Riittakerttu Kaltiala

Tampere University | UTA · Faculty of Medicine and Health Technology

Nuorten käytöshäiriö on monimuotoinen ja yleinen psykiatrinen häiriö. Vaikka vaikean käytöshäiriön ja tunnekylmyyden hoitoa pidetään erittäin vaativana, uusimmat terapiainterventiot ja niihin liittyvä tutkimus antavat toivoa siitä, että näistä häiriöistä kärsivät nuoret voivat oppia uusia keinoja tunnistaa ja hallita tunteitaan sekä käytöstään. Täs...

From the early years of this century, many Western countries adopted the “Dutch Protocol” as a new medical pathway for treating children and adolescents with childhood-onset gender dysphoria. On this approach, gonadotrophin-releasing hormone agonists (GnRHa) were used to suppress puberty, followed by cross-sex hormones (testosterone or oestrogen)....

Background With increasing numbers of people seeking medical gender reassignment, the scientific community has become increasingly aware of the issue of detransitioning from social, hormonal or even surgical gender reassignment (GR). This study aimed to assess the proportion of patients who discontinued their established hormonal gender transition...

Aims Estimates of the occurrence of bipolar disorder among adolescents vary from country to country and from time to time. Long delays from first symptoms to diagnosis of bipolar disorder have been suggested. Studies among adults suggest increased mortality, particularly due to suicide and cardiovascular diseases. We set out to study the prognosis...

Background:Implementation of evidence-based interventions is one of the proposed responses to increased demand for treatment of adolescent depression. While the efficacy of interpersonal psychotherapy to treat depression of adolescents (IPT-A) is well established, the effectiveness and cost-effectiveness of the shorter adolescent interpersonal coun...

ESCAP firmly believes that there is an urgent need to apply widely endorsed clinical, scientific, and ethical standards to the care of children and adolescents with gender dysphoria. It is important to base decisions for possible medical transitions on a rigorous assessment of individual needs and their capacity to consent regarding the serious lon...

Background All-cause and suicide mortalities of gender-referred adolescents compared with matched controls have not been studied, and particularly the role of psychiatric morbidity in mortality is unknown. Objective To examine all-cause and suicide mortalities in gender-referred adolescents and the impact of psychiatric morbidity on mortality. Me...

Background Legislators often want to positively affect psychiatric inpatient care and reduce coercion by a stricter judicial regulation. However, staff experiences and comprehension of such legal changes are largely unknown, yet essential in obtaining the intended outcomes. We examined staff understanding and implementation of a July 1, 2020 legal...

Background The number of people seeking gender reassignment (GR) has increased everywhere and these increases particularly concern adolescents and emerging adults with female sex. It is not known whether the psychiatric needs of this population have changed alongside the demographic changes. Methods A register-based follow-up study of individuals...

Background Legislators often want to positively affect psychiatric inpatient care and reduce coercion by strictening relevant judicial regulation. However, staff experiences and comprehension of such legal changes are largely unknown, yet essential in obtaining the intended outcomes. We examined staff understanding and implementation of a July 1, 2...

Purpose: This retrospective study utilized comprehensive Finnish national register data to examine the course and mortality of eating disorders among Finnish adolescent inpatients. Methods: The study population (N = 17,112) comprised of all subjects admitted for the first time to psychiatric hospital care at age 13-17 in 1980-2010. In 10-year fo...

Only a very few studies to date have comprehensively assessed children’s knowledge of sexuality. In this study, we examined the level of sexual knowledge among children aged 3–6 years in Finland. We analysed children’s explanations of what they saw in drawings related to genital naming, conception and childbirth, safety skills, and adult sexual act...

Sociodemographic and psychosocial family factors have profound implications for adolescent development, identity formation and mental health during the adolescent years. We explored the associations of sociodemographic and psychosocial family factors with transgender identity in adolescence and the role of these factors in the associations between...

Objective This study explored the incidence and stability of schizophrenia in a large national register data of all adolescents first admitted to psychiatric inpatient care at ages 13–17 in Finland 1980–2010. Methods The study population (N 17,112) comprised all Finnish citizens aged 13–17 receiving their first ever psychiatric inpatient treatment...

Chronic disease may affect adolescents’ educational success. We study whether adolescents with a somatic chronic condition have lower school performance, lower odds for academic education, and a delayed start of upper-secondary studies. Seventh graders and ninth graders in the Helsinki Metropolitan Region, Finland, were invited to participate in a...

Gender-referred adolescents (GR) have been reported to present with considerable psychiatric symptomatology compared to their age-peers. There is, however, little research on how they compare to adolescents referred due to mental health problems (MHR). We set out to compare psychopathology in adolescents referred to our specialized gender identity...

Subjection to sexual harassment (SH) has been reported more commonly by girls than by boys, by sexual and gender minority youth more than by mainstream youth, and by sexually active youth more than by those not yet experienced in romantic and erotic encounters. However, the research so far has not addressed these correlates simultaneously. This stu...

Mental disorders may for various reasons impair educational attainment, and with far-reaching consequences given the impact of education on subsequent employment, social life, life choices and even health and mortality. This register-based study addresses trends in educational attainment among Finnish adolescents aged 13–17 with mental disorders se...

Adolescence is an important period for identity formation and identity consolidation is one of the main developmental tasks. Gender identity is an essential aspect of identity but so far little is known about its development. Neither has the identity development of adolescents with features of gender dysphoria (GD) been extensively studied so far....

Background: Some mental disorders have been associated with increased likelihood of sexual offending in adolescents (and adults), but relevant studies tend to be of established sex offenders. Aims: To examine relationships between adolescent mental disorders and subsequent involvement in sex offending and to explore any predictive value of prima...

Purpose of the study School absenteeism and school dropout jeopardize the future health and wellbeing of students. Reports on the participation of school health care in absenteeism reduction are infrequent, although physical and mental health problems are the most common causes of school absenteeism. Our aim was to explore what reasons different pr...

Gender‐diverse adolescents have reported excessive experiences of sexual harassment, but studies on this are few and suffer from methodological problems. Our aim was to compare experiences of sexual harassment between adolescents belonging to different gender‐identity groups. A nationally representative cross‐sectional survey of 127,210 adolescents...

Objective To examine secular trends and sociodemographic determinants of thinness, overweight, and obesity among Malaysian children and adolescents in 2006-2015. Design We used cross-sectional data from the National Health and Morbidity Surveys 2006, 2011, and 2015. Individuals were classified into pre- (6-9 years), early (10-13 years) and mid (14...

Purpose This register-based study aimed to evaluate trends in adolescent psychiatric inpatient care using nationwide data from three consecutive decades. Methods The study population (N 17,112) comprised all Finnish citizens aged 13–17 receiving their first-ever psychiatric inpatient treatment between 1980 and 2010 in Finland. Information on inpat...

Background: Mental health problems are common in adolescence and seeking help for them is becoming more common. Referrals to adolescent mental healthcare have recently increased in Finland. Objective: To examine time trends in internalizing and externalizing mental health symptoms among Finnish adolescents. Method: A time-trend school survey w...

Objectives Emerging evidence reveals disparities in suicidal behaviour and ideation exist between transgender and cisgender youth. It has been hypothesized that certain gender minority specific risk factors, such as experiences of victimization, could partially explain the mental health disparities between transgender and cisgender youth. We set ou...

Adolescents brought before court suffer excessively of mental disorders. Less is known about subsequent criminal participation of adolescent psychiatric inpatients. Our register study comprised all subjects that had between 1980 and 2010 been admitted to psychiatric inpatient care in Finland for the first time in their lives at ages 13–17 (n = 16 8...

Background During adolescence, bullying often has a sexual content. Involvement in bullying as a bully, victim or both has been associated with a range of negative health outcomes. Transgender youth appear to face elevated rates of bullying in comparison to their mainstream peers. However, the involvement of transgender youth as perpetrators of bul...

Mentalization, emotion regulation, and identity diffusion are theoretically and clinically important transdiagnostic psychological constructs that contribute to mental health. In order to advance meaningful empirical research on these constructs, we need measures that are well tested. In this study, we used confirmatory factor analysis to assess th...

Background Despite reduced sanctions and more permissive attitudes toward cannabis use in the USA and Europe, the prevalences of adolescent cannabis use have remained rather stable in the twenty-first century. However, whether trends in adolescent cannabis use differ between socioeconomic groups is not known. The aim of this study was to examine tr...

Background: Sexuality is a major facet of development during adolescence. Apace with normal sexual development, sexual experiences become more common and intimate. Recent research reports mixed results as to whether this is the case among transgender identifying adolescents. Recent research also suggests that trans youth experience negative sexual...

Background: Ignorance, misconceptions and fear hinder the implementation of young children’s age-appropriate sexuality education (SE) globally. Methods to promote the SE of young children are needed. Aim: We aimed to evaluate why parents and professionals resist the concept of childhood SE and to test whether a child-centred term could reduce this...

Background Serious long-term diseases like asthma, diabetes or epilepsy in adolescence means extra efforts to cope everyday life in school, hobbies or at home. These also set extra challenges on adolescents to go through the developmental tasks of that age. We study here, if adolescents with a long-term disease have lower chances for an academic ed...

Importance The association between income and mental health has long been a question of interest. Nationwide register data provide means to examine trends and patterns of these associations. Objectives To compare income-specific trends in the incidence rates of first psychiatric hospital admissions and to evaluate whether an income gradient exists...

All over Europe youth delinquency is decreasing; our understanding of the factors related to juvenile delinquency and the characteristics of effective forensic youth care has increased substantially. However, effective prevention and intervention strategies are not always employed due to financial, demographical and socio-political challenges count...

Purpose: To assess how adolescent development progresses and psychiatric symptoms develop among transsexual adolescents after starting cross-sex hormone treatment. Materials and methods: Retrospective chart review among 52 adolescents who came into gender identity assessment before age 18, were diagnosed with transsexualism and started hormonal gen...

We investigated whether the associations between involvement in bullying and emotional and behavioral symptoms among adolescents differ according to sexual orientation. Respondents were 25 147 boys and 25 257 girls in comprehensive school (Mage 15.4, SD 0.6), and 33 231 males and 36 765 females in upper secondary education (Mage 17.4, SD 0.8) in Fi...

Purpose: To explore whether the increase observed in referrals to child and adolescent gender identity services (GIDSs) has been similar in four Nordic countries and in the UK. Materials and methods: Numbers of referrals per year in 2011–2017 were obtained from all GIDS in Denmark, Finland, Norway, Sweden and the UK and related to population aged <...

Background: Scientific literature suggests that the prevalence of delinquency amongst adolescents has decreased internationally in past decades. However, whether this change is consistent across all socioeconomic groups has not yet been studied. Objective: The aim of this study was to examine changes in delinquency amongst Finnish adolescents acco...

Objective: To review research on emotional, cognitive, and behavioral levels of sexual development in children and adolescents, and, based on that, to propose a model of sexual development from infancy to early adulthood, the Steps of Sexuality. Methods: Literature review. Results: We present a model of sexual development from infancy to early adul...

Introduction: Subjection to sexual harassment among adolescents have been associated with negative mental health outcomes, such as depression and social anxiety. Self-esteem and social support may modify these associations. Methods: The Adolescent Mental Health Cohort 10-year replication data were used. It is a cross-sectional classroom survey invo...

Purpose: Smoking is a significant cause of morbidity and mortality worldwide. In the past decades, the prevalence of adolescent smoking has decreased in industrial countries. However, whether the decreasing trend can be seen across all socioeconomic groups is unknown. The aim of this study was to examine time trends in adolescent smoking according...

Gender dysphoria in adolescence could be expected to be associated with delayed sexual development because of the distress related to the sexual characteristics of the body. However, identity challenges may also increase early and risk-taking sexual behaviours among adolescents with gender dysphoria. We studied sexual experiences among 101 adolesce...

The aim of this study was to explore whether there has been an increase in prevalence and changes in sex ratio in feelings of gender dysphoria (GD) in an adolescent population in Northern Europe, and to study the impact of invalid responding on this topic. We replicated an earlier survey among junior high school students in Tampere, Finland. All fi...

Purpose: To explore whether sexual harassment experiences are more common among adolescents reporting romantic and erotic interests in the same sex and both sexes, when sociodemographic and mental health confounding are controlled for, and whether the associations are similar in both sexes and in different phases of adolescence. Methods: A cross-se...

Background: Increasing numbers of adolescents are seeking treatment from gender identity services, particularly natal girls. It is known from survey studies some adolescents exaggerate their belonging to minorities, thereby distorting prevalence estimates and findings on related problems. The aim of the present study was to explore the susceptibil...

Symptoms of generalized anxiety disorder (GAD) are common among adolescents and can lead to severe psychosocial impairment, yet there is a lack of a good quality scale to measure symptoms of generalized anxiety in young people. The 7-item Generalized Anxiety Disorder Scale (GAD-7) is a self-report scale used to measure GAD symptoms and has been val...

Manifold factors connect with adolescent sexual behavior, but studies on their reciprocal associations are scarce. This study seeks to find the ways in which parental involvement, family characteristics, depression, and delinquency are connected to adolescent early/risky sexual behavior, and to what extent they modify each other. A population-based...

Bullying at school has far-reaching impacts on adolescent well-being and health. The aim of this study was to examine trends in bullying at school according to socioeconomic adversities among Finnish adolescents from 2000 to 2015. A population-based school survey was conducted biennially among 14-16-year-old Finns between 2000 and 2015 (n = 761,278...

We analyzed the associations between sexual orientation and subjection to/perpetration of bullying at school, taking into account confounding by psychiatric symptom dimensions and involvement in the other role. Survey data among 25,147 boys and 25,257 girls in comprehensive school, and 33,231 boys and 36,765 girls in upper secondary education in Fi...

Riittakerttu Kaltiala-Heino,1–3 Hannah Bergman,4 Marja Työläjärvi,2 Louise Frisén4 1Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland; 2Department of Adolescent Psychiatry, Tampere University Hospital, Tampere, Finland; 3Vanha Vaasa Hospital, Vaasa, Finland; 4Department of Clinical Neuroscience, Karolinska Institutet, S...

Subjection to sexual harassment is associated with a number of negative outcomes, such as internalizing and externalizing symptoms and a disinclination to attend school. Among adolescents, sexual harassment may increase with both their emerging sexual desires and increased socializing in mixed-gender peer groups during early adolescence. We set out...

Background: Overweight and perceived overweight are common among adolescents. The nature of the relationship between overweight/perceived overweight and mental health problems is still unclear. Aims: The aim of this study was to examine whether actual overweight, perceived overweight or both are associated with internalizing and externalizing disor...

Purpose: To elucidate a possible connection between delinquency and adolescent sexual behaviours in different age groups from 14 to 20 and the role of depression therein. Materials and methods: Data were gathered from the cross-sectional Finnish School Health Promotion Study 2010 and 2011 with 186,632 respondents. We first examined the bivariate re...

Background: Longitudinal associations between social phobia (SP), depression and eating disorders (EDs), and the impact of antecedent SP and depression on subsequent treatment seeking for EDs have rarely been explored in prospective adolescent population studies. Aim: We aimed to examine these associations in a large-scale follow-up study among mid...

Abstract Background The mortality rate of young offenders is high. Furthermore, mortality in young offenders is associated with psychiatric and substance use disorders. The primary aim of this national register-based follow-up study was to investigate the mortality rate of Finnish delinquents who underwent a forensic psychiatric examination between...

Background: Early sexual activity and multiple sexual partners are deemed risky sexual behaviors and connected to mental disorders such as depression. Parent–adolescent relationship is connected both to risky sexual behaviors and depression. Objective: To ascertain if there is a connection between parental involvement and adolescent sexual behavior...

Background: Aggressive and disruptive behaviors often precede the onset of schizophrenia. In this register-based follow-up study with a case-control design, we wanted to investigate if serious delinquency was associated with future diagnoses of schizophrenia or schizoaffective disorder (here, broadly defined schizophrenia) among a nationwide conse...

We studied current (GIDYQ-A) and recalled (RCGI) childhood gender identity among 719 upper secondary school students 401 girls, mean age 17.0 (SD = 0.88) years old and 318 boys, mean age 17.2 (SD = 0.86 years old in Finland. We also compared these dimensions of identity in community youth to same dimensions among adolescent sex reassignment (SR) ap...

Background: Psychopathy research has thus far focused mostly on child, male, and delinquent samples, but the results are most likely non-generalizable to adolescent girls with mental health disorders. Aim: The present study aimed to compare self-rated psychopathic traits between female psychiatric outpatients and girls in the community, and to inve...

Background More research is needed to improve our understanding of the manifestation of psychopathic traits in violently offending girls. Our aim here was to assess psychopathic traits and psychopathy-related background variables in a Finnish nationwide consecutive sample of girls charged with violent crimes and referred to a pretrial forensic psyc...

Background: Mental health profiles differ between boys and girls from puberty onwards. It is not known whether differences also extend to symptom presentation in schizophrenia spectrum disorders. It may be that girls and boys are not treated entirely equally by the professionals. Aims: To study gender differences in symptom profiles, family adversi...

Background: In DSM 5, conduct disorder was expanded with the new specifier ‘with limited prosocial emotions (LPE)’. These callous-unemotional traits have been emphasized as the ‘core’ of psychopathy syndrome providing greater information about current and future impairment. Individuals with callous-unemotional traits have shown elevated levels of i...

Objectives: The aim of our study was to explore whether gender dysphoria in adolescent girls is associated with early pubertal timing. Methods: We compared menarcheal timing among 52 adolescent girl-to-boy sex reassignment (SR) applicants with that of 644 adolescent girls who participated in an adolescent population mental health survey. Results: O...

Background: A debate concerns whether eating disorders are increasing in prevalence. The role of socio-economic status (SES) for adolescent eating disorders (ED) is another matter of debate. Aims: To ascertain whether self-reported eating disorders or their symptoms have increased in prevalence in adolescent population from the early 2000s to early...

Aims To assess temporal trends of adolescent alcohol use in Finland from 2000 to 2011, according to socio-economic status and depression. Methods Classroom self-administered questionnaires concerning health, health behaviours and school experiences were administered biennially from 2000–2001 to 2010–2011 to nationwide samples of 14- to 16-year-old...

We examined longitudinal associations between social phobia (SP) and educational and interper-sonal impairments among Finnish adolescents. Participants were 3278 adolescents (9th grade; M age = 15.5 years) who completed measures of SP and depressive symptoms; 2070 participated in follow-up two years later. Indicators for educational and interperson...

Purpose To study the associations between subjection to sexual harassment and emotional (depression) and behavioural (delinquency) symptoms among 14-to-18-year-old adolescents, and gender differences within these associations. Methods 90,953 boys and 91,746 girls aged 14–18 participated in the School Health Promotion Study (SHPS), a school-based su...

Objective: Proeating disorder (pro-ED) communities online encourage harmful weight-loss and weight-control practices. This study examined the association between exposure to pro-ED content online and subjective well-being (SWB) among adolescents and young adults in four countries. Method: Cross-national data were collected in the US, Germany, th...

Sexual harassment has been studies as a mechanism reproducing inequality between sexes, as gender based discrimination, and more recently, as a public health problem. The role of family-related factors for subjection to sexual harassment in adolescent has been little studied. Our aim was to study the role of socio-demographic family factors and par...

Overweight is reportedly a risk factor for being bullied, and body image may mediate this association. Research on associations between overweight and bullying has so far only focused on children and early adolescents. We explored associations between actual and perceived overweight at age 15 and involvement in bullying at ages 15 and 17. A total o...

Schizophrenia (SCH) and pervasive developmental disorders (PDDs) belong to different diagnostic categories. There is, however, overlap between these 2 diagnostic groups. The aim of this preliminary study was to evaluate some aspects of neurocognitions and social cognitions in adolescents with SCH (n = 10, 2 boys and 8 girls; age range = 13.3-17.7 y...

Background: Culture‑related differences in psychopathic traits have been reported for adults, but for adolescents such knowledge is lacking. The aim of this cross‑national study was to compare self‑reported psychopathic traits between Finnish and Dutch samples of mid‑adolescent community youth. Methods: The Youth Psychopathic traits Inventory (YPI)...

Background: Associations between psychopathic traits and other forms of psychopathology among youth in the community, as well as gender differences in these associations have been scarcely studied yet. The present study aimed to explore this relationship in a sample of Finnish mid-adolescent girls and boys. Methods: The sample comprised 370 seconda...

In aftermath of the school shootings in Finland (2007 and 2008), hundreds of schools were threatened with similar acts. These threats of homicidal violence occupied both police and psychiatrists, but little is known about the potential threat these cases posed. Our study compared the threats of homicidal violence communicated by pupils aged 12–18 u...

Purpose: Adolescents engaging in early sexual intercourse are at elevated risk for depression, but it is not clear at what point of adolescent development this connection ceases to be significant. Depression is a highly prevalent mental health problem in adolescence compared to childhood, especially among girls. This study examines the association...

Sexually offending behavior by adolescents may be directed towards children, age-mates and adults. Neurocognitive and psychiatric disorders and the associated inability to age-related interpersonal relationships and inability to control the sexual desires activated during adolescence may lead a young person to seek inappropriate sexual satisfaction...

Ethical challenges in child and adolescent forensic psychiatry arise, on the one hand, from the dilemmas commonly faced in forensic psychiatry with adult patients, such as the dual role of the forensic psychiatrist, questions of criminal responsibility, autonomy and competence and involuntary treatment, and, on the other, from the immaturity and de...

In general psychiatric services, cost-benefit screening instruments for psychopathic traits in adolescents are needed. The aim of the present study was to study the psychometric properties of the Finnish versions of the Youth Psychopathic traits Inventory (YPI) and the Antisocial Process Screening Device (APSD-SR) in community youth. As gender-spec...

Increasing numbers of adolescents present in adolescent gender identity services, desiring sex reassignment (SR). The aim of this study is to describe the adolescent applicants for legal and medical sex reassignment during the first two years of adolescent gender identity team in Finland, in terms of sociodemographic, psychiatric and gender identit...

Transsexualism and other variations of gender identity are based on a stable sense of identity. The aetiology of this phenomenon is not fully known. Suffering caused by gender dysphoria is alleviated with sex reassignment. The psychiatric assessment of both adolescents and adults has been centralized in Finland to two university hospitals, the Hels...

Objective: To study associations between emotional and behavioural symptoms and later engagement in sexual behaviours in middle adolescence. Materials and methods: All ninth graders in two Finnish cities were recruited to respond to a questionnaire focusing on mental health and disorders, health behaviours and risk and protective factors (T1), and...