Lene Falgaard Eplov

Representativeness in population-based studies: A detailed description of non-response in a Danish cohort study:

Background: Decreasing rates of participation in population-based studies increasingly challenge the interpretation of study results, in both analytic and descriptive epidemiology. Consequently, estimates of possible differences between participants and non-participants are increasingly important for the interpretation of study results and generalization to the background population. Methods: An age-specific, population-based cohort of 1,198 individuals was examined at age 40, 45, 51, and 60. Participants were compared with non-participants and when possible also with the background population using a wide range of detailed information on somatic and mental health collected at each examination, including data from a clinical examination, biochemical measurements, questionnaires, interviews, and public registers. Results: Participation rates were higher than 80% at examinations at age 40, 45, and 51, but decreased to 65% at age 60. At the baseline investigation at age 40, analyses indicated that participants were representative of the cohort as well as the background population. However, the mortality rate was higher among non-participants in the succeeding 20 years. Among living cohort members at the 60-year examination, non-participants had lower socioeconomic status, higher hospitalization rate, and a worse overall health profile than participants. Conclusions: The detailed data presented reinforce the contention that the health profile of non-participants is typically worse than that of participants. The results also indicate that while data from public registers give easily accessible information about non-participants, these crude proxy measures of health may not be enough to document representativeness.

Association between the Five Factor personality traits and perceived stress: is the effect mediated by general self-efficacy?

Abstract Ill-health resulting from chronic stress is influenced by personality traits leading to different ways of appraising and coping with lifes daily hassles. Using a large population sample the study aimed to investigate possible associations between perceived stress and the personality dimensions of neuroticism, extroversion, openness, agreeableness, and conscientiousness, and to explore the role of general self-efficacy (GSE). A population-based cross-sectional study was conducted at the Research Centre for Prevention and Health, Denmark, in 2006–2008. Men and women (N=3471) aged 18–69, were randomly sampled in the suburbs of Copenhagen. We used the NEO Five-Factor Inventory (NEO-FFI), Cohens Perceived Stress Scale and the General Self-Efficacy Scale. Negative associations were found between perceived stress and extroversion, conscientiousness, agreeableness, and openness – the latter initially non-significant – whilst neuroticism had a positive association. The associations with agreeableness and openness became positive and significant, respectively, when GSE was included. All five personality-stress models were mediated by GSE, with extroversion and conscientiousness having the strongest mediating effect. The strongest stress-association was found for neuroticism. GSE was shown to change the impact and interpretation of the personality dimensions on perceived stress. These results indicate that GSE is an important factor to consider in the link between personality and perceived stress.

Sexual desire in a nationally representative Danish population.

INTRODUCTION There are only a few studies on the frequency of sexual desire in the general population, whereas studies investigating the frequency of disordered sexual desire are more common. AIM The aim of this study was to describe the frequency of sexual desire in a representative sample of the adult Danish population and to analyze the relationships between a number of relevant variables and sexual desire. METHODS The study population (N = 10,458, response rate 84.8%) answered a questionnaire with questions on sexual matters. The representativity of the population was examined. The frequency of self-reported sexual desire and decrease in sexual desire over a 5-year period was calculated for the two genders across age cohorts. Multiple logistic regression analysis was used to analyze the relationship between potential determinants and sexual desire. MAIN OUTCOME MEASURES The frequency of self-reported sexual desire and decrease in sexual desire was examined. Factors of importance for sexual desire were tested using two outcome measures: (i) often having sexual desire; and (ii) seldom having sexual desire. RESULTS A significant association between gender and sexual desire was found in all age groups, as men had a significantly higher level of sexual desire than women. In both genders, the frequency of sexual desire was significantly reduced with increasing age. Among the 45- to 66-year-olds, 57% of the men and 47% of the women reported no change in the level of sexual desire over the past 5 years. In general terms, factors related to seldom having sexual desire were age and social, psychological, and physical distress in both genders. CONCLUSION This study shows that overall, men have a higher level of sexual desire than women; sexual desire decreases with increasing age; and social, psychological, or physical distress are associated with low level of sexual desire in both genders.

ORIGINAL RESEARCH—EPIDEMIOLOGY: Sexual Desire in a Nationally Representative Danish Population

INTRODUCTION There are only a few studies on the frequency of sexual desire in the general population, whereas studies investigating the frequency of disordered sexual desire are more common. AIM The aim of this study was to describe the frequency of sexual desire in a representative sample of the adult Danish population and to analyze the relationships between a number of relevant variables and sexual desire. METHODS The study population (N = 10,458, response rate 84.8%) answered a questionnaire with questions on sexual matters. The representativity of the population was examined. The frequency of self-reported sexual desire and decrease in sexual desire over a 5-year period was calculated for the two genders across age cohorts. Multiple logistic regression analysis was used to analyze the relationship between potential determinants and sexual desire. MAIN OUTCOME MEASURES The frequency of self-reported sexual desire and decrease in sexual desire was examined. Factors of importance for sexual desire were tested using two outcome measures: (i) often having sexual desire; and (ii) seldom having sexual desire. RESULTS A significant association between gender and sexual desire was found in all age groups, as men had a significantly higher level of sexual desire than women. In both genders, the frequency of sexual desire was significantly reduced with increasing age. Among the 45- to 66-year-olds, 57% of the men and 47% of the women reported no change in the level of sexual desire over the past 5 years. In general terms, factors related to seldom having sexual desire were age and social, psychological, and physical distress in both genders. CONCLUSION This study shows that overall, men have a higher level of sexual desire than women; sexual desire decreases with increasing age; and social, psychological, or physical distress are associated with low level of sexual desire in both genders.

The impact of changes in self-rated general health on 28-year mortality among middle-aged Danes

Objective. Self-rated general health (SRH) predicts future mortality. SRH may change, and these changes may alter the mortality risk. All-cause mortality until the age of 68 and its association with changes in SRH from the age of 40–45, 45–51, and 51–60 years was examined in a cohort of Danes. Design. Prospective population study started in 1976 with follow-up in 1981, 1987, and 1996. Setting. Suburban area of Copenhagen. Subjects. A total of 1198 individuals born in 1936. Main outcome measure. All-cause mortality. Results. Among participants with two consecutive SRH ratings the mortality rate per 1000 observation years was 7.6 (95% CI 6.4; 8.9), 8.5 (95% CI 7.1; 10.2), and 8.9 (95% CI 6.4; 10.3) after the 45-, 51-, and 60-year examination. Decline in SRH between two time-points was in bivariate Cox regression analyses associated with an increased mortality risk, the association increasing as participants grew older. Multivariate analysis of the effect of changes of SRH on mortality gave similar results: hazard ratios for declined SRH were (reference: “unchanged good”) 1.55 (95% CI 0.93–2.58), 1.96 (95% CI 1.09–3.53), and 2.22 (95% CI 0.97–5.09) at the 40–45, 45–51, and 51–60-year intervals. However, unchanged poor and improved SRH (at the 40–45-year interval) were also associated with an increase, and additional analyses showed that just rating SRH as poor at one rating was associated with increased risk. Conclusion. Changes in SRH are associated with higher mortality risks than unchanged good SRH.

Health Care Use by Patients with Somatoform Disorders: A Register-Based Follow-Up Study

OBJECTIVE Studies have shown a greater use of medical than mental health services in patients with somatoform disorders. However, not many studies are based on structured interviews and include the entire somatoform spectrum of diagnoses. We conducted a register-based case-control study to investigate medical care use prior to and three years after diagnosis in patients with somatoform disorders. METHODS We included 380 patients with somatoform diagnoses (SCID-NP for DSM-IIIR) in a case-control study and compared them with 174 patients with anxiety disorders and 5540 controls from the background population. Data from the Danish National Registers were used to assess health care use in both primary and secondary care. RESULTS Somatoform patients incurred 2.11 (2.09-2.12) times the primary care visits of controls. They had 3.12 (3.08-3.16) times as many somatic bed-days than controls and 3.94 (3.91-3.97) as many psychiatric bed-days. Primary care use remained stable 3 years after diagnosis (p = 0.14) and the award of disability pension (p = 0.82). However, the number of somatic admissions decreased from 5.64 to 2.76 (p = 0.0004) 3 years after diagnosis. Somatization had an independent effect on health care use when controlling for psychiatric comorbidity. CONCLUSIONS Patients with somatoform disorders make significantly greater use of health care services than do controls and patients with anxiety. Somatoform patients made more use of psychiatric services than expected. The use of somatic health care was independent of psychiatric comorbidity. Primary care use and disability pension award were not influenced by proper diagnosing of somatoform disorders whereas number of somatic admissions were halved.

Mental vulnerability as a predictor of early mortality.

Background: Studies have demonstrated that mental vulnerability (ie, a tendency to experience psychosomatic symptoms or inadequate interpersonal interactions) is associated with various diseases. The objective of our study is to evaluate whether mental vulnerability is a risk factor for early mortality. Methods: We conducted a prospective cohort study of 3 random samples of the population in Copenhagen County, Denmark selected in 1976, 1982–1984, and 1991 (n = 6435). Baseline data collection included measures of mental vulnerability, social factors, comorbidity, biologic risk markers (eg, blood pressure, lipid levels), and lifestyle factors. We determined vital status of the study sample through linkage to the Civil Registration System until 2001 and to the Cause of Death Registry until 1998. The mean follow-up time was 15.9 years for analysis of total mortality and 13.6 years for analysis of mortality as the result of natural causes. The association between mental vulnerability and survival was examined using Kaplan-Meir plots and Cox proportional-hazard models adjusting for possible confounding factors. Results: With respect to mental vulnerability, 79% of the sample was classified as not vulnerable, 13% as moderately vulnerable, and 8% as highly vulnerable. Compared with the nonvulnerable group, highly vulnerable persons showed increased total mortality (hazard ratio = 1.6; 95% confidence interval = 1.3–1.9) and increased mortality from natural causes (1.6; 1.2–2.0). The inclusion of the mental vulnerability score as a continuous variable gave similar results. Conclusions: Mental vulnerability may be an independent risk factor for premature mortality. The biologic mechanisms that may underlie this association need further exploration.

Cohort description: The Danish study of Functional Disorders

The Danish study of Functional Disorders (DanFunD) cohort was initiated to outline the epidemiology of functional somatic syndromes (FSS) and is the first larger coordinated epidemiological study focusing exclusively on FSS. FSS are prevalent in all medical settings and can be defined as syndromes that, after appropriate medical assessment, cannot be explained in terms of a conventional medical or surgical disease. FSS are frequent and the clinical importance varies from vague symptoms to extreme disability. No well-described medical explanations exist for FSS, and how to delimit FSS remains a controversial topic. The specific aims with the cohort were to test delimitations of FSS, estimate prevalence and incidence rates, identify risk factors, delimitate the pathogenic pathways, and explore the consequences of FSS. The study population comprises a random sample of 9,656 men and women aged 18–76 years from the general population examined from 2011 to 2015. The survey comprises screening questionnaires for five types of FSS, ie, fibromyalgia, whiplash-associated disorder, multiple chemical sensitivity, irritable bowel syndrome, and chronic fatigue syndrome, and for the unifying diagnostic category of bodily distress syndrome. Additional data included a telephone-based diagnostic interview assessment for FSS, questionnaires on physical and mental health, personality traits, lifestyle, use of health care services and social factors, and a physical examination with measures of cardiorespiratory and morphological fitness, metabolic fitness, neck mobility, heart rate variability, and pain sensitivity. A biobank including serum, plasma, urine, DNA, and microbiome has been established, and central registry data from both responders and nonresponders are similarly available on morbidity, mortality, reimbursement of medicine, heath care use, and social factors. A complete 5-year follow-up is scheduled to take place from year 2017 to 2020, and further reexaminations will be planned. Several projects using the DanFunD data are ongoing, and findings will be published in the coming years.

Illness management and recovery (IMR) in Danish community mental health centres

BackgroundSchizophrenia and bipolar disorder are severe mental illnesses that can have a significant disabling impact on the lives of people. Psychosocial interventions that stress hope and recovery as a part of a multi-dimensional approach are possibly indicated to support people with severe mental illness in facilitating recovery. Illness Management and Recovery (IMR) is a curriculum-based psychosocial intervention designed as structured program with a recovery-oriented approach. The aim of IMR is to rehabilitate people with severe mental illnesses by helping them acquire knowledge and skills in managing their illness and achieve personal recovery goals. Previous randomised clinical trials indicate that IMR can be implemented with a good effect and a high fidelity though further trials are crucial to demonstrate the potential effectiveness of IMR.Methods/DesignThe trial design is a randomised, assessor-blinded, multi-centre, clinical trial of the IMR program compared with treatment as usual for 200 participants diagnosed with schizophrenia or bipolar disorder under the care of two community mental health centres in the Capital Region of Denmark. The primary outcome is level of functioning at the end of treatment. The secondary outcomes are disease symptoms; use of alcohol/drugs; individual meaning of recovery; hope; hospital admissions and out-patient psychiatric treatment at the end of treatment and the abovementioned and level of functioning at follow-up 21 months after baseline.DiscussionIf the results of this trial show IMR to be effective these positive results will strengthen the evidence of IMR as an effective comprehensive psychosocial intervention with a recovery-oriented approach for people with severe mental illness. This will have significant implications for the treatment and recovery of people with severe mental illness.Trial registrationRegistration number NCT01361698.

The Mental Vulnerability Questionnaire: A psychometric evaluation

The Mental Vulnerability Questionnaire was originally a 22 item scale, later reduced to a 12 item scale. In population studies the 12 item scale has been a significant predictor of health and illness. The scale has not been psychometrically evaluated for more than 30 years, and the aim of the present study was both to evaluate the psychometric properties of the 22 and 12 item scales and of three new scales. The main study sample was a community sample comprising more than 6,000 men and women. In this sample the coefficients of homogeneity were all over 0.30 for the three new scales, but below 0.30 for the 12 and the 22 item scales. All five Mental Vulnerability scales had positively skewed score distributions which were associated significantly with both SCL-90-R symptom scores and NEO-PI-R personality scales (primarily Neuroticism and Extraversion). Coefficient alpha was highest for the 22 and 12 item scales, and the two scales also showed the highest long-term stability. The three new scales reflect relatively independent dimensions of Psychosomatic Symptoms, Mental Symptoms, and Interpersonal Problems, but because of reliability problems it remains an open question whether they will prove useful as predictors of health and morbidity.