By Jussi Alho, Mai Gutvilig, Ripsa Niemi, Kaisla Komulainen, Petri Böckerman, Roger T. Webb, Marko Elovainio, Christian Hakulinen.
22 may 2024, JAMA Network - JAMA Psychiatry
Key Points
Question
Is having peers with a mental disorder in the same social network during adolescence associated with later risk of mental disorder?
Findings
In this cohort study including more than 700 000 individuals in Finland, analysis of nationwide, interlinked registry data found that having classmates diagnosed with a mental disorder in the ninth grade of comprehensive school was associated with increased risk of receiving a mental disorder diagnosis later in life. Increased risk remained after adjusting for an array of parental, school-level, and area-level confounders.
Meaning
The findings of this study suggest that mental disorders might be socially transmitted within adolescent peer networks.
Abstract
Importance
Previous research indicates that mental disorders may be transmitted from one individual to another within social networks. However, there is a lack of population-based epidemiologic evidence that pertains to the full range of mental disorders.
Objective
To examine whether having classmates with a mental disorder diagnosis in the ninth grade of comprehensive school is associated with later risk of being diagnosed with a mental disorder.
Design, Setting, and Participants
In a population-based registry study, data on all Finnish citizens born between January 1, 1985, and December 31, 1997, whose demographic, health, and school information were linked from nationwide registers were included. Cohort members were followed up from August 1 in the year they completed ninth grade (approximately aged 16 years) until a diagnosis of mental disorder, emigration, death, or December 31, 2019, whichever occurred first. Data analysis was performed from May 15, 2023, to February 8, 2024.
Exposure
The exposure was 1 or more individuals diagnosed with a mental disorder in the same school class in the ninth grade.
Main Outcomes and Measures
Being diagnosed with a mental disorder during follow-up.
Results
Among the 713 809 cohort members (median age at the start of follow-up, 16.1 [IQR, 15.9-16.4] years; 50.4% were males), 47 433 had a mental disorder diagnosis by the ninth grade. Of the remaining 666 376 cohort members, 167 227 persons (25.1%) received a mental disorder diagnosis during follow-up (7.3 million person-years). A dose-response association was found, with no significant increase in later risk of 1 diagnosed classmate (HR, 1.01; 95% CI, 1.00-1.02), but a 5% increase with more than 1 diagnosed classmate (HR, 1.05; 95% CI, 1.04-1.06). The risk was not proportional over time but was highest during the first year of follow-up, showing a 9% increase for 1 diagnosed classmate (HR, 1.09; 95% CI, 1.04-1.14), and an 18% increase for more than 1 diagnosed classmate (HR, 1.18; 95% CI, 1.13-1.24). Of the examined mental disorders, the risk was greatest for mood, anxiety, and eating disorders. Increased risk was observed after adjusting for an array of parental, school-level, and area-level confounders.
Conclusions and Relevance
The findings of this study suggest that mental disorders might be transmitted within adolescent peer networks. More research is required to elucidate the mechanisms underlying the possible transmission of mental disorders.
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