Kaisla Joutsenniemi

Living alone and antidepressant medication use: a prospective study in a working-age population

BackgroundAn increasing proportion of the population lives in one-person households. The authors examined whether living alone predicts the use of antidepressant medication and whether socioeconomic, psychosocial, or behavioral factors explain this association.MethodsThe participants were a nationally representative sample of working-age Finns from the Health 2000 Study, totaling 1695 men and 1776 women with a mean age of 44.6 years. In the baseline survey in 2000, living arrangements (living alone vs. not) and potential explanatory factors, including psychosocial factors (social support, work climate, hostility), sociodemographic factors (occupational grade, education, income, unemployment, urbanicity, rental living, housing conditions), and health behaviors (smoking, alcohol use, physical activity, obesity), were measured. Antidepressant medication use was followed up from 2000 to 2008 through linkage to national prescription registers.ResultsParticipants living alone had a 1.81-fold (CI = 1.46-2.23) higher purchase rate of antidepressants during the follow-up period than those who did not live alone. Adjustment for sociodemographic factors attenuated this association by 21% (adjusted OR = 1.64, CI = 1.32-2.05). The corresponding attenuation was 12% after adjustment for psychosocial factors (adjusted OR = 1.71, CI = 1.38-2.11) and 9% after adjustment for health behaviors (adjusted OR = 1.74, CI = 1.41-2.14). Gender-stratified analyses showed that in women the greatest attenuation was related to sociodemographic factors and in men to psychosocial factors.ConclusionsThese data suggest that people living alone may be at increased risk of developing mental health problems. The public health value is in recognizing that people who live alone are more likely to have material and psychosocial problems that may contribute to excess mental health problems in this population group.

Psychiatric comorbidity in couples: a longitudinal study of 202,959 married and cohabiting individuals

PurposeTo examine whether partner’s psychiatric and somatic disorders are risk factors for incidence of psychiatric disorders among non-psychiatric individuals at baseline.MethodsRegister-based 6-year follow-up on Finns (106,935 men and 96,024 women aged 40 and over), living with a married or cohabiting partner at the end of 1997. The outcome measures included non-psychotic major depressive disorder (MDD), substance use disorder (SUD), and severe psychiatric disorder, evaluated using information on reimbursement for drug costs, purchases of prescription medication, and principal causes of hospitalization.ResultsAmong persons whose partner had any psychiatric disorder, the incidence rate ratio (IRR) for own MDD, controlling for own age at baseline, was 1.58 (95% confidence interval 1.48–1.69) in men, and 1.58 (1.48–1.69) in women. Among persons whose partner had somatic hospitalization, the IRR for own MDD was 1.14 (1.08–1.20) in men and 1.20 (1.15–1.25) in women. Among both men and women, the highest risk for incidence of own MDD was among persons whose partner had both MDD and SUD (IRR 2.65, 1.67–4.21 and IRR 2.13, 1.62–2.80, respectively). Further adjustment for sociodemographic and union characteristics had little effect on the associations.ConclusionsIn married and cohabiting couples, partner’s somatic and particularly psychiatric morbidity associate with psychiatric disorders in non-psychiatric subjects, independent of sociodemographic and union characteristics. The healthy spouse’s care burden is a potential point of intervention in order to prevent new psychiatric morbidity, but also to provide the mentally ill first partner a chance to recover in a supportive family environment.

Alcohol-related deaths and social factors in depression mortality: a register-based follow-up of depressed in-patients and antidepressant users in Finland.

BACKGROUNDnExcess mortality of depression is established for various causes of death, but evidence is scarce on alcohol-related causes. It also remains unclear whether the magnitude of the excess varies by social factors. This study aimed to quantify the contribution of alcohol-related causes of death and to assess modifying effects of socioeconomic position, employment status, and living arrangements in the excess mortality of depression.nnnMETHODSnA 14% sample of community-dwelling Finns aged 40-64 at the end of 1997 was assessed for depression, using register data on psychiatric hospital care and antidepressant use in 1996-1997. Depressed in-patients (n=897), out-patients using antidepressants (n=13,658), and non-depressed individuals (n=217,140) were followed up for cause-specific mortality in 1998-2007, distinguishing between alcohol- and non-alcohol-related deaths, and testing for variation in the excess mortality according to baseline social factors.nnnRESULTSnDepressed in- and out-patients had significant excess mortality for suicide (age-adjusted rate ratios RR=3.77 for men and RR=6.35 for women), all accidental and violent causes (RR=3.47 and RR=4.43), and diseases (RR=1.67 and RR=1.41). Of the excess, alcohol-related causes accounted for 50% among depressed men and 30% among women. Excess mortality varied little by social factors, particularly in non-alcohol-related causes. Where variation was significant, the relative excess was larger among those with higher socioeconomic position and the employed. Absolute excess was, however, larger among those with lower socioeconomic position, the unemployed, and the unpartnered.nnnLIMITATIONSnDepression was measured indirectly by hospital and antidepressant use.nnnCONCLUSIONSnThe results highlight the major role of alcohol in depression mortality.

Does hospital admission risk for depression vary across social groups? A population-based register study of 231,629 middle-aged Finns

PurposeEvidence on social differentials in depression outcomes remains inconsistent. We assess social predictors of psychiatric admission for depression in a community setting.MethodsA register-based 14xa0% sample of community-dwelling Finns aged 40–64 at the end of 1997 was assessed for depression and psychiatric comorbidity, using register data on psychiatric hospital care and medication purchases in 1996–1997. Those with inpatient treatment for unipolar depression (nxa0=xa0846), those with antidepressant treatment (nxa0=xa08,754), and those with neither (nxa0=xa0222,029) were followed for psychiatric admission with a diagnosis of unipolar depression in 1998–2003. Differentials in admission rates by socioeconomic position, employment status, and living arrangements were studied using Cox proportional hazards modelling.ResultsAmong those with prior inpatient or antidepressant treatment, the material aspects of socioeconomic position increased admission risk for depression by 20–40xa0%, even after controlling for baseline depression severity and psychiatric comorbidities, whereas education and occupational social class were unrelated to admission risk. Among inpatients, also having no partner, and among antidepressant users, being previously married and living without co-resident children increased admission risk. However, among inpatients few excess risks reached statistical significance. Among those with no inpatient or antidepressant treatment, all measures of low social position and not living with a partner predicted admission, and the factors had more predictive power in admission than among those with prior treatment.ConclusionsFurther studies should disentangle the mechanisms behind the higher admission risk among those with fewer economic resources and no co-resident partner.

Confidence in the future, health-related behaviour and psychological distress: results from a web-based cross-sectional study of 101 257 Finns

Objectives To investigate the role of socioeconomic status and psychological stress to potential associations between confidence in the future and a wide range of health-related behaviours. Design Web-based cross-sectional study including an ‘Electronic Health Check’ at the Finnish Happiness-Flourishing Study website linked to a TV programme on happiness and depression. Setting The Finnish population with access to the internet. Participants 101u2005257 Finns aged 18 and above (21u2005365 men; 79u2005892 women). Participants who were under the age of 18 and who did not provide information about their gender were excluded. Primary outcome measures As planned, we assessed smoking, weekly alcohol consumption and binge drinking, daily intake of fruits and vegetables and regular exercise. Results Compared with participants with low confidence in the future, those with high confidence were less likely to be daily smokers (men OR 0.58, 95% CI 0.52 to 0.65; women 0.57, 95% CI 0.53 to 0.61) and binge drinkers (men 0.57; 0.52 to 0.63; women 0.54; 0.50 to 0.57). Participants with high confidence in the future were more likely to exercise regularly (men OR 2.82, 95% CI 2.55 to 3.13; women 2.57, 95% CI 2.44 to 2.71) and consume vegetables (men OR 2.48, 95% CI 2.25 to 2.74; women 2.13, 95% CI 2.03 to 2.24) and fruits (men OR 2.09, 95% CI 1.86 to 2.35; women 1.83, 95% CI 1.74 to 1.93) daily. Adjustment for current psychological distress and satisfaction for income attenuated the results. Conclusions Having confidence in the future is strongly associated with a healthy lifestyle, as assessed by a healthy diet, physical exercise and substance abuse. Health-related interventions may benefit from tailoring interventions according to the target populations level of confidence in the future as well as their level of psychological distress.

Prediction of the outcome of short- and long-term psychotherapy based on socio-demographic factors.

BACKGROUNDnSocio-demographic factors predict the outcome of short-term psychotherapy (STT) in the treatment of mood and anxiety disorders, but information on the prediction for long long-term therapy (LPP) is lacking. We aimed to compare the prediction of changes in psychiatric symptoms afforded by socio-demographic factors across two treatment conditions, short- versus long-term psychotherapy.nnnMETHODSnIn the Helsinki Psychotherapy Study, 326 outpatients with mood or anxiety disorders, aged 20-46 years, were randomly assigned to STT or LPP. Socio-demographic factors (i.e. age, gender, education, employment status, marital status, and living arrangement) were self-reported. Psychiatric symptoms were measured by the Symptom Check List, Global Severity Index (SCL-90-GSI) and Anxiety scale (SCL-90-Anx), and the Beck Depression Inventory (BDI) at baseline and seven times during a three-year follow-up period.nnnRESULTSnSocio-demographic factors were found to predict symptom development during follow-up irrespective of the baseline symptom level. Patients in a relatively good position, i.e. married and highly educated patients benefited from STT, whereas patients in less advantaged positions, i.e. homemakers, lone parents, and divorced patients needed LPP or did not benefit from either therapy. In several categories of socio-demographic factors, the extent to which a patients background predicted the outcome of the psychotherapy varied according to whether general, anxiety or depressive symptoms were studied.nnnLIMITATIONSnWe were unable to assess widows and pensioners. For ethical reasons, a no-treatment control group with a long follow-up could not be included in the study design.nnnCONCLUSIONSnSocio-demographic factors may need to be considered in the selection of patients for short- and long-term therapy.

Antidepressant Sales and the Risk for Alcohol-Related and Non-Alcohol-Related Suicide in Finland-An Individual-Level Population Study

Objectives A marked decline in suicide rates has co-occurred with increased antidepressant sales in several countries but the causal connection between the trends remains debated. Most previous studies have focused on overall suicide rates and neglected differential effects in population subgroups. Our objective was to investigate whether increasing sales of non-tricyclic antidepressants have reduced alcohol- and non-alcohol-related suicide risk in different population subgroups. Methods We followed a nationally representative sample of 950,158 Finnish adults in 1995–2007 for alcohol-related (nu200a=u200a2,859) and non-alcohol-related (nu200a=u200a8,632) suicides. We assessed suicide risk by gender and social group according to regional sales of non-tricyclic antidepressants, measured by sold doses per capita, prevalence of antidepressant users, and proportion of antidepressant users with doses reflecting minimally adequate treatment. Fixed-effects Poisson regression models controlled for regional differences and time trends that may influence suicide risk irrespective of antidepressant sales. Results The number of sold antidepressant doses per capita and the prevalence of antidepressant users were unrelated to male suicide risk. However, one percentage point increase in the proportion of antidepressant users receiving minimally adequate treatment reduced non-alcohol-related male suicide risk by one percent (relative risk 0.987, 95% confidence interval 0.976–0.998). This beneficial effect only emerged among men with high education, high income, and employment, among men without a partner, and men not owning their home. Alcohol-related suicides and female suicides were unrelated to all measures of antidepressant sales. Conclusion We found little evidence that increase in overall sales or in the prevalence of non-tricyclic antidepressant users would have caused the fall in suicide rates in Finland in 1995–2007. However, the rise in the proportion of antidepressant users receiving minimally adequate treatment, possibly due to enhanced treatment compliance, may have prevented non-alcohol-related suicides among men.

Depressive symptoms, major depressive episodes and cognitive test performance—What is the role of physical activity?

Abstract Background: Positive associations between physical activity and cognitive test performance in depressed subjects have been proposed in clinical studies. The contribution of severity and recency of depressive symptoms at the population level is not known. Aims: This study aims to examine whether regular physical activity associates with better verbal fluency and psychomotor speed in depressed subjects using a large population-based sample. Methods: Data was obtained from the population-based Finnish Health 2000 Study, gathered in 2000–2001. Depressive symptoms and depressive disorders were assessed by the Beck Depression Inventory (BDI) and the Composite International Diagnostic Interview (CIDI), correspondingly. Cognitive test performance was assessed by the animal naming test and psychomotor speed with a simple and multi-choice reaction time test. Physical activity (Gothenburg scale) was self-reported. Complete data were obtained from 3658 subjects aged 30–64 years. Socio-demographic factors, health behaviours and use of antidepressants and anxiolytics were used as covariates in the linear regression models. Adjusted means were calculated using the predictive margins method. Results: Regular physical activity associated with better performance in reaction time tests and better verbal fluency among men with depressive symptoms or with a major depressive episode. Physical activity also associated with cognitive test performance among non-depressed men and women, but among them the differences between the physical activity groups were smaller. Conclusion: Regular physical activity may be a useful tool in supporting neurocognitive functioning among depressed subjects.

Parental use of antidepressant medication and family type in the risk for incident psychiatric morbidity in offspring

Background Maternal depression increases the risk for psychiatric morbidity in offspring but the effects of paternal depression and family type are less studied. Methods We assessed the effects of parental antidepressant use on offspring psychiatric morbidity in various family settings. Results Our register-based study followed 132637 children for incident psychiatric morbidity in 1998–2003. The highest risk for psychiatric morbidity was in children living with both parents on antidepressants or with a lone parent on antidepressants. We found little variation in the effects according to parental or offspring gender. Conclusions Parental depression as measured by antidepressant use, and single parenthood pose a risk for psychiatric morbidity in offspring.

Living alone and antidepressant medication use

BackgroundAn increasing proportion of the population lives in one-person households. The authors examined whether living alone predicts the use of antidepressant medication and whether socioeconomic, psychosocial, or behavioral factors explain this association.MethodsThe participants were a nationally representative sample of working-age Finns from the Health 2000 Study, totaling 1695 men and 1776 women with a mean age of 44.6 years. In the baseline survey in 2000, living arrangements (living alone vs. not) and potential explanatory factors, including psychosocial factors (social support, work climate, hostility), sociodemographic factors (occupational grade, education, income, unemployment, urbanicity, rental living, housing conditions), and health behaviors (smoking, alcohol use, physical activity, obesity), were measured. Antidepressant medication use was followed up from 2000 to 2008 through linkage to national prescription registers.ResultsParticipants living alone had a 1.81-fold (CI = 1.46-2.23) higher purchase rate of antidepressants during the follow-up period than those who did not live alone. Adjustment for sociodemographic factors attenuated this association by 21% (adjusted OR = 1.64, CI = 1.32-2.05). The corresponding attenuation was 12% after adjustment for psychosocial factors (adjusted OR = 1.71, CI = 1.38-2.11) and 9% after adjustment for health behaviors (adjusted OR = 1.74, CI = 1.41-2.14). Gender-stratified analyses showed that in women the greatest attenuation was related to sociodemographic factors and in men to psychosocial factors.ConclusionsThese data suggest that people living alone may be at increased risk of developing mental health problems. The public health value is in recognizing that people who live alone are more likely to have material and psychosocial problems that may contribute to excess mental health problems in this population group.