Finnish Adolescents Treated in Psychiatric Inpatient Care from 1980 to 2010 and Their Long-term Life Situations

Mental disorders during adolescence are often diverse and variable. They often recur in or continue into adulthood and have a significant impact on adolescents’ future. Earlier research has shown that adolescent-onset mental disorders are associated, for example, with less education, lower socioeconomic status, increased criminality and also increased hospitalization and mortality. Since the 1980s the adolescent psychiatric services in Finland have undergone developments aiming to treat mental disorders by taking account of the developmental stage of the patient. These exceptional services are expected to improve the outcomes of early onset mental disorders.

Comprehensive follow-up studies are crucial for the prognosis of mental disorders during adolescence and therefore in preventing marginalization. This register-based study examined subsequent use of psychiatric inpatient care, criminality, education and mortality among those Finnish adolescents aged 13-17 who had their first psychiatric inpatient care during adolescence between 1980 and 2010. Incidence and prevalence of schizophrenia was also studied. Subjects (N 17112) were followed up in the registers of the Finnish Institute of Health and Welfare, the Finnish Centre for Pensions and Statistics Finland until end of 2014.

An increase in adolescent psychiatric inpatient care was observed from the mid- 1990s, the growth being especially prominent in the late 2000s. An increasing proportion of adolescents were hospitalized in psychiatric inpatient care, the growth being especially prominent in girls. The proportion of mood disorders as the primary diagnostic reason for inpatient care increased significantly, but this could not be explained by epidemiological reasons, but instead by changes in society and healthcare policies.

There was a decrease in length of stay, especially in the 1980s and 1990s, but this seemed not to impair the the prognoses of mental disorders nor to increase the risk for rehospitalization. Mental disorders requiring adolescent psychiatric inpatient care were observed to have a negative effect on adolescents’ future. The educational level of those adolescents who had been psychiatric inpatients was generally lower than that in general population; only 50% of those had completed post-comprehensive school education compared to 85% of general population. Those needing inpatient care due to externalizing disorder (conduct, personality or substance use disorder) or schizophrenia spectrum psychoses diagnoses were at risk for lower educational attainment. Those with externalizing disorder diagnoses were also at the higher risk for criminal behaviour. Also, those adolescents undergoing psychiatric inpatient care had a high risk for later receiving a diagnosis of schizophrenia diagnosis. Despite the development and increased availability of outpatient and other support services in recent decades, the outcomes of mental disorders requiring inpatient care during adolescence have not shown any marked improvement.

Severe mental disorders compromise normal adolescent development, increase the risk of antisocial development and of marginalization due to the negative effect, for example on the educational pathway. Therefore, it is important to focus on adequate support in everyday life, availability of psychiatric care and school welfare especially in those adolescents with episodes of psychiatric inpatient care. It is beneficial to aim at keeping the duration of inpatient care is as short as possible and keeping adolescents’ care and rehabilitation as close as possible to their environment in everyday life.