Sebastián Peña

Mortality in people with depressive, anxiety and alcohol use disorders in Finland

BACKGROUND Mental disorders are associated with increased mortality, but population-based surveys with reliable diagnostic procedures controlling for somatic health status are scarce. AIMS To assess excess mortality associated with depressive, anxiety and alcohol use disorders and the principal causes of death. METHOD In a nationally representative sample of Finns aged 30-70 years, psychiatric disorders were diagnosed with the Composite International Diagnostic Interview. After an 8-year follow-up period, vital status and cause of death of each participant was obtained from national registers. RESULTS After adjusting for sociodemographic factors, health status and smoking, depressive (hazard ratio (HR) = 1.97) and alcohol use disorders (HR = 1.72) were statistically significantly associated with mortality. Risk of unnatural death was increased among individuals diagnosed with anxiety disorders or alcohol dependence. CONCLUSIONS Individuals with depressive and alcohol use disorders have an increased mortality risk comparable with many chronic somatic conditions, that is only partly attributable to differences in sociodemographic, somatic health status and hazardous health behaviour.

Prevalence and correlates of major depressive disorder and dysthymia in an eleven-year follow-up – Results from the Finnish Health 2011 Survey

BACKGROUND Up-to-date epidemiological data on depressive disorders is needed to understand changes in population health and health care utilization. This study aims to assess the prevalence of major depressive disorder (MDD) and dysthymia in the Finnish population and possible changes during the past 11 years. METHODS In a nationally representative sample of Finns aged 30 and above (BRIF8901), depressive disorders were diagnosed with the Composite International Diagnostic Interview (M-CIDI) in 2000 and 2011. To account for nonresponse, two methods were compared: multiple imputation (MI) utilizing data from the hospital discharge register and from the interview in 2000 and statistical weighting. RESULTS The MI-corrected 12-month prevalence of MDD was 7.4% (95% CI 5.7-9.0) and of dysthymia was 4.5% (95% CI 3.1-5.9), whereas the corresponding figures using weights were 5.4% (95% CI 4.7-6.1) for MDD and 2.0% (95% CI 1.6-2.4) for dysthymia. Women (OR 2.33, 95% CI 1.6-3.4) and unmarried people (OR 1.54, 95% CI 1.2-2.0) had a higher risk of depressive disorders. There was a significant increase in the prevalence of depressive disorders during the follow-up period from 7.3% in 2000 to 9.6% in 2011. Prevalences were two percentage points higher, on average, when using MI compared to weighting. Hospital treatments for depressive disorders and other mental disorders were strongly associated with nonparticipation. LIMITATIONS The CIDI response rate dropped from 75% in 2000 to 57% in 2011, but this was accounted for by MI and weighting. CONCLUSIONS Depressive disorders are a growing public health concern in Finland. Non-participation of persons with severe mental disorders may bias the prevalence estimates of mental disorders in population-based studies.

The Chilean Rural Practitioner Programme: a multidimensional strategy to attract and retain doctors in rural areas

Developing countries currently face internal and external migration of their health workforce and interventions are needed to attract and retain health professionals in rural areas. Evidence of multidimensional interventions, however, is scarce. This study explores a long-standing strategy to attract and retain doctors to rural areas in Chile: the Rural Practitioner Programme. The main objective is to describe the programme, characterize its multidimensional set of incentives and appraise preliminary programme outcomes.Retrospective national data were employed to examine recruitment, retention and incentives provided to extend the length of stay and motivate non-clinical work. The programme has successfully recruited a large number of applicants, with acceptance rates close to 100%. Retention rates are nearly 100% (drop-outs are exceptional), but only 58% of participants stay for the maximum period. Areas with greater work difficulty are attracting the best-ranked applicants, but incentives to engage in community projects, management responsibilities, continuous medical education and research have achieved mixed results. Rural doctors are satisfied with their experience and 70% plan to practise as specialists in a referral hospital.The programme has successfully matched the interests of physicians in specialization with the countrys need for rural doctors. However, a gap might be forming between the demand for certain specialties and what the programme can offer. There is a need to conciliate both parties, which will require a more refined strategy than before. This should be grounded in robust knowledge based on programme outcomes and evidence of the interests and motivations of health professionals.

Socioeconomic inequalities in alcohol consumption in Chile and Finland

BACKGROUND Reasons for socioeconomic inequalities in alcohol harm are not sufficiently understood. One explanation relates to differential exposure to alcohol by socioeconomic status (SES). The present study investigated socioeconomic inequalities in alcohol use in two countries with high alcohol consumption and alcohol harm. METHODS Data from nationally representative surveys in 2009-2010 in Chile and in 2008-2011 in Finland were used. Surveys comprised 3477 participants in Chile and 9994 in Finland aged 30-64 years. Outcome measures included abstinence, weekly consumption of pure alcohol, heavy volume drinking and heavy episodic drinking (HED). We employed a novel method in alcohol research, the concentration index, to measure socioeconomic inequalities. RESULTS Alcohol abstinence showed a strong association with lower SES in Chile and Finland. These were largely driven by inequalities among women in Chile and older subgroups in Finland. In both countries, women aged 45-64 of higher SES showed higher weekly consumption of pure alcohol and heavy volume drinking. Heavy volume drinking among Chilean women aged 45-64 showed the highest inequality, favouring higher SES. HED was equally distributed among SES groups in Chile; in Finland HED disproportionally affected lower SES groups. CONCLUSIONS Lower SES was associated with higher abstinence rates in both countries and heavy episodic drinking in Finland. Heavy volume drinking was more prevalent in middle-aged women of high SES. The results identified groups for targeted interventions, including middle-aged higher SES women, who traditionally have not been specifically targeted. The concentration index could be a useful measure of inequalities in alcohol use.

Prevalence, trends, correlates and treatment of depression in Chile in 2003 to 2010

PurposeThere is a need for recent, nationally representative data on the prevalence of mental disorders in Latin America. We aim to assess the prevalence of depression in Chile and possible changes over time.MethodsIn the Chilean National Health Surveys in 2003 (n = 5469) and 2010 (n = 7212), two nationally representative cross-sectional population surveys, the Composite International Diagnostic Interview, Short Form (CIDI-SF) was applied to establish diagnosis of major depressive episode (MDE) using DSM-IV criteria. Sociodemographic correlates of MDE and time trends were analyzed.ResultsThe prevalence of MDE was 20.5% (95% CI 18.3–22.7) in 2003 and 18.4% (95% CI 16.5–20.2) in 2010. In 2003, women and persons residing in urban areas had increased risk of depression, whereas in 2010 the risk factors were female sex, younger age and lower education. There were up to 15-fold differences in prevalence between regions. No significant changes in prevalence occurred over the observation period. 21.2% (95% CI 16.6–25.8) of those depressed were currently receiving antidepressant treatment, with large regional variations in access to treatment.ConclusionsDepressive disorders are a pressing public health concern in Chile, and particularly women, persons with low education, and the poorer regions of the country are affected. Prompt actions are needed to address the burden of depression with sufficient resources for treatment and prevention.

Mapping SAGE questionnaire to the International Classification of Functioning, Disability and Health (ICF).

The collaborative research on ageing in Europe protocol was based on that of the World Health Organization Study on global AGEing and adult health (SAGE) project that investigated the relationship between health and well-being and provided a set of instruments that can be used across countries to monitor health and health-related outcomes of older populations as well as the strategies for addressing issues concerning the ageing process. To evaluate the degree to which SAGE protocol covered the spectrum of disability given the scope of the World Health Organization International Classification of Functioning, Disability and Health (ICF), a mapping exercise was performed with SAGE protocol. Results show that the SAGE protocol covers ICF domains in a non-uniform way, with environmental factors categories being underrepresented, whereas mental, cardiovascular, sensory functions and mobility were overrepresented. To overcome this partial coverage of ICF functioning categories, new assessment instruments have been developed. PRACTITIONER MESSAGE: Mapping exercises are valid procedures to understand the extent to which a survey protocol covers the spectrum of functioning. The mapping exercise with SAGE protocol shows that it provides only a partial representation of body functions and activities and participation domains, and the coverage of environmental factors is poor. New instruments are therefore needed for researchers to properly understand the health and disability of ageing populations.

Predictors of Persistence of Risky Drinking in Adults: An 11-Year Follow-Up Study

Aim: To examine the long-term predictors of persistence of risky drinking in a baseline group of risky drinkers in whom alcohol use disorder had not been diagnosed. Methods: The data was derived from a representative sample of the Finnish adult population aged 30 years or more, surveyed at 2 time points in the years 2000 (n = 5,726) and 2011 (n = 3,848, 67.2% of the baseline sample). Risky drinking was defined using BSQF-measurement (for men, 21 standard UK drinks or more per week; for women 14+ drinks) and not having alcohol abuse or alcohol dependence. The sample of risky drinkers in baseline comprised 642 persons, of whom 380 (59.2%) people provided follow-up data. Multivariable logistic regression models were estimated to identify determinants of persistence of risky drinking. Results: The rate for persistence of risky drinking was 48.7%. Persistence was predicted by daily smoking, low physical activity, and male gender, whereas higher age and later onset of drinking predicted cessation of risky drinking. Daily smoking remained an independent predictor after adjusting for other risk factors. Conclusions: Health behaviour predicts the persistence of risky drinking in a study population of adults aged 30 and over. These factors should be taken into account when assessing the long-term prognosis on risky drinking.

Salud mental en Chile y Finlandia: desafíos y lecciones

This article analyses and compares the epidemiology of mental disorders and relevant public policies in Chile and Finland. In Chile, a specific mental health law is still lacking. While both countries highlight the role of primary care, Finland places more emphasis on participation and recovery of service users. Comprehensive mental health policies from Finland, such as a successful suicide prevention program, are presented. Both countries have similar prevalence of mental disorders, high alcohol consumption and high suicide rates. In Chile, the percentage of total disease burden due to psychiatric disorders is 13% and in Finland 14%. However, the resources to address these issues are very different. Finland spends 4.5% of its health budget on mental health, while in Chile the percentage is 2.2%. This results in differences in human resources and service provision. Finland has five times more psychiatric outpatient visits, four times more psychiatrists, triple antidepressant use and twice more clinical guidelines for different psychiatric conditions. In conclusion, both countries have similar challenges but differing realities. This may help to identify gaps and potential solutions for public health challenges in Chile. Finland’s experience demonstrates the importance of political will and long-term vision in the construction of mental health policies

Evaluación de la experiencia de participantes en estrategia de dotación de médicos generales en zonas rurales

Background: Rural areas have scarce medical resources. Initiatives to address this situation in Latin America exist, but have been poorly evaluated. The Chilean Rural Practitioner Program, a policy of recruitment and retention of physicians in rural areas, has been stable over time. Aim: To examine how physicians who participate in this program evaluate it. Material and methods: Nationally representative cross sectional study. Physicians were chosen to respond online or by telephone a specially designed questionnaire about the Program. Results: 202 participants answered (response rate of 60%). The overall experience was evaluated with 5.75 points (in a 1 to 7 scale). Participants gave the best scores to climatic conditions and economic income, and rated infrastructure, human resources and workload the worst. The evaluation of social relationships at the destination place was the only condition associated significantly with the overall assessment of the experience. Seventy percent of physicians would return to the destination place as a specialist. The value given to social relations and infrastructure were associated positively with this potential return. Conclusions: Overall, the experience was positively evaluated. This study provides information to improve retention policies for human resources for health care in rural areas.BACKGROUND Rural areas have scarce medical resources. Initiatives to address this situation in Latin America exist, but have been poorly evaluated. The Chilean Rural Practitioner Program, a policy of recruitment and retention of physicians in rural areas, has been stable over time. AIM To examine how physicians who participate in this program evaluate it. MATERIAL AND METHODS Nationally representative cross sectional study. Physicians were chosen to respond online or by telephone a specially designed questionnaire about the Program. RESULTS 202 participants answered (response rate of 60%). The overall experience was evaluated with 5.75 points (in a 1 to 7 scale). Participants gave the best scores to climatic conditions and economic income, and rated infrastructure, human resources and workload the worst. The evaluation of social relationships at the destination place was the only condition associated significantly with the overall assessment of the experience. Seventy percent of physicians would return to the destination place as a specialist. The value given to social relations and infrastructure were associated positively with this potential return. CONCLUSIONS Overall, the experience was positively evaluated. This study provides information to improve retention policies for human resources for health care in rural areas.

Mapping SAGE questionnaire to the International Classification of Functioning, Disability and Health (ICF)

The collaborative research on ageing in Europe protocol was based on that of the World Health Organization Study on global AGEing and adult health (SAGE) project that investigated the relationship between health and well-being and provided a set of instruments that can be used across countries to monitor health and health-related outcomes of older populations as well as the strategies for addressing issues concerning the ageing process. To evaluate the degree to which SAGE protocol covered the spectrum of disability given the scope of the World Health Organization International Classification of Functioning, Disability and Health (ICF), a mapping exercise was performed with SAGE protocol. Results show that the SAGE protocol covers ICF domains in a non-uniform way, with environmental factors categories being underrepresented, whereas mental, cardiovascular, sensory functions and mobility were overrepresented. To overcome this partial coverage of ICF functioning categories, new assessment instruments have been developed. PRACTITIONER MESSAGE: Mapping exercises are valid procedures to understand the extent to which a survey protocol covers the spectrum of functioning. The mapping exercise with SAGE protocol shows that it provides only a partial representation of body functions and activities and participation domains, and the coverage of environmental factors is poor. New instruments are therefore needed for researchers to properly understand the health and disability of ageing populations.