Else Nygaard

Social inequality in the prevalence of depressive disorders

Background: Uncertainties exist about the strength of the relation between socioeconomic position and depressive disorders. The aim of this study was to investigate the association between education, occupation, employment and income and depressive disorders measured as minor and major depression, as well as antidepressant prescriptions. Methods: Data were collected from a Danish cross-sectional study collected year 2000, comprising 9254 subjects, 55% women, and aged 36–56 years. Register-based information on education, income and prescription were used. Results: The prevalence of major depression DSM-IV algorithm was 3.3% among men and women, whereas minor depression and prescriptions revealed statistically significant higher prevalence among females. A social gradient was found for all depressive end-points with the strongest estimates related to major depressive disorder (MDD). The associations were as follows: MDD and low education odds ratio (OR) 2.38 (CI 95% 1.68 to 3.37), MDD and non-employment OR 11.67 (CI 95% 8.06 to 16.89), MDD and low income OR 9.78 (CI 95% 6.49 to 14.74). Education only explained a minor part of the association between non-employment and depressive disorders and no associations were found between education and prescription. This indicates a strong two-way association between depression and non-employment, low-income respectively. Conclusion: A social gradient in depressive disorders was found regardless of socioeconomic position being measured by education, occupation, employment or income. Severe socioeconomic consequences of depression are indicated by the fact that the associations with non-employment and low income were much stronger than the association with low education.

Increasing prevalence of depression from 2000 to 2006.

Aim: Depression is the leading cause of disability and is projected to become the second highest burden of disease (measured in disability-adjusted life years) by 2020, but only a few studies have examined changes over time in the occurrence of depression. The aim of this study is to provide evidence to the hypothesis that the prevalence of depression is rising in the Danish population. We will do that in a longitudinal design among adult Danes by studying the trends from 2000 to 2006 of major depressive disorder (MDD) as well as the distribution across the whole Major Depression Inventory (MDI) scale. In addition, we will investigate whether the trend in MDD is similar across socioeconomic groups. Methods: A random sample of 4759 Danes in their forties and fifties were followed in a longitudinal study based on postal questionnaires answered in 2000 and 2006. Results: The prevalence of MDD increased from 2.0% to 4.9% during 2000–06. Also the distribution of the MDI score in its entirety moves higher up the scale, with the 90th percentile changing from 12 in year 2000 to 20 in 2006. The increasing prevalence is in absolute terms more pronounced among women in their forties and in lower socioeconomic positions. Conclusions: The rising MDI score indicates that MDD as well as mental health generally is of public health concern.

Addressing Social Inequality in Aging by the Danish Occupational Social Class Measurement

Objective: To present the Danish Occupational Social Class (DOSC) measurement as a measure of socioeconomic position (SEP) applicable in a late midlife population, and to analyze associations of this measure with three aging-related outcomes in midlife, adjusting for education. Method: Systematic coding procedures of the DOSC measurement were applied to 7,084 participants from the Copenhagen Aging and Midlife Biobank (CAMB) survey. We examined the association of this measure of SEP with chronic conditions, self-rated health, and mobility in logistic regression analyses, adjusting for school education in the final analysis. Results: The measure of SEP showed a strong social gradient along the social classes in terms of prevalence of chronic conditions, poor self-rated health, and mobility limitations. Adjusting for school education attenuated the association only to a minor degree. Discussion: The DOSC measure was associated with aging-related outcomes in a midlife Danish population, and is, thus, well suited for future epidemiological research on social inequalities in health and aging.

Job insecurity and the use of antidepressant medication among Danish employees with and without a history of prolonged unemployment: a 3.5-year follow-up study

Background: A study was undertaken to investigate whether job insecurity predicts incident use of antidepressant medication and whether the association is modified by a history of prolonged unemployment. Methods: A prospective follow-up study was performed in 5142 Danish employees, including 632 employees with and 4510 without a history of prolonged unemployment. Participants were drawn from a random 10% sample of the Danish population. Survey data on job insecurity were linked with register data on history of unemployment and dispensing of antidepressant medication between June 2000 and December 2003 retrieved from the Danish Medicinal Product Statistics. Respondents with major depression at baseline or antidepressant use in the 5 years preceding baseline were excluded. Results: Job insecurity predicted use of antidepressants after adjustment for sex, age, cohabitation, socioeconomic position and alcohol consumption (OR 1.43, 95% CI 1.09 to 1.88). The effect was attenuated after further adjustment for baseline depressive symptoms (OR 1.15, 95% CI 0.87 to 1.52). A history of prolonged unemployment predicted use of antidepressants in both models (OR 1.62, 95% CI 1.14 to 2.30 and OR 1.49, 95% CI 1.04 to 2.13, respectively) Compared with participants with neither job insecurity nor unemployment history, the OR for the joint effect of job insecurity and history of prolonged unemployment was substantially higher (OR 1.79, 95% CI 1.15 to 2.79) than the OR for job insecurity (OR 1.02) and unemployment history (OR 1.10) alone in the fully adjusted model. Conclusion: Job insecurity predicts incident use of antidepressants among Danish employees with a history of prolonged unemployment.

Misclassification and the use of register‐based indicators for depression

Objective:  To study the degree to which depression indicators based on register data on hospital and antidepressant treatment suffer from differential misclassification with respect to gender, age and social group.

Subgrouping of fast twitch fibres in skeletal muscles of man

SummarySubgroups of fast twitch (FT) muscle fibres were identified by histochemical techniques on muscle samples of m. quadriceps femoris from six male and six female subjects, who had been assigned to three groups; untrained, active and well trained (endurance runners). Slow twitch (ST) and FT fibres were initially identified using the histochemical stain for myofibrillar ATPase, preincubated at pH 10.3 and 4.3. Three people, working independently, then identified the subgroups FTa and FTb on the basis of the staining intensity for only one of the following reactions: α-glycerophosphate dehydrogenase, α-GPD; NADH tetrazolium reductase, NADH-TR; and myofibrillar ATPase preincubated at pH 4.6, ATPase (4.6). FTa fibres were clearly distinguished from the darker staining FTb fibres using the ATPase (4.6) reaction. Differences in the staining within the FT fibres using the α-GPD and NADH-TR reactions were more subtle, and differences between subject groups were evident. The percentage of FTa fibres was overestimated for the untrained and underestimated for the well trained subjects using NADH-TR. With the α-GPD stain the percentage of FTa fibres was generally underestimated. When the data for all three stains were compared, only 27% of the FT fibres were placed in the same subgroups. These results demonstrate that the subgrouping of FT fibres in man is more reliable using the differences in pH sensitivity for the myofibrillar ATPase reaction compared to histochemical reactions for oxidative or glycolytic enzymes.

Job stress and the use of antidepressant medicine: a 3.5-year follow-up study among Danish employees

Objectives To investigate if exposure to adverse psychological job characteristics predicts incident use of antidepressants, taking into account differential misclassification and residual confounding. Methods A prospective cohort study with a 3.5-year follow-up of 4661 Danish employees, aged 40 and 50 years, drawn from a 10% random sample of the Danish population was carried out. Job characteristics were the predictor variables and use of antidepressants was the outcome variable. Survey data on psychosocial work environment were linked with register data on dispensing of antidepressant medicine between June 2000 and December 2003. Respondents with major depression at baseline, with antidepressant use in the 5 years preceding baseline, or not employed at baseline were excluded. Results Among men, the OR for antidepressant use was significantly increased for high quantitative demands (OR 2.12, 95% CI 1.29 to 3.48) and low social support from colleagues (OR 2.28, 95% 1.36 to 3.82) after adjustment for lifestyle factors, socio-demographic factors, co-morbidity, other work factors and depressive symptoms at baseline. Both effects were dose dependent. An interaction effect with high demands was found for high anticipated private social support and living with children. Among women, no effect of job characteristics on antidepressant use was found. Conclusion Among men, but not among women, high quantitative demands and low social support from colleagues were predictive of incident use of antidepressants, indicating incident depressive episodes, even after taking into account differential misclassification and residual confounding. The effects were buffered for those with high anticipated private social support and for those having children.

Employment consequences of depressive symptoms and work demands individually and combined

BACKGROUND Denmark, like other Western countries, is recently burdened by increasingly high social spending on employment consequences caused by ill mental health. This might be the result of high work demands affecting persons with ill mental health. Therefore, this study assesses to what extent depressive symptoms and high work demands, individually and combined, have an effect on employment consequences. METHODS We conducted a population-based 7-year longitudinal follow-up study with baseline information from the year 2000 on socio-demographics, lifestyle, depressive symptoms and work demands. In total, 5785 employed persons, aged 40 and 50 years, were included. Information about employment status, sick leave and work disability was obtained from registers. Logistic regression models were used to measure separate and combined effects of depressive symptoms and work demands on job change, unemployment and sick leave during 2001-02 and work disability during 2003-07. RESULTS After adjustment for covariates, high physical work demands and depressive symptoms had a graded effect on subsequent unemployment, sick leave and permanent work disability. Persons with both depressive symptoms and high physical demands had the highest risks, especially for sick leave, but the combined effect did not exceed the product of single effects. Persons who perceived high amount of work changed job significantly more frequently. CONCLUSION Persons with depressive symptoms might have an increased risk of negative employment consequences irrespective of the kind and amount of work demands. This might be an effect on the level of work ability in general as well as partly the result of health selection and co-morbidity.

Physiological Demands in Downhill Skiing

The aerobic and strength requirements in downhill skiing are high, and the authors outline a conditioning program to help the skier meet them.

Demand-specific work ability, poor health and working conditions in middle-aged full-time employees.

We investigated the prevalence of reduced demand-specific work ability, its association with age, gender, education, poor health, and working conditions, and the interaction between poor health and working conditions regarding reduced demand-specific work ability. We used cross-sectional questionnaire data from 3381 full-time employees responding to questions about vocational education, job demands and social support (working conditions), musculoskeletal pain (MSP) and major depression (MD) (poor health) and seven questions about difficulty managing different job demands (reduced demand-specific work ability). Reduced demand-specific work ability varied from 9% to 19% among the 46-year old and from 11% to 21% among the 56-year old. Age was associated with two, gender with four, and education with all measures of reduced demand-specific work ability. MSP was associated with four and MD was associated with six measures of reduced demand-specific work ability. We found no interaction between working conditions and poor health regarding reduced demand-specific work ability.