Katinka Tuisku

Socio-economic differences in long-term psychiatric work disability: prospective cohort study of onset, recovery and recurrence

Objectives To examine the associations between socio-economic position (SEP) and the onset of psychiatric work disability, return to work and recurrence of disability. Methods Prospective observational cohort study (1997–2005) including register data on 141 917 public-sector employees in Finland. Information on International Classification of Diseases, 10th Revision diagnosis-specific psychiatric work disability (≥90 days) was obtained from national registers. Results During a mean follow-up of 6.3 years, 3938 (2.8%) participants experienced long-term psychiatric work disability. Of these, 2418 (61%) returned to work, and a further 743 (31%) experienced a recurrent episode. SEP was inversely associated with onset of disability owing to depressive disorders, anxiety disorders, personality disorders, schizophrenia and substance-use disorders. No association was found between SEP and disability owing to bipolar disorders or reaction to severe stress and adjustment disorders. High SEP was associated with a greater likelihood of a return to work following depressive disorders, personality disorders, schizophrenia and substance-use disorders, but not bipolar disorders, anxiety disorders or reaction to severe stress and adjustment disorders. Low SEP predicted recurrent episodes of work disability. Conclusions High SEP is associated with lower onset of work disability owing to mental disorders, as well as return to work and lower rates of recurrence. However, the socio-economic advantage is diagnosis-specific. SEP predicted neither the onset and recovery from disability owing to bipolar disorders and reaction to severe stress and adjustment disorders, nor recovery from disability owing to anxiety disorders. SEP should be taken into account in the attempts to reduce long-term work disability owing to mental disorders.

Overcrowding in psychiatric wards and physical assaults on staff: data-linked longitudinal study

BACKGROUND Patient overcrowding and violent assaults by patients are two major problems in psychiatric healthcare. However, evidence of an association between overcrowding and aggressive behaviour among patients is mixed and limited to small-scale studies. AIMS This study examined the association between ward overcrowding and violent physical assaults in acute-care psychiatric in-patient hospital wards. METHOD Longitudinal study using ward-level monthly records of bed occupancy and staff reports of the timing of violent acts during a 5-month period in 90 in-patient wards in 13 acute psychiatric hospitals in Finland. In total 1098 employees (physicians, ward head nurses, registered nurses, licensed practical nurses) participated in the study. The outcome measure was staff reports of the timing of physical assaults on both themselves and ward property. RESULTS We found that 46% of hospital staff were working in overcrowded wards, as indicated by >10 percentage units of excess bed occupancy, whereas only 30% of hospital personnel were working in a ward with no excess occupancy. An excess bed occupancy rate of >10 percentage units at the time of an event was associated with violent assaults towards employees (odds ratio (OR) = 1.72, 95% CI 1.05-2.80; OR = 3.04, 95% CI 1.51-6.13 in adult wards) after adjustment for confounding factors. No association was found with assaults on ward property (OR = 1.06, 95% CI 0.75-1.50). CONCLUSIONS These findings suggest that patient overcrowding is highly prevalent in psychiatric hospitals and, importantly, may increase the risk of violence directed at staff.

Quantitative rest activity in ambulatory monitoring as a physiological marker of restless legs syndrome: A controlled study

An objective marker of restless legs syndrome (RLS) is needed for developing diagnostic tools and monitoring symptoms. Actometric ambulatory monitoring of 15 RLS patients and 15 healthy controls was undertaken in order to differentiate between RLS‐related motor symptoms and normal motor activity. Nocturnal lower‐limb activity per minute differentiated and discriminated between groups with no overlap, whereas the periodic limb movement index and the controlled rest activity during sitting showed less discriminative power. The naturalistic recording of nocturnal activity by actometry may prove useful for assessing the severity of RLS and for finding an objective marker to support the diagnosis of RLS.

Actometry in measuring the symptom severity of restless legs syndrome

In a previous, controlled study we demonstrated that the general lower limb activity measured by three‐channel actometry is a promising objective measure of restless legs syndrome (RLS) severity. In the present study we have further evaluated the method in measuring RLS symptom severity in an open, single‐day pramipexole intervention with 15 RLS patients. Both our standardized actometric parameters (nocturnal lower limb activity and controlled rest activity) decreased significantly during the intervention in parallel with the subjectively reported relief of RLS symptoms.

Health risk behaviors and morbidity among hospital staff--comparison across hospital ward medical specialties in a study of 21 Finnish hospitals.

OBJECTIVE This study examined whether indicators of poor health and health risk behaviors among hospital staff differ between the ward specialties. METHODS Across 21 hospitals in Finland, 8003 employees (mean age 42 years, 87% women, 86% nurses) working in internal medicine, surgery, obstetrics and gynecology, pediatrics, intensive care, and psychiatry responded to a baseline survey on health and health risk behaviors (response rate 70%). Responses were linked to records of sickness absence and medication over the following 12 months. RESULTS Psychiatric staff had higher odds of smoking [odds ratio (OR) 2.58, 95% confidence interval (95% CI) 2.14-3.12], high alcohol use (OR 1.55, 95% CI 1.21-1.99), physical inactivity (OR 1.30, 95% CI 1.11-1.53), chronic physical disease (OR 1.19, 95% CI 1.04-1.36), current or past mental disorders (OR 1.81, 95% CI 1.50-2.17), and co-occurring poor health indicators (OR 2.65, 95% CI 2.08-3.37) as compared to those working in other specialties. They also had higher odds of sickness absence due to mental disorders (OR 1.40, 95% CI 1.02-1.92) and depression (OR 1.61, 95% CI 1.02-2.55) at follow-up after adjustment for baseline health and covariates. Personnel in surgery had the lowest probability of morbidity. No major differences between specialties were found in the use of psychotropic medication. CONCLUSION The prevalence of hospital employees with an adverse health risk profile is higher in psychiatric wards than other specialties.

Neuroleptic-induced movement disorders in a naturalistic schizophrenia population: diagnostic value of actometric movement patterns

BackgroundNeuroleptic-induced movement disorders (NIMDs) have overlapping co-morbidity. Earlier studies have described typical clinical movement patterns for individual NIMDs. This study aimed to identify specific movement patterns for each individual NIMD using actometry.MethodsA naturalistic population of 99 schizophrenia inpatients using conventional antipsychotics and clozapine was evaluated. Subjects with NIMDs were categorized using the criteria for NIMD found in the Diagnostic and Statistical Manual for Mental Disorders – Fourth Edition (DSM-IV).Two blinded raters evaluated the actometric-controlled rest activity data for activity periods, rhythmical activity, frequencies, and highest acceleration peaks. A simple subjective question was formulated to test patient-based evaluation of NIMD.ResultsThe patterns of neuroleptic-induced akathisia (NIA) and pseudoakathisia (PsA) were identifiable in actometry with excellent inter-rater reliability. The answers to the subjective question about troubles with movements distinguished NIA patients from other patients rather well. Also actometry had rather good screening performances in distinguishing akathisia from other NIMD. Actometry was not able to reliably detect patterns of neuroleptic-induced parkinsonism and tardive dyskinesia.ConclusionThe present study showed that pooled NIA and PsA patients had a different pattern in lower limb descriptive actometry than other patients in a non-selected sample. Careful questioning of patients is a useful method of diagnosing NIA in a clinical setting.

Lower limb motor restlessness in Asperger's disorder, measured using actometry

The movement disturbances and brain imaging findings in Aspergers disorder (AD) suggest a dopaminergic deficit in movement regulation. Movement disorders of different etiologies have been quantified and specified with actometry. We compared 10 AD patients with 10 healthy controls, measuring their rest-activities by actometry. The lower limb motor activity was significantly higher in the AD group. They also displayed a rhythmic, periodic movement pattern similar to akathisia. These findings suggest a hypothesis of idiopathic akathisia and a special sensitivity to adverse effects of neuroleptic drugs.

Cultural leisure activities, recovery and work engagement among hospital employees

This study explored the relationship between cultural leisure activities, recovery experiences and two outcomes among hospital workers. The differences in recovery experiences (detachment, relaxation, mastery and control) and outcomes (work engagement and subjective recovery state) among hospital personnel (N=769) were analysed by the type (receptive or creative) and frequency of cultural activities. The cross-sectional data were collected by a digital questionnaire. Employees who reported both receptive and creative cultural leisure activities on a weekly basis had the highest relaxation, mastery and control experiences during off-job time. In addition, those with weekly creative activities had beneficial mastery experiences. There were no differences in recovery outcomes after adjustment for age, except in work engagement. Cultural leisure activities, and creative activities in particular, play an important role in certain aspects of recovery.

Is Asperger syndrome associated with abnormal nocturnal motor phenomena

Subjective insomnia as well as decreased sleep quality without objective changes in sleep architecture have been reported in adults with Asperger syndrome (AS). In the study by Tuisku et al., an increased daytime motor activity in the lower limbs was found in AS adults. This finding raises an interesting question as to whether these patients would also display periodic leg movements during sleep (PLMS) or other abnormal motor phenomena during sleep. In order to further study the nature of insomnia, a novel method of 5channel actometry with simultaneous polysomnographic recording was applied in 14 adults with Asperger syndrome, and in nine healthy age-matched controls without neuropsychiatric syndromes. Based on the polysomnographic recording, movement time and wake activity were then removed from the actometric data, and sum activity was calculated for sleep stages 1 + 2 (S1 + 2), slow-wave sleep (SWS), and rapid eye movement (REM) sleep. Patients were medication free. Peripheral neuropathy, uremia, and iron deficiency, which are frequently associated with PLMS in adult populations, were excluded. All AS patients fulfilled the DSM-IV criteria for chronic insomnia. The control group consisted of healthy volunteers with no complaints of sleep problems. In the AS group, 29% (4/14) and in controls, 33% (3/9) were female. Age in the AS group (28 ± 7 years) did not differ from that of the controls (27 ± 9 years). Height and weight were also similar for the two groups. All participants were within the range of normal intelligence. The aim was to characterize the overall nocturnal motor function in the two groups. As indicated in Table 1, there was no difference in occurrence of periodic leg movements between the adults with Asperger syndrome and the controls. The overall body and limb movements in various sleep stages were similar in both groups. Neither abnormal nocturnal motor activity nor deviant sleep architecture explained the chronic subjective insomnia of the AS patients. This finding gives

Cultural events provided by employer and occupational wellbeing of employees: A cross-sectional study among hospital nurses

BACKGROUND Occupational well-being in health care is essential for the quality of care and productivity. Some of the major challenges facing hospital nurses are the personnel turnover, emotional loading and health care reforms. After primary occupational safety and risk management, complementary positive health promotion approaches with cultural interventions can be experimented. OBJECTIVE To examine the association between well-being indicators of hospital nurses and their participation in cultural events provided by the employer (theater, concerts, exhibitions, museums, sight-seeing, and musicals) during past 6 months. METHODS Subjective well-being was measured by work engagement, workplace support for new ideas, work satisfaction and experienced stress. RESULTS A dose-dependent association was found between participation in cultural events and positive psychology parameters of occupational well-being (support for new ideas and work engagement), but the experience of stress was unrelated to participation in cultural events. Collective participation has a positive covariant effect on work engagement and seems to mediate the innovative work climate measured by workplace support for new ideas. CONCLUSIONS Collective cultural events for employees may promote positive aspects of occupational wellbeing.