One-month prevalence of depression and other DSM-IV disorders among young adults

BACKGROUND

We aimed to provide prevalence data on depression and other current mental disorders, impairment, need of psychiatric care and use of mental health services among young adults.

METHODS

Based on a semi-structured clinical interview, current DSM-IV disorders, impairment, need of psychiatric care and use of mental health services were evaluated in a sample of 20-24-year-old young urban adults (N = 245), mean age 21.8, screened from a baseline population of 706. One-month prevalence estimates for disorders were calculated by the double sampling method, using various additional criteria to identify cases.

RESULTS

One in four young adults (23.8%) suffered from a current mental disorder, the most prevalent being depressive (10.8%), anxiety (6.9%), substance use (6.2%) and personality disorders (6.0%). Prevalence estimates varied substantially according to the use of additional diagnostic criteria. Impairment (GAF < 61) together with DSM-IV symptom criteria produced an overall disorder prevalence of 10.3%, and 5.5% for depression. Prevalences were higher for females than males, except for alcohol abuse and personality disorders. Current co-morbidity was found in 39% of subjects with any disorder, and in more than half of those with depression. One-third of subjects with a current disorder reported an associated contact with psychiatric services and 16% had an ongoing contact.

CONCLUSIONS

Our findings support the use of additional criteria to produce clinically relevant prevalence data. Co-morbidity should receive special attention due to its amplification of both need for psychiatric care and severity of impairment. Finally, our results show disturbed young adults to be severely undertreated.

Attempted suicide rates and trends during a period of severe economic recession in Helsinki, 1989-1997

BACKGROUND

This study investigated attempted suicide trends during a deep economic recession in the 1990s in a well-defined urban catchment area.

METHODS

The data covered every suicide attempt treated in health care during sample periods in 1989-1997 in Helsinki, Finland. Annual rates were estimated, 3-year moving averages for trends calculated, and significances tested.

RESULTS

The overall attempted suicide rate remained stable over the 9-year study period. Against expectations, male rates decreased significantly (P < 0.01), especially among those aged 15-34. There was a convergence of female and male rates, although male rates remained higher. The proportion of poisonings as method increased (P < 0.01).

CONCLUSIONS

Despite the deep economic recession, with rapidly rising unemployment attempted suicide rates remained unexpectedly stable. The total attempted suicide rate did not increase as might have been anticipated, and the male rate even decreased.

Transitions of employment status among suicide attempters during a severe economic recession

Previous studies have shown a positive association between unemployment and attempted suicide. This study investigated transitions of employment status among suicide attempters during the severe economic recession. The main research question was whether inequality in the labour market also prevails among as selected a population as suicide attempters. The material consisted of 2495 persons who attempted suicide during 1989-1994 in Helsinki, Finland. Logistic regression analysis and survival analysis were used. Unemployment rates among suicide attempters were higher than in the general population, male rates being higher than female rates throughout the recession. There were significant changes in the employment status of the entire attempted suicide population from 1989 to 1994, especially in terms of the transition from employment to unemployment. Gender, age and education level predicted exit from the labour market. Among suicide attempters young middle-aged men with low education had the highest risk of unemployment.

Incidence of cancer among persons with schizophrenia and their relatives

BACKGROUND

It has repeatedly been reported that the risk for cancer in patients with schizophrenia is different from that of the general population, specifically a lower risk for lung cancer despite increased smoking. Confirmation of these associations could lead to hypotheses on shared risk or protective factors, either genetic or environmental.

METHODS

From Finland's National Hospital Discharge and Disability Pension registers, Helsinki, we identified a cohort of 26 996 individuals born between 1940 and 1969 and treated for schizophrenia between 1969 and 1991. They were followed up for cancer from 1971 to 1996 by record linkage with the Finnish Cancer Registry, yielding 446 653 person-years at risk, and standardized incidence ratios (SIRs) were calculated. Likewise, 39 131 parents and 52 976 siblings of the patients with schizophrenia were followed up to explore familial genetic hypotheses on deviations in cancer risk.

RESULTS

In patients with schizophrenia, an increased overall cancer risk was found (724 cases observed vs 619 expected; SIR, 1.17; 95% confidence interval [CI], 1.09-1.25). Half of the excess cases were attributable to lung cancer (SIR, 2.17; 95% CI, 1.78-2.60), and the strongest relative increase in risk was in pharyngeal cancer (SIR, 2.60; 95% CI, 1.25-4.77). Cancer incidence in siblings (SIR, 0.89; 95% CI, 0.83-0.94) and parents (SIR, 0.91; 95% CI, 0.89-0.93) was consistently lower than that in the general population.

CONCLUSION

Although specific lifestyle factors, particularly tobacco smoking and alcohol consumption, probably account for the increased cancer risk in patients with schizophrenia, the decreased risk in relatives would be compatible with a postulated genetic risk factor for schizophrenia offering selective advantage to unaffected relatives.

Targeted use of naltrexone without prior detoxification in the treatment of alcohol dependence: a factorial double-blind, placebo-controlled trial

Several studies have shown the opioid antagonist naltrexone to be effective when combined with psychosocial therapies for the treatment of patients who are dependent on alcohol with fixed medication and time (12 weeks). In this study, 121 nonabstinent outpatients with alcohol dependence (DSM-IV) were treated with sessions of cognitive coping skills (N = 67) or supportive therapy (N = 54) and either naltrexone 50 mg/day (N = 63) or placebo (N = 58) daily for the first 12 weeks and thereafter for 20 weeks only when craving alcohol (i.e., targeted medication) in a prospective one-center, dual, double-blind, randomized clinical trial. The dropout rate for all subjects was 16.5% during the first 12-week period and approximately twice that level by the end of the study. There were no significant group differences in study completion and therapy participation rates. After the continuous medication (12 weeks), the coping/naltrexone group had the best outcome, and coping/placebo had the worst. This difference remained during the targeted medication period (the following 20 weeks). Naltrexone was not better than placebo in the supportive groups, but it had a significant effect in the coping groups: 27% of the coping/naltrexone patients had no relapses to heavy drinking throughout the 32 weeks, compared with only 3% of the coping/placebo patients. The authors' data confirm the original finding of the efficacy of naltrexone in conjunction with coping skills therapy. In addition, their data show that detoxification is not required and that targeted medication taken only when craving occurs is effective in maintaining the reduction in heavy drinking.

Correlates of initiation to cannabis use: a 5-year follow-up of 15-19-year-old adolescents

Initiation to cannabis is often the first step in the use of illicit drugs. We studied the correlates of initiation in a 5-year follow-up study. A total of 21.4% of the subjects reported using cannabis at some time. Of the 139 users, 89.2% had tried cannabis not more than once or a few times. This initiation to cannabis was related to male gender, absence of mother, frequent lack of interest and early age at first sexual intercourse in logistic regression analysis. These factors seem to be useful in predicting initiation to cannabis.

A cross-cultural study of suicide intent in parasuicide patients

As part of the WHO/EURO Multicentre Study on Parasuicide, the level of suicide intent among female and male parasuicide patients from various European regions was compared. From nine regions, a total of 1,212 parasuicide patients, 752 females and 460 males, were included in the study. Although some statistical significant differences in level of suicide intent between the regions and genders were found, the effect sizes of these relationships were so small that the differences have neither theoretical nor practical significance. As far as level of suicide intent is concerned, the WHO study has succeeded in recruiting a relatively homogeneous group of self-harming patients across borders of region, culture, and country.

Suicide mortality in mental retardation:a 35-year follow-up study

OBJECTIVE

We investigated suicide mortality among people with mental retardation (MR) over a period of 35 years.

METHOD

The nationwide, population-based cohort of 2369 people with MR was followed-up from a representative sample of 9.4% of the population in Finland in 1962. The standardized mortality ratio of suicides was calculated and case studies of all MR suicides based on all available data were performed.

RESULTS

Women with MR had an equal suicide risk to Finnish women in general, while men had only one-third of the population risk. Risk factors for suicide were similar to those in the general population. Most suicide victims had mild MR and were hospitalized for comorbid mental disorders. Suicide methods were passive and alcohol was involved in only one case.

CONCLUSION

Suicide mortality in MR is significantly lowered among males. Suicide prevention in MR should be focused on people with comorbid mental disorders. Problems in adjustment to new circumstances need to be recognized. Appropriate and adequate treatment of comorbid depression is emphasized.

The Schizophrenia Suicide Risk Scale (SSRS): development and initial validation

BACKGROUND

Estimations about the lifetime risk of suicide in schizophrenia vary between 4 and 10%. At present, there does not exist a suicide risk scale developed particularly for schizophrenic patients. The aims of the present study were to: (1) develop a clinically useful semi-structured scale for the estimation of short-term suicide risk among schizophrenic patients, and (2) to carry out an initial validation of the scale.

METHODS

A 25-item Schizophrenia Suicide Risk Scale (SSRS) was constructed on the base of the literature. The SSRS scores of 69 living schizophrenic patients (LS group) were compared with the scores of 69 schizophrenic suicides (SS group) whose data had been collected previously from The Finnish nationwide and representative psychological autopsy study. Internal consistency of the SSRS was evaluated with Cronbach alpha. The most important SSRS items predicting suicide were identified with a logistic regression analysis. Sensitivity, specificity, positive predictive value, and negative predictive value of the SSRS in predicting suicide with various cut-off scores were calculated.

RESULTS

In the final logistic regression model, the following SSRS items significantly predicted suicide: suicide plans communicated to someone during the past 3 months; one or more previous suicide attempts; loss of professional skills demanding job; depression observed during an interview; and suicide plans communicated during an interview. With high cut-off scores the specificity of the SSRS became satisfactory, but the sensitivity dropped below 32%. Internal consistency of the anamnestic history of the SSRS was low, which suggests that anamnestic risk factors for suicide in schizophrenia are multifactorial. Internal consistency of the interview-based items was high, and present state risk factors seemed to consist of two separate factors, depression-anxiety and irritability.

CONCLUSIONS

The SSRS may be clinically useful in identifying schizophrenic patients with a particularly high risk for suicide. However, the SSRS seems not to be a practical screening instrument for suicide risk in schizophrenia, and it is probably impossible to construct a suicide risk scale with both high sensitivity and high specificity in this disorder.

Depressive symptoms in middle-aged women are more strongly associated with physical health and social support than with socioeconomic factors

The association of socioeconomic factors, health-related factors, and social support with depressive symptoms has been extensively studied. However, most epidemiological studies have focused on a few factors such as marital status, social class, and employment. In this study of middle-aged women we analyzed both univariate and multivariate associations of socioeconomic factors, perceived physical health factors, and social support with self-rated depressive symptoms measured with the Beck Depression Inventory. A nationwide sample (n = 1851) of Finnish women aged 48-50 years was analyzed. Socioeconomic, health-related, and social support factors were all measured with single items. All variables, except level of urbanization, were significantly associated with depressive symptoms in univariate analyses. Multivariate associations were examined with standard multiple regression analyses in three stages: first with the socioeconomic factors, then with socioeconomic and health factors, and finally entering the social support factors into the regression model. In the first model, being either on a sick leave or at home as working status, being divorced, and having low income reached significance. In the second model, being divorced and having poor perceived physical health were the most powerful among the five significant variables. In the last model, explaining 32% of the variance, the most powerful predictors of depressive symptoms were perceived current physical health, satisfaction with received social support, and quality of intimate relationships. For the prevention or intervention of depressive symptoms among middle-aged women in the population subjects with concurrent subjective or objective health problems and poor social support seem to comprise a particularly important target group.

Excess mortality of suicide attempters

BACKGROUND

Excessive mortality of suicide attempters has emerged from many follow-up studies. Completed suicide is the main cause of excess deaths, but the increased risk of deaths from other unnatural and natural causes is also of major public health concern. We lack follow-up studies of the different causes of death in cohorts of suicide attempters. The present study aimed to determine the mortality by suicide and other causes of death and to investigate risk factors.

METHODS

This mean 5.3-year follow-up study was based on an unselected cohort of suicide attempts by both violent and non-violent methods, treated in hospitals in a well-defined urban catchment area in Helsinki. In total, 2782 patients aged 15 years and over admitted to the emergency rooms after suicide attempt between 1989 and 1996 were included in the follow-up analysis. Standardised mortality ratios (SMR) for suicide, disease, accident, homicide, and undetermined death were calculated.

RESULTS

Mortality from all causes was 15 times higher than that expected among men and nine times higher in women. SMRs in men were 5402 (95% CI 4339-6412) for suicide, 2480 (95% CI 925-4835) for homicide, and 11,139 (95% CI 6884-16,680) for undetermined cause, and for women 7682 (95% CI 5423-9585), 3763 (95% CI 52-5880) and 15,681 (95% CI 6894-22,294), respectively. Fifteen percent of all suicide attempters died during the average 5.3-year follow-up of the index attempt. Deaths from suicide accounted for 37% of all excess deaths in men and 44% in women. The mortality ratio was highest during the 1st follow-up year. The total number of lost years of life among the 413 suicide attempters who died during follow-up was 13,883. The risk factors for all causes of death were male sex, single, retirement, drug overdose as a method, an index attempt not involving alcohol, and a repeated attempt.

CONCLUSION

A suicide attempt indicates a severe risk of premature death, and suicide is the main cause of excess deaths. However, it appears that concentrating efficient treatment only on the most suicidal patients could prevent no more than two of five premature deaths. More effort is therefore needed to prevent the excess mortality of suicide attempters by also addressing causes of death other than suicide.

Predictors of alcohol intake and heavy drinking in early adulthood: a 5-year follow-up of 15-19-year-old Finnish adolescents

Relative contributions of earlier drinking and smoking vs mental health risk factors in predicting alcohol intake and heavy drinking in young adulthood were assessed. Higher average alcohol intake and heavy drinking (13 or more drinks on one occasion) in 1995 were significantly related to male gender and earlier high scores in 1990 of relief smoking, relief drinking, and their interaction. Parental alcohol problems, social group, perceived degree of social support, trait anxiety, number of negative life events, self-esteem, grade-point average, somatic symptoms score, or immature, neurotic, or mature defence style measured in 1990 did not predict alcohol intake or heavy drinking 5 years later. The findings suggest that alcohol intake and heavy drinking in young adulthood can be predicted by earlier self-reports on relief smoking and alcohol intake in adolescence.

Predictors of somatic symptoms: a five year follow up of adolescents

BACKGROUND

Somatisation is common among adolescents.

AIMS

To study factors predicting somatisation later in adulthood.

METHODS

Self report questionnaires were administered at baseline examination in 1990 to students (mean age 16.8 years) in schools, and by mail five years later. Results are based on the 615 subjects with no serious disease or injury at baseline.

RESULTS

Regression analyses showed that in men the level of somatic symptoms in 1995 was significantly predicted by the respective level in 1990 and by relief smoking. In women, the level of somatic symptoms in 1995 was significantly predicted by the respective level in 1990, self esteem, and the number of negative life events in 1990. After exclusion of cases with a long standing disease in 1995, the multivariate results remained materially similar except that self esteem was no longer significant among women.

CONCLUSION

These findings may help in early identification of adolescents with somatisation persisting into early adulthood.

Obstetric risk factors for early-onset schizophrenia in a Finnish birth cohort

OBJECTIVE

Although case-control investigations have shown an association between obstetric complications and schizophrenia, particularly among patients with early onsets, cohort studies have mostly failed to confirm this effect. The authors examined whether a history of fetal hypoxia and other obstetric complications elevated risk for early-onset schizophrenia in a 1955 Helsinki birth cohort.

METHOD

The subjects were 80 randomly selected patients with schizophrenia (36 with early and 44 with later onsets) representative of all available probands in the cohort, 61 of their nonschizophrenic siblings, and 56 demographically matched nonpsychiatric comparison subjects. Psychiatric diagnoses were obtained from structured clinical interviews, and obstetric data were taken from standardized, prospectively ascertained obstetric records. A score for hypoxia-associated obstetric complications was entered into logistic regression models, along with measures of prenatal infection and fetal growth retardation.

RESULTS

Hypoxia-associated obstetric complications significantly increased the odds of early-onset schizophrenia but not of later-onset schizophrenia or unaffected sibling status, after prenatal infection and fetal growth retardation were taken into account.

CONCLUSIONS

These findings support an association between obstetric complications and increased risk for early-onset schizophrenia. The authors advance a model whereby the neurotoxic effects of fetal hypoxia may lead to an early onset of schizophrenia due to premature cortical synaptic pruning.

Genome-wide scan for schizophrenia in the Finnish population: evidence for a locus on chromosome 7q22

We report the results of a four-stage genome-wide scan in a schizophrenia study sample consisting of 134 affected sib-pairs collected in Finland. In stage I we genotyped 370 markers from the Weber 6 screening set ( N = 52 affected sib-pairs); in stage II we followed up 40 markers by typing first-degree relatives of the sib-pairs; in stage III we genotyped 15 markers in 134 families; and in stage IV we genotyped a denser marker map in the two most promising regions, one on chromosome 1 and another on chromosome 7, in all families. Diagnoses were based on three nationwide health care registers and consensus diagnosis based on review of all medical records. The most significant finding was a two-point lod score of 3.18 with marker D7S486 using a dominant model and treating all individuals with either schizophrenia, schizoaffective disorder or other schizophrenia spectrum disorder as affected. Multipoint analysis with MAPMAKER/SIBS resulted in a MLS of 3.53 between markers D7S501 and D7S523 using the broadest diagnostic model, including major depressive disorder and bipolar type I as affecteds in addition to the aforementioned phenotypes. These results were obtained by including in the analyses only individuals from the late settlement region of Finland settled in the 16th century. Additionally, some support was obtained for linkage to chromosome 1, in a region previously identified in a genome-wide scan of a study sample from a sub-isolate of Finland. Our data demonstrate the importance of genealogical information for studies aiming at identification of predisposing loci in complex diseases.

Methods used for parasuicide: results of the WHO/EURO Multicentre Study on Parasuicide

BACKGROUND

National suicide statistics show remarkable differences in the frequencies of various methods used for completed suicide. The WHO/EURO Multicentre Study on Parasuicide makes possible for the first time an international comparison of the frequencies of methods used in attempted suicide, because the data are based on geographical catchment areas of medical institutions.

METHOD

Ongoing standardized monitoring of attempted suicide in all medical institutions serving the catchment areas was performed in 14 centres in 12 European countries. The data analysis is based on 20,649 events involving 15,530 persons, recorded between 1989 and 1993.

RESULTS

The comparison of rates per 100,000 shows striking differences between the centres. The highest rates for drug overdoses were found for female attempters in Oxford (347/100,000), Helsinki (238/100,000) and Stockholm (221/100,000). Guipuzcoa had the lowest rates (61/100,000). The differences were most prominent in the age group 15-24, with outstanding rates for women in Oxford (653/100,000), which was mainly due to the frequent use of analgesics. Szeged had outstandingly high rates for pesticides and solvents. In some centres the use of multiple methods was frequent.

CONCLUSIONS

There is a need, especially for areas with high frequencies for certain methods, to understand the factors involved and to develop new and specific prevention projects and to monitor their effects. The WHO/EURO Multicentre Study on Parasuicide has proved to be a useful and reliable instrument for continuous monitoring of trends in parasuicide.

Factors associated with early dropout from adolescent psychiatric outpatient treatment

OBJECTIVE

To examine background factors, psychopathology, and psychosocial impairment among adolescents complying with or dropping out early from outpatient psychiatric treatment.

METHOD

Family background, psychiatric history, and other data were collected prospectively on 143 male and 154 female outpatients aged 12 to 22 years. DSM-II-R psychiatric diagnoses were assessed at the end of treatment.

RESULTS

Fifty-three adolescents (17.8%) attended 1 or 2 treatment appointments, and 33 of them (11.1% of 297) then dropped out; 50.5% of the total attended 3 to 13, and 31.6% attended 14 or more appointments. Low parental socioeconomic status was more common among the early dropouts than the other patient groups (88%, 69%, 63%, respectively). The early dropouts had had more problems with the law than the adolescents attending 14 or more appointments (18%, 6%), but less suicidal behavior (24%, 56%, respectively). Among the early dropouts, mood disorders were less common (21%, 49%), especially major depression (0%, 20%), and substance abuse was more common (9%, 0%) than among patients attending 14 or more appointments.

CONCLUSIONS

Low parental socioeconomic status, not having mood disorder, not having psychotropic medication, and having substance abuse were associated with early dropout of adolescents from outpatient psychiatric treatment.

Is it possible to adapt to the suicide of a close individual? Results of a 10-year prospective follow-up study

We conducted a prospective ten-year follow-up study on the consequences of a suicide among relatives or other individuals close to the suicide victim. Baseline interviews (n = 104) were carried out during the National Suicide Prevention Project in Finland from 1987 to 1988. Semi-structured follow-up interviews including the 12-item General Health Questionnaire and the 21-item Beck Depression Inventory were carried out ten years later (n = 64, 64% of those still alive). Mental symptoms were reported to have been common after suicide but they had subsided during three years. Mental symptoms had been common especially among children after their parent's suicide. At baseline mothers had had depressive symptoms more often than others, but at follow-up there was no statistical difference. Life changes associated with the suicide were common, and they could be unfavourable as well as favourable. At the time of the follow-up study, half of the interviewees felt that baseline interviews had helped them to adjust to the suicide.

Bright light improves vitality and alleviates distress in healthy people

BACKGROUND

The relative shortage of light during the decreasing photoperiod may compromise well-being. Earlier studies suggest that bright-light exposure may be of help to alleviate winter-bound symptoms.

METHODS

We carried out a field study with exposure to bright light on office employees during winter.

RESULTS

Repeated bright-light exposure improved vitality and reduced depressive symptoms. The benefit was observed not only in healthy subjects with season-dependent symptoms but also in those not having the seasonal variation.

CONCLUSIONS

Bright-light exposure during winter appears to be effective at improving the health-related quality of life and alleviating distress in healthy subjects.

CLINICAL IMPLICATIONS

Administration of bright light is a useful option to improve vitality and mood among subjects working indoors in wintertime. LIMITATIONS OF STUDY: Our field setting used self-reports, not interviews, for the assessment of outcome.

Tyrosine hydroxylase polymorphism and phenotypic heterogeneity in bipolar affective disorder: a multicenter association study

Tyrosine hydroxylase (TH), the rate-limiting enzyme in the metabolism of catecholamines, is considered a candidate gene in bipolar affective disorder (BPAD) and has been the subject of numerous linkage and association studies. Taken together, most results do not support a major gene effect for the TH gene in BPAD. Genetic and phenotypic heterogeneity may partially explain the difficulty of confirming the exact role of this gene using both association and linkage methods. Four hundred one BPAD patients and 401 unrelated matched controls were recruited within a European collaborative project (BIOMED1 project in the area of brain research, European Community grant number CT 92-1217, project leader: J. Mendlewicz) involving 14 centers for a case-control association study with a tetranucleotide polymorphism in the TH gene. Patients and controls were carefully matched for geographical origin. Phenotypic heterogeneity was considered and subgroup analyses were performed with relevant variables: age at onset, family history, and diagnostic stability. No association was observed in the total sample or for subgroups according to age at onset (n = 172), family history alone (n = 159), or high degree of diagnostic stability and a positive family history (n = 131). The results of this association study do not confirm the possible implication of TH polymorphism in the susceptibility to BPAD.

Suicide risk in schizophrenia: an analysis of 17 consecutive suicides

The aim of this study was to investigate interactional factors related to the recognition of suicide risk in patients with schizophrenia. The study focused on 17 schizophrenia patients who had committed suicide during the National Suicide Prevention Project in Finland between April 1, 1987, and March 31, 1988, in the province of Kuopio. Consensus case reports were assembled by using the psychological autopsy method. Study methods included structured and in-depth interviews of next of kin and interviews of health care or social services workers who had treated the suicide victims. Male and female patients with schizophrenia committed suicide in equal proportions. Most had suffered from schizophrenia for more than 15 years; all but one had been receiving psychiatric treatment at the time of suicide. Retrospective assessment indicated that 59 percent of the patients were clinically depressed at the time of suicide. In 76 percent of the cases, the mental health professionals involved in treatment had not believed that there was a risk of suicide during their last contact with the patient. In 29 percent of the cases, the patient's paranoid ideas concerning treatment personnel had increased. Patients' withdrawal from human relationships because of depression was related to loss of the treatment professionals' concern for the patients. The findings in this descriptive study suggest that withdrawal by a patient with schizophrenia and an increase in the patient's paranoid behavior should be regarded as signals of risk of suicide.

Association of low serum total cholesterol with major depression and suicide

BACKGROUND

It has been suggested that low serum total cholesterol is associated with an increased risk of suicide.

AIMS

To study the association between serum total cholesterol, depression and suicide using versatile, prospective data.

METHOD

A total of 29,133 men aged 50-69 years were followed up for 5-8 years. Baseline blood samples were analysed for serum total and high-density lipoprotein cholesterol concentrations. Self-reported depression was recorded, data on hospital treatments due to depressive disorders were derived from the National Hospital Discharge Register and deaths from suicide were identified from death certificates.

RESULTS

Low serum total cholesterol was associated with low mood and subsequently a heightened risk of hospital treatment due to major depressive disorder and of death from suicide.

CONCLUSIONS

Our results suggest that low serum total cholesterol appears to be associated with low mood and thus to predict its serious consequences.

Treatment of mental disorders in seven physicians committing suicide

Through psychological autopsy seven cases of physician suicide were studied. All seven victims received a diagnosis of current mood disorder, two of them bipolar disorder. Five had suffered a disabling physical condition. None of the victims had had adequate treatment with antidepressant or mood-stabilizing drugs, nor had they been in psychotherapy. Current adequate treatment for depression seems to be as rare among physician victims as among suicides with major depressive disorders in the population.

Association between prenatal exposure to poliovirus infection and adult schizophrenia

OBJECTIVE

The authors' goal was to determine whether there is an association between prenatal exposure to poliovirus infection and later development of schizophrenia.

METHOD

All Finnish patients born between 1951 and 1969 with discharge diagnoses of schizophrenia (N = 13,559) were identified from the Finnish Hospital Discharge Register. Information on the monthly number of cases of paralytic poliomyelitis was obtained for each province in Finland. The authors analyzed the incidence of births of individuals who later developed schizophrenia by using a Poisson regression model with year and place of birth, age, sex, season of birth, and smoothed incidence of poliomyelitis in different gestational periods as explanatory variables.

RESULTS

An association between the incidence of poliomyelitis and the incidence of births 5 months later of individuals who later developed schizophrenia was observed. Without controlling for seasonality, the effect was significant throughout the second trimester.

CONCLUSIONS

Second-trimester exposure to poliovirus infection may increase the risk for the later development of schizophrenia.

Prevention of poststroke depression: 1 year randomised placebo controlled double blind trial of mianserin with 6 month follow up after therapy

OBJECTIVES

(1) To test whether early prophylactic antidepressive treatment by mianserin is able to prevent poststroke depression, and (2) to discover whether mianserin as an antidepressant has any beneficial influence on the outcome of ischaemic stroke.

METHODS

A randomised, double blind, placebo controlled study involved 100 consecutive patients under 71 years old admitted to hospital for an acute ischaemic stroke; they were enrolled to receive 60 mg/day mianserin or placebo for 1 year. They were examined on admission, and at 2, 6, 12, and 18 months with depression, stroke, and functional outcome scales.

RESULTS

According to DSM-III-R, the prevalence of major depression was 6% at the initial stage, 11% at 1 year, and 16% at 18 months. At no time point did prevalences differ between the treatment groups, nor were differences found in depression scales, although at 2 months a greater improvement from initial assessment on the Hamilton depression scale was evident in patients on mianserin (p=0.05). Some beneficial changes on the Hamilton depression scale and Beck depression inventory were found in patients older than 56 (median age) and in men treated with mianserin, but not in other subgroups. Mianserin treatment did not affect stroke outcome as measured by neurological status, nor did it have any influence on functional outcome as measured by Rankin scale or Barthel index.

CONCLUSION

It was not possible to show that early initiation of antidepressant therapy can prevent poststroke depression, because the prevalence of poststroke depression remained low even in patients on placebo. In this stroke population with a low rate of depressive patients, antidepressive medical treatment failed to affect stroke outcome.