Päivikki Koponen

Infertility, mental disorders and well-being – a nationwide survey

Objective. Earlier studies suggest that infertility and mental health problems are related and that infertility is a different experience for women and men. The aim of this population‐based study is to examine mental disorders, depressivity, psychological distress, perceived health and quality of life among women and men who have experienced infertility. Design. Cross‐sectional nationwide Health 2000 Survey. Setting. Population‐based. Population. A representative random sample of Finnish people aged 30–44 years (n = 2291). Methods. Outcomes were compared between those who had experienced infertility (n = 338) and the rest of the population. Age, marital status, education, income, body mass index, and smoking were controlled for using logistic and linear regressions. Main outcome measures. Mental disorders (composite international diagnostic interview, CIDI), depressivity (beck depression inventory, BDI), psychological distress (general health questionnaire, GHQ‐12), perceived health, and subjective quality of life. Results. Approximately 20% of women and 9% of men reported having experienced infertility. Childless women with infertility experience had increased adjusted risks for dysthymia (OR 3.41, 95% CI; 1.01–11.5) and anxiety disorders (2.67, 1.00–7.12) compared to women who had not experienced infertility. Women with infertility experience but with a current child had an increased risk for panic disorder (2.58, 1.11–6.01). Childless men with infertility experience had a significantly poorer quality of life compared to men without infertility. Conclusions. Infertility was associated with mental health, especially dysthymia and anxiety. The results differed by gender and the permanency of infertility. Gender‐specific psychosocial support and follow‐up for infertile people is warranted.

An overview of the European Health Examination Survey Pilot Joint Action

BackgroundHealth Examination Surveys (HESs) can provide essential information on the health and health determinants of a population, which is not available from other data sources. Nevertheless, only some European countries have systems of national HESs. A study conducted in 2006–2008 concluded that it is feasible to organize national HESs using standardized measurement procedures in nearly all EU countries. The feasibility study also outlined a structure for a European Health Examination Survey (EHES), which is a collaboration to organize standardized HESs in countries across Europe.To facilitate setting up national surveys and to gain experience in applying the EHES methods in different cultures, EHES Joint Action (2010–2011) planned and piloted standardized HESs in the working age population in 12 countries. This included countries with earlier national HESs and countries which were planning their first national HES. The core measurements included in all surveys were weight, height, waist circumference and blood pressure, and blood samples were taken to measure lipid profiles and glucose or glycated haemoglobin (HbA1c). These are modifiable determinants of major chronic diseases not identified in health interview surveys. There was a questionnaire to complement the data on the examination measurements.MethodsEvaluation of the pilot surveys was based on review of national manuals and evaluation reports of survey organizers; observations and discussions of survey procedures during site visits and training seminars; and other communication with the survey organizers.ResultsDespite unavoidable differences in the ways HESs are organized in the various countries, high quality and comparability of the data seems achievable. The biggest challenge in each country was obtaining high participation rate. Most of the pilot countries are now ready to start their full-size national HES, and six of them have already started.ConclusionsThe EHES Pilot Project has set up the structure for obtaining comparable high quality health indicators on health and important modifiable risk factors of major non-communicable diseases from the European countries. The European Union is now in a key position to make this structure sustainable. The EHES core survey can be expanded to cover other measurements.

Sexual health among young adults in Finland: Assessing risk and protective behaviour through a general health survey

Objective: To describe the extent of sexual risk and protective behaviours and reproductive health outcomes comparing men and women of 18—29 and assess the demographic correlates of these indicators within genders. Design: A module of questions on sexual behaviour and reproductive health outcomes was integrated into a population-based general health survey in Finland. Methods: A representative sample of people over 17, including 1,894 individuals between 18 and 29 years, was drawn from the population registry in 2001. Individual interviews and self-administered questionnaires were used with a response rate of 79% for the interview and 68% for the questionnaire. Results: It was more common for younger men to stay single and have multiple partners while women of the same age were cohabiting or married and chose a regular sex partner. The mean number of sexual partner for men was 5.0 (SD 5.1) and for women 3.4 (SD 2.1). Besides higher prevalence of multiple partners, men reported also casual sex contacts more often than women, 33% vs. 20%. Both genders reported relatively high and concordant rates of contraception use. However, in casual sex contacts a condom was used consistently only by less than half of both sexes. Marital status was the strongest predictor for behaviour and health outcomes. Conclusions: Casual sex is common among young adults in Finland and often occurs without a condom. This study shows that it is feasible to incorporate sexual behaviour questions as part of a larger health survey offering an option for monitoring sexual behaviour when funding for large-scale HIV surveys is decreasing.

Miscarriage and mental health: Results of two population-based studies

A miscarriage may have a sustained negative effect on mental health. Our aim was to analyze the association of the history and, if any, the number of miscarriages with mental health. The participants were women from two population-based studies, the Finnish Health 2000 survey and the National FINRISK 2002 Survey. Data were collected with a set of self-reported questionnaires, a clinical health examination and/or a home interview. A modified Beck Depression Inventory (BDI), the 12-item General Health Questionnaire (GHQ-12), the Munich-Composite International Diagnostic Interview (M-CIDI) and other non-structured interviews were used for the assessment of mental health. A diagnosis of depressive disorder and the presence of depressive symptoms were more prevalent among women with a history of miscarriage. In both datasets the higher the number of miscarriages was, the worse the current state of mood was and the higher the frequency of a psychiatric diagnosis was. These results suggest that a miscarriage, and in particular the number of miscarriages, contributes to mental health in a negative way for long.

Quality of care in abortion services in Finland.

BACKGROUND The aim of this study was to describe the quality of abortion services and womens experiences with the care they had received during their abortion. METHODS A population-based postal survey of 3000 randomly selected 18-44-year old Finnish women in 1994. The response rate was 74% (n=2189). The following were used as indicators of quality of services: referral problems, loss of follow up, adequacy of counseling, and satisfaction with treatment. RESULTS Fifteen percent (n=320) of the respondents had experienced at least one abortion. After adjusting for age, women who had an abortion were more likely to come from the lower social class, to be divorced, widowed, or in a nonmarital relationship, and to have had previous pregnancies. Fifty-two percent reported not using any contraceptive method when getting pregnant. Altogether 6% reported referral problems and 8% did not have post-abortion follow-up. Twenty-five percent would have preferred more discussion with a physician or a nurse before the abortion and 30% after it. Psychological effects of abortion was the most often mentioned subject upon which they needed discussion. The need for discussion was not influenced by the length of time lapsed since the abortion. The satisfaction with treatment increased from 69% (abortion >10 years ago) to 82% (abortion <5 years ago). Dissatisfaction was related to need for more discussion and the abortion having been performed in a central hospital. CONCLUSION The overall quality of abortion care was good but there is still a need for improvement, especially in the communication and human part of the care.

European Health Examination Survey--towards a sustainable monitoring system.

BACKGROUND  Health examination surveys (HESs), including both questionnaire and physical measurements, and in most cases also collection of biological samples, can provide objective health indicators. This information complements data from health interview surveys and administrative registers, and is important for evidence-based planning of health policies and prevention activities. HESs are valuable data sources for research. The first national HESs in Europe were conducted in the late 1950s and early 1960s. They have recently been carried out in an increasing number of countries, but there has been no joint standardization between the countries. METHODS The European Health Examination Survey Pilot Project was conducted in 2009-2012. The European Health Examination Survey Pilot Reference Centre was established and pilot surveys were conducted in 12 countries. RESULTS  European standardized protocols for key measurements on main chronic disease risk factors (height, weight, waist circumference, blood pressure, blood lipids and fasting glucose or HbA1c) were prepared. European-level training and external quality assessment were organized. Although the level of earlier experience, infrastructures, economic status and cultural settings varied between the pilot countries, it was possible to standardize measurements of HESs across the populations. Obtaining high participation rates was challenging. CONCLUSION  HESs provide high-quality and representative population data to support policy decisions and research. For future national HESs, centralized coordination, training and external quality assessment are needed to ensure comparability of the results. Further studies on effects of different survey methods on comparability of the results and on recruitment and motivation of survey participants are needed.

Under-estimation of obesity, hypertension and high cholesterol by self-reported data: comparison of self-reported information and objective measures from health examination surveys.

BACKGROUND Non-communicable diseases (NCDs) cause 63% of deaths worldwide. The leading NCD risk factor is raised blood pressure, contributing to 13% of deaths. A large proportion of NCDs are preventable by modifying risk factor levels. Effective prevention programmes and health policy decisions need to be evidence based. Currently, self-reported information in general populations or data from patients receiving healthcare provides the best available information on the prevalence of obesity, hypertension, diabetes, etc. in most countries. METHODS In the European Health Examination Survey Pilot Project, 12 countries conducted a pilot survey among the working-age population. Information was collected using standardized questionnaires, physical measurement and blood sampling protocols. This allowed comparison of self-reported and measured data on prevalence of overweight, obesity, hypertension, high blood cholesterol and diabetes. RESULTS Self-reported data under-estimated population means and prevalence for health indicators assessed. The self-reported data provided prevalence of obesity four percentage points lower for both men and women. For hypertension, the self-reported prevalence was 10 percentage points lower, only in men. For elevated total cholesterol, the difference was 50 percentage point among men and 44 percentage points among women. For diabetes, again only in men, the self-reported prevalence was 1 percentage point lower than measured. With self-reported data only, almost 70% of population at risk of elevated total cholesterol is missed compared with data from objective measurements. CONCLUSIONS Health indicators based on measurements in the general population include undiagnosed cases, therefore providing more accurate surveillance data than reliance on self-reported or healthcare-based information only.

Challenges in standardization of blood pressure measurement at the population level

BackgroundAccurate blood pressure measurements are needed in clinical practice, intervention studies and health examination surveys. Blood pressure measurements are sensitive: their accuracy can be affected by measurement environment, behaviour of the subject, measurement procedures, devices used for the measurement and the observer. To minimize errors in blood pressure measurement, a standardized measurement protocol is needed.MethodsThe European Health Examination Survey (EHES) Pilot project was conducted in 2009–2012. A pilot health examination survey was conducted in 12 countries using a standardized protocol. The measurement protocols used in each survey, training provided for the measurers, measurement data, and observations during site visits were collected and evaluated to assess the level of standardization.ResultsThe EHES measurement protocol for blood pressure was followed accurately in all 12 pilot surveys. Most of the surveys succeeded in organizing a quiet and comfortable measurement environment, and staff instructed survey participants appropriately before examination visits. In all surveys, blood pressure was measured three times, from the right arm in a sitting posture. The biggest variation was in the device used for the blood pressure measurement.ConclusionsIt is possible to reach a high level of standardization for blood pressure measurements across countries and over time. A detailed, standardized measurement protocol, and adequate training and monitoring during the fieldwork and centrally organized quality assessment of the data are needed. The recent EU regulation banning the sale of mercury sphygmomanometer in European Union Member States has set new challenges for the standardization of measurement devices since the validity of oscillometric measurements is device-specific and performance of aneroid devices depends very much on calibration.

Health and life style among infertile men and women

OBJECTIVE Lifetime prevalence of infertility among couples is approximately 10-15%, but studies addressing their health behavior are few. Our aim was to describe health and life style of Finnish men and women who had experienced infertility. DESIGN Cross-sectional survey. SETTING Finland. POPULATION AND METHODS Data from a population-based survey (n=7021) was utilized. Life style of infertile men (n=289) and women (n=155) were compared to other men and fertile women. MAIN OUTCOME MEASURES Life style (dietary factors, use of alcohol, physical activity), reproductive factors, other diseases and symptoms. RESULTS After adjusting for age, area and education, infertile women under 50 years consumed more polyunsaturated fat (OR 1.23, 95% CI 1.03-1.46), less saturated fat (OR 0.83, 95% CI 0.74-0.92) and had experienced more hangovers during previous year (OR 1.02, 95% CI 1.00-1.05) than fertile women. Infertile men under 50 years consumed more total fat (OR 1.06, 95% CI 1.03-1.10), polyunsaturated fat (OR 1.20, 95% CI 1.05-1.37) and monounsaturated fat (OR 1.17, 95% CI 1.06-1.28) compared to other men. Infertile men did not consume more alcohol nor smoke more cigarettes but reported more often allergies than fertile men. Infertile women also had Chlamydia trachomatis infection, benign tumor in their uterus and intestinal disease more often than fertile women. Infertile women over 50 years were more often current smokers than fertile women, but the differences in other age-groups were not significant. CONCLUSIONS Women with infertility experience reported more diseases and less use of oral contraceptives than other women, possibly reflecting reasons to infertility. Since both infertility and unhealthy use of alcohol are an increasing public health issues in western societies, more attention should be paid towards life style, especially alcohol use of infertile women.

Further evidence for lack of negative associations between hormonal contraception and mental health

BACKGROUND There is limited and inconsistent information concerning the effects of hormonal contraception [oral contraceptives (OCs) and the levonorgestrel-releasing intrauterine system (LNG-IUS)] on mental health. The aim of this work was to further study the association(s) between the use of OCs and the LNG-IUS and psychopathology. STUDY DESIGN Data concerning adult women who participated in the national FINRISK Study Surveys in Finland in 1997, 2002 and 2007 were analyzed. The associations between the current use, as well as the duration of use of OCs and the LNG-IUS vs. mood symptoms, psychological and physical symptoms and recent psychiatric diagnoses were tested. RESULTS A negative association between the current use of OCs and Beck Depression Inventory-13 (BDI-13) score was found. Some other negative associations, all characterized by a small effect size, were detected between current use of OCs and the BDI items feelings of dissatisfaction, feelings of uselessness, irritability, lost interest in people and lost appetite. Additionally, only weak positive associations were found between the duration of OC use and irregular heart rate, insomnia and recent anhedonia. No noteworthy associations emerged between current use of the LNG-IUS, or its duration, and any of the inquired items. CONCLUSION The use of hormonal contraception is not associated with negative influence on mental health. Current OC use seems to be associated with better mood, whereas the associations between duration of use of hormonal contraception and mental health effects are not clear.