37% (28%) scored as depressed compared with 8% (5%) of those who reported never having experimented with substances. These associations persisted in multivariate analyses controlling for sociodemographic background. In conclusion, frequent drinking and experimenting with substances indicate a risk for adolescent depressive disorders, and depressive adolescents are at risk for substance use. Health services should pay attention to the identified depressive adolescents to prevent the possibly subsequent substance use problems among them and also pay attention to frequently drinking adolescents and substance experimenters, to increase identification of depressive disorder and possibilities for early interventions.

Adolescent↗
PubMed2001

Deprivation of liberty in psychiatric treatment: a Finnish perspective.

This article is concerned with the deprivation of patients' liberty while undergoing psychiatric treatment, with special reference to the situation in Finland. It is based on a review of Finnish law, health care statistics, and empirical and theoretical studies. Relevant research findings from other countries are also discussed. In Finland, it is required that patients are cared for by mutual understanding with themselves; coercive measures may be applied only if they are necessary for the treatment of the illness, or for safeguarding patients' safety or the safety of others. Involuntary psychiatric hospitalization is closely regulated by the Mental Health Act. However, the rules concerning the deprivation of liberty during inpatient treatment (by seclusion, restraint and restricted leave) are formulated in very general terms. Therefore, Finnish psychiatric hospitals have their own policies concerning when and how seclusion may be used. The practice of seclusion and the use of restraint therefore vary among the psychiatric hospitals in Finland.

Commitment of Persons with Psychiatric Disorders↗
PubMed2000

Bullying at school--an indicator of adolescents at risk for mental disorders.

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.

Adolescent↗
PubMed2000

Coercion and restrictions in psychiatric inpatient treatment.

To find out to what extent coercion and restrictions are used in psychiatric inpatient treatment and with which patient characteristics the use of coercion is associated. To this end, the hospital records of 1,543 admissions (six-month admission samples) to the psychiatric clinics in three Finnish university towns were evaluated by retrospective chart review. The study clinics provide all psychiatric inpatient treatment for the working-age population in their catchment areas. Use of coercion and restrictions was recorded in a structured form. Coercion and restrictions were applied to 32% of the patients. Mechanical restraints were used on 10% of the patients, and forced medication on 8%. Compared to international statistics the figures in the current study are high.

Adolescent↗
PubMed1999

Bullying, depression, and suicidal ideation in Finnish adolescents: school survey.

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: 16 410 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.

Adolescent↗
PubMed1999

Bulimia and bulimic behaviour in middle adolescence: more common than thought?

OBJECTIVE: Studies on the prevalence of bulimia and bulimic behaviour have focused on female populations from their late teens. This study assesses the prevalence of bulimia and bulimic behaviour in 14- to 16-year-old adolescents. Biological, sociodemographic and social correlates of these disorders are sought. METHOD: A self-report questionnaire was administered to pupils of the 8th and 9th grades of secondary school in four regions of Finland. In total, 4453 girls and 4334 boys aged 14 to 16 years participated. RESULTS: Bulimia was detected in 1.8% of girls and 0.3% of boys. Bulimic eating behaviour was reported by 14.4% of subjects. Sociodemographic variables were not associated with increased risk. Bulimia was associated with being bullied by peers and higher than average weight in both sexes. CONCLUSION: Bulimia and bulimic eating behaviour appear to be more common than was previously thought in middle adolescence, and also among boys. Bulimia deserves more attention in younger age groups than main risk groups so far considered.

Adolescent↗