Discussion
disorders in general when using treatment-based data, the extent to which treatment use data underestimates true prevalence seems to differ between socioeconomic strata. This has two implications to further research
endeavours. First, researchers interested in inequalities of treatment might consider a similar trajectory approach as applied here or other methods to control for the need of treatment. Second, longer measurement periods could improve the reliability of prevalence measures of psychiatric and substance use disorders derived from healthcare data. Compared to shorter observation windows, cumulative measurement periods of several years are less sensitive to possible differences in, e.g., frequency of treatment, waiting periods, regional differences, treatment-seeking and timing of healthcare contacts.
Combining hospital data with psychotropic medication purchases could also yield a more comprehensive estimate of prevalence of treatment for certain psychiatric disorders at population level. However, when the data are based on drug classification systems rather than diagnoses as in this study, caution is required since many medications have different multiple uses. A measure derived by combining different data sources might therefore be better to be interpreted as an estimate of prevalence of treatment for psychiatric symptoms in general rather than prevalence of treatment for any certain disorder.
Finally, the external validity of the results in different contexts needs to be discussed. Similar register-based research on self-harm and ACEs and SEP as determinants has been conducted in other Nordic countries, and, when comparable, the results here are in line with the results in these studies, as they are with results from most survey-based studies (see Chapter 4).
However, there are contextual differences in the patterns and prevalence of self-harm, ACEs and social inequality between societies, as there are in healthcare systems and treatment of psychiatric disorders. Thus, it is plausible that especially the results on treatment use in this study might be different to results derived from other contexts and healthcare systems. For instance, socioeconomic differences in treatment use in other welfare regimes might be more often driven by differences in economic resources than they are in the Nordic welfare regime. On the other hand, differences in treatment use by SEP seem to be rather persistent across different healthcare systems (OECD, 2019), which suggests that different context-specific
characteristics produce convergent patterns of SEP differences. Either way, these topics deserve further study in diverse contexts to establish if the socioeconomic patterns of treatment use among adolescents and young adults who self-harm, and their parents, are in fact generalisable.
10 CONCLUSION
In Dostoevsky’s Crime and Punishment (2006 [1866], part III, chapter I), the doctor Zosimov comments that the lead character Raskolnikov’s illness ‘was due partly to his unfortunate material surroundings during the last few months, but it had partly also a moral origin, “was, so to speak, the product of several material and moral influences, anxieties, apprehensions, troubles, certain ideas … and so on.”’ This study, along with previous work, showed that a similarly complex web of contributing factors is present in self- harming behaviours as well. The thesis focused on childhood conditions and showed that adverse experiences and low income in childhood are associated with the risk of hospital-presenting self-harm, and that these factors interact.
The thesis also showed that many individual-level risk markers of self-harm present in adolescence have a shared set of childhood determinants.
Furthermore, results from this study suggest that even in the context of a universal healthcare system, there are socioeconomic inequalities in the use of psychiatric treatment within a population in a high need of treatment.
Finally, the study showed that offspring self-harm increases the need of psychiatric treatment among parents, although only among mothers in a higher socioeconomic position.
From a social and health policy perspective, the results from this study highlight the importance of family well-being to self-harm prevention, as well as its possible contribution to the prevention of other health and social problems in adolescence and young adulthood. In light of several field reports before and during the COVID19 pandemic, there might be an increasing number of Finnish young people struggling with mental health problems, and this might require a speedy response. To address these issues, both universal and targeted multidisciplinary support programmes for families and children facing adversity might be beneficial, as would securing a sustainable basic level of income for economically disadvantaged families.
In addition, guaranteeing equal access to healthcare and adequate resources for the mental healthcare system are also important. Fortunately, Finland has well-established institutions through which implementation of such policy measures is feasible. Recognising the importance of population mental health for the welfare state in general might be what is needed to pursue necessary reforms.
ACKNOWLEDGEMENTS
This work was conducted at the Population Research Unit (PRU) at the Faculty of Social Sciences, University of Helsinki. I would like to thank the head of the unit, professor Pekka Martikainen, who recruited me first as a research assistant, supervised my master’s thesis and then acted as the principal supervisor of this doctoral dissertation. I am grateful for his guidance during this journey and for giving me the opportunity to work in this community of highly skilled researchers with extraordinary research facilities. I would also like to thank Pekka Martikainen for providing funding for the first stages of this work. In addition to Pekka, this work was
supervised by Dr Hanna Remes, who was also part of the supervising team of my master’s thesis, and Professor Mikko Aaltonen. Thank you for your support, advice and the possibility to ask the smallest things bothering me. I am also thankful to Mikko for securing funding for this project through the CRIMCAR project and for inviting me to be a part of criminological research ventures.
I would like to express my gratitude to Associate Professor David Gyllenberg and Professor Ping Qin for taking their time to thoroughly pre-examine this thesis and providing constructive comments. I also thank Associate Professor Liz Washbrook for agreeing to act as the opponent in the public examination of this dissertation, and Dr Matti Nelimarkka and Dr Arho Toikka for accepting the invitation to act as the faculty representatives in the grading committee. In addition, I would like to thank Statistics Finland, the Finnish Institute for Health and Welfare, and the Social Insurance Institution of Finland for providing the register data underlying this thesis. Without these institutions, the work conducted here would not have been possible.
Participating in the Population, Health, and Living Conditions (VTE) seminar has been an important part of my doctoral studies. I would like to thank all the students, coordinators, steering committee members and alumni for enlightening methodological and conceptual discussions,
constructive critique, and detailed feedback to the drafts of my manuscripts.
I miss the Monday evening get-togethers after the seminar sessions, and I hope these will continue in the future now that we are adjusting back to life with in-person meetings.
During the past several years thesis, I have also had the opportunity to take part in various academic articles unrelated to my thesis. I wish to thank Dr Silvia Loi, Dr Amir Sariaslan and Dr Noora Ellonen, who were the lead authors in some of these ventures, as well as all the other collaborators I have had the opportunity to work with. Thank you for giving me the possibility to learn on a diverse range of topics and the craft of writing an academic article.
I have also been fortunate to participate as an affiliated student in the International Max Planck School for Population, Health and Data Science (IMPRS-PHDS), hosted at the Max Planck Institute for Demographic
Research (MPIDR) in Rostock. I would like to thank the administrative crew, especially Heiner Maier and Christina Westphal, for making the programme possible. Dr Maarten Bijlsma kindly accepted to act as my supervisor at the MPIDR and was also involved as a co-author and a methodological mentor in one of the sub-studies of this thesis. I am grateful to Maarten for all the time and effort he invested to that project. I would also like to thank Dr Mine Kühn for all the advice related to both academic work and everyday life at the MPIDR during my research visit there. Obviously, I wish also to thank all the student and faculty members I have had the privilege to meet during our annual seminars and my research visit to Rostock. Special thanks to Lauren and Josephine, for all our professional and unprofessional discussions, and to Ricarda, Philipp, Adarsh, Henrik and all the others in Rostock for making my research stay enjoyable.
In addition to my supervisors, I would like to thank all the past and present members of the PRU that I have had the pleasure to meet and spend time with: Elina Einiö, Elina Hiltunen, Maria Guzman Castillo, Julia Hellstrand, Liina Junna, Sanna Kailaheimo-Lönnqvist, Kaarina Korhonen, Sini Laakso, Hannu Lahtinen, Riku Laine, Juha Luukkonen, Satu Malmberg, Niina Metsä-Simola, Janne Mikkonen, Heta Moustgaard, Mikko Myrskylä, Maria Ponkilainen, Sanni Saarinen, Karri Silventoinen, Lasse Tarkiainen, Citlali Trigos-Raczkowski, Lotta Volotinen, Ziwei Rao, Ulla Suulamo, Kelsey Wright, Isa Yang, Minna Ylinen, and Xu Zong, among others. Thank you for your insights, sense of humour and willingness to answer even the stupidest questions. It has been a pleasure to spend time with you, both inside and outside of the office.
Finally, I would like to thank all my friends and family members, just for being there. Maaria, thank you for sharing a home and dog care
responsibilities with me, and for being such a loving and wonderful person.
Kiitos kaikesta tuesta, kannustuksesta ja muustakin äidille, isälle, Martalle, Juholle, Millalle, Maijalle, Matleenalle ja Einolle.
Helsinki, February 2023
Joonas Pitkänen
Mun silmät huutaa apua en tiedä mitä nään Voi kuinka paljon toivonkaan et joku kohti aurinkoo vois kääntää mun pään Kyyneleet ne kastelee mun silmäripset, posket hiljalleen Ihan yksin sänkyyn itkemään mä meen En missään valoa nyt nää Kai vain pimeässä kulkee ihminen tää Jos vielä saisin kiinni säteestä auringon Jos vielä menis pois tää olo toivoton Jos saisin vielä lennellä lailla perhosen Kai se päivä vielä koittaa, voi kuiskaathan sä mulle sen?
Martta Pitkänen, 2022.
REFERENCES
Aaltonen, M., Kivivuori, J., Martikainen, P., & Sirén, R. (2012).
Socioeconomic differences in violent victimization: Exploring the impact of data source and the inclusivity of the violence concept. European Journal of Criminology, 9(6), 567–583.
https://doi.org/10.1177/1477370811422800
Act on the Secondary Use of Health and Social Data, no. 552/2019 (2019).
https://www.finlex.fi/fi/laki/alkup/2019/20190552
Afifi, T. O., Enns, M. W., Cox, B. J., Asmundson, G. J. G., Stein, M. B., &
Sareen, J. (2008). Population Attributable Fractions of Psychiatric Disorders and Suicide Ideation and Attempts Associated With Adverse Childhood Experiences. American Journal of Public Health, 98(5), 946–
952. https://doi.org/10.2105/AJPH.2007.120253
Agerbo, E. (2005). Midlife suicide risk, partner’s psychiatric illness, spouse and child bereavement by suicide or other modes of death: A gender specific study. Journal of Epidemiology and Community Health, 59(5), 407–412. https://doi.org/10.1136/jech.2004.024950
Agerbo, E., Nordentoft, M., & Mortensen, P. B. (2002). Familial, psychiatric, and socioeconomic risk factors for suicide in young people: Nested case- control study. BMJ 325, 74.
Aggarwal, S., Patton, G., Reavley, N., Sreenivasan, S. A., & Berk, M. (2017).
Youth self-harm in low- and middle-income countries: Systematic review of the risk and protective factors. The International Journal of Social Psychiatry, 63(4), 359–375. https://doi.org/10.1177/0020764017700175 Alastalo, M., & Helén, I. (2022). A code for care and control: The PIN as an
operator of interoperability in the Nordic welfare state. History of the Human Sciences, 35(1), 242–265.
https://doi.org/10.1177/09526951211017731
Alegría, M., NeMoyer, A., Falgàs Bagué, I., Wang, Y., & Alvarez, K. (2018).
Social Determinants of Mental Health: Where We Are and Where We Need to Go. Current Psychiatry Reports, 20(11), 95.
https://doi.org/10.1007/s11920-018-0969-9
Allison, P. (2009). Fixed Effects Regression Models. SAGE Publications.
https://doi.org/10.4135/9781412993869
Anderson, L. R., Monden, C. W. S., & Bukodi, E. (2021). Stressful Life Events, Differential Vulnerability, and Depressive Symptoms: Critique and New Evidence. Journal of Health and Social Behavior, 00221465211055993.
https://doi.org/10.1177/00221465211055993
Andrade, L. H., Alonso, J., Mneimneh, Z., Wells, J. E., Al-Hamzawi, A., Borges, G., Bromet, E., Bruffaerts, R., Girolamo, G. de, Graaf, R. de, Florescu, S., Gureje, O., Hinkov, H. R., Hu, C., Huang, Y., Hwang, I., Jin, R., Karam, E. G., Kovess-Masfety, V., … Kessler, R. C. (2014). Barriers to mental health treatment: Results from the WHO World Mental Health surveys. Psychological Medicine, 44(6), 1303–1317.
https://doi.org/10.1017/S0033291713001943
Angelakis, I., Austin, J. L., & Gooding, P. (2020). Association of Childhood Maltreatment With Suicide Behaviors Among Young People: A Systematic Review and Meta-analysis. JAMA Network Open, 3(8), e2012563.
https://doi.org/10.1001/jamanetworkopen.2020.12563
Arango, C., Díaz-Caneja, C. M., McGorry, P. D., Rapoport, J., Sommer, I. E., Vorstman, J. A., McDaid, D., Marín, O., Serrano-Drozdowskyj, E., Freedman, R., & Carpenter, W. (2018). Preventive strategies for mental health. The Lancet Psychiatry, 5(7), 591–604.
https://doi.org/10.1016/S2215-0366(18)30057-9
Arbuthnott, A. E., & Lewis, S. P. (2015). Parents of youth who self-injure: A review of the literature and implications for mental health professionals.
Child and Adolescent Psychiatry and Mental Health, 9, 35.
https://doi.org/10.1186/s13034-015-0066-3
Arsenault-Lapierre, G., Kim, C., & Turecki, G. (2004). Psychiatric diagnoses in 3275 suicides: A meta-analysis. BMC Psychiatry, 4, 37.
https://doi.org/10.1186/1471-244X-4-37
Bacigalupe, A., & Martín, U. (2021). Gender inequalities in
depression/anxiety and the consumption of psychotropic drugs: Are we medicalising women’s mental health? Scandinavian Journal of Public Health, 49(3), 317–324. https://doi.org/10.1177/1403494820944736 Bambra, C., Pope, D., Swami, V., Stanistreet, D., Roskam, A., Kunst, A., &
Scott-Samuel, A. (2009). Gender, health inequalities and welfare state regimes: A cross-national study of 13 European countries. Journal of Epidemiology & Community Health, 63(1), 38–44.
https://doi.org/10.1136/jech.2007.070292
Baron, R. M., & Kenny, D. A. (1986). The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173.
Bartley, M. (2016). Health Inequality: An Introduction to Concepts, Theories and Methods. John Wiley & Sons.
Bellis, M. A., Hughes, K., Leckenby, N., Jones, L., Baban, A., Kachaeva, M., Povilaitis, R., Pudule, I., Qirjako, G., Ulukol, B., Raleva, M., & Terzic, N.
(2014). Adverse childhood experiences and associations with health- harming behaviours in young adults: Surveys in eight eastern European countries. Bulletin of the World Health Organization, 92(9), 641–655.
https://doi.org/10.2471/BLT.13.129247
Bennett, S., Farrington, D. P., & Huesmann, L. R. (2005). Explaining gender differences in crime and violence: The importance of social cognitive skills. Aggression and Violent Behavior, 10(3), 263–288.
https://doi.org/10.1016/j.avb.2004.07.001
Bentley, K. H., Nock, M. K., & Barlow, D. H. (2014). The Four-Function Model of Nonsuicidal Self-Injury: Key Directions for Future Research.
Clinical Psychological Science, 2(5), 638–656.
https://doi.org/10.1177/2167702613514563
Berens, S., & Gelepithis, M. (2019). Welfare state structure, inequality, and public attitudes towards progressive taxation. Socio-Economic Review, 17(4), 823–850. https://doi.org/10.1093/ser/mwx063
Berkman, L. F. (2011). Unintended consequences of social and economic policies for population health: Towards a more intentional approach.
European Journal of Public Health, 21(5), 547–548.
https://doi.org/10.1093/eurpub/ckr124
Bijlsma, M. J., Tarkiainen, L., Myrskylä, M., & Martikainen, P. (2017).
Unemployment and subsequent depression: A mediation analysis using the parametric G-formula. Social Science & Medicine, 194, 142–150.
https://doi.org/10.1016/j.socscimed.2017.10.011
Bitler, M. P., & Karoly, L. A. (2015). Intended And Unintended Effects Of The War On Poverty: What Research Tells Us And Implications For Policy.
Journal of Policy Analysis and Management 34(3), 639–696.
https://doi.org/10.1002/pam.21842
Björkenstam, C., Kosidou, K., & Björkenstam, E. (2017). Childhood adversity and risk of suicide: Cohort study of 548 721 adolescents and young adults in Sweden. BMJ, 357, j1334. https://doi.org/10.1136/bmj.j1334
Björkenstam, E., Burström, B., Brännström, L., Vinnerljung, B., Björkenstam, C., & Pebley, A. R. (2015). Cumulative exposure to
childhood stressors and subsequent psychological distress. An analysis of US panel data. Social Science & Medicine, 142, 109–117.
https://doi.org/10.1016/j.socscimed.2015.08.006
Björkenstam, E., Burström, B., Vinnerljung, B., & Kosidou, K. (2016).
Childhood adversity and psychiatric disorder in young adulthood: An analysis of 107,704 Swedes. Journal of Psychiatric Research, 77, 67–75.
https://doi.org/10.1016/j.jpsychires.2016.02.018
Björkenstam, E., Hjern, A., Björkenstam, C., & Kosidou, K. (2018).
Association of Cumulative Childhood Adversity and Adolescent Violent Offending With Suicide in Early Adulthood. JAMA Psychiatry, 75(2), 185–193. https://doi.org/10.1001/jamapsychiatry.2017.3788
Björkenstam, E., Kosidou, K., & Björkenstam, C. (2016). Childhood household dysfunction and risk of self-harm: A cohort study of 107 518 young adults in Stockholm County. International Journal of
Epidemiology, 45(2), 501–511. https://doi.org/10.1093/ije/dyw012 Blomgren, J., & Virta, L. J. (2020). Socioeconomic differences in use of
public, occupational and private health care: A register-linkage study of a working-age population in Finland. PLOS ONE, 15(4), e0231792.
https://doi.org/10.1371/journal.pone.0231792
Bohus, M., Stoffers-Winterling, J., Sharp, C., Krause-Utz, A., Schmahl, C., &
Lieb, K. (2021). Borderline personality disorder. The Lancet, 398(10310), 1528–1540. https://doi.org/10.1016/S0140-6736(21)00476-1
Bolhuis, K., Lång, U., Gyllenberg, D., Kääriälä, A., Veijola, J., Gissler, M., &
Kelleher, I. (2021). Hospital Presentation for Self-Harm in Youth as a Risk Marker for Later Psychotic and Bipolar Disorders: A Cohort Study of 59 476 Finns. Schizophrenia Bulletin, 47(6), 1685–1694.
https://doi.org/10.1093/schbul/sbab061
Bolton, J. M., Au, W., Leslie, W. D., Martens, P. J., Enns, M. W., Roos, L. L., Katz, L. Y., Wilcox, H. C., Erlangsen, A., Chateau, D., Walld, R., Spiwak, R., Seguin, M., Shear, K., & Sareen, J. (2013). Parents Bereaved by Offspring Suicide: A Population-Based Longitudinal Case-Control Study.
JAMA Psychiatry, 70(2), 158–167.
https://doi.org/10.1001/jamapsychiatry.2013.275
Bom, J., Bakx, P., Schut, F., & van Doorslaer, E. (2019). Health effects of caring for and about parents and spouses. The Journal of the Economics of Ageing, 14, 100196. https://doi.org/10.1016/j.jeoa.2019.100196 Borschmann, R., Becker, D., Coffey, C., Spry, E., Moreno-Betancur, M.,
Moran, P., & Patton, G. C. (2017). 20-year outcomes in adolescents who self-harm: A population-based cohort study. The Lancet Child &
Adolescent Health, 1(3), 195–202. https://doi.org/10.1016/S2352- 4642(17)30007-X
Boyd, A., Van de Velde, S., Vilagut, G., de Graaf, R., O׳Neill, S., Florescu, S., Alonso, J., & Kovess-Masfety, V. (2015). Gender differences in mental
population-based study. Journal of Affective Disorders, 173, 245–254.
https://doi.org/10.1016/j.jad.2014.11.002
Brent, D. A., & Melhem, N. (2008). Familial Transmission of Suicidal Behavior. Psychiatric Clinics of North America, 31(2), 157–177.
https://doi.org/10.1016/j.psc.2008.02.001
Bresin, K., & Schoenleber, M. (2015). Gender differences in the prevalence of nonsuicidal self-injury: A meta-analysis. Clinical Psychology Review, 38, 55–64. https://doi.org/10.1016/j.cpr.2015.02.009
Bruffaerts, R., Demyttenaere, K., Borges, G., Haro, J. M., Chiu, W. T.,
Hwang, I., Karam, E. G., Kessler, R. C., Sampson, N., Alonso, J., Andrade, L. H., Angermeyer, M., Benjet, C., Bromet, E., de Girolamo, G., de Graaf, R., Florescu, S., Gureje, O., Horiguchi, I., … Nock, M. K. (2010).
Childhood adversities as risk factors for onset and persistence of suicidal behaviour. The British Journal of Psychiatry: The Journal of Mental Science, 197(1), 20–27. https://doi.org/10.1192/bjp.bp.109.074716 Burrows, S., & Laflamme, L. (2010). Socioeconomic disparities and
attempted suicide: State of knowledge and implications for research and prevention. International Journal of Injury Control and Safety
Promotion, 17(1), 23–40. https://doi.org/10.1080/17457300903309231 Buus, N., Caspersen, J., Hansen, R., Stenager, E., & Fleischer, E. (2014).
Experiences of parents whose sons or daughters have (had) attempted suicide. Journal of Advanced Nursing, 70(4), 823–832.
https://doi.org/10.1111/jan.12243
Calderaro, M., Baethge, C., Bermpohl, F., Gutwinski, S., Schouler-Ocak, M.,
& Henssler, J. (2022). Offspring’s risk for suicidal behaviour in relation to parental death by suicide: Systematic review and meta-analysis and a model for familial transmission of suicide. The British Journal of Psychiatry, 220(3), 121–129. https://doi.org/10.1192/bjp.2021.158 Campbell, J. M., & Oei, T. P. (2010). A cognitive model for the
intergenerational transference of alcohol use behavior. Addictive
Behaviors, 35(2), 73–83. https://doi.org/10.1016/j.addbeh.2009.09.013 Campos, A. I., Verweij, K. J. H., Statham, D. J., Madden, P. A. F.,
Maciejewski, D. F., Davis, K. A. S., John, A., Hotopf, M., Heath, A. C., Martin, N. G., & Rentería, M. E. (2020). Genetic aetiology of self-harm ideation and behaviour. Scientific Reports, 10, 9713.
https://doi.org/10.1038/s41598-020-66737-9
Carroll, R., Metcalfe, C., & Gunnell, D. (2014). Hospital Presenting Self- Harm and Risk of Fatal and Non-Fatal Repetition: Systematic Review and Meta-Analysis. PLOS ONE, 9(2), e89944.
https://doi.org/10.1371/journal.pone.0089944
Cavanagh, J. T. O., Carson, A. J., Sharpe, M., & Lawrie, S. M. (2003).
Psychological autopsy studies of suicide: A systematic review.
Psychological Medicine, 33(3), 395–405.
https://doi.org/10.1017/s0033291702006943
Christiansen, E., Goldney, R. D., Beautrai, A. L., & Agerbo, E. (2011). Youth suicide attempts and the dose-response relationship to parental risk factors: A population-based study. Psychological Medicine; Cambridge, 41(2), 313–319. http://dx.doi.org/10.1017/S0033291710000747
Christiansen, E., & Larsen, K. J. (2012). Young people’s risk of suicide attempts after contact with a psychiatric department—A nested case- control design using Danish register data. Journal of Child Psychology &
Psychiatry, 53(1), 16–25. https://doi.org/10.1111/j.1469- 7610.2011.02405.x
Christiansen, E., Larsen, K. J., Agerbo, E., Bilenberg, N., & Stenager, E.
(2013). Incidence and risk factors for suicide attempts in a general population of young people: A Danish register-based study. Australian &
New Zealand Journal of Psychiatry, 47(3), 259–270.
https://doi.org/10.1177/0004867412463737
Cipriano, A., Cella, S., & Cotrufo, P. (2017). Nonsuicidal Self-injury: A Systematic Review. Frontiers in Psychology, 8.
https://doi.org/10.3389/fpsyg.2017.01946
Cleare, S., Wetherall, K., Eschle, S., Forrester, R., Drummond, J., &
O’Connor, R. C. (2021). Using the integrated motivational-volitional (IMV) model of suicidal behaviour to differentiate those with and without suicidal intent in hospital treated self-harm. Preventive Medicine, 152, 106592. https://doi.org/10.1016/j.ypmed.2021.106592
Cluver, L., Orkin, M., Boyes, M. E., & Sherr, L. (2015). Child and Adolescent Suicide Attempts, Suicidal Behavior, and Adverse Childhood Experiences in South Africa: A Prospective Study. Journal of Adolescent Health, 57(1), 52–59. https://doi.org/10.1016/j.jadohealth.2015.03.001
Data Protection Act, no. 1050/2018 (2018).
https://www.finlex.fi/en/laki/kaannokset/2018/20181050
Denissoff, A., Niemelä, S., Scott, J. G., Salom, C. L., Hielscher, E., Miettunen, J., Alakokkare, A.-E., & Mustonen, A. (2022). Does cannabis use in adolescence predict self-harm or suicide? Results from a Finnish Birth Cohort Study. Acta Psychiatrica Scandinavica, 145(3), 234–243.
https://doi.org/10.1111/acps.13384
Devaux, M. (2015). Income-related inequalities and inequities in health care services utilisation in 18 selected OECD countries. The European Journal of Health Economics, 16(1), 21–33. https://doi.org/10.1007/s10198-013- 0546-4
Devenish, B., Hooley, M., & Mellor, D. (2017). The Pathways Between Socioeconomic Status and Adolescent Outcomes: A Systematic Review.
American Journal of Community Psychology, 59(1–2), 219–238.
https://doi.org/10.1002/ajcp.12115
DiBlasi, E., Kang, J., & Docherty, A. R. (2021). Genetic contributions to suicidal thoughts and behaviors. Psychological Medicine, 51(13), 2148–
2155. https://doi.org/10.1017/S0033291721001720
Dohrenwend, B. P., Levav, I., Shrout, P. E., Schwartz, S., Naveh, G., Link, B.
G., Skodol, A. E., & Stueve, A. (1992). Socioeconomic status and
psychiatric disorders: The causation-selection issue. Science, 255(5047), 946–952. https://doi.org/10.1126/science.1546291
Doorslaer, E. van, Masseria, C., & Koolman, X. (2006). Inequalities in access to medical care by income in developed countries. CMAJ, 174(2), 177–183.
https://doi.org/10.1503/cmaj.050584
Dostoyevsky, F. (2006). Crime and Punishment (C. Garnett, Trans.).
https://www.gutenberg.org/ebooks/2554
Drapeau, A., Boyer, R., & Diallo, F. B. (2011). Discrepancies between survey and administrative data on the use of mental health services in the general population: Findings from a study conducted in Québec. BMC Public Health, 11(1), 837. https://doi.org/10.1186/1471-2458-11-837 Dube, S. R., Anda, R. F., Felitti, V. J., Chapman, D. P., Williamson, D. F., &
Giles, W. H. (2001). Childhood Abuse, Household Dysfunction, and the Risk of Attempted Suicide Throughout the Life Span: Findings From the Adverse Childhood Experiences Study. JAMA, 286(24), 3089–3096.