matti.joukamaa@uta.fi
www.nape.dk

Nordic Association for Psychiatric Epidemiology
Mini symposium, Kuopio, Finland June 17, 2004

Program:
9 00 - 9 15 President of Nape Opening

9 15 - 9 45 L Haarasilta Psychiatric comorbidity in adolescent psychiatric outpatients with DSM-IV depressive disorders

9 45 - 10 15 H Karlsson Prevalence and treatment of depression and bipolar disorder in primary care

10 15 - 10 45 J Veijola Very early maternal separation and mental health in adulthood

10 45 - 11 15 M Joukamaa Epidemiology of alexithymia

11 15 - 12 15 Lunch

12 15 - 12 30 O Bjerkeset Mortality and suicide rate related to self-reported anxiety and depression

12 30 - 12 45 O Bjerkeset Association between depression and elevated C- reactive protein in a large community study; the significance of confounding factors

12 45 - 13 00 K Haatainen Hopelessness in a general population

13 00 - 13 15 K Honkalampi Which factors are important in women's depression?

13 15 - 13 30 H Koivumaa-Honkanen Life dissatisfaction and subsequent work disability in an 11-year follow-up

13 30 - 13 45 J Koskinen A bibliometric analysis of Finnish epidemiological schizophrenia research

13 45 - 14 00 E Lauronen Development at age 1 and later illness course in schizophrenia?

14 00 - 14 15 O Mantere The Clinical Characteristics of DSM-IV Bipolar I and II Disorders in the Jorvi Bipolar Study (JoBS)

14 15 - 14 30 J Miettunen Normative data of the Finnish version of Hypomanic Personality Scale

14 30-14 45 E Sihvola Depressive Disorders in a Population-Based Adolescent Twin Sample

14 45 - 15 00 H Viinamäki Recovery from depression - a general population study


Title: Psychiatric comorbidity in adolescent psychiatric outpatients with DSM-IV depressive disorders
Authors: Haarasilta L, Pelkonen M, Ruuttu T, Holi M, Heilä H, Kettunen K, Kiviruusu O, Tuisku V, Tuulio-Henriksson AM, Törrönen J, Marttunen M.
Corresponding author: Haarasilta, Linnea
Abstract:
Objective: We aimed at describing the patterns of psychiatric comorbidity among adolescent psychiatric outpatients with depressive mood disorders. Comparisons with school-welling controls are made. Method: A sample of 218 consecutively referred adolescent (13-19 years) outpatients and 200 age- and sex-matched school-based controls was interviewed for DSM-IV Axis I (K-SADS-PL) and Axis II (SCID-II) disorders.
Results: Psychiatric comorbidity was observed in majority of depressed adolescents both among the outpatients and the controls with current episode of depression. Age and sex differences were observed in the patterns of comorbidity. Impairment independently associated with comorbidity. Severity and the lifetime age of onset for depression were unaffected by the presenece of other psychiatric disorders.
Conclusions: Comorbidity appears to be inherent in adolescent mood disorders. Thorough evaluation of psychopathology is called for in research and clinical practice as different contexts of presentation may require different approaches. The concept of comorbidity is discussed.

Authors:Hasse Karlsson , Sinikka Luutonen, Mervi Nieminen, Raimo KR Salokangas
Abstract:
Objective:. The aim of this work was to study the prevalence and treatment of depression and bipolar disorder in primary care. Methods: 563 primary care patients from 3 health centers were screened for depression by using the DEPS - scale. Patients with depressive symptoms and also some screen negative patients were interviewed by phone and the psychiatric diagnosis was made by M.I.N.I. (Mini International Neuropsychiatric Interview). Results: Out of the 117 patients phoned to, clinical depression (major depression or depressive episode of bipolar disease or/and dysthymia) was found altogether in 39 patients. Of all screened patients, 6,9% had clinical depression. Of the depressed patients, 69,4% received no treatment for depression. The corresponding numbers for bipolar disorder will be presented at the symposium.
Conclusions: The prevalence rates correspond to the rates in many previous studies. Most depression patients are untreated. The implications of this will be discussed.

Title: Very early maternal separation and mental health in adulthood
Authors: Veijola, J, Mäki P, Joukamaa M, Hakko H, Isohanni M
Corresponding author: Veijola, J
Abstract:
Objective. We studied the association between very early separation and later development of schizophrenia and depression.
Method. The index cohort consisted of 3020 subjects born in 1945-1965 in Finland who were temporarily isolated from their family immediately after birth to nursing homes due to tuberculosis in the family. The average separation time was seven months. For every index subject, two reference subjects were matched for sex, year and place of birth. The data on schizophrenia and depression were obtained from the Finnish Hospital Discharge Register by December 31, 1998.
Results. The 28-year cumulative incidence of schizophrenia was 1.6% both in the index cohort and in the reference cohort. 4.0% of the index subjects and 3.1% of the reference subjects had been treated in hospital due to depressive episode (RR 1.3; 1.1-1.7).
Conclusion. Separation at birth was not found to be associated with schizophrenia, but associated with later depression.

Title: Alexithymia - epidemiological findings
Author: Joukamaa M
Abstract:
During the 30 years since its definition alexithymia has been the topic of about one thousand scientific publications. Most of the papers have dealt with the association of alexithymia and some somatic disease or mental disorder. Only few papers have been published on the epidemiology of alexithymia. According to them some fairly clear associations between alexithymia and sociodemographic factors have been found so far. Alexithymia seems to be normally distributed in population. Roughly one out of ten persons in general population is alexithymic, men more commonly than women. The prevalence of alexithymia seems to increase with age. Still, alexithymia has been shown to associate with low educational level, poor social situation, unemployment and living alone. The results of two large-scale population studies on alexithymia (measured with the Toronto Alexithymia Scale 20) are described in more detail in the presentation.

Mortality and suicide rate related to self-reported anxiety and depression;
4.5 year follow up after the North-Trøndelag Health study (HUNT 2)
Ottar Bjerkeset MD1, Arnstein Mykletun MA2 , Olav Linaker MD PhD3
1) HUNT Research Centre, Norwegian University of Science and Technology, Trondheim
2) Research Centre for Health Promotion, University of Bergen, Bergen
3) Department of Psychiatry, Norwegian University of Science and Technology, Trondheim
Corresponding author:
Ottar Bjerkeset, MD
Abstract
Background: Although there is a great overlap between anxiety and depression symptoms (1), the association with increased mortality has previously been studied for depression (2) and anxiety (3) separately. In most studies, psychiatric interviews have been used to assess psychiatric disorders. Unfortunately, the majority of previous studies are poorly controlled for confounding factors, and methods and results differ considerably (2). Our aim was to study the association between severity of self-reported, co-morbid anxiety and depression and 4.5-year total mortality and cause of death in the general population, adjusting for relevant confounders.
Method: 2.624 participants from the HUNT 2 study 1995-97 (4) in Norway between 20 and 94 years of age were included. Baseline measure was the total score on the Hospital Anxiety and Depression rating Scale (HADS). HADS has proven to have good psychometric properties and reliable case-finding abilities both in the general population and in medical settings (5). Cox regression analysis in SPSS version 11.01 was used to estimate the mortality rates.
Results: 114 deaths occurred in the first 4.5 years. The mortality risk increased with rising anxiety and depression symptom level (p for trend =.02). The adjusted HR for total mortality was 1.57 (95% CI 1.07- 2.31), cut-off was set at 95th percentile (19 points) on HADS. Chronic somatic illness, male gender, and daily smoking were important mediating factors for increased mortality in the anxious and depressed. Our results are consistent with findings from previous well-controlled studies using structured psychiatric interviews (2) . HADS score above cut-off at the 95th percentile predicted all 7 suicides in the sample.
Conclusion: Self-reported anxiety and depression symptom severity obtained by HADS performed as a reliable predictor for excess total mortality and future suicides in our sample. Self-report is cost-efficient and often the only feasible method in daily clinical practise.
Reference List
(1) Kessler RC, Keller MB, Wittchen HU. The epidemiology of generalized anxiety disorder. Psychiatr Clin North Am 2001; 24(1):19-39.
(2) Cuijpers P, Smit F. Excess mortality in depression: a meta-analysis of community studies. J Affect Disord 2002; 72(3):227-236.
(3) Grasbeck A, Rorsman B, Hagnell O, Isberg PE. Mortality of anxiety syndromes in a normal population. The Lundby Study. Neuropsychobiology 1996; 33(3):118-126.
(4) Holmen J, Midthjell K, Kruger Ø, Langhammer A, Holmen TL, Bratberg GH et al. The Nord-Trøndelag Health Study 1995-97 (HUNT 2): Objectices, content, methods and participation. Norsk Epidemiologi 2003; 13(1):19-32.
(5) Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res 2002; 52(2):69-77.

Association between depression and elevated C- reactive protein in a large community study; the significance of confounding factors
Ottar Bjerkeset 1,2, Kristian Hveem 1,2
1) HUNT Research Centre, Norwegian University of Science and Technology, Trondheim
2) Levanger Hospital, Norway
Corresponding author:
Ottar Bjerkeset, MD
Abstract
Background: Clinical studies show that depression and cardiovascular diseases share the common feature of elevated inflammatory markers. Population study findings are more divergent (1;2) .Our aim was to explore the relationship between elevated C-reactive protein (CRP) and severity of depression symptoms in a large population study.
Methods: A random sample of 9258 subjects (9.8%) from the Nord-Trøndelag Health Study (HUNT 2, 1995-97) in Norway aged 20-94 with high-sensitive CRP < 10 mg/l comprised our study group. Elevated CRP was defined as > 2.2 mg/l and depression was self-reported in the Hospital Anxiety and Depression rating Scale (HADS). HADS is commonly used and has been proven to have good psychometric properties and reliable case-finding abilities (3). Binary logistic regression in SPSS version 11.01 was used for the analysis, adjusting for relevant sociodemographic, life-style and clinical characteristics.
Results: 970 subjects (10.5%) had a HADS-D score > 8. In this group depression was associated with elevated CRP only after adjustment for gender, age and sociodemographic variables (OR 1.18, p= .03). After adjustment for life-style factors (smoking, alcohol consumption and exercise) and clinical characteristics (chronic somatic illnesses, rheumatism, BMI, and blood pressure) the OR`s were 1.11 (p= .371) and 1.15 (p= .076) respectively.
The findings were the same in the 294 subjects (3.1%) with more severe depressive symptoms, HADS-D >11. In the fully adjusted model, employment (OR=0.73, p= .001) was a protective factor whereas smoking (OR 1.54, p= <.001), BMI > 30 (OR=2.17, p= <.001), rheumatism (OR= 1.50, p= <.001), and diastolic hypertension (OR=1.32, p=.005) predicted elevated CRP values in the depressed. Tests for trend were not significant after adjustment (all p values > .328).
Conclusion: Our results suggest that the association between elevated CRP and depressive symptoms in the general population is explained by confounding factors. The study is based on self-reported symptoms and findings were the same in moderately and severely depressed subjects.
Reference List
(1) Danner M, Kasl SV, Abramson JL, Vaccarino V. Association between depression and elevated C-reactive protein. Psychosom Med 2003; 65(3):347-356.
(2) Tiemeier H, Hofman A, van Tuijl HR, Kiliaan AJ, Meijer J, Breteler MM. Inflammatory proteins and depression in the elderly. Epidemiology 2003; 14(1):103-107.
(3) Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res 2002; 52(2):69-77.

Title: Hopelessness in a general population
Authors: Kaisa Haatainen, Antti Tanskanen, Jari Kylmä, Kirsi Honkalampi, Heli Koivumaa-Honkanen, Jukka Hintikka, Heimo Viinamäki Corresponding author: Kaisa Haatainen
Abstract:
Objective: To assess the prevalence and the associated factors of hopelessness in a general population sample.
Methods: The random population sample consisted of 1 722 subjects. The study questionnaires included the Beck Hopelessness Scale (BHS), Beck Depression Inventory (BDI), Toronto Alexithymia Scale (TAS-20), and Life Satisfaction Scale (LS).
Results: Eleven percent of the subjects reported at least moderate hopelessness. A poor financial situation (OR 3.64), poor subjective health (OR 2.87), and reduced working ability (OR 2.67) independently associated with hopelessness. Moreover, the likelihood of moderate or severe hopelessness was significantly increased in subjects dissatisfied with life (OR 5.99), with depression (OR 4.86), with alexithymia (OR 2.37), and with suicidal ideation (OR 1.85).
Conclusions: This study demonstrated a moderately high prevalence of hopelessness in a general population. Hopelessness appears to be an important indicator of low subjective well-being at the population level that health care personnel should pay attention to.

Title: Which factors are important in women's depression?
Authors: Kirsi Honkalampi, Jukka Hintikka, Kaisa Haatainen, Heli Koivumaa-Honkanen, Antti Tanskanen, Heimo Viinamäki Corresponding author: Kirsi Honkalampi
Abstract:
Objective: The aim of this study was to simultaneously tested adverse childhood experiences, stressful life events and prior depressive symptoms for their ability to predict depression in women among the general population. Methods: A stratified random sample of women (N = 835) from the general population was collected at baseline in 1999. Depression (BDI-21), ACEs, stressful life-events and background factors were assessed by postal questionnaire at baseline and at follow-up in 2001. Results: The prevalence of depression was 14% at baseline and 13.9% on follow-up. Considerable financial difficulties, subjective working disability, frequent alcohol use and some other heavy ordeal were associated with depression on follow-up. Furthermore, the main variable explaining depression on follow-up was the existence of prior depressive symptoms at baseline. Conclusions: This study confirmed that psychosocial impairment increased the risk of depression in women among the general population. In addition, prior symptoms of depression associated with depression on follow-up.

Title:Life dissatisfaction and subsequent work disability in an 11-year follow-up
Authors: Koivumaa-Honkanen H, MD, PhD, MPH; Koskenvuo M, MD, PhD; Honkanen RJ, MD, PhD; Viinamäki H, MD, PhD; Heikkilä K PhLic; Kaprio J, MD, PhD
Corresponding author: Heli Koivumaa-Honkanen
Abstract:
Objective: Life dissatisfaction predicts total mortality, suicides and unintentional injury deaths in adults. We investigated whether it predicts also work disability.
Methods: A nationwide sample of Finnish twins aged 18-54yr (N=22,136) responded to a questionnaire with a 4-item life satisfaction scale (interest, happiness, easiness and loneliness in life) in 1975. The risk of subsequent work disability (1977-1987) between the dissatisfied and satisfied was compared with Cox regression and conditional logistic regression.
Results: Self-reported life dissatisfaction predicted work disability pensions (age-adjusted HR=2.3; 95%CI 1.9-2.9). It predicted disability due to psychiatric (HR=4.2; 2.4-7.4) and non-psychiatric causes (HR=2.0; 1.4-2.7) among the healthy at baseline and that due to psychiatric causes among the ill (HR=2.4; 1.3-4.5). These risk differences were still seen after adjusting for marital status, social class and health and among twin pairs discordant by their end-point disability status.
Conclusion: Subjective well-being predicts work disability in general population, especially among the healthy.

Title: A bibliometric analysis of Finnish epidemiological schizophrenia research
Authors: Johanna Koskinen B Med, Jouko Miettunen MSc, MPhil, Pekka Tienari MD, Pentti Nieminen PhD, Erika Lauronen B Med, Hannu Koponen MD, Matti Isohanni MD, PhD
Corresponding author: Johanna Koskinen
Abstract:
The aim of this study was to find out the current status of Finnish schizophrenia research in general and focusing in epidemiological study.
The articles were found by using the database Web of Science. We included articles that had schizophrenia as a keyword, were published during the years 1994-2003 and had at least one Finnish participating organisation.
Altogether 319 articles met our criteria, 100 of them being epidemiological studies. During the years the interest towards epidemiological schizophrenia study has maintained the same. International co-operation is rather common. The universities Oulu and Turku as well as the National Public Health Institute have published most epidemiological schizophrenia articles. The Department of Forensic Psychiatry in Kuopio and the National Public Health Institute have received most citations. Finnish epidemiological schizophrenia study is active. The most visible epidemiological schizophrenia research is made in the National Public Health Institute and Department of Forensic Psychiatry in Kuopio.

Title: Development at age 1 and later illness course in schizophrenia?
Authors:
Erika Lauronen, B. Med, Jouko Miettunen, M.Sc Matti Isohanni, MD, PhD, Professor
Corresponding author: Erika Lauronen
Abstract:
Objective: The relation between early development and later clinical course is poorly characterised. We analyzed whether the children who achieved developmental milestones later at age 1 year and developed psychosis also experience worse illness course than early learners.
Method: All cases with psychosis by the year 1997 (N=156) in the Northern Finland 1966 Birth Cohort were studied. We studied the relationship between motor development and course of illness in schizophrenia and other psychoses using developmental markers (learning to stand, walk, and speak) at about age 1 year. Psychiatric hospitalisations, ability to work, antipsychotic medication, education and early death were used as markers of illness course.
Results: The development at age 1 did not relate to subsequent course of illness.
Conclusion: Adulthood psychoses seem to be complex in their developmental trajectory. Slow motor development is a marker of increased risk but seems not to predict clinical course of schizophrenia.

Title: The Clinical Characteristics of DSM-IV Bipolar I and II Disorders in the Jorvi Bipolar Study (JoBS)
Authors: Outi Mantere, MD (1,2), Kirsi Suominen, MD, PhD (1,2), Sami Leppämäki, MD (1,2), Hanna Valtonen, MD (1,2), Petri Arvilommi, MD (1,2), Erkki Isometsä, MD, PhD (1). 1) Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland 2). Department of Psychiatry, Jorvi Hospital, Helsinki University Central Hospital, Espoo, Finland
Corresponding author: Outi Mantere
Abstract:
Objective: To obtain a comprehensive view of the clinical epidemiology of bipolar I and II disorder in secondary-level psychiatric settings.
Methods: In the Jorvi Bipolar Study (JoBS), 1630 non-schizophrenic psychiatric in- and outpatients in three Finnish cities were screened for bipolar I and II disorders with the Mood Disorder Questionnaire. Diagnoses were made using semistructured SCID-I and -II interviews. Information collected included clinical history, current episode, symptom status, and other characteristics.
Results: 191 patients with bipolar disorder (90 bipolar I and 101 bipolar II) were included in the JoBS. The majority of bipolar II (54.5%) and many bipolar I (28.9%) patients were previously undiagnosed; the remainder had a median 8.2 years delay from first episode to diagnosis. Despite several lifetime episodes, 27% and 59% of bipolar I and II patients, respectively, had never been hospitalized. A polyphasic episode was current in 50.3%, rapid cycling in 32.5%, and psychotic symptoms in 16.8% of patients. Mixed episodes occurred in 16.7% of bipolar I, and depressive mixed states in 25.7% of bipolar II patients.
Conclusion: Even in psychiatric settings, bipolar disorders usually go undetected, or recognized only after a long delay. A significant proportion of not only bipolar II, but also bipolar I patients are never hospitalized. Polyphasic episodes and rapid cycling are prevalent in both types. Depressive mixed states are at least as common among bipolar II patients as mixed episodes among bipolar I.

Title: Normative data of the Finnish version of Hypomanic Personality Scale
Authors: Miettunen J, Kantojärvi L, Ekelund J, Veijola J, Karvonen JT, Freimer N, Lichtermann D, Isohanni M, Läksy K, Joukamaa M
Corresponding author: Jouko Miettunen
Abstract:
Objective: The aim of the study is to present Finnish normative data of the Hypomanic Personality Scale (HPS) and study the structural validity of the scale. Association of gender and education level to the scores will also be studied.
Method: As part of the 31-year follow-up survey of the prospective Northern Finland 1966 Birth Cohort, the HPS was filled in without missing items by 4661 subjects. Cronbach's alpha was used to explore the reliability of the scale.
Results: Mean score for males was 10.6 (SD 7.0) and for females 11.8 (7.0). People with basic level of education scored higher than those with tertiary level education, mean values were 12.7 (7.3) and 10.7 (7.0) respectively. Cronbach's alpha for the scale in the total sample was 0.86.
Conclusion: Preliminary results in this Finnish data set show relatively low scores on the HPS scale compared to previous studies in other countries.

Title: Depressive Disorders in a Population-Based Adolescent Twin Sample
Authors: Elina Sihvola1,2, Anna K. Keski-Rahkonen1,2, Danielle M. Dick4, Lea Pulkkinen3, Richard J. Rose4, Mauri Marttunen5,6, Jaakko Kaprio1,5

Corresponding author: Elina Sihvola, MD
Abstract:
Objective. The examine the genetic etiology and descriptions of DSM-III-R and DSM-IV major depressive disorder(MDD), minor depression(MD), subtreshold depression(SD) and depressive disorder NOS using a population-based sample of 1,854 adolescent twins.
Method. A semi-structured lay-administered interview.
Results. Lifetime prevalences were 4.53 %( DSM-IIIR MDD), 2.32% (DSM-IV MDD), 6.63% (MD) 5.23 %( SD) and 29.56 %( depressive disorder NOS). All definitions were primarily characterized by mood and cognitive symptoms. The phenomenology of MD and SD largely resembled the one observed for DSM-IV MDD, but the subjects had lower rates of classical neurovegetative symptoms. Genetic modeling suggested additive genetic effects for different definitions of depressive disorders in females and individual environmental factors in males.
Conclusions. Minor depression could be considered as a new category for DSM-V, target for longitudinal studies, treatment and preventive efforts in adolescence. The results support evidence on greater genetic contribution on depression in adolescent girls compared to boys.

Title: Recovery from depression - a general population study
Authors: Heimo Viinamäki, Antti Tanskanen, Kirsi Honkalampi, Heli Koivumaa-Honkanen, Risto Antikainen, Kaisa Haatainen, Jukka Hintikka
Corresponding author: Heimo Viinamäki
Abstract:
Objective: The recovery from depression and factors associated with it are not well-known in the general population. We conducted a two-year follow up of general population subjects and investigated their recovery from depression.
Method: Individuals who were assessed as suffering from depression on the basis of Beck Depression Inventory (BDI) scores were monitored for two years.
Results: Sixty-five per cent were still depressed after two years of follow-up. Negative life events had occurred more often in those who had remained depressed than in the others. Logistic regression analysis revealed that a high initial BDI score and a worsening of a subject's economic situation during the follow-up period were associated with failure to recover. Lack of use of health services associated with non-recovery.
Conclusion: Depression may be more chronic in the general population than previously has been thought.

List of corresponding authors:

Linnea Haarasilta,
Address: Kauppiaskatu 15 E 33, 20100 Turku Email: linnea.haarasilta@ktl.fi Tel: +358-40-744 5052

Hasse Karlsson
Address: University of Helsinki, Dept. Of Psychiatry, Lapinlahdentie, 00014 Helsingin yliopisto Email: hasse.karlsson@helsinki.fi Tel: 040-5195247

Juha Veijola
Address: Dept of Psychiatry, 90014 University of Oulu, Finland
Email: juha.veijola@oulu.fi Tel: +358-400-851440 Fax: +358-8-333167

Matti Joukamaa, School of Public Health, FIN-33014 Univ. of Tampere; matti.joukamaa@uta.fi

Ottar Bjerkeset
Sykehuset Levanger, Psykiatrisk klinikk , Norway Phone +47 74098600 E-mail: ottar.bjerkeset@hnt.no; HUNT Research Centre, Neptunveien 1, 7650 Verdal, Norway
Phone +47 74075191 Fax +47 74075181 E-mail ottar.bjerkeset@medisin.ntnu.no

Kaisa Haatainen
Address: Department of Psychiatry 4977, Kuopio University Hospital, P.O. Box 1777,
FI-70211 Kuopio, Finland Email: kaisa.haatainen@kuh.fi Tel: +358-17-172 939 Fax: +358-17-173 549

Kirsi Honkalampi
Address: Dept of Psychiatry 4977, Kuopio University Hospital, P.O. Box 1777, FI-70211 Kuopio, Finland Email: kirsi.honkalampi@kuh.fi Tel: +358-17-172 920 Fax: +358-17-173549

Heli Koivumaa-Honkanen
Address: Dep.Psychiatry(2700), Kuopio University Hospital, P.O.B.1777, 70211 Kuopio, Finland Email: heli.koivumaa@kuh.fi Tel: tel: +358-17-172952 Fax: +358-17-173549

Johanna Koskinen
Address: Department of Psychiatry, University of Oulu, P.O.Box 5000, FIN-90014, University of Oulu, Finland Email: jokoskin@mail.student.oulu.fi Tel: +358-40-7259713 Fax: : +358-8-333167

Erika Lauronen
Address: Department of Psychiatry, PL 5000, 90014 University of Oulu, Finland
Email: llaurone@paju.oulu.fi Tel: +358-40-7474376 Fax: +358-8-333167

Outi Mantere
Address: Sunanniitynkuja 1B8 02760 Espoo Email: olinnaranta@yahoo.com Tel: 050-5943786

Jouko Miettunen
Address: Psykiatrian klinikka, Oulun yliopisto, PL 5000, 90014 OULUN YLIOPISTO
Email: jouko.miettunen@oulu.fi Tel: 040-7167261 Fax: 08-333167

Elina Sihvola
Address: Department of Public Health (5th floor) Mannerheimintie 172 P.O. Box 41
FIN-00041 University of Helsinki, FINLAND
Email:elina.sihvola@helsinki.fi Tel: +358-50-352 9072 Fax: +358-9-191 27 600

Heimo Viinamäki
Address: Department of Psychiatry, Kuopio University Hospital, P.O. Box 1777, FI-70211 Kuopio, Finland Email: heimo.viinamaki@kuh.fi Tel: +358-17-172 970 Fax: +358-17-172 966

For further information, please contact Maarit Korhonen or Tiina Rissanen