Research at the Research Centre for Child Psychiatry

Finnish Psychiatric Birth Cohort Consortium PSYCOHORTS

The Finnish Psychiatric Birth Cohort Consortium (PSYCOHORTS) combines the major prospectively designed Finnish psychiatric birth cohorts. The integration of these cohorts will enable us to address issues related to the development, trajectories and life outcomes of psychiatric disorders.

Unique from a global perspective, Finland has several nationwide registers and a biobank of maternal sera. Linkages can be made between registers, biobank data and records from health check-ups. The PSYCOHORTS Consortium comprises of eight prospective birth cohorts in Finland: the Northern Finland Birth Cohorts 1966 and 1986, Finnish 1981 Birth Cohort Study, Finnish Prenatal Studies, 1987 and 1997 Birth Cohorts, SSRI pregnancy cohort and Southwest Finland Birth Cohort. The integration of these cohorts enables us to address issues related to the life course development of psychiatric disorders. Data spanning from 1960s to date allows us to study time trends between different cohorts and between different time points.

The consortium was funded by the Research Council of Finland Programme Health from Cohorts and Biobanks from 2017 to 2020.

PI: Andre Sourander, University of Turku

Consortium parties

Juha Veijola, University of Oulu
Mika Gissler, National Institute for Health and Welfare

Further information on Psycohorts Consortium

Lapset 1981 cohort study (FNBCS-1981)

The Finnish Birth Cohort is a nationwide representative sample of 10% of all children born in 1981 in Finland (N=6,014) followed until age 37. Data on maternal health during pregnancy and labor, neonatal events, developmental milestones and growth have been collected from medical records.

At age eight, 97% of children were assessed using questionnaires. The parents and the teacher completed questionnaires with items concerning family structure, parental education level, conduct problems, hyperactive problems, emotional symptoms, bullying, and victimization of bullying behavior. The children themselves completed the Children’s Depression Inventory with questions regarding depressive symptoms, and extra questions regarding bullying, and victimization of bullying behavior.

Data on psychiatric symptoms and sense of coherence in conscripts were collected and register-based data on treatment for psychiatric disorders, crimes, psychotropic medication use, abortions, teenage pregnancies and family history of psychiatric disorders are available.

The consortium is funded by the Research Council of Finland.

PI and co-PI’s: Docent David Gyllenberg, Docent Venla Lehti, Prof. Andre Sourander.

The Finnish Prenatal Studies is a large case-control study examining prenatal and early development factors associated with major neuropsychiatric disorders. The subprojects include studies on schizophrenia, bipolar disorder, autism, ADHD, conduct disorder, anxiety, Tourette Syndrome, depression and obsessive compulsive disorder.

FIPS is the largest seroepidemiologic study of prenatal exposures in psychiatric disorders using archived prenatal sera, based on the Finnish Maternity Cohort (FMC). The samples were obtained from over 98% of all pregnancies in Finland in 1983-2016 (2 million pregnancies) during the first trimester.

The team has used register based information including obstetric complications, gestational age and birth weight, indicators for hypoxia, neonatal disorders, family psychopathology, and parental age.

The findings include showing that several maternal prenatal biomarkers including cotinine, vitamin D and inflammatory markers, other early developmental factors, and family history of psychiatric disorder are independently associated with neuropsychiatric disorders

Main funding: National Institutes of Health, National Institutes of Mental health, Autism Speaks Foundation, several other foundations and Turku University Hospital Tyksin erityisvastuualueen (Erva) tutkimustoimikunnan valtion tutkimusrahoitus.

PI and co-PI’s: prof. Andre Sourander, docent Heljä-Marja Surcel, docent Roshan Chudal, docent David Gyllenberg, MD, PhD Kim Kronström, prof. Alan Brown.

Fips study desing

Neuropsychiatric disorders with an onset in childhood such as Autism spectrum disorder (ASD), Tourette syndrome (TS), attention-deficit/hyperactivity disorder (ADHD) and conduct disorders (CD) have not been thoroughly studied for risk of suicidality.

In this project we study the prevalence and potential risk factors associated with completed suicides and severe suicide attempts among children and adolescents with neuropsychiatric disorders. The aim is to advance early identification of high-risk groups among NPDs for severe suicidal behavior.

The nationwide, population-based, nested case-control, follow-up study  is based on Finnish registers including several thousands of cases per studied disorder together with 4 matched controls per case.

Substudies

•          Autism spectrum disorder: 4698 cases and 18792 controls
•          Tourette syndrome: 2919 cases and 11 676 controls
•          Attention-deficit/hyperactivity disorder (ADHD): 10 367 cases and 41 468 controls
•         Conduct disorders: 12554 cases and 50216 controls.

Main funding: American Foundation of Suicide Prevention

PI and co-PI’s: Docent David Gyllenberg, docent Roshan Chudal, Professor Andre Sourander

—The study investigates long-term risk factors in offspring for the maternal use of SSRIs during pregnancy, whether the fetus is particularly sensitive to the effects of SSRIs at a spesific stage of pregnancy and whether there are differences between the antidepressants in terms of fetal safety. The study is conducted in collaboration between the University of Turku, and Columbia University, New York.

Registers used: Medical Birth Register, Register of Congenital Malformations, Drug Reimbursement Register, Hospital Discharge Register, and Population Register.

Funding: National Institutes of Mental Health, USA.
PI & co-PI’s: Heli Malm, David Gyllenberg, Andre Sourander, Susanna Hinkka-Yli-Salomäki, Mika Gissler, Alan Brown (Columbia University)

The main objective is to study how the children's and adolescents' mental health, perceived need of help, psychiatric diagnoses and the use of psychiatric inpatient and outpatient services has developed by sex and geographic area in Finland during the last three decades.

•A multi-method approach with significant data triangulation

•Nationally inclusive register-based data in a longitudinal setting allowing for population-based estimates in large numbers

•Rare exposures and outcomes studied by using register-based data where no participation, research- or reporting bias can affect the results

•Separately collected cohort data with clinical measurements and self-reported data collected to get more specific information on health outcomes among children, adolescent and young adults.

Main funding: Research Council of Finland

PI and co-PI’s: Mika Gissler, Tiina Ristikari, Andre Sourander, David Gyllenberg, Terhi Luntamo, Lotta Lempinen, Kaisa Mishina

The main aim of the project is to evaluate the effectiveness of the digitalized CBT-intervention “YHDESSÄ VAHVAKSI” in treatment of perinatal depressive symptoms in mothers screened from the general population. We will also assess the personal, familial and treatment-related factors that may affect the impact of the treatment.

Population: Pregnant women attending the maternity clinic at 15th to 16th gestational week and screened for symptoms of antenatal depression. Target population is 10,000 mothers and estimated 500 are included in the study.

PI and co-PI’s: Andre Sourander, Terja Ristkari, Tarja Korpilahti-Leino, Tarja Koffert, Miika Vuori

The objective of this study is to evaluate the effectiveness of a self-directed, digitally delivered universal parenting program among families with 3-year-old children. The effectiveness of the program will be assessed using a randomized, controlled, single-blinded clinical trial with a pragmatic, two-arm group with waiting list design.

Population: All parents with a 3-year old child recruited from child health clinics.

PI and co-PI’s: Andre Sourander, Kaisa Mishina, Terja Ristkari, Malin Kinnunen

Oppositional and conduct problems are developmental precursors to a wide range of negative outcomes that indicate a later risk of marginalization, including peer rejection, school failure, psychopathology, substance abuse, criminality and suicidality. Approximately half of the preschool children who are identified as aggressive and have externalizing behavior develop persistent problems. Untreated disruptive behavior disorders are some of the most costly early childhood psychiatric disorders.

Parental training is the most effective approach to the psychosocial treatment of disruptive behavior and one of the best‐validated therapeutic techniques. Parents who take part in training interventions typically learn to identify, define and observe problem behaviors in new ways and acquire strategies to prevent and respond to oppositional behavior.

Voimaperheet intervention is based on telephone coaching, evidence-based digitalized psychoeducation and parent training. The families have been identified as part of the risk group during their fourth-year visit to a child health clinic. The Finnish child health clinics provide regular check-ups that offer universal health care and are attended by 99.6% of the children.

The Randomized Controlled Trial (RCT) was conducted on an intervention offering remote or internet-assisted parental training and population-based screening. The follow-up and implementation studies are ongoing. 

PI and co-PI’s: Andre Sourander, Terja Ristkari, Marjo Kurki, Susanna Hinkka-Yli-Salomäki

Anxiety is the most common psychiatric problem in childhood. It causes significant functional impairment at home, school and in social situations. Significant comorbid problems include subsequent anxiety, depression, substance abuse, and even suicide attempts, indicating a risk for adverse developmental pathways, decreased work readiness and finally marginalization, causing significant suffering, as well as economic burden on society.

However, children with anxiety often remain untreated, as the symptoms easily remain unidentified, even by their parents. Additionally, there is a significant lack of therapists, and in some areas, there are no therapists at all.

The aim of this study is to develop an internet-based cognitive-behavioral intervention with telephone coaching, “HUOLET HALLINTAAN”, and study it’s efficacy among school-aged children, whose anxiety symptoms are screened at routine school health care check-ups. Systematic symptom screening combined with an easily accessible treatment program creates an exceptional opportunity to reach those children, whose symptoms have not been recognized, or who have not had an opportunity to get treated.

PI and co-PI’s: Andre Sourander, Terja Ristkari, Tarja Korpilahti-Leino, Terhi Luntamo, Susanna Hinkka-Yli-Salomäki

There are many barriers for seeking help in mental health care services, including lack of knowledge about and negative attitudes towards mental disorders and treatment, and poor access to appropriate care. Educational interventions on Mental Health Literacy (MHL) – understanding how to obtain and maintain good health, understanding mental disorders and their treatment, decreasing stigma and enhancing help-seeking behavior – are needed to promote good mental health.

First year at the university is a challenging phase at a young adult’s life. According to many studies, especially medical students have a high risk of stress-related problems, mental health problems, depression and anxiety due to demands of the studies and their future profession, posing a threat to their wellbeing.

Transitions/ Kohti uutta is an intervention study to evaluate how digitally delivered mental health literacy intervention changes mental health knowledge, attitudes and help-seeking behavior among first year medical students.

Eurasian Child and Adolescent Mental Health Study (EACMHS) group, a network of researchers and clinicians, was established in 2016 to respond to the need for collaborative research addressing timely and pressing questions in adolescent mental health in a cross-cultural, multi-site research setting.

In the early years, the EACMHS network includes prominent child and adolescent psychiatrists and psychology experts from the following European and Asian countries: Bahrain, China, Finland, Greece, India, Indonesia, Iran, Israel, Japan, Lithuania, Nepal, Norway, Russia, Singapore, Switzerland, Thailand, Ukraine, and Vietnam. These countries, with the exception of Bahrain, Nepal, Switzerland and Thailand, conducted the same cross-sectional school-survey among adolescents aged 13 to 15 years. The survey was conducted between 2011-17 in each of the 13 countries.

The survey will be conducted again between 2022-2023 in the same schools, using the same protocol, method and tools. Together the data collected in two time-points will form time-trend data, which enables examination of secular changes in adolescents’ mental health over time. This is an especially valuable and unique data set and approach in the current era of crises. The Covid-19 pandemic changed people’s lives across the world and has greatly impacted also mental health, especially among adolescents.

In the planning phase of the second survey, the network has extended and has now become the Global Child and Adolescent Mental Health Study -network. It includes mental health experts from not only Europe and Asia, but also from Africa and Latin America. At present the GCAMHS network extends to 33 countries.

The overall aim is to the conduct the same survey in all 33 countries between 2022-2023 and examine the changes in mental health over time, as described above, but also to compare the prevalence of mental health problems among adolescents in all GCAMHS countries. The findings will also be related to the severity of the pandemic and to the governmental responses to the spread of the virus. 

Follow-up study on psychiatric symptoms experienced by adolescents in Nepal following the 2015 earthquake – Dr. Sanju Silwal, Docent Roshan Chudal, Prof. Lars Lien, Prof. Andre Sourander, Dr. Ragnhild Dybdahl

Dr. Olga Osokina, Prof. Norbert Skokauskas

Japan, Nagoya, Prof. Hitoshi Kaneko
Indonesia, Jakarta, Dr. Fransiska Kaligis
Kenya, Nairobi, Prof. David Ndetei