Kadri Suija

The association between physical fitness and depressive symptoms among young adults: results of the Northern Finland 1966 birth cohort study

BackgroundThe effect of physical activity on mental health has been the subject of research for several decades. However, there is a lack of studies investigating the association between physical fitness, including both cardiorespiratory and muscular fitness and depressive symptoms among general population. The aim of this study was to determine the association between physical fitness and depressive symptoms among young adults.MethodsThe study population consists of 5497 males and females, members of the Northern Finland birth cohort of 1966, who at age 31 completed fitness tests and filled in a questionnaire including questions about depressive symptoms (Hopkins’ Symptom Checklist-25) and physical activity. Cardiorespiratory fitness was measured by a 4-min step test and muscular fitness by tests of maximal isometric handgrip and isometric trunk extension. The odds ratios (OR) with 95% confidence intervals (95% CI) for having depressive symptoms were calculated for quintiles groups of physical fitness using the third, median quintile as reference group, and the results were adjusted for potential confounding variables.ResultsDepressive symptoms were most common among males and females in the lowest quintile group of trunk extension test (OR 1.58 and 95% CI 1.07-2.32 in males and OR 1.43 and 95% CI 1.03-2.0 in females) and among males in the lowest quintile group of handgrip strength (OR 1.64 95% CI 1.11-2.42) compared to the reference group. Level of self-reported physical activity was inversely associated with depressive symptoms both in males (OR 1.74 95% CI 1.25-2.36) and females (OR 1.36 95% CI 1.05-1.75). The cardiorespiratory fitness was not associated with depressive symptoms (OR 1.01 95% CI 0.68-1.49 in males and 0.82 95% CI 0.57-1.16 in females).ConclusionsThe results indicate that low level of isometric endurance capacity of trunk extensor muscles is associated with high level of depressive symptoms in both sexes. In males, also poor handgrip strength is associated with increased levels of depressive symptoms. The physical activity level is inversely associated with the prevalence of depressive symptoms among young adults.

Validation of the Whooley questions and the Beck Depression Inventory in older adults

Abstract Objective. To analyse the psychometric properties of the Whooley questions and the 21-item Beck Depression Inventory (BDI-21) in older adults with depression and chronic health problems. Design. A population-based study. Setting. Community. Subjects. 474 adults, aged 72–73 years, living in the city of Oulu, Finland. Main outcome measures. The screening parameters of the Whooley questions and the BDI-21 for detecting major depression. Results. The prevalence of major depression according to the DSM-IV was 5.3% (single or recurrent episode) obtained by the Mini Neuropsychiatric Interview (MINI). The BDI-21 was best able to identify a current episode of major depression with a cut-off point of 11. The sensitivity and specificity of this cut-off point were 88.0% (95% confidence interval (95% CI) 68.8–97.5) and 81.7% (95% CI 77.8–85.2), respectively. The area under the receiver operating characteristics (ROC) curve was 0.89 (95% CI 0.83–0.96). The two Whooley screening questions had a sensitivity of 62.5% (95% CI 40.6–81.2) and either screening question plus the help question had a sensitivity of 66.7% (44.7–84.4). Conclusions. The Beck Depression Inventory is a valid instrument for the diagnosis of depression in older adults. As a screening measure, the optimal cut-off score should be 11 or higher. Our results indicate that the sensitivity of the Whooley questions is not high enough to be used as a screening scale among the elderly.

Factors associated with recurrent depression: a prospective study in family practice

BACKGROUND Depression has a high rate of recurrence. Finding the variables that predict which patients are at higher risk of experiencing a recurrent episode of depression would benefit an individual patient. OBJECTIVE To determine the factors associated with recurrent depression >12 months. METHODS Consecutive patients (N = 1094), aged 18-75 years, were recruited from 23 family practices across Estonia. The patients were followed up at 6- and 12-month intervals as suggested in the PredictD study. Depression was assessed using the Composite International Diagnostic Interview. Each participant filled in a questionnaire to assess their risk factors for depression. RESULTS Major depression was diagnosed in 13% of the patients. Twenty-eight per cent of the depressed patients had a recurrent episode of depression 12 months later. The odds of having recurrent depression were significantly higher for patients who had a history of drug abuse, odds ratio (OR) 7.48 [95% confidence interval (CI) = 1.42-39.43), for patients who had experienced discrimination, OR 2.92 (95% CI = 1.05-8.11) and for patients with a history of childhood abuse, OR 1.58 (95% CI = 1.05-2.38). CONCLUSIONS One-third of the patients developed recurrent depression. Drug abuse, discrimination and childhood abuse predicted recurrent depression. These factors should be taken into consideration by family doctors when managing patients with depression.

Depression and musculoskeletal problems

A recent study by Mallen et al ,1 published in the October issue of the BJGP , concluded that older patients consulting their GP due to musculoskeletal pain have frequently comorbid depressive symptoms, and that brief depression screening during the consultation can miss a large number of persons with depressive symptoms. The authors found that a total of 51.4% of the study participants had depressive symptoms, according to a …

The Role of General Practitioners in Cancer Care: A Mixed Method Design

The aims of this study were to identify the current role of general practitioners (GP) and the unmet needs of cancer patients in primary care. First, we conducted individual interviews with 10 cancer patients. Next, we developed a questionnaire, which was distributed among cancer patients across Estonia. Altogether, 113 questionnaires were returned. We observed that while the patients were satisfied with their GP’s work, they mostly preferred to discuss cancer-related problems with oncologists. The role of GPs in regard to other diseases was perceived as very important, also patients found it relevant to consult all investigations with their primary health care physician. The main problems experienced by the patients were a lack of proper accessible information about their disease and its inadequate presentation by doctors, as well as problems with coordination between primary and secondary health care providers. In conclusion, we can say that even treatment of cancer is centralised to oncology clinics, patients also contact their GPs during cancer care. Therefore, GPs should be aware of patients’ general health and comorbid medical problems. Better communication between primary and secondary health care doctors as well as more integration of GPs in cancer care is needed.

Patients’ experience with cancer care: A qualitative study in family practice

Abstract Background: Continuity is an important aspect of cancer care that is often a challenge owing to the movement of patients between family practice, cancer clinics, and hospitals. Objectives: To investigate the experiences of cancer patients in relation to continuity of care. Methods: A qualitative study was conducted in a family practice setting. Semi-structured interviews were used for data collection. 10 cancer patients with a wide variation in their disease duration and experiences with medical care were interviewed. Open questions were used to encourage patients to express their personal experiences with cancer care. The interviews were recorded, transcribed and analysed by three researchers using thematic analysis. Results: Cancer patients experienced a lack of information concerning cancer and its treatment. They also perceived that the cancer treatment made them suffer. In the patients’ opinion, the family doctor has a limited role in cancer care. However, the patients felt that the family doctor should be aware of their health. The patients’ satisfaction with the oncologists care was high. They considered that their role in cancer care was to mediate an exchange of information between the oncologist and the family doctor. Conclusion: Cancer patients experience continuity of care in several ways: continuity in cancer care should be implemented by co-ordinating activities, such as regular check-ups, a clear timeframe and provision of adequate information. In addition, communication between the primary and secondary sector could be improved.

How to Improve Integrated Care for People with Chronic Conditions: Key Findings from EU FP-7 Project INTEGRATE and Beyond

Background: Political and public health leaders increasingly recognize the need to take urgent action to address the problem of chronic diseases and multi-morbidity. European countries are facing unprecedented demand to find new ways to deliver care to improve patient-centredness and personalization, and to avoid unnecessary time in hospitals. People-centred and integrated care has become a central part of policy initiatives to improve the access, quality, continuity, effectiveness and sustainability of healthcare systems and are thus preconditions for the economic sustainability of the EU health and social care systems. Purpose: This study presents an overview of lessons learned and critical success factors to policy making on integrated care based on findings from the EU FP-7 Project Integrate, a literature review, other EU projects with relevance to this study, a number of best practices on integrated care and our own experiences with research and policy making in integrated care at the national and international level. Results: Seven lessons learned and critical success factors to policy making on integrated care were identified. Conclusion: The lessons learned and critical success factors to policy making on integrated care show that a comprehensive systems perspective should guide the development of integrated care towards better health practices, education, research and policy.

Co-morbid condition as an important factor influencing depression treatment

There are different factors influencing the treatment of depression. An important factor is co-morbidity. We made an analysis of depression treatment within general practice in Estonia as part of the PREDICT study in 2003–2005. The study group consisted of consecutive patients (n=1094), aged 18–75 years, who sought consultation from their family doctor. We found that more antidepressants, anxiolytics, and hypnotics were prescribed to patients with co-morbid mental disorder (odds ratio [95% confidence interval] 5.49 [3.61–8.40], 8.38 [5.33–13.18], and 4.02 [2.30–7.02], respectively) compared to those patients who did not have this disorder.

Patient Involvement in Geriatric Care – Results and Experiences from a Mixed Models Design Study within Project INTEGRATE

Introduction: Patient involvement is a core component of an integrated care approach. While the benefits and prerequisites of patient involvement have been described in general and additionally for some target populations, little is known about the views and experiences of older people regarding this matter. Methods: A study with a mixed-methods design was conducted to gain a better understanding about patient involvement in geriatric care. A questionnaire on shared decision-making was administered within a group of older adults in Germany. Additionally, 7 focus groups with health professionals and geriatric patients in Germany and Estonia were held to deepen the insight of the questionnaire and discussing experiences and barriers of patient involvement. Results: Older people without an actual medical problem expressed a significantly higher desire to participate in shared decisions than those requiring actual medical care. No significant differences could be found for the desire to be informed as part of the care process. No correlation between patients’ desire and experiences on shared decision-making could be observed. In the focus groups, patients demanded a comprehensive and understandable information and education process while the health professionals’ view was very task-specific. This conflict led to a loss of trust by the patients. Conclusions: There is a gap between patients’ and health professionals’ views on patient involvement in older people. The involvement process should therefore be comprehensive and should take into account different levels of health literacy.

Student- and learning-centred educational strategies in medical education: an Estonian example

Every family doctor will face death and grief in his/her work. Physicians usually manage problems related with symptom control. Challenge is often how to communicate with dying patients and their f...