Jukka Hintikka

Depression is strongly associated with alexithymia in the general population.

OBJECTIVE This study examines how alexithymia and depression are related to each other in men and women in a sample of Finnish general population (n = 2018). METHODS Alexithymia was screened using the 20-item version of the Toronto Alexithymia Scale. Level of depression was assessed using the 21-item Beck Depression Inventory (BDI). Life satisfaction was estimated with a structured scale. RESULTS The prevalence of alexithymia was 12.8% in men and 8.2% in women. However, the prevalence of alexithymia was 32.1% among those having BDI scores of > or = 9, but only 4.3% among the nondepressed subjects (p < 0.001). The BDI scores explained 29.2% of the variation in TAS-20 scores. Alexithymia was associated with several sociodemographic factors if depression was not taken into account. However, after including depression in the logistic regression models, only depression and low life satisfaction were associated with alexithymia, both in men and women. CONCLUSION These results suggest that alexithymia has a close relationship to depression in the general population. The impact of social factors on alexithymia may be primarily explained by depression. Depression must be taken into account as a confounding factor when studying alexithymia in general populations due to the strong association between alexithymia and depression.

Dietary Folate and the Risk of Depression in Finnish Middle-Aged Men

Background: Several cross-sectional studies have focused on the low blood folate levels of depressive patients. Nevertheless, no prospective studies have been published on the association between dietary folate and depression. Methods: We studied the association between dietary folate and cobalamin and receiving a discharge diagnosis of depression in a prospective follow-up setting. Our cohort was recruited between 1984 and 1989 and followed until the end of 2000, and it consisted of 2,313 men aged between 42and 60 years from eastern Finland. Results: The mean intake of folate in the whole cohort was 256 µg/day (SD = 76). Those below the median of energy-adjusted folate intake had higher risk of getting discharge diagnosis of depression (RR 3.04, 95% CI: 1.58, 5.86) during the follow-up period than those who had a folate intake above the median. This excess risk remained significant after adjustment for current socioeconomic status, the baseline HPL depression score, the energy-adjusted daily intake of fibre and vitamin C, and the total fat intake. Conclusions: A low dietary intake of folate may be a risk factor for severe depression. This also indicates that nutrition may have a role in the prevention of depression.

Factors Associated with Alexithymia in Patients Suffering from Depression

Background: We studied the factors associated with alexithymia in 137 depressed outpatients. Methods: Diagnosis of depression was confirmed by means of the Structured Clinical Interview for DSM-III-R. Alexithymia was screened using the 20-item version of the Toronto Alexithymia Scale. Severity of depression was assessed using the 21-item Beck Depression Inventory, and other psychiatric symptoms with the help of the Symptoms Checklist (SCL-90). Life satisfaction was also assessed with a structured scale. Results: Almost half of the patients were considered alexithymic. They were significantly more often male, unmarried and had a lower education than the nonalexithymic patients. Alexithymic patients more often showed psychiatric symptoms (SCL-90) and were also more often severely depressed and dissatisfied with their life than were the other patients. Logistic regression analyses revealed that four factors were independently associated with alexithymia: male gender, a low level of education, low life satisfaction and severe depression. Sleep disturbances were independently associated with alexithymia in men and severe depression in women. Conclusions: Alexithymia is very common among patients with depressive disorder. An awareness of these risk factors would be useful in improving the efficacy of treatment.

Is Alexithymia a Permanent Feature in Depressed Patients

Background: A six-month follow-up study was conducted to determine whether alexithymia is a permanent feature in 169 depressed outpatients. Methods: Diagnosis of depression was confirmed by means of the Structured Clinical Interview for DSM-III-R (SCID-I). Alexithymia was screened using the 20-item version of the Toronto Alexithymia Scale (TAS-20) and severity of depression was assessed using the 21-item Beck Depression Inventory (BDI). Results: Almost 40% of the patients were considered alexithymic at baseline, but only 23% at follow-up. Alexithymic patients were more often moderately or severely depressed than other patients in both study phases. The BDI scores explained 23% (at baseline) and 42% (at follow-up) of the variation in TAS-20 scores. The decrease in the TAS-20 scores was associated with a concurrent decrease in BDI scores. Conclusions: Alexithymic patients with depressive disorders do not appear to form a stable group. On the contrary, alexithymia seems to change as a function of depression. In the light of these results, alexithymia appears not to be a stable personality trait among depressed patients, and furthermore, it seems possible that alexithymic features respond to psychiatric treatment.

Suicidal ideation in the Finnish general population. A 12-month follow-up study

Background The epidemiology of suicidal ideation has remained a relatively unstudied area. The aim of this study was to investigate the incidence, prevalence and persistence of and recovery from suicidal ideation in a sample of the Finnish general population. Methods Postal questionnaires including the Beck Depression Inventory (BDI) were mailed to the study subjects (n = 1,593) at baseline and on follow-up after 12 months. The suicidality item of BDI was used to screen suicidal ideation. Results The 12-month incidence (4.6 %) and prevalence of suicidal ideation (14.7 %) were higher in men than in women (3.1 % and 9.2 %, respectively). Sixty-nine per cent of those men and 59 % of those women who had suicidal ideation at baseline continued to have suicidal thoughts on follow-up. Suicidal ideation and the severity of depression associated strongly. Over half of the men and women who had persistent suicidal ideation had not visited any health services for help with psychological distress during the 12-month follow-up period. Daily smoking associated with a decreased probability of recovery from suicidal ideation. Conclusions Suicidal ideation is common and persistent at the population level. Seeking professional help for depression with suicidal tendencies is disproportionately low in relation to the high prevalence of suicidal ideation.

Self-reported life satisfaction and treatment factors in patients with schizophrenia, major depression and anxiety disorder

Our aim was to study the associations between life satisfaction and treatment factors and how depression affects these associations among patients with schizophrenia (n=403), major depression (n= 349) and anxiety disorder (n= 139) from a defined area. Treatment satisfaction and compliance were high, but life satisfaction was low regardless of diagnostic group. Patients with schizophrenia recorded better life satisfaction than patients with the other disorders. There were few independent associations between life satisfaction and treatment factors. Fortunately, factors amenable to treatment intervention, such as depression, problem‐solving ability and social support. were independently related to life satisfaction in every diagnostic group. Depression decreased these associations significantly only in patients with schizophrenia. Life satisfaction and treatment satisfaction should be included as separate variables in treatment outcome studies.

Mental disorders in young adulthood

BACKGROUND The effect of mental disorders may be particularly detrimental in early adulthood, and information on mental disorders and their correlates in this age group is important. METHOD A questionnaire focusing on mental health was sent to a nationally representative two-stage cluster sample of 1863 Finns aged 19 to 34 years. Based on a mental health screen, all screen-positives and a random sample of screen-negatives were asked to participate in a mental health assessment, consisting of the Structured Clinical Interview for DSM-IV (SCID-I) interview and neuropsychological assessment. We also obtained case-notes from all lifetime mental health treatments. This paper presents prevalences, sociodemographic associations and treatment contacts for current and lifetime mental disorders. RESULTS Forty percent of these young Finnish adults had at least one lifetime DSM-IV Axis I disorder, and 15% had a current disorder. The most common lifetime disorders were depressive disorders (17.7%) followed by substance abuse or dependence (14.2%) and anxiety disorders (12.6%). Of persons with any lifetime Axis I disorder, 59.2% had more than one disorder. Lower education and unemployment were strongly associated with current and lifetime disorders, particularly involving substance use. Although 58.3% of persons with a current Axis I disorder had received treatment at some point, only 24.2% had current treatment contact. However, 77.1% of persons with a current Axis I disorder who felt in need of treatment for mental health problems had current treatment contact. CONCLUSIONS Mental disorders in young adulthood are common and often co-morbid, and they may be particularly harmful for education and employment in this age group.

Suicide mortality in Finland during an economic cycle, 1985-1995.

This is a study on associations between suicide mortality, unemployment, divorce rate and mean alcohol consumption during an economic cycle in Finland, from 1985 to 1995. Data on annual suicide mortality, gross domestic product, unemployment, divorce rate and mean alcohol consumption were collected from official Finnish statistics. Regression analyses using a correction for serial autocorrelation were performed. Suicide mortality in both males and females increased during an economic upswing from 1985 to 1990, and decreased during an economic recession from 1990 to 1995. Suicide mortality was not associated with unemployment or divorce rate. These results are opposed to those of many previous studies. However, a significant association was found between male suicide mortality and mean alcohol consumption, in accord with other studies. In conclusion, the results suggest diversity in associations between suicide mortality, socio-economic factors and alcohol consumption.

Why do alexithymic features appear to be stable? A 12-month follow-up study of a general population

Background: This 12-month follow-up study investigated the prevalence of alexithymia and its relationship with depression in a sample of the general population from Eastern Finland (n = 1,584). Methods: Alexithymia was assessed using the 20-item version of the Toronto Alexithymia Scale (TAS) and depression using the 21-item Beck Depression Inventory (BDI). Results: The prevalence of alexithymia in each study phase was similar (baseline: 9.7%; follow-up: 10.1%). Mean values of BDI, TAS-20 and subfactors of the TAS-20 also remained unchanged between the study phases. However, by using the original cutoff points, we found that a proportion of the subjects were in a different TAS-20 category on follow-up than at baseline. The mean values of BDI had not changed in those subjects who had similar alexithymia status in both phases, but increased or decreased in parallel with the change in TAS-20 score among all other subjects. Conclusions: Our findings indicate that it is important to use a variety of viewpoints when studying changes in alexithymia status. Alexithymia appears to be a stable trait based on the similarity of the mean TAS-20 scores in separate study phases. However, when focusing on the changes in alexithymia status at the individual level, alexithymic features also appear to be state dependent and strongly related to depressive symptoms.

Is the Beck Depression Inventory suitable for screening major depression in different phases of the disease

This prospective study aimed to assess the suitability of the 21-item Beck Depression Inventory (BDI-21) as a screening method for current episodes of major depressive disorder in different phases of the disease. In a sample of treatment-seeking outpatients (n=125), a structured interview method (SCID) was used twice with a 2-year interval to screen whether the patient had a current episode of major depressive disorder. The validity of the BDI-21 was also analysed by means of receiver operating characteristic (ROC) curves. The results showed that with a cut-off point of 14/15 the BDI-21 can be used to indicate the presence of a major depressive episode regardless of the phase of the major depressive disorder. The sensitivity and specificity were quite satisfactory with this cut-off point. The areas under the ROC curves were large (0.81 at baseline and 0.93 at follow-up). The same BDI-21 cut-off point is suitable for screening major depression among outpatients in any phase of the disease.