DSM-IV mood-, anxiety- and alcohol use disorders and their comorbidity in the Finnish general population--results from the Health 2000 Study

Clock genes in human alcohol abuse and comorbid conditions

Alcohol-use disorders are often comorbid conditions with mood and anxiety disorders. Clinical studies have demonstrated that there are abnormalities in circadian rhythms and clocks in patients with alcohol-use disorders. Circadian clock gene variants are therefore a fruitful target of interest. Concerning alcohol use, the current findings give support, but are preliminary to, the associations of ARNTL (BMAL1) rs6486120 with alcohol consumption, ARNTL2 rs7958822 and ARNTL2 rs4964057 with alcohol abuse, and PER1 rs3027172 and PER2 rs56013859 with alcohol dependence. Furthermore, it is of interest that CLOCK rs2412646 and CLOCK rs11240 associate with alcohol-use disorders only if comorbid with depressive disorders. The mechanistic basis of these associations and the intracellular actions for the encoded proteins in question remain to be elucidated in order to have the first insight of the potential small-molecule options for treatment of alcohol-use disorders.

Treatment received and treatment adequacy of depressive disorders among young adults in Finland

BACKGROUND

Under-treated depression may be especially harmful in early adulthood. The aims of this study are to describe treatments received for depressive disorders, to define factors associated with treatment adequacy and dropouts from treatment in a Finnish general population sample of young adults.

METHODS

A nationally representative two-stage cluster sample of 1894 Finns aged 19 to 34 years was sent a questionnaire containing several mental health screens. All screen positives and a random sample of screen negatives were invited to participate in a mental health assessment including a SCID interview. Case records from mental health treatments for the same sample were obtained for the final diagnostic assessment. Based on all available information, receiving antidepressant pharmacotherapy for at least two months with at least four visits with any type of physician or at least eight sessions of psychotherapy within 12 months or at least four days of hospitalization were regarded as minimally adequate treatment. Treatment dropout was rated if the treatment strategy was assessed to be adequate according to the case records but the patient discontinued the visits.

RESULTS

Of participants with depressive disorders (n = 142), 40.9% received minimally adequate treatment. In multiple logistic regression models, substance use disorder and female gender were associated with at least one visit with a physician, while having major depressive disorder was associated with visits with a physician at least 4 times a year. Women had higher odds of having received any psychotherapy and psychotherapy lasting for at least 8 sessions in a year. Low education and a history of suicide attempt were associated with increased odds of treatment dropout. None of the factors explained the final outcome of minimally adequate treatment.

CONCLUSIONS

Treatment adequacy in the present study was better than previously seen, but more efforts are needed to provide adequate treatment for young adults, especially those with low education and suicidality.

Reasons and determinants of help-seeking in people with a subclinical depression

BACKGROUND

Subclinical depression is common. Although interventions have proven to be effective, participation rates are low. This study first aimed to get more insight in help-seeking and reasons for (not) seeking care. The second aim was to identify characteristics that distinguish people who receive help, those with an unmet need, or no perceived need for care.

METHODS

Respondents with a subclinical depression (n=162) were recruited from the general population. They were eligible for participation if they were aged 18 years or older, scored 20 or higher on the K10 screening instrument for depression, and did not meet the criteria for major depression.

RESULTS

Of all participants, 27% received help, 33% had an unmet need, and 40% had no perceived need for care. Participants with no perceived need reported not to experience symptoms, were able to solve problems on their own, and could mobilize their own support. They were characterized by lower scores on neuroticism and an older age than those who received care.

LIMITATIONS

The response rate in this study was relatively low which may have caused a selection bias.

CONCLUSION

Not all people with subclinical depression may need help for their symptoms, some are able to deal with problems on their own. However, others experience a need for care but do not receive any. Gaining insight into potential barriers for help seeking and receiving in people with an unmet need is important so appropriate measures can be taken to ensure that those who need care get the help they want.

Prevalence of and potential influencing factors for alcohol dependence in Europe

Alcohol use disorders (AUDs), and alcohol dependence (AD) in particular, are prevalent and associated with a large burden of disability and mortality. The aim of this study was to estimate prevalence of AD in the European Union (EU), Iceland, Norway, and Switzerland for the year 2010, and to investigate potential influencing factors. The 1-year prevalence of AD in the EU was estimated at 3.4% among people 18-64 years of age in Europe (women 1.7%, men 5.2%), resulting in close to 11 million affected people. Taking into account all people of all ages, AD, abuse and harmful use resulted in an estimate of 23 million affected people. Prevalence of AD varied widely between European countries, and was significantly impacted by drinking cultures and social norms. Correlations with level of drinking and other drinking variables and with major known outcomes of heavy drinking, such as liver cirrhosis or injury, were moderate. These results suggest a need to rethink the definition of AUDs.

Health-care climate, perceived self-care competence, and glycemic control among patients with type 2 diabetes in primary care

This study showed, in line with self-determination theory, that glycemic control among patients with type 2 diabetes (n = 2866) was strongly associated with perceived self-care competence, which in turn was associated with autonomous motivation and autonomy-supportive health-care climate. These associations remained after adjusting for the effect of important life-context factors. Autonomous motivation partially mediated the effect of health-care climate on perceived competence, which fully mediated the effect of autonomous motivation on glycemic control. The results of the study emphasize health-care personnel's important role in supporting patients' autonomous motivation and perceived self-care competence.

Childhood Traumatic Experiences, Anxiety, and Depression Levels in Fibromyalgia and Rheumatoid Arthritis

INTRODUCTION

The close relationship between chronic pain, anxiety, depression, and childhood traumatic experiences is well known. The aim of this study is to investigate childhood traumatic experiences, anxiety, and depression levels in patients with fibromyalgia and rheumatoid arthritis, which are diseases that cause chronic pain.

METHOD

A total of 30 patients with fibromyalgia, 30 patients with rheumatoid arthritis, and 30 healthy controls, matched with patients with respect to gender, age, and education, were included in the study (90 participants in total). All participants were given a form for sociodemographic characteristics, the Childhood Trauma Questionnaire (CTQ), and Hospital Anxiety and Depression Scale (HAD). Patients were also asked to complete a numeric pain scale (NPS).

RESULTS

Patients with fibromyalgia reported significantly higher scores for CTQ emotional abuse and HAD depression compared with healthy controls. Patients with fibromyalgia reported significantly higher scores for HAD anxiety than both healthy controls and patients with rheumatoid arthritis. Patients with rheumatoid arthritis reported significantly higher scores for CTQ emotional abuse and HAD depression compared with healthy controls. Pain scores of patients with fibromyalgia were higher than in patients with rheumatoid arthritis. Participants who had scores over the threshold on HAD anxiety and depression had significantly higher scores on CTQ sexual abuse.

CONCLUSION

Both patients with fibromyalgia and patients with rheumatoid arthritis have high levels of childhood traumatic experiences and depression. Patients with pain-related disorders should be examined for childhood traumatic experiences, anxiety, and depression for better treatment outcomes.

The regional distribution of anxiety disorders: implications for the Global Burden of Disease Study, 2010

Anxiety disorders are increasingly acknowledged as a global health issue however an accurate picture of prevalence across populations is lacking. Empirical data are incomplete and inconsistent so alternate means of estimating prevalence are required to inform estimates for the new Global Burden of Disease Study 2010. We used a Bayesian meta-regression approach which included empirical epidemiological data, expert prior information, study covariates and population characteristics. Reported are global and regional point prevalence for anxiety disorders in 2010. Point prevalence of anxiety disorders differed by up to three-fold across world regions, ranging between 2.1% (1.8-2.5%) in East Asia and 6.1% (5.1-7.4%) in North Africa/Middle East. Anxiety was more common in Latin America; high income regions; and regions with a history of recent conflict. There was considerable uncertainty around estimates, particularly for regions where no data were available. Future research is required to examine whether variations in regional distributions of anxiety disorders are substantive differences or an artefact of cultural or methodological differences. This is a particular imperative where anxiety is consistently reported to be less common, and where it appears to be elevated, but uncertainty prevents the reporting of conclusive estimates.

Alcohol consumption among the over 50s: international comparisons

AIM

Research exploring alcohol consumption patterns and behaviour change among older adults is relatively scarce, often necessitating reliance on international evidence. To understand the degree to which findings may be generalizable across countries, this review compares recent epidemiological evidence from developed countries on the prevalence of abstention and potentially problematic alcohol consumption in older adults.

METHODS

Medline, EMBASE, Web of Science and PsychInfo were searched for English language publications, identifying 21 peer-reviewed publications and six reports, including data from 17 national surveys and 10 general practice and community samples published since 2000.

RESULTS

Of the developed countries for which data are available on adults aged over 50 years, rates of past 12-month abstention and former drinking are lowest in England and Finland, and highest in Korea and the USA. The prevalence of binge drinking varies widely between studies, whilst rates of alcohol dependence are broadly similar.

CONCLUSIONS

Older adults in developed countries report different rates of abstention and alcohol consumption. This places obvious limitations on the extrapolation of results from specific research findings and policy strategies to other countries.

Difference in diet between a general population national representative sample and individuals with alcohol use disorders, but not individuals with depressive or anxiety disorders

BACKGROUND

Mental disorders influence diet and food consumption, but there is a lack of consistent findings.

AIMS

To investigate food consumption, nutrient intakes and serum metabolic biomarkers in depressive, anxiety and alcohol use disorders in comparison with the remaining from a population-based nationwide sample.

METHODS

The study was based on the Health 2000 Survey data of which 5504 subjects aged 30 and over (3009 women and 2495 men) were used for the analysis. Depressive disorder, anxiety disorders and alcohol use disorders were diagnosed using the Composite International Diagnostic Interview (M-CIDI). The consumption of food and beverage items, and nutrient intakes were measured with a validated food frequency questionnaire, and the concentrations of biomarkers were determined in blood samples.

RESULTS

Overall, no similar differences with both genders were found in the intakes of energy, dietary fibre or macronutrients or in biomarkers in depressive or anxiety disorders. Women suffering from depressed disorder consumed more soft drinks (P = 0.034) and women suffering from anxiety disorders consumed more oils (P = 0.001), polyunsaturated fatty acids (P = 0.001) and less potatoes (P = 0.002) than the remaining participants. Men suffering from depressive disorder consumed less sweets and chocolate (P = 0.001) and men with anxiety disorder consumed more tea (P = 0.033) compared with the remaining participants. In alcohol use disorders, the intake of carbohydrate was lower in both genders (P = 0.001 for women, P = 0.001 for men).

CONCLUSIONS

A difference in the usual diet exists between individuals with alcohol use disorders and the remaining participants on a population level. No consistent difference in both genders between those with depressive or anxiety disorders and the remaining was found.

Mental and somatic health and pre- and post-migration factors among older Somali refugees in Finland

Mental and somatic health was compared between older Somali refugees and their pair-matched Finnish natives, and the role of pre-migration trauma and post-migration stressors among the refugees. One hundred and twenty-eight Somalis between 50-80 years of age were selected from the Somali older adult population living in the Helsinki area (N = 307). Participants were matched with native Finns by gender, age, education, and civic status. The BDI-21 was used for depressive symptoms, the GHQ-12 for psychological distress, and the HRQoL was used for health-related quality of life. Standard instruments were used for sleeping difficulties, somatic symptoms and somatization, hypochondria, and self-rated health. Clinically significant differences in psychological distress, depressive symptoms, sleeping difficulties, self-rated health status, subjective quality of life, and functional capacity were found between the Somali and Finnish groups. In each case, the Somalis fared worse than the Finns. No significant differences in somatization were found between the two groups. Exposure to traumatic events prior to immigrating to Finland was associated with higher levels of mental distress, as well as poorer health status, health-related quality of life, and subjective quality of life among Somalis. Refugee-related traumatic experiences may constitute a long lasting mental health burden among older adults. Health care professionals in host countries must take into account these realities while planning for the care of refugee populations.

Depressive Symptoms and Their Psychosocial Correlates Among Older Somali Refugees and Native Finns

In this study, we analyzed the manifestation of somatic-affective and cognitive depressive symptoms among older Somali refugees and native Finns. Second, we explored how depressive symptoms, alexithymia, and somatization are associated in the two groups. Finally, we analyzed how two psychosocial factors, sense of coherence (SOC) and social support, are connected to depressive symptoms among Somalis and Finns. The participants were examined with the Beck Depression Inventory (BDI) for depressive symptoms, the Symptom Checklist–90–Revised (SCL-90-R) for somatization, Toronto Alexithymia Scale (TAS-20) for alexithymia, and the Sense of Coherence (SOC-13) concept for SOC. Social support was indicated by help received from social networks and marital status. Results showed that Somalis manifested more somatic-affective symptoms of depression than Finns, whereas Finns manifested more cognitive symptoms than Somalis. The association between depressive symptoms and alexithymia was stronger in the Finnish group, whereas the association between depressive symptoms and somatization was stronger in the Somali group. The association between alexithymia and somatization did not differ between the groups. A weak SOC explained depressive symptoms among Somalis and Finns, but poor social support did not explain depression in either group. The results are discussed in relation to Somali and Finnish cultures, mental health beliefs, and immigrant populations.

Prevalence of anxiety disorders among Finnish primary care high utilizers and validation of Finnish translation of GAD-7 and GAD-2 screening tools

OBJECTIVE

To analyse the prevalence of GAD and other anxiety disorders, as well as sensitivity and specificity of GAD-7 among high utilizers of health care.

SETTING

Four municipal health centres in Northern Finland.

SUBJECTS

A psychiatric interview was conducted for 150 high utilizers of health care.

MAIN OUTCOME MEASURES

Prevalence of GAD as well as sensitivity and specificity of GAD-7.

RESULTS

The prevalence of GAD was 4% in this study group of Finnish high utilizers of health care. The sensitivity of GAD-7 was 100.0% (95% CI 54.1-100.0) and the specificity of GAD-7 was 82.6% (95% CI 75.4-88.4) with a cut-off point of 7 or more.

CONCLUSION

GAD is rather common among high utilizers of primary care, although the prevalence of 4% is lower than that previously reported. GAD-7 is a valid and useful tool for detecting GAD among primary health care patients.

Five-year outcome of major depressive disorder in primary health care

BACKGROUND

Primary health care provides treatment for most patients with depression. Despite their importance for organizing services, long-term course of depression and risk factors for poor outcome in primary care are not well known.

METHOD

In the Vantaa Primary Care Depression Study, a stratified random sample of 1119 patients representing primary care patients in a Finnish city was screened for depression with the Primary Care Evaluation of Mental Disorders. SCID-I/P and SCID-II interviews were used to diagnose Axis I and II disorders. The 137 patients with DSM-IV depressive disorder were prospectively followed up at 3, 6, 18 and 60 months. Altogether, 82% of patients completed the 5-year follow-up, including 102 patients with a research diagnosis of major depressive disorder (MDD) at baseline. Duration of the index episode, recurrences, time spent in major depressive episodes (MDEs) and partial or full remission were examined with a life-chart.

RESULTS

Of the MDD patients, 70% reached full remission, in a median time of 20 months. One-third had at least one recurrence. The patients spent 34% of the follow-up time in MDEs, 24% in partial remission and 42% in full remission. Baseline severity of depression and substance use co-morbidity predicted time spent in MDEs.

CONCLUSIONS

This prospective, naturalistic, long-term study of a representative cohort of primary care patients with depression indicated slow or incomplete recovery and a commonly recurrent course, which need to be taken into account when developing primary care services. Severity of depressive symptoms and substance use co-morbidity should be systematically evaluated in planning treatment.

Do depressive symptoms have an impact on the effectiveness of lifestyle counseling in prevention of type 2 diabetes? One-year follow-up of FIN-D2D

AIM

To examine whether depressive symptoms are associated with the effectiveness of lifestyle counseling on cardio-metabolic risk profile and glucose homeostasis during one-year follow-up in individuals at high risk for type 2 diabetes (T2D).

METHODS

A total of 10,149 individuals took part in the implementation project of the national diabetes prevention program (FIN-D2D) conducted in primary health care setting in Finland. At baseline, altogether 2798 non-diabetic individuals participated in the one-year follow-up, and 2275 of them had at least one group or individual counseling visit.

RESULTS

4.0% of the individuals (n=78) had depressive symptoms, while 96.0% (n=1889) were free of depressive symptoms at baseline. Individuals who had depressive symptoms had higher body mass index and waist circumference at baseline than individuals without depressive symptoms. In terms of changes in cardio-metabolic risk profile and glucose homeostasis the effectiveness of lifestyle counseling was parallel between individuals with and without depressive symptoms during the one-year follow-up.

CONCLUSIONS

Effectiveness of lifestyle counseling did not differ between individuals with and without depressive symptoms. Individuals with depressive symptoms should not be excluded from lifestyle intervention programs.

Prevalence and correlates of eating disorders among young adults in Finland

BACKGROUND

This study investigated the epidemiology of eating disorders in a population-based sample of young adults.

METHOD

A mental health questionnaire was sent to a nationally representative two-stage cluster sample of 1863 Finns aged 20-35 years. All screen-positives and a random sample of screen-negatives were invited to participate in a Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) interview. Case records from all lifetime mental health treatments were also obtained and were used to complement the diagnostic assessment.

RESULTS

The lifetime prevalence of anorexia nervosa, bulimia nervosa, eating disorder not otherwise specified and any eating disorder among women were 2.1%, 2.3%, 2.0% and 6.0%, respectively, while there was only one man with an eating disorder. Unlike other mental disorders, they are associated with high education. Of women diagnosed with lifetime eating disorder, 67.9% had at least one comorbid Axis I psychiatric disorder, most commonly depressive disorder. While 79.3% of women with lifetime eating disorder had had a treatment contact, only one third of persons with current eating disorder had a current treatment contact. Women whose eating disorder had remitted still experienced more psychological distress and had lower psychosocial functioning that women without lifetime Axis I disorders.

CONCLUSION

Eating disorders are the fourth largest group of mental disorders among young women. They tend to be comorbid, often remain untreated and are associated with residual symptoms after the remission of eating disorder symptoms.

Excess mortality after disability retirement due to mental disorders: variations by socio-demographic factors and causes of death

PURPOSE

Mental disorders are the key causes of disability retirement and are associated with a high risk of mortality. Social variations in excess mortality after disability retirement are nevertheless poorly understood. We examined socio-demographic differences in all-cause and cause-specific mortality after disability retirement due to depression and other mental disorders.

METHODS

The data comprised a nationally representative sample of the Finnish population aged 25-64 in 1996 with no prior disability retirement due to mental disorders (N = 392,985). We used Cox regression analysis with disability retirement due to mental disorders as a time-varying covariate and mortality between 1997 and 2007 as the outcome variable.

RESULTS

We found excess mortality after disability retirement due to mental disorders as compared to those with no such retirement in all specific causes of death, in particular alcohol-related causes, suicide, and other unnatural causes. Excess suicide mortality was particularly large after depression-based disability retirement. Younger age groups, non-manual classes, and those living with a partner and children had largest excess mortality, especially from unnatural and alcohol-related causes. However, the absolute number of excess deaths was not always largest in these socio-demographic groups.

CONCLUSIONS

In young adulthood, disability retirement due to depression signifies severe health and other social disadvantages that lead to particularly large excess mortality, especially due to unnatural causes. The protective effects of a high socioeconomic position and family ties against unnatural and alcohol-related deaths are limited among those who have already developed depression or other mental disorders that have led to disability retirement.

Is income inequality 'toxic for mental health'? An ecological study on municipal level risk factors for depression

Most inequality research on the relationship between inequality and mental health has focused on cross-country variation. Findings from within-country data are mixed. We examined whether changes in municipal Gini index or in the share of people living in relative poverty were linked to changes in the use of antidepressants in several Finnish municipalities between 1995 and 2010. We found that more young adult females used antidepressants in municipalities where relative poverty had increased. Changes in municipal-level Gini index were not positively associated with changes in the use of antidepressants in the municipalities between 1995 and 2010. However, fewer elderly females used antidepressants in municipalities where the Gini index increased. In addition, more young adults used antidepressants in municipalities where the number of those not being educated or trained had also increased. An increase in the number of persons over 65 years of age living alone was positively associated with an increase in the use of antidepressants among elderly females.

Does hospital admission risk for depression vary across social groups? A population-based register study of 231,629 middle-aged Finns

PURPOSE

Evidence on social differentials in depression outcomes remains inconsistent. We assess social predictors of psychiatric admission for depression in a community setting.

METHODS

A register-based 14% sample of community-dwelling Finns aged 40-64 at the end of 1997 was assessed for depression and psychiatric comorbidity, using register data on psychiatric hospital care and medication purchases in 1996-1997. Those with inpatient treatment for unipolar depression (n = 846), those with antidepressant treatment (n = 8,754), and those with neither (n = 222,029) were followed for psychiatric admission with a diagnosis of unipolar depression in 1998-2003. Differentials in admission rates by socioeconomic position, employment status, and living arrangements were studied using Cox proportional hazards modelling.

RESULTS

Among those with prior inpatient or antidepressant treatment, the material aspects of socioeconomic position increased admission risk for depression by 20-40%, even after controlling for baseline depression severity and psychiatric comorbidities, whereas education and occupational social class were unrelated to admission risk. Among inpatients, also having no partner, and among antidepressant users, being previously married and living without co-resident children increased admission risk. However, among inpatients few excess risks reached statistical significance. Among those with no inpatient or antidepressant treatment, all measures of low social position and not living with a partner predicted admission, and the factors had more predictive power in admission than among those with prior treatment.

CONCLUSIONS

Further studies should disentangle the mechanisms behind the higher admission risk among those with fewer economic resources and no co-resident partner.

Psychometric evaluation and normative data of the Swedish version of the 10-item perceived stress scale

The perceived stress scale (PSS) has been translated to several languages and validated in many cultures. The longer 14-item version (PSS-14), has been translated to Swedish and validated for Swedish use. However, the Swedish version of the shorter 10-item version (PSS-10) has not been validated before. Therefore, the aim of this study was to evaluate the Swedish version of the PSS-10 with regard to reliability and validity, and to provide normative data. Data from 3,406 individuals who took part in the Västerbotten Environmental Health Study in Sweden were used. The respondents constitute a random sample, aged 18 to 79 years, and stratified for age and sex. They responded to the Swedish version of the PSS-10 as well as to the hospital anxiety and depression scale, and the Shirom Melamed burnout questionnaire for assessment of construct validity. The results show that the PSS-10 provides approximately normally distributed data, has good internal reliability (Cronbach's alpha 0.84), and has good construct validity with anxiety (r = 0.68), depression (r = 0.57), and mental/physical exhaustion (r = 0.71). The favorable psychometric properties of the Swedish version of the PSS-10 suggest use of the instrument for assessing perceived stress in Swedish and similar populations.

Reactions to acute psychotic symptoms in a rural community

BACKGROUND

Recognition of psychotic disorders constitutes a challenge to the population and health and social care.

AIM

To evaluate the reactions of the general population, professionals in the health and social services, and local politicians in light of the symptoms of a patient evincing acute psychotic mental symptoms.

MATERIAL AND METHODS

A postal questionnaire study was conducted in the rural Suupohja area in Finland. Three target groups: a randomized sample of residents aged 15-84 years (n = 1200), local social and healthcare personnel (n = 463) and politicians (n = 148) responded to alternatives in identifying the need and urgency of treatment.

RESULTS

Seventy-six per cent of residents, 85% of politicians and 87% of health and social employees recognized that the patient was in need of urgent support and treatment. A significant positive association was found in the resident cohort between recognizing urgent need for support and female gender. Forty-eight per cent of inhabitants, 69% of social and healthcare staff, and 65% of politicians estimated that appropriate care and access to care would be obtained in the acute outpatient care of the health centre.

CONCLUSION

Almost one quarter of residents were not aware of the patient's urgent need for acute mental healthcare. It is a challenge to promote the knowledge and sensitivity of the population in recognizing mental and psychotic symptoms. Also appropriate information is called for regarding local services and how to access the care.

Factors associated with needs of users with severe mental disorders

For persons suffering from severe mental disorders (SMD), better quantification of needs may facilitate services planning and evaluation, as well as patient recovery. This study aimed to assess associations of sociodemographic, socioeconomic, service utilization, life events, social support and clinical variables with the level of perceived needs of users with SMD globally and according to their factorial structure. A total of 351 adults with SMD from Montreal (Canada) were interviewed using the Montreal Assessment of Needs Questionnaire and seven other standardized instruments. Clinical records were also consulted. Eight variables were associated with levels of needs. Four factors were extracted from the factor analysis and labeled respectively: Helplessness, Social Integration, Functional Skills and Interpersonal Relationships. Models built from needs assessment factors are stronger than global needs and have a greater association with pertinent variables. Linear regression models based on factors show the importance of satisfaction with life domains and substance abuse in association with higher levels of perceived needs. The recognition of variables associated with each factor would optimize care planning and implementation.

Social anxiety in parents of high-functioning children with autism and Asperger syndrome

We evaluated social anxiety (SA) symptoms in parents of children with autism spectrum disorders (ASDs; N = 131) and community parents (N = 597) using the Social Phobia and Anxiety Inventory (SPAI). SA was significantly more common in ASD than control mothers (15.6 vs. 6.7 %) and more equal between the ASD and control fathers (3.3 vs. 4.8 %). The ASD mothers scored significantly higher than control mothers on all SPAI scales. ASD fathers scored significantly higher than control fathers on the somatic, cognitive, avoidance and agoraphobic symptoms of SA. It is of clinical import to support ASD parents' well-being as their psychiatric features may contribute greatly to their children's emotional development and the well-being of the whole family.

Depressive symptoms, major depressive episodes and cognitive test performance-what is the role of physical activity?

BACKGROUND

Positive associations between physical activity and cognitive test performance in depressed subjects have been proposed in clinical studies. The contribution of severity and recency of depressive symptoms at the population level is not known.

AIMS

This study aims to examine whether regular physical activity associates with better verbal fluency and psychomotor speed in depressed subjects using a large population-based sample.

METHODS

Data was obtained from the population-based Finnish Health 2000 Study, gathered in 2000-2001. Depressive symptoms and depressive disorders were assessed by the Beck Depression Inventory (BDI) and the Composite International Diagnostic Interview (CIDI), correspondingly. Cognitive test performance was assessed by the animal naming test and psychomotor speed with a simple and multi-choice reaction time test. Physical activity (Gothenburg scale) was self-reported. Complete data were obtained from 3658 subjects aged 30-64 years. Socio-demographic factors, health behaviours and use of antidepressants and anxiolytics were used as covariates in the linear regression models. Adjusted means were calculated using the predictive margins method.

RESULTS

Regular physical activity associated with better performance in reaction time tests and better verbal fluency among men with depressive symptoms or with a major depressive episode. Physical activity also associated with cognitive test performance among non-depressed men and women, but among them the differences between the physical activity groups were smaller.

CONCLUSION

Regular physical activity may be a useful tool in supporting neurocognitive functioning among depressed subjects.

Prospective study of risk factors for suicidal behavior in individuals with anxiety disorders

BACKGROUND

Anxiety disorders are very common and increase risk for suicide attempts. Little is known about predictors of increased risk specifically among individuals with anxiety disorders. The purpose of this study was to investigate whether specific anxiety disorders and other co-morbid psychiatric disorders, physical health, or work or social functioning increased the future likelihood of a suicide attempts among individuals with anxiety disorders. Method In this prospective study, 676 individuals with an anxiety disorder were followed for an average of 12 years.

RESULTS

As hypothesized, we found that post-traumatic stress disorder, major depressive disorder (MDD), intermittent depressive disorder (IDD), epilepsy, pain, and poor work and social functioning all predicted a shorter time to a suicide attempt in univariate analyses. In multivariate analyses, baseline MDD and IDD were independent predictors of time to suicide attempt, even when controlling for a past history of suicide attempt. No specific anxiety disorder was an independent predictor of time to attempt in this anxiety-disordered sample. Adding baseline physical health variables and social functioning did not improve the ability of the model to predict time to suicide attempt.

CONCLUSIONS

Mood disorders and past history of suicide attempts are the most powerful predictors of a future suicide attempt in this sample of individuals, all of whom have an anxiety disorder.

Alcohol-related deaths and social factors in depression mortality: a register-based follow-up of depressed in-patients and antidepressant users in Finland

BACKGROUND

Excess mortality of depression is established for various causes of death, but evidence is scarce on alcohol-related causes. It also remains unclear whether the magnitude of the excess varies by social factors. This study aimed to quantify the contribution of alcohol-related causes of death and to assess modifying effects of socioeconomic position, employment status, and living arrangements in the excess mortality of depression.

METHODS

A 14% sample of community-dwelling Finns aged 40-64 at the end of 1997 was assessed for depression, using register data on psychiatric hospital care and antidepressant use in 1996-1997. Depressed in-patients (n=897), out-patients using antidepressants (n=13,658), and non-depressed individuals (n=217,140) were followed up for cause-specific mortality in 1998-2007, distinguishing between alcohol- and non-alcohol-related deaths, and testing for variation in the excess mortality according to baseline social factors.

RESULTS

Depressed in- and out-patients had significant excess mortality for suicide (age-adjusted rate ratios RR=3.77 for men and RR=6.35 for women), all accidental and violent causes (RR=3.47 and RR=4.43), and diseases (RR=1.67 and RR=1.41). Of the excess, alcohol-related causes accounted for 50% among depressed men and 30% among women. Excess mortality varied little by social factors, particularly in non-alcohol-related causes. Where variation was significant, the relative excess was larger among those with higher socioeconomic position and the employed. Absolute excess was, however, larger among those with lower socioeconomic position, the unemployed, and the unpartnered.

LIMITATIONS

Depression was measured indirectly by hospital and antidepressant use.

CONCLUSIONS

The results highlight the major role of alcohol in depression mortality.

μ-Opioid receptor gene (OPRM1) polymorphism A118G: lack of association in Finnish populations with alcohol dependence or alcohol consumption

Aims: The molecular epidemiological studies on the association of the opioid receptor µ-1 (OPRM1) polymorphism A118G (Asn40Asp, rs1799971) and alcohol use disorders have given conflicting results. The aim of this study was to test the possible association of A118G polymorphism and alcohol use disorders and alcohol consumption in three large cohort-based study samples. Methods: The association between the OPRM1 A118G (Asn40Asp, rs1799971) polymorphism and alcohol use disorders and alcohol consumption was analyzed using three different population-based samples: (a) a Finnish cohort study, Health 2000, with 503 participants having a DSM-IV diagnosis for alcohol dependence and/or alcohol abuse and 506 age- and sex-matched controls; (b) a Finnish cohort study, FINRISK (n = 2360) and (c) the Helsinki Birth Cohort Study (n = 1384). The latter two populations lacked diagnosis-based phenotypes, but included detailed information on alcohol consumption. Results: We found no statistically significant differences in genotypic or allelic distribution between controls and subjects with alcohol dependence or abuse diagnoses. Likewise no significant effects were observed between the A118G genotype and alcohol consumption. Conclusion: These results suggest that A118G (Asn40Asp) polymorphism may not have a major effect on the development of alcohol use disorders at least in the Finnish population.

Association of depressiveness with chronic facial pain: a longitudinal study

OBJECTIVE

Depression and pain are often co-morbid. Temporomandibular disorders (TMD) include facial pain as one main symptom. Reports are lacking on the association between chronic facial pain and earlier depressiveness. The aim of the study was to investigate whether depressiveness increases the risk for chronic facial pain in a longitudinal population-based study.

MATERIALS AND METHODS

Subjects included in the Northern Finland Birth Cohort 1966 (n = 5696) answered a questionnaire on facial pain and depressiveness using the Symptom Checklist-25 depression sub-scale at the age of 31 years. In addition, reported depression diagnosed by a doctor was enquired about. Three years later a sub-sample of the cohort, including 63 cases with chronic facial pain and 85 pain-free controls, was formed based on the question concerning facial pain.

RESULTS

Of the chronic facial pain cases 17.5% and of the pain-free controls 7.1% were depressive 3 years earlier at baseline (p = 0.050, χ(2) test, crude OR = 2.8, 95% CI = 1.0-8.0). Of the chronic facial pain cases 6.3% and of the pain-free controls 1.2% reported having had diagnosed depression (p = 0.085, crude OR = 5.7, 95% CI = 0.6-52.2). After adjusting the gender, the association between depressiveness reported at the baseline and chronic facial pain was significant (OR = 4.2, 95% CI = 1.1-16.2). When widespread pain was included in the analysis, the association was not significant.

CONCLUSIONS

Depressiveness increases the risk for chronic facial pain in a 3-year follow-up. This association seems to be mediated through widespread pain.

Global prevalence of anxiety disorders: a systematic review and meta-regression

BACKGROUND

The literature describing the global prevalence of anxiety disorders is highly variable. A systematic review and meta-regression were undertaken to estimate the prevalence of anxiety disorders and to identify factors that may influence these estimates. The findings will inform the new Global Burden of Disease study. Method A systematic review identified prevalence studies of anxiety disorders published between 1980 and 2009. Electronic databases, reference lists, review articles and monographs were searched and experts then contacted to identify missing studies. Substantive and methodological factors associated with inter-study variability were identified through meta-regression analyses and the global prevalence of anxiety disorders was calculated adjusting for study methodology.

RESULTS

The prevalence of anxiety disorders was obtained from 87 studies across 44 countries. Estimates of current prevalence ranged between 0.9% and 28.3% and past-year prevalence between 2.4% and 29.8%. Substantive factors including gender, age, culture, conflict and economic status, and urbanicity accounted for the greatest proportion of variability. Methodological factors in the final multivariate model (prevalence period, number of disorders and diagnostic instrument) explained an additional 13% of variance between studies. The global current prevalence of anxiety disorders adjusted for methodological differences was 7.3% (4.8-10.9%) and ranged from 5.3% (3.5-8.1%) in African cultures to 10.4% (7.0-15.5%) in Euro/Anglo cultures.

CONCLUSIONS

Anxiety disorders are common and the substantive and methodological factors identified here explain much of the variability in prevalence estimates. Specific attention should be paid to cultural differences in responses to survey instruments for anxiety disorders.

Facets of Negative Affectivity and Blood Pressure in Middle-Aged Men

Research results suggesting that facets of negative affectivity, i.e. anxiety, anger-hostility, and depression, relate to incident cardiovascular diseases have been steadily increasing. Evidence for depression has been especially extensive. Elevated blood pressure, a major risk factor of cardiovascular diseases, is one probable mediator in this context. The purpose of this study was to clarify the relationship of specific key elements of depressive disposition, i.e. depressive symptoms, hopelessness and vital exhaustion, with health behavior and blood pressure. Study sample was comprised of 710 middle-aged men. Participants completed self-report questionnaires assessing health behavior, depressive symptoms, vital exhaustion and hopelessness. Statistical analyses involved descriptive analyses, correlations and path analysis. Depressive symptoms and vital exhaustion associated with several unfavorable lifestyles such as smoking, alcohol consumption, and inactivity (standardized solution coefficients: 0.10, 0.14, 0.17, accordingly). However, no significant direct associations with blood pressure could be found for depressive symptoms or vital exhaustion. Hopelessness associated only with unhealthy diet (standardized solution coefficient -0.10) Moreover, for hopelessness, results showed a direct but inverse association with systolic blood pressure (standardized solution coefficient -0.08). Results suggest that the previously reported relations of depression and vital exhaustion with blood pressure could be mediated by unfavorable lifestyles. The relation of hopelessness with adverse health behaviors seems to be less significant. Also, the role of hopelessness as a risk factor of elevated blood pressure is not supported by the results of this study.

Socioeconomic differences in disability retirement in Finland: the contribution of ill-health, health behaviours and working conditions

AIMS

Socioeconomic differences in disability retirement are large. In this study, the main interest was to find out the contribution of diseases, self-rated health, health behaviours and working conditions to socioeconomic differences in disability retirement.

METHODS

The data are from the nationally-representative Health 2000 Survey to which register-based retirement data have been linked. These data include 3674 persons aged 30-62 years who were employed at baseline. Of the participants, 363 ended up in disability retirement during the follow-up period 2000-2009. Cox regression analysis was used to calculate hazard ratios and their 95% confidence intervals.

RESULTS

The risk of all-cause disability retirement was higher among manual workers (HR for men 2.44, 95% CI 1.64-3.63, women 2.33, 1.57-3.44) than upper-grade non-manual employees. Ill-health and physical working conditions contributed to the socioeconomic differences in disability retirement. The importance of physical working conditions was seen in particular among those aged 50 years or over and those in disability retirement due to musculoskeletal diseases. The contribution of self-rated health was stronger in older than younger disability retirees.

CONCLUSIONS

Our findings suggest that preventing ill-health and improving working conditions, especially among the lower socioeconomic classes, would help reduce socioeconomic differences in disability retirement.

Alcohol use disorder, smoking and dental fear among adults in Finland

OBJECTIVE

This study investigated the association between dental fear and alcohol use disorder and smoking controlling for age, gender and attained level of education as well as anxiety and depressive disorders.

MATERIALS AND METHODS

Nationally representative data on Finnish adults, 30 + years old (n = 5953), were gathered in interviews. Dental fear was measured in an interview using the question: 'How afraid are you of visiting a dentist?' The alternatives for replying were: 'Not at all', 'Somewhat' and 'Very'. Alcohol use, anxiety and depressive disorders were assessed with a standardized structured psychiatric interview based on DSM-IV criteria. The question on regularity of smoking gave three reply alternatives: smoking 'Daily', 'Occasionally' or 'Not at all'.

RESULTS

When socio-demographics and anxiety and depressive disorders were controlled for, those with lifetime alcohol use disorder were more likely to have high dental fear than were those without this disorder. When smoking was added to the model, those who smoked regularly were more likely to have high dental fear than those who smoked occasionally or not at all. In this model, alcohol use disorder was not statistically significantly associated with dental fear.

CONCLUSIONS

The results of this study support the suggestion that some individuals may have personality traits that make them vulnerable to substance use disorders and dental fear.

The prevalence of mental disorders in older people in Western countries - a meta-analysis

OBJECTIVE

To conduct a meta-analysis assessing the prevalence of mental disorders in older people in Europe and North America.

METHOD

Studies that reported prevalence rates of mental disorders in older people from the general population were identified through MEDLINE, PsycINFO, Web of Science, and reference lists for the period between January 2000 and December 2011. Studies were included if they reported prevalence rates of mental disorders in older people (50+ years) from the community. The final sample comprised 25 studies. Prevalence rates were extracted, and effect sizes were transformed into logits. Random-effects models were calculated due to significant heterogeneity. In meta-regression analyses possible sources of bias, including age of onset, gender distribution, and risk of bias were examined. To analyze the robustness of the results, sensitivity analyses were performed. Publication bias was assessed with funnel plots and the Egger method.

RESULTS

Disorders with the highest prevalence estimates were dimensional depression (19.47%), lifetime major depression (16.52%), and lifetime alcohol use disorders (11.71%). Disorders with the lowest estimates were current and lifetime drug use disorders (0.34% and 0.19%, respectively), and current bipolar disorder and current agoraphobia (both 0.53%).

CONCLUSION

The majority of studies investigated major depression, panic disorder and social phobia. Future research requires a larger database on the epidemiology of mental disorders in the elderly. Furthermore, an improvement to the methodology that addresses the challenges of older age and produces comparable data, including the use of instruments tailored to the needs of older people, is required.

Prediction of the outcome of short- and long-term psychotherapy based on socio-demographic factors

BACKGROUND

Socio-demographic factors predict the outcome of short-term psychotherapy (STT) in the treatment of mood and anxiety disorders, but information on the prediction for long long-term therapy (LPP) is lacking. We aimed to compare the prediction of changes in psychiatric symptoms afforded by socio-demographic factors across two treatment conditions, short- versus long-term psychotherapy.

METHODS

In the Helsinki Psychotherapy Study, 326 outpatients with mood or anxiety disorders, aged 20-46 years, were randomly assigned to STT or LPP. Socio-demographic factors (i.e. age, gender, education, employment status, marital status, and living arrangement) were self-reported. Psychiatric symptoms were measured by the Symptom Check List, Global Severity Index (SCL-90-GSI) and Anxiety scale (SCL-90-Anx), and the Beck Depression Inventory (BDI) at baseline and seven times during a three-year follow-up period.

RESULTS

Socio-demographic factors were found to predict symptom development during follow-up irrespective of the baseline symptom level. Patients in a relatively good position, i.e. married and highly educated patients benefited from STT, whereas patients in less advantaged positions, i.e. homemakers, lone parents, and divorced patients needed LPP or did not benefit from either therapy. In several categories of socio-demographic factors, the extent to which a patient's background predicted the outcome of the psychotherapy varied according to whether general, anxiety or depressive symptoms were studied.

LIMITATIONS

We were unable to assess widows and pensioners. For ethical reasons, a no-treatment control group with a long follow-up could not be included in the study design.

CONCLUSIONS

Socio-demographic factors may need to be considered in the selection of patients for short- and long-term therapy.

Social Anxiety Scale for Adolescents (SAS-A): measuring social anxiety among Finnish adolescents

The aim of this study was to investigate symptoms of social anxiety and the psychometric properties of the Social Anxiety Scale for Adolescents (SAS-A) among Finnish adolescents, 13-16 years of age. Study 1 (n = 867) examined the distribution of SAS-A scores according to gender and age, and the internal consistency and factor structure of the SAS-A. In a subsample (n = 563; Study 2) concurrent and discriminant validity of the SAS-A were examined relative to the Social Phobia Inventory and the Beck Depression Inventory. Test-retest stability was examined over a 30-month period by repeated measures every 6 months in another subsample (n = 377; Study 3). Results mostly revealed no gender differences in social anxiety, except that boys reported more general social avoidance and distress than girls. Older adolescents (14-16-year-olds) reported higher social anxiety than younger adolescents (12-13-year-olds). Internal consistency for the SAS-A was acceptable for both genders and for all three SAS-A subscales. Confirmatory factor analysis replicated the original 18-item three-factor structure of the SAS-A, accounting for 61% of the variance between items. Evidence for concurrent and discriminant validity was found. Test-retest stability over 6 months was satisfactory. Results support the reliability and validity of the Finnish adaptation of the SAS-A, and further indicate that gender differences in adolescents' social anxiety may vary across Western countries.

Psychiatry in Germany 2012

Healthcare in Germany is characterized by a dichotomy of a private and a public healthcare sector, which also pertains to mental healthcare. While the prevalence figures of mental disorders in Germany remained fairly constant over the last 15 years, utilization rates of healthcare services due to mental disorders increased by 70-80% including inpatient and outpatient services, sick leave cases and cases of early retirement due to mental disorders. Several challenges are currently evident for mental healthcare in Germany, ranging from interesting a sufficient number of medical students for this field of medicine, dealing with the yet unforeseeable consequences of a novel mental hospital remuneration system, better integration of services and remuneration providers, to elucidating the causes of the increasing utilization rates. Mental healthcare research will take centre stage in addressing these challenges.

The Beck Depression Inventory and General Health Questionnaire as measures of depression in the general population: a validation study using the Composite International Diagnostic Interview as the gold standard

The Beck Depression Inventory (BDI) and the General Health Questionnaire (GHQ) are commonly used in population studies as measures of depression. We examined in a population sample the validity of four scales for depressive symptoms, the GHQ-12, the 21- and 13-item versions of the BDI, and a new 6-item version of the BDI developed for this study. A total of 5561 participants in the "Health 2000" survey (30-79 years) completed the four scales and were assessed with the Composite International Diagnostic Interview (CIDI), which was used as the validation criterion. We selected items for the BDI-6 through an exploratory factor analysis for the BDI-21. The accuracy of the scales, including the BDI-6, was satisfactory (c-statistics 0.88-0.92 for depression within the past 2 weeks and 0.80-0.83 within the past 12 months) and slightly better for men (0.92-0.96 and 0.85-0.87) than for women (0.86-0.88 and 0.78-0.79). Higher scores in all the scales were associated with more severe depression and more recent depressive episodes. This study suggests that various versions of the BDI and the GHQ-12 are useful in detecting depressive disorders in the general population. Even the 6-item version of the BDI showed acceptable criterion validity, although replication in an independent dataset is needed to confirm its validity.

Determinants of the utilization of diversified types of professionals for mental health reasons in a Montreal (Canadian) catchment area

The study was designed to identify factors associated with the diversity of professionals consulted by 212 individuals affected by at least one mental disorder in the past 12 months in a Montreal catchment area. For inclusion in the study, participants had to be aged 15 to 65 and reside in the study zone. A comprehensive set of variables were analyzed in accordance with the Andersen's behavioural model of health service use. General practitioners, psychiatrists, and psychologists were the main professionals consulted in this study. Having post-secondary education, more than a single mental disorder, excellent relationships with neighbours, and (marginally) being a lifelong victim of violence were associated with higher numbers of professionals consulted. As this study highlights the large number of diversified professionals consulted for reason of mental disorders, shared care initiatives may prove beneficial. Greater effort could also be made in increasing services toward those deemed more vulnerable.

Support for involvement of glutamate decarboxylase 1 and neuropeptide Y in anxiety susceptibility

Genetic mapping efforts have identified putative susceptibility genes for human anxiety disorders. The most intensively studied genes are involved in neurotransmitter metabolism and signaling or stress response. In addition, neuropeptides and targets of anxiolytics have been examined. It has become apparent that gene × environment interactions may explain individual variation in stress resilience and predisposition to mental disorders. We aimed to replicate previous genetic findings in 16 putative anxiety susceptibility genes and further test whether they modulate the risk for developing an anxiety disorder in adulthood after childhood stress exposure. We tested 93 single-nucleotide polymorphisms (SNPs) for genetic association to anxiety disorders in the Finnish population-based Health 2000 sample (282 cases and 575 matched controls). In addition, we examined by logistic regression modeling whether the SNP genotypes modified the effect of the number of self-reported childhood adversities on anxiety disorder risk. The most significant evidence for association was observed in glutamate decarboxylase 1 (GAD1) with phobias (P = 0.0005). A subsequent meta-analysis (N = 1985) incorporating previously published findings supported involvement of a single GAD1 risk haplotype in determining susceptibility to a broad range of internalizing disorders (P = 0.0009). We additionally found that SNPs and haplotypes in neuropeptide Y (NPY) modified the effect of childhood adversities on anxiety susceptibility (P = 0.003). In conclusion, we provide further support for involvement of mainly GAD1, but also NPY in determining predisposition to anxiety disorders.

Working conditions and psychotropic medication: a prospective cohort study

PURPOSE

To examine whether work arrangements, physical working conditions and psychosocial working conditions are associated with subsequent mental health problems, measured by prescribed psychotropic drugs.

METHODS

Data on working conditions collected among 40-60-year-old employees of the City of Helsinki, Finland (N = 6,498) were linked with the register of prescribed medication. Purchases of antidepressants (ATC class N06A), sleeping pills and sedatives (N05B and N05C), and any psychotropic drugs during a 5-year follow-up were examined. Current users and those with regular use of psychotropic drugs during the past 3 years were excluded, leaving 5,786 respondents for analysis.

RESULTS

Working overtime was associated with purchases of sleeping pills among men but otherwise the associations between work arrangements and psychotropic medication were negligible. Desktop work was associated with purchases of sleeping pills among women. Among psychosocial working conditions, high self-assessed mental strenuousness and job dissatisfaction were consistently associated with purchases of antidepressants, sleeping pills and any psychotropic drugs. The strongest association was found for job dissatisfaction, which increased the risk of antidepressant purchases by 24% per one standard deviation increase in job dissatisfaction. The results for men were largely similar, with high mental strenuousness and job dissatisfaction, and poor workplace climate showing the strongest associations, particularly with antidepressant purchases.

CONCLUSIONS

Adjustment of work environments by reducing mental strenuousness and improving job satisfaction might help in prevention of mental health problems that account for a major part of the disease burden among employees.

Living alone and antidepressant medication use: a prospective study in a working-age population

Background

An increasing proportion of the population lives in one-person households. The authors examined whether living alone predicts the use of antidepressant medication and whether socioeconomic, psychosocial, or behavioral factors explain this association.

Methods

The participants were a nationally representative sample of working-age Finns from the Health 2000 Study, totaling 1695 men and 1776 women with a mean age of 44.6 years. In the baseline survey in 2000, living arrangements (living alone vs. not) and potential explanatory factors, including psychosocial factors (social support, work climate, hostility), sociodemographic factors (occupational grade, education, income, unemployment, urbanicity, rental living, housing conditions), and health behaviors (smoking, alcohol use, physical activity, obesity), were measured. Antidepressant medication use was followed up from 2000 to 2008 through linkage to national prescription registers.

Results

Participants living alone had a 1.81-fold (CI = 1.46-2.23) higher purchase rate of antidepressants during the follow-up period than those who did not live alone. Adjustment for sociodemographic factors attenuated this association by 21% (adjusted OR = 1.64, CI = 1.32-2.05). The corresponding attenuation was 12% after adjustment for psychosocial factors (adjusted OR = 1.71, CI = 1.38-2.11) and 9% after adjustment for health behaviors (adjusted OR = 1.74, CI = 1.41-2.14). Gender-stratified analyses showed that in women the greatest attenuation was related to sociodemographic factors and in men to psychosocial factors.

Conclusions

These data suggest that people living alone may be at increased risk of developing mental health problems. The public health value is in recognizing that people who live alone are more likely to have material and psychosocial problems that may contribute to excess mental health problems in this population group.

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.

Psychiatric disorders as assessed with SCID in chronic pain patients: the anxiety disorders precede the onset of pain

OBJECTIVE

The aim of the study was to determine the prevalence of psychiatric disorders in patients referred to a tertiary pain clinic. The temporal relationship between the onset of pain and depression and anxiety and the association of psychiatric disorders with pain intensity were also analyzed.

METHOD

One hundred consecutive outpatients underwent a psychiatric assessment using the Structured Clinical Interview and Statistical Manual of Mental Disorders Axis I.

RESULTS

The psychiatric disorders diagnosed for the past 12 months included major depressive (37%), anxiety (25%) and substance use disorder (12%). The prevalence of any lifetime psychiatric disorder was 75%. Most anxiety disorders (77%) had been present before pain onset, whereas 63% of the depressive disorders appeared after the onset of pain. Psychiatric morbidity was associated with increased pain intensity.

CONCLUSIONS

Chronic pain patients have a remarkable psychiatric morbidity. A structured diagnostic interview, covering a large range of psychiatric diagnoses, allows a more comprehensive approach to the assessment of the patient. This should improve the management of chronic pain. However, prospective studies are needed to show this.