Sari Lindeman

The 12‐month prevalence and risk factors for major depressive episode in Finland: representative sample of 5993 adults

Objective: This study reports the 12‐month prevalence of major depressive episode and its risk factors in a representative nationwide sample.

Cigarette smoking, alcohol intoxication and major depressive episode in a representative population sample

OBJECTIVE This study investigated the associations of cigarette smoking and alcohol intoxication with major depressive episode. DESIGN Major depressive episode during the past 12 months was assessed in a national representative cross sectional study using the Short Form of the University of Michigan version of the Composite International Diagnostic Interview (the UM-CIDI Short Form). SUBJECTS A random sample of 5993 non-institutionalised Finnish people aged 15–75 years was interviewed as a part of the 1996 Finnish Health Care Survey. RESULTS In logistic regression models the factors associated with major depressive episode in the past 12 months were smoking 10 or more cigarettes daily (odds ratio (OR) 2.26; 95% confidence intervals (95% CI) 1.68, 3.04) and alcohol intoxication at least once a week (OR 2.99; 95%CI 1.70, 5.25). Their effects were independent of each other, and remained significant even after adjusting for other major risk factors (marital status, education, unemployment and chronic diseases). The attributable proportion (a measure of the impact of the risk factors of the disease on the population) for daily smoking of 10 or more cigarettes was 0.15, and for alcohol intoxication at least once a week 0.04. CONCLUSION Cigarette smoking and alcohol intoxication seem to be important risk factors for major depressive episode. In this population the impact of smoking was greater.

Use of health services for major depressive episode in Finland.

BACKGROUND A universal finding in psychiatric epidemiology is that only a minority of currently depressed people seek or receive treatment. AIMS To investigate the predictors of use of health care services for depression. METHODS A representative random sample of 5993 non-institutionalised Finnish individuals aged 15-75 years was interviewed in 1996. Major depressive episode during the last 12 months was assessed using the Short Form of the University of Michigan version of the Composite International Diagnostic Interview (the UM-CIDI Short Form). Characteristics and health service use of the 557 depressed individuals were assessed. RESULTS The proportion of people classified as having a major depressive episode who used any health services for their depression during the past 12 months was only 31% for men and 25% for women. Use of services was not predicted by sociodemographic factors. Longer duration, and greater severity and perceived disability predicted overall health service use for depression, but not significantly whether treatment was sought from primary or psychiatric care. CONCLUSIONS The probability of use of health services for major depression increases with duration, severity and perceived disability related to depression. Only 59% of those suffering from even the most severe major depressive episodes use health services for depression. Use appears to be unrelated to sociodemographic factors in Finland.

The effect of eating behavior on weight loss and maintenance during a lifestyle intervention.

OBJECTIVE To investigate the effects of intensive counseling on eating behavior and weight loss and maintenance and their associations. METHODS A randomized weight loss counseling intervention with follow-up of 18 months, conducted between 2002-2004 at Oulu University Hospital, Finland included obese adults (n=82, body mass index >27 kg/m(2)). Subjects were randomized into 1) intensive counseling and 2) short-term counseling. Forty-nine subjects who completed the study were included. Eating behavior was repeatedly assessed by the Three Factor Eating Questionnaire-18 and Binge Eating Scale. RESULTS Eating behavior improved in both groups. Effect of counseling was -5.0+/-5.7 kg compared with -2.4+/-2.5 kg in the control group (p<0.05 between the groups) during the first 6 months. At 18 months the weight loss results were -2.6+/-6 kg and -0.7+/-3.5 kg, respectively (NS). Success in weight loss maintenance is associated with improved eating behavior (p<0.05). By contrast, failure in weight loss is associated with high scores of uncontrolled eating and binge eating symptoms at the baseline (p<0.05). CONCLUSIONS Both intensive and short-term interventions improved eating behavior and weight loss but there was no difference between the two modes of intervention. The association between the improvement of eating behaviour and the success of weight loss suggests a causal relationship which however should be confirmed in a prospective study focusing specifically on this aspect.

Major depressive episode related to long unemployment and frequent alcohol intoxication.

We studied the association between two major problems – unemployment and major depressive episode – and the impact of different timing of periods of unemployment and risk factors, especially alcohol intoxication, for major depressive episode among the unemployed. Major depressive episode during the last 12 months, plus current and past employment status and frequency of alcohol intoxication, were assessed within the nationally representative, cross-sectional 1996 Finnish Health Care Survey, in which non-institutionalized individuals aged 15–75 years were interviewed by using the Short Form of the University of Michigan version of the Composite International Diagnostic Interview (the UM-CIDI Short Form). Of the 5993 subjects interviewed, 3818 (64%) were occupationally active and included in the logistic regression analysis, showing that even after adjusting for other potentially confounding variables, current unemployment was associated with major depressive episode (odds ratio, OR = 1.78, 95% confidence interval, CI, 1.38–2.29). Further analysis revealed that the increased risk of major depressive episode was only related to long-term unemployment. Frequent alcohol intoxication (at least once a week) increased the risk of major depressive episode remarkably. Compared with the group “Constantly employed, no frequent alcohol intoxication”, long-term unemployment with no frequent alcohol intoxication had moderately increased risk of major depressive episode (OR = 1.72 (95% CI 1.29–2.30) and those with frequent alcohol intoxication had highly increased risk [OR = 11.27 (95% CI 5.51–23.09) vs. OR = 1.72 (95% CI 1.29–2.30]. Long-term unemployment is associated with increased risk of major depressive episode. Frequent alcohol intoxication among long-term unemployed individuals greatly increases the risk of depression.

Association between age at onset and clinical features of schizophrenia: the Northern Finland 1966 birth cohort study.

PURPOSE To study the association between age at onset and the clinical picture of schizophrenia in an unselected young birth cohort. SUBJECTS AND METHODS The study sample consists of 98 (64 males and 34 females) individuals with DSM-III-R schizophrenia collected from the Northern Finland 1966 birth cohort. Firstly, subjects were divided into very early- and young-onset subgroups by using the median age at onset (22 years in males and 20 in females), as a cut-off point. Secondly, we used age at onset as a continuous variable. Clinical features of schizophrenia were assessed using the Operational Criteria Checklist for Psychotic Illnesses (OCCPI). RESULTS Inappropriate affect, positive thought disorder and deterioration from premorbid level of function associate with very early-onset schizophrenia, while slowed activity and dysphoria relate to young-onset. These symptoms correlate significantly with the age at onset. DISCUSSION Differences in the clinical picture associating to the age at onset of schizophrenia are seen early. CONCLUSION These findings indicate that certain symptoms of schizophrenia are dependent on the age at onset, and schizophrenia occurring initially in early life has some typical features. Using the age at onset as a continuous variable is independent of arbitrary cut-off points and produces more explicable results.

Medical and psychology students’ self-assessed communication skills: A pilot study

OBJECTIVE The purpose of this study was to describe how psychology and medical students assess their own competency and skills before and after training, in which role-play was used to teach interpersonal and communication skills. METHOD Interpersonal and communication skills were assessed with a semi-structured questionnaire before and after the training. RESULTS The students of both medicine and psychology estimated their skill levels to be higher after the course. The psychology students estimated their skills for communication, motivating interviewing, empathy and reflection, and change orientation to be better at the end of the course. Medical students estimated their communication skills, motivating interviewing skills, and change orientation skills to be better at the end of the course. CONCLUSION Even a short period of training in interpersonal and communication skills can positively affect the self-assessed skills of the medical students. PRACTICE IMPLICATIONS In the future, it would be worthwhile to pay attention to reflective teaching practices in the training of both medical and psychology students. The cognitive and emotional components of these practices help students to develop their own communication skills.

Suicide mortality among medical doctors in Finland: are females more prone to suicide than their male colleagues?

BACKGROUND Suicide mortality among medical practitioners is in many countries significantly higher compared with other professionals and the general population. Differences between male and female physicians are difficult to estimate reliably because previous comparisons are mainly based on crude mortality rates. METHODS Age-specific mortality rates were calculated for physicians, other professionals and the general population, males and females separately, as well as standardized mortality ratios (SMR) comparing physicians with the other groups. Crude mortality rates were calculated for the specialist groups. RESULTS The SMR for male (female) physicians was 0.9 (2.4) compared with the general male (female) population and 2.4 (3.7) compared with other male (female) professionals. The SMR between male and female physicians was 1.2 (95% CI 0.9-1.7). CONCLUSIONS Our results do not support the claim that female physicians have a greater risk of suicide than their male colleagues, but are concordant with previous observations of a higher suicide rate in female physicians compared with the general population and other female professionals.

Serum lipids in schizophrenia and other functional psychoses: a general population northern Finland 1966 birth cohort survey

Objective:  To compare fasting serum lipid concentrations of subjects with schizophrenia with a comparison group.

Suicide among medical doctors: Psychological autopsy data on seven cases

Suicide mortality among medical doctors is significantly higher compared with other professionals and the general population in Finland as well as in many other industrialized countries, concerning especially female doctors. The National Suicide Prevention Project in Finland covered all suicides that happened during one year (1.4.1987–31.3.1988). The data were collected and analysed by the psychological autopsy method. It is possible that the physicians who committed suicide tended to have an emphasized reliance on professional identity, in which case a crucial internal resource would have been a sense of autonomy. A variety of problems (physical or mental illness, professional setbacks) could then be perceived as threats to the doctor identity and a sense of autonomy. Moreover, doctors often preferred to medicate themselves instead of seeking outside medical help. It is possible that medical professionals easily resort to chemical forms of coping, which increase the risk of suicide.