ACKNOWLEDGEMENTS
This work was supported by the Alma and K.A. Snellman Foundation, Oulu, Finland.
The authors have no potential conflicts of interest to disclose.
Author Contributions
Conceptualization: Santtu Räsänen, Hannu Mäkelä, Pirkko Riipinen, Kaisa Riala, Helinä Hakko. Data curation: Pirkko Riipinen, Kaisa Riala, Helinä Hakko. Formal analyses: Santtu Räsänen, Hannu Mäkelä, Helinä Hakko. Funding aquisition: Kaisa Riala, Pirkko Riipinen. Investigation: Santtu Räsänen, Hannu Mäkelä, Pirkko Riipinen, Kaisa Riala, Helinä Hakko. Methodology: Pirkko Riipinen, Kaisa Riala, Helinä Hakko. Project administration: Pirkko Riipinen, Kaisa Riala, Helinä Hakko. Resources: Pirkko Riipinen, Kaisa Riala, Helinä Hakko. Supervision: Pirkko Riipinen, Kaisa Riala, Helinä Hakko. Validation: Pirkko Riipinen, Kaisa Riala, Helinä Hakko. Visualization: Santtu Räsänen, Hannu Mäkelä, Pirkko Riipinen, Kaisa Riala, Helinä Hakko. Writing—original draft: Santtu Räsänen, Hannu Mäkelä. Writing—review & editing: Santtu Räsänen, Hannu Mäkelä, Pirkko Riipinen, Kaisa Riala, Helinä Hakko.
Table 1.
Background and clinical characteristics assessed during adolescent psychiatric hospitalization of the study subjects with neoplasms, by gender
Characteristics assessed at index hospitalization |
Study subjects with neoplasms
|
p |
Total (N=32) |
Male patients (N=8) |
Female patients (N=24) |
Age (in years) at admission, mean (SD) |
15.9 (1.3) |
16.5 (1.2) |
15.8 (1.4) |
0.175 |
Family type, N (%) |
|
|
|
|
Two-parent family |
43.8 (14) |
50.0 (4) |
41.7 (10) |
0.703 |
One-parent family |
28.1 (9) |
0.0 (0) |
37.5 (9) |
0.070 |
Out of home placement |
21.9 (7) |
50.0 (4) |
12.5 (3) |
0.047 |
Other family type |
6.3 (2) |
0.0 (0) |
8.3 (2) |
1.000 |
Psychiatric diagnoses,* N (%) |
|
|
|
|
Substance use disorder |
46.9 (15) |
50.0 (4) |
45.8 (11) |
1.000 |
Psychotic disorder |
6.3 (2) |
12.5 (1) |
4.2 (1) |
0.444 |
Non-psychotic disorder†
|
87.5 (28) |
87.5 (7) |
87.5 (21) |
1.000 |
Nicotine dependence (ND), N (%) |
|
|
|
|
No ND |
50.0 (16) |
37.5 (3) |
54.2 (13) |
0.685 |
Moderate ND |
28.1 (9) |
37.5 (3) |
25.0 (6) |
0.654 |
High ND |
21.9 (7) |
25.0 (2) |
20.8 (5) |
1.000 |
Unhealthy lifestyle,* N (%) |
|
|
|
|
Regular smoking |
75.0 (24) |
75.0 (6) |
75.0 (18) |
1.000 |
Taking snuff |
31.3 (10) |
75.0 (6) |
16.7 (4) |
0.005 |
Fear of becoming obese |
31.3 (10) |
0.0 (0) |
41.7 (10) |
0.035 |
Unhealthy weight control methods |
18.8 (6) |
12.5 (1) |
20.8 (5) |
1.000 |
Table 2.
Characteristics of hospital treatment episodes for neoplasms and clinical diagnosis of psychiatric disorders around neoplasm diagnosis during register-based follow up by the end of year 2016, by gender
Neoplasm-related characteristics |
Number of treatment episodes for neoplasm
|
p |
Total (N=42) |
In males (N=8) |
In females (N=34) |
Age (in years) at neoplasm diagnosis, mean (SD) |
22.0 (6.6) |
22.3 (6.9) |
22.0 (6.7) |
0.916 |
Type of neoplasm, N (%) |
|
|
|
|
Oral cavity/digestive system |
23.8 (10) |
25.0 (2) |
23.5 (8) |
1.000 |
Skin/soft tissue |
38.1 (16) |
50.0 (4) |
35.3 (12) |
0.454 |
Other types*
|
38.1 (16) |
25.0 (2) |
41.2 (14) |
0.688 |
Immediate psychiatric diagnosis within two years before neoplasm,† N (%) |
|
|
|
|
Substance use disorders (F10-F19) |
14.3 (6) |
12.5 (1) |
14.7 (5) |
1.000 |
Psychotic disorders (F20-F29) |
16.7 (7) |
12.5 (1) |
17.6 (6) |
1.000 |
Non-psychotic disorders (F30-F89) |
26.2 (11) |
25.0 (2) |
26.5 (9) |
1.000 |
Immediate psychiatric diagnosis 2 years after neoplasm,† N (%) |
|
|
|
|
Substance use disorders (F10-F19) |
9.5 (4) |
0.0 (0) |
11.8 (4) |
0.572 |
Psychotic disorders (F20-F29) |
4.8 (2) |
12.5 (1) |
2.9 (1) |
0.348 |
Non-psychotic disorders (F30-F89) |
33.3 (14) |
50.0 (4) |
29.4 (10) |
0.406 |
Table 3.
Clinical diagnosis of psychiatric disorders within two years around neoplasm diagnosis during register-based follow up by the end of year 2016, by type of neoplasms
Psychiatric disorders relating to diagnosis of neoplasm |
Number of treatment episodes, by type of neoplasm
|
p |
Oral cavity/digestive system (N=10) |
Skin/soft tissue (N=16) |
Other types (N=16) |
Immediate psychiatric diagnosis within two years before neoplasm,* N (%) |
|
|
|
|
Substance use disorders (F10-F19) |
10.0 (1) |
12.5 (2) |
18.8 (3) |
1.000 |
Psychotic disorders (F20-F29) |
20.0 (2) |
18.8 (3) |
12.5 (2) |
0.884 |
Non-psychotic disorders (F30-F89) |
20.0 (2) |
6.3 (1) |
50.0 (8) |
0.017 |
Immediate psychiatric diagnosis 2 years after neoplasm,* N (%) |
|
|
|
|
Substance use disorders (F10-F19) |
0.0 (0) |
0.0 (0) |
25.0 (4) |
0.034 |
Psychotic disorders (F20-F29) |
10.0 (1) |
6.3 (1) |
0.0 (0) |
0.703 |
Non-psychotic disorders (F30-F89) |
30.0 (3) |
18.8 (3) |
50.0 (8) |
0.171 |
Table 4.
Unhealthy lifestyle habits in adolescence in relation to the treatment episodes of neoplasms, by type of neoplasms
Characteristics assessed at index hospitalization |
Number of treatment episodes, by type of neoplasm
|
p |
Oral cavity/digestive system (N=10) |
Skin/soft tissue (N=16) |
Other types (N=16) |
Nicotine dependence (ND), N (%) |
|
|
|
|
No ND |
70.0 (7) |
43.8 (7) |
43.8 (7) |
0.367 |
Moderate ND |
20.0 (2) |
25.0 (4) |
25.0 (4) |
1.000 |
High ND |
10.0 (1) |
31.3 (5) |
31.3 (5) |
0.496 |
Unhealthy lifestyle habits* N (%) |
|
|
|
|
Regular smoking |
50.0 (5) |
87.5 (14) |
87.5 (14) |
0.049 |
Taking snuff |
10.0 (1) |
37.5 (6) |
18.8 (3) |
0.282 |
Fear of becoming obese |
50.0 (5) |
50.0 (8) |
37.5 (6) |
0.788 |
Unhealthy weight control methods |
40.0 (4) |
37.5 (6) |
25.0 (4) |
0.765 |
Table 5.
Case table for study subjects with malignant neoplasm
|
Neoplasm characteristics |
Information assessed during psychiatric hospitalization at ages 13–17 years old |
Information from the register-based follow-up
|
Immediate psychiatric diagnosis (ICD-10 code) |
Immediate use of psychotropic medication |
Case |
ICD-10 code |
Onset age, gender |
Psychiatric disorders at adolescence |
Family type and lifestyle habits at adolescence |
Within two years before neoplasm |
Within two years after neoplasm |
Within two years before neoplasm |
Within two years after neoplasm |
#1 |
Basal cell carcinoma of skin of trunk (C44) |
29 years, female |
Affective and substance use disorder |
Other family type, high nicotine dependence (ND), fear of becoming obese |
Non-organic psychosis (F29) |
None |
Sertraline, mirtazapine, quetiapine, aripiprazole |
None |
#2 |
Malignant neoplasm of ascending colon (C18) |
20 years, female |
Affective, conduct and substance use disorder |
One-parent family background, moderate ND, fear of becoming obese |
Drug use (Z72) |
Anxiety disorder (F41) |
Oxazepam |
Oxazepam |
#3a |
Malignant neoplasm of floor of mouth, unspecified (C04) |
11 years, female |
Anxiety and affective disorder |
Two-parent family, no ND, fear of becoming obese, emaciation, vomiting, exercising a lot, drinking only non-energy fluids, binge eating |
None |
Anorexia nervosa (F50) |
None |
Citalopram |
#3b |
Malignant neoplasm of border of tongue (C02) |
22 years, female |
Same as above |
Same as above |
Anorexia nervosa (F50) |
None |
None |
Codeine |
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