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Koschig M, Hußenöder F, Conrad I, Alberti M, Gatzsche K, Bieler L, Stengler K, Riedel-Heller SG. [Mentally ill people with means-tested benefits at the job center : Diagnosis spectrum and care-First results from the LIPSY project]. DER NERVENARZT 2024; 95:845-852. [PMID: 39105752 DOI: 10.1007/s00115-024-01723-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/18/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND Although people receiving means-tested benefits are regularly taken care of at the job center, little is known about their mental health situation and mental health care. OBJECTIVE The aim of the study was to describe the diagnostic spectrum and the functional status as well as the mental health care utilization of individuals with mental illnesses who are receiving means-tested benefits. METHODS Mentally ill people with means-tested benefits were recruited at the job center as part of the "Leipzig Individual Placement and Support for Mentally Ill People" (LIPSY) project, where they were initially diagnosed according to ICD-10 and included in the project if they had a mental disorder. Mental healthcare utilization was recorded. In the present study, data from n = 583 consecutively included persons were analyzed descriptively and by multivariate statistics. RESULTS Of the study participants 60.7% (n = 583; 51.5% female; average age 36 years; unemployed for an average of 4.8 years) suffered from affective disorders, followed by neurotic, stress and somatoform disorders (42.5%). With a mean global assessment of functioning (GAF) value of 49.4 (SD 7.7), there was on average a serious impairment. Nearly half of the subjects (48.5%) had never received psychotherapeutic, psychiatric or neurological treatment in the 6 months prior to inclusion in the project. DISCUSSION It could be shown that there is a broad spectrum of mental disorders with substantial functional impairment. The data suggest that this group is significantly undertreated and difficult to reach.
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Affiliation(s)
- M Koschig
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health, Medizinische Fakultät, Universität Leipzig, Leipzig, Deutschland.
| | - F Hußenöder
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health, Medizinische Fakultät, Universität Leipzig, Leipzig, Deutschland
| | - I Conrad
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health, Medizinische Fakultät, Universität Leipzig, Leipzig, Deutschland
| | - M Alberti
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie, Helios Park-Klinikum Leipzig, Leipzig, Deutschland
| | - K Gatzsche
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie, Helios Park-Klinikum Leipzig, Leipzig, Deutschland
| | - L Bieler
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie, Helios Park-Klinikum Leipzig, Leipzig, Deutschland
| | - K Stengler
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie, Helios Park-Klinikum Leipzig, Leipzig, Deutschland
| | - S G Riedel-Heller
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health, Medizinische Fakultät, Universität Leipzig, Leipzig, Deutschland
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Nurmela KS, Heikkinen VH, Ylinen AM, Uitti JA, Virtanen PJ. Healthcare attendance styles among long-term unemployed people with substance-related and mood disorders. Public Health 2020; 186:211-216. [PMID: 32861086 DOI: 10.1016/j.puhe.2020.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 06/16/2020] [Accepted: 07/19/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Both increased and decreased health service usage and unmet care needs are more prevalent among unemployed people than in the general population. STUDY DESIGN This study investigates the associations of substance-related and mood disorders among long-term unemployed people with styles of healthcare attendance in Finland. METHODS The study material consisted of the health register information on 498 long-term unemployed people in a project screening for work disabilities. The data were analysed by mixed methods: qualitative typological analysis was applied to identify differential healthcare attendance styles, and the associations of the obtained styles with mental health disorders were analysed quantitatively by multinomial logistic regression. RESULTS Three styles, characterized as smooth, faltering and marginalized, were identified. Compared with participants with the smooth attendance style without mental disorders, those with the faltering style had tenfold relative risk for substance-related disorder and fourfold relative risk for mood disorder. Those with the marginalized style had fivefold relative risk for substance-related disorder and twofold relative risk for mood disorder. Adjusting for background characteristics did not alter the statistical significance of substance-related disorder. In the case of mood disorders, the statistical significance persisted throughout the adjustments in the faltering style. CONCLUSION Dysfunctional use of health services is more common among people with substance-related or mood disorders, who are at risk of drifting towards long-term unemployment and work disabilities. The early detection of those with faltering or marginalized healthcare attendance style may prevent prolonged unemployment, enable rehabilitation measures and reduce the risk of disability pensions.
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Affiliation(s)
- K S Nurmela
- Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland; Mental Health and Substance Abuse Services, City of Tampere, Finland.
| | - V H Heikkinen
- Department of Neurosciences and Rehabilitation, Tampere University Hospital, Tampere, Finland
| | - A M Ylinen
- Department of Neurosciences and Rehabilitation, Tampere University Hospital, Tampere, Finland
| | - J A Uitti
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Clinic of Occupational Medicine, Tampere University Hospital, Tampere, Finland; Finnish Institute of Occupational Health, Tampere, Finland
| | - P J Virtanen
- Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland; Faculty of Medicine, Department of Public Health, Uppsala University, Uppsala, Sweden
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Nurmela K, Mattila A, Heikkinen V, Uitti J, Ylinen A, Virtanen P. Identification of Depression and Screening for Work Disabilities among Long-Term Unemployed People. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E909. [PMID: 29751563 PMCID: PMC5981948 DOI: 10.3390/ijerph15050909] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 04/30/2018] [Accepted: 05/02/2018] [Indexed: 11/30/2022]
Abstract
The study explores whether clinical screening targeted at work disabilities among long-term unemployed people reveals eligible individuals for a disability pension and the importance of depression in granting the disability pensions. A total of 364 participants of the screening project were considered as eligible to apply for disability pension. Among them, 188 were diagnosed as clinically depressed. They were classified into those with earlier depression diagnosis (n = 85), those whose depression had not been diagnosed earlier (n = 103), and those without diagnosed depression (n = 176). The association of this ‘Depression identification pattern’ with being granted a disability pension was explored by logistic regression analyses. Compared to those with earlier diagnosis, those whose depression had not been diagnosed earlier were granted disability pension more commonly (72% vs. 54% OR 2.2, p = 0.012). Corresponding figures of the undepressed were 73%, OR 2.3, p = 0.002. The adjustments did not affect the results. Clinical examination of the long-term unemployed people in terms of work disability seems to be worthwhile. In particular, the examination reveals new depression diagnoses, which contribute more to the award of disability pension than depression diagnosed earlier by regular health care. Novel ways to detect depression among the unemployed should be implemented in the health and employment services.
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Affiliation(s)
- Kirsti Nurmela
- Faculty of Social Sciences, Health Sciences, University of Tampere, 33014 Tampere, Finland.
- Mental Health and Substance Abuse Services, 33900 Tampere, Finland.
| | - Aino Mattila
- Faculty of Social Sciences, Health Sciences, University of Tampere, 33014 Tampere, Finland.
- Department of Adult Psychiatry, Tampere University Hospital, 33521 Tampere, Finland.
| | - Virpi Heikkinen
- Department of Neurosciences and Rehabilitation, Tampere University Hospital, 33521 Tampere, Finland.
| | - Jukka Uitti
- Faculty of Medicine and Life Sciences, University of Tampere, 33521 Tampere, Finland.
- Clinic of Occupational Medicine, Tampere University Hospital, 33521 Tampere, Finland.
- Finnish Institute of Occupational Health, 33100 Tampere, Finland.
| | - Aarne Ylinen
- Department of Neurological Sciences, Faculty of Medicine, University of Helsinki, 00100 Helsinki, Finland.
- Department of Neurology, Helsinki University Central Hospital, 00260 Helsinki, Finland.
| | - Pekka Virtanen
- Faculty of Social Sciences, Health Sciences, University of Tampere, 33014 Tampere, Finland.
- Department of Public Health, Faculty of Medicine, Uppsala University, 75124 Uppsala, Sweden.
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Nurmela K, Mattila A, Heikkinen V, Uitti J, Ylinen A, Virtanen P. Identification of major depressive disorder among the long-term unemployed. Soc Psychiatry Psychiatr Epidemiol 2018; 53:45-52. [PMID: 29124293 DOI: 10.1007/s00127-017-1457-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 10/27/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Depression is a common mental health disorder among the unemployed, but research on identifying their depression in health care is scarce. The present study aimed to explore the identification of major depressive disorder (MDD) in health care on long-term unemployed and find out if the duration of unemployment correlates with the risk for unidentified MDD. METHODS The study sample consisted the patient files of long-term unemployed people (duration of unemployment 1-35 years, median 11 years), who in a screening project diagnosed with MDD (n = 243). The MDD diagnosis was found in the health care records of 101. Binomial logistic regression models were used to explore the effect of the duration of unemployment, as a discrete variable, to the identification of MDD in health care. RESULTS MDD was appropriately identified in health care for 42% (n = 101) of the participants with MDD. The odds ratio for unidentified MDD in health care was 1.060 (95% confidence interval 1.011; 1.111, p = 0.016) per unemployment year. When unemployment had continued, for example, for five years the odds ratio for having unidentified MDD was 1.336. The association remained significant throughout adjustments for the set of background factors (gender, age, occupational status, marital status, homelessness, criminal record, suicide attempts, number of health care visits). CONCLUSIONS This study among depressed long-term unemployed people indicates that the longer the unemployment period has lasted, the more commonly these people suffer from unidentified MDD. Health services should be developed with respect to sensitivity to detect signs of depression among the long-term unemployed.
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Affiliation(s)
- Kirsti Nurmela
- Faculty of Social Sciences, University of Tampere, 33014, Tampere, Finland. .,Mental Health and Substance Abuse Services, Tampere, Finland.
| | - Aino Mattila
- Faculty of Social Sciences, University of Tampere, 33014, Tampere, Finland.,Department of Adult Psychiatry, Tampere University Hospital, Tampere, Finland
| | - Virpi Heikkinen
- Faculty of Social Sciences, University of Tampere, 33014, Tampere, Finland.,Department of Neurosciences and Rehabilitation, Tampere University Hospital, Tampere, Finland
| | - Jukka Uitti
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Clinic of Occupational Medicine, Tampere University Hospital, Tampere, Finland.,Finnish Institute of Occupational Health, Tampere, Finland
| | - Aarne Ylinen
- Department of Neurological Sciences, University of Helsinki, Helsinki, Finland.,Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Pekka Virtanen
- Faculty of Social Sciences, University of Tampere, 33014, Tampere, Finland
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Pfeil S, Holtz K, Kopf KA, Hegerl U, Rummel-Kluge C. Minor depression in older, long-term unemployed people seeking vocational support. BMC Psychiatry 2017; 17:243. [PMID: 28679439 PMCID: PMC5498893 DOI: 10.1186/s12888-017-1404-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 06/27/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prevalence rates of minor and major depression vary from 0.7 to 6.8 (minor) and 3.8 to 10.9 (major) for the general population. Twenty-two percent of older, long-term unemployed people suffer from major depression. However, the prevalence rate of minor depression (depression on a subthreshold level with less than 5, but more than 1 depression symptom) in this population is unknown. The first aim of this study is to identify that prevalence rate, because we already know that minor depression increases the risk of developing a major depression and this in turn reduces the chances of reemployment what increases social and individual costs at the same time. The second aim is to find out whether there are symptoms that distinguish the different groups "no depression", "minor depression" and "major depression" in this population. In contrast to the general population, the most frequent symptoms within major and minor depression in older, long-term unemployed people are unknown so far. METHODS A total of 234 long-term unemployed people (response rate 59%) were included in a study within a project of the Department of Psychiatry and Psychotherapy at the University of Leipzig and an unemployment agency. Based on the results of the Patient Health Questionnaire, the participants were classified as non depressive, minor depressive or major depressive. Descriptive statistics and chi-square tests were performed to identify whether there are symptoms stated by the participants that are more frequent than others, and if the classified groups differ in this regard. RESULTS Fifty percent had no depression, 15.6% had a minor depression and 34.4% were suffering from major depression. Difficulty with concentration is the symptom that differentiated the last two groups the most. Fatigue, depressed mood and anhedonia were the symptoms that distinguished participants with minor depression the most from participants with no depression. Main limitations are: The sample was determined by programme conditions, e.g. not all potentially available people participated. The sample may therefore not be representative for the general long-term unemployed. Due to limited resources the PHQ 9 was used instead of a clinical interview to assess minor and major depression. CONCLUSIONS Results indicate that minor depression in older, long-term unemployed persons is significant, as, almost 16% of the participants were affected in the study. Especially when fatigue is present for a period of more than 2 weeks, people should be informed about the option to consult a primary care physician or professionals from the unemployment agency in order to prevent the possible onset of major depression.
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Affiliation(s)
- Sabrina Pfeil
- 0000 0001 2230 9752grid.9647.cDepartment of Psychiatry and Psychotherapy, Klinik und Poliklinik für Psychiatrie und Psychotherapie, University of Leipzig, Germany, Semmelweisstraße 10, 04103 Leipzig, Germany
| | - Katrin Holtz
- 0000 0001 2230 9752grid.9647.cDepartment of Psychiatry and Psychotherapy, Klinik und Poliklinik für Psychiatrie und Psychotherapie, University of Leipzig, Germany, Semmelweisstraße 10, 04103 Leipzig, Germany
| | - Kathrin-Andrea Kopf
- 0000 0001 2230 9752grid.9647.cDepartment of Psychiatry and Psychotherapy, Klinik und Poliklinik für Psychiatrie und Psychotherapie, University of Leipzig, Germany, Semmelweisstraße 10, 04103 Leipzig, Germany
| | - Ulrich Hegerl
- 0000 0001 2230 9752grid.9647.cDepartment of Psychiatry and Psychotherapy, Klinik und Poliklinik für Psychiatrie und Psychotherapie, University of Leipzig, Germany, Semmelweisstraße 10, 04103 Leipzig, Germany ,Depression Research Centre, German DepressionFoundation,, Leipzig, Germany
| | - Christine Rummel-Kluge
- Department of Psychiatry and Psychotherapy, Klinik und Poliklinik für Psychiatrie und Psychotherapie, University of Leipzig, Germany, Semmelweisstraße 10, 04103, Leipzig, Germany.
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Reissner V, Scherbaum N, Wiltfang J, Kis B, Meiler B, Lieb B, Mikoteit T, Ehren G, Hebebrand J. Psychiatrische Interventionen für Arbeitslose. DER NERVENARZT 2015; 87:74-81. [DOI: 10.1007/s00115-015-4299-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Trefflich F, Kalckreuth S, Mergl R, Rummel-Kluge C. Psychiatric patients' internet use corresponds to the internet use of the general public. Psychiatry Res 2015; 226:136-41. [PMID: 25623020 DOI: 10.1016/j.psychres.2014.12.037] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 12/22/2014] [Accepted: 12/23/2014] [Indexed: 11/30/2022]
Abstract
The use of Internet has grown in the past number of years, including the increased application of various therapy programs for psychiatric patients which can be accessed online. Few studies investigating psychiatric patients' Internet use exist. Therefore, the aim of this study was to examine the number of psychiatric patients that use the Internet in comparison to the general population. Since patients with mental health disorders frequently suffer from a variety of disadvantages in society, it was evaluated whether psychiatric patients were disadvantaged particularly concerning the use and access of the Internet. Three hundred and thirty-seven patients participated in the study and completed a 29-item questionnaire. A response rate of 66% was achieved. Descriptive statistics, analysis of variance and binary logistic regression analysis were used. Out of the participants, 79.5% were Internet users. This number corresponds to the Internet use of the general population. Young patients in particular were found to use online information, using mostly search engines to seek medical information. The results show that psychiatric patients do not rank below the general population concerning the frequency of Internet use, which is especially important for accessing health related information online or participating in online programs.
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Affiliation(s)
- Friederike Trefflich
- (a)Department of Psychiatry and Psychotherapy, Faculty of Medicine, Leipzig University
| | - Sophie Kalckreuth
- (a)Department of Psychiatry and Psychotherapy, Faculty of Medicine, Leipzig University
| | - Roland Mergl
- (a)Department of Psychiatry and Psychotherapy, Faculty of Medicine, Leipzig University
| | - Christine Rummel-Kluge
- (a)Department of Psychiatry and Psychotherapy, Faculty of Medicine, Leipzig University; Forschungszentrum der Stiftung Deutsche Depressionshilfe, Semmelweißstraße 10, DE-04103 Leipzig, Germany.
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