Long-term life satisfaction in ageing women with work disability due to mental and musculoskeletal disorders

BACKGROUND

Mental disorders (MDs) and musculoskeletal disorders (MSDs) are the major causes of global disability and increase in prevalence with age.

AIMS

To support healthy ageing, we studied how work disability due to MDs or MSDs is related to life satisfaction (LS) cross-sectionally and in 5- and 10-year follow-ups among ageing women.

METHODS

In the population-based OSTPRE cohort (women aged 58-67 in 1999), data on lifetime permanent work disability pensions (DPs) due to 'MDs only' (n = 337), 'MSDs only' (n = 942) and 'MDs + MSDs' (n = 212) and 'no DP' (n = 6322) until 1999 was obtained from the Finnish national register. The OSTPRE postal enquiry included a four-item life satisfaction (LS) scale (range 4-20: satisfied 4-6, intermediate 7-11, dissatisfied 12-20) at 5-year intervals, in 1999-2004 (n = 6548) and in 1999-2009 (n = 5562).

RESULTS

In 1999, the risks of belonging to the dissatisfied LS group (score 12-20) vs. the satisfied group (score 4-6) were higher in 'MDs only' (OR = 4.30; 95%CI 2.95-6.28), 'MSDs only' (OR = 2.69; 2.12-3.40) and 'MDs + MSDs' (OR = 2.72; 1.77-4.16) groups than in the 'no DP' group. In the follow-ups, these risks were OR5yr = 5.59 (3.54-8.84) and OR10yr = 4.94 (2.80-8.73) for 'MDs only', OR5yr = 3.36 (2.58-4.37) and OR10yr = 3.18 (2.40-4.21) for 'MSDs only', and OR5yr = 4.70 (2.75-8.05) and OR10yr = 6.84 (3.53-13.27) for 'MDs + MSDs' (all: p ≤ 0.001). Adjusting for baseline LS did not change the pattern (all p ≤ 0.001).

CONCLUSION

Work disability due to MDs and MSDs undermines healthy ageing among women via life dissatisfaction.

Comorbidity of mental and musculoskeletal disorders in ageing women: A data linkage study using national registries

BACKGROUND

Mental disorders (MDs) and musculoskeletal disorders (MSDs) are the main causes of disability. Yet, their comorbidity has not received the deserved attention.

OBJECTIVE

To investigate the extent of the comorbidity between MDs and MSDs in ageing women using national registries on prescription medications and work disability pensions (DPs).

METHODS

The study included 7,809 Finnish women, born during 1932-41, from the population-based Kuopio Osteoporosis Risk Factor and Prevention Study (OSTPRE) cohort, established in 1989. Lifetime permanent DPs due to: 1) 'MDs only' (n = 359), 2) 'MSDs only' (n = 954), 3) 'MDs + MSDs' (n = 227), were recorded till 2003. The reference group was 'no DP' (n = 6,269). Data from the OSTPRE questionnaires was obtained in 1994. Use of medications was recorded in 1995 and 2003. The use of musculoskeletal or psychotropic medications by women having a DP or medication due to MD, or MSD diagnoses, respectively, was considered as an indicator of comorbidity.

RESULTS

In 1995, all DP groups had used psychotropic and musculoskeletal medications more often than the referents. Use of musculoskeletal medications was associated with a higher use of psychotropic medications, and vice versa (OR=2.45; 95% CI 2.17-2.77), compared with non-use. The 'MSDs only' group was more likely to use psychotropic (OR=1.79; 95% CI 1.50-2.12), and the 'MDs only' group musculoskeletal medications (OR=1.38; 95% CI 1.09-1.74), compared with those without DPs. The proportions of medication users were similar in 1995 and 2003; however, the amounts used increased.

CONCLUSIONS

There was strong evidence for comorbidity between MDs and MSDs in ageing women. Further research concerning their longitudinal relationships is warranted.

A fall in the previous 12 months predicts fracture in the subsequent 5 years in postmenopausal women

PURPOSE

The purpose of this study was to evaluate if a history of falls predicts future postmenopausal fractures and if this prediction variesaccording to frequency, mechanism, and severity of falls and site of fractures.

METHODS

This study used data from OSTPRE prospective cohort. Total study population consisted of 8744 postmenopausal women (mean age 62.2 years) who responded to postal enquiry in 1999 (baseline) and in 2004 (follow-up).

RESULTS

Women were classified by frequency (non/occasional/frequent fallers), mechanism (slip/nonslip), and severity (injurious/ non-injurious) of falls and fractures by site (major osteoporotic/other). A total of 1693 (19.4%) women reported a fall during the preceding 12 months in 1999; 812 a slip fall, 654 a nonslip, 379 an injurious fall, and 1308 a non-injurious fall. A total of 811 women (9.3%) sustained a fracture during the 5-year follow-up period (1999-2004); 431 major osteoporotic fractures and 380 other fractures. Compared with non-fallers, earlier falls predicted subsequent fractures with an OR of 1.41 (95% CI 1.19-1.67, p ≤ 0.001), 1.43 (95% CI 1.14-1.80, p = 0.002) for earlier slip falls, and 1.35 (95% CI 1.04-1.74, p = 0.02) for earlier nonslip falls. Earlier injurious falls predicted future fractures (OR = 1.64, 95% CI 1.21-2.23, p ≤ 0.01), especially other fractures (OR = 1.86, 95% CI 1.24-2.80, p ≤ 0.01), but not major osteoporotic fractures (OR = 1.37, 95% CI 0.89-2.10, p = 0.151). Fracture risk predictions for earlier non-injurious falls was OR = 1.36, 95% CI 1.12-1.64, p = 0.002. These risk patterns remain same after adjustments.

CONCLUSION

History of falls (especially injurious falls) predicts subsequent fractures (mainly other fractures compared with major osteoporotic fractures) inpostmenopausal women. We aimed to investigate if history of falls (frequency, mechanism, and severity) is a predictor of future fractures in postmenopausal women. Our results indicate that history of falls (especially injurious falls) appeared to be an indicator for subsequent fracture overall. Earlier injurious falls were stronger predictors for future other fractures than for typical major osteoporotic fractures.

Physical health comorbidities in women with personality disorder: Data from the Geelong Osteoporosis Study

Background

Associations between common psychiatric disorders, psychotic disorders and physical health comorbidities are frequently investigated. The complex relationship between personality disorders (PDs) and physical health is less understood, and findings to date are varied. This study aims to investigate associations between PDs with a number of prevalent physical health conditions.

Methods

This study examined data collected from women (n = 765; ≥ 25 years) participating in a population-based study located in south-eastern Australia. Lifetime history of psychiatric disorders was assessed using the semi-structured clinical interviews (SCID-I/NP and SCID-II). The presence of physical health conditions (lifetime) were identified via a combination of self-report, medical records, medication use and clinical data. Socioeconomic status, and information regarding medication use, lifestyle behaviors, and sociodemographic information was collected via questionnaires. Logistic regression models were used to investigate associations.

Results

After adjustment for sociodemographic variables (age, socioeconomic status) and health-related factors (body mass index, physical activity, smoking, psychotropic medication use), PDs were consistently associated with a range of physical health conditions. Novel associations were observed between Cluster A PDs and gastro-oesophageal reflux disease (GORD); Cluster B PDs with syncope and seizures, as well as arthritis; and Cluster C PDs with GORD and recurrent headaches.

Conclusions

PDs were associated with physical comorbidity. The current data contribute to a growing evidence base demonstrating associations between PDs and a number of physical health conditions independent of psychiatric comorbidity, sociodemographic and lifestyle factors. Longitudinal studies are now required to investigate causal pathways, as are studies determining pathological mechanisms.

Role of musculoskeletal disorders in falls of postmenopausal women

We aimed to investigate the role of musculoskeletal disorders (MSDs) as risk factors for falls among postmenopausal women. Our results indicate that MSDs are common and are associated with increased falling risk, especially nonslip falls. Excess number of falls due to MSDs is greater than that due to any other disease class.

PURPOSE

Falls are a major public health problem worldwide. The aim of the study was to investigate the role of MSDs as risk factors for falls among postmenopausal women.

METHODS

This cohort study utilized data from a population-based, prospective cohort study (OSTPRE). The study population consisted of 8656 women aged 57-66 years (in 1999) living in Kuopio Province, Eastern Finland, who responded to postal enquiries in 1999 and 2004. Information on MSDs and other morbidities was obtained from the 1999 enquiry and information on falls from the 2004 enquiry. Women were classified as fallers or non-fallers according to their falling events in the preceding 12 months. The fallers were further divided into women with slip and nonslip falls.

RESULTS

Of the study sample, 53.3% reported a MSD and 39.2% reported a fall during the preceding 12 months. MSDs predicted falls (OR = 1.38; 95% CI 1.26-1.50) and the association was stronger for nonslip (OR = 1.56; 95% CI 1.39-1.75) than slip falls (OR 1.22; 95% CI 1.08-1.38) compared to the women without MSDs. The risk of falls increased with increasing number (1, 2, ≥ 3) of MSDs: 1.25 (95%CI 1.13-1.38), 1.48 (95%CI 1.30-1.68), and 1.92 (95%CI 1.60-2.31), respectively. After adjustments, the risk of falling related to MSDs reduced by about 5% (adjusted p < 0.001). The population attributable fraction of falls due to MSDs was 10.3% of all falls, greater than that due to any other disease class.

CONCLUSION

MSDs are common and an important risk factor for falls and especially nonslip falls among postmenopausal women. The number of excess falls due to MSDs in this population group is greater than that due to any other disease class.

Early motor developmental milestones and schizophrenia: A systematic review and meta-analysis

The neurodevelopmental hypothesis of schizophrenia proposes that impaired brain development is a cause of the illness. Early motor developmental milestones, such as learning to walk, are predictors of later schizophrenia but studies have not been systematically reviewed. The aim of the present systematic review and meta-analysis was to explore the association between early motor developmental milestones and the risk of adult schizophrenia. In addition, we updated a systematic review on motor function and risk of schizophrenia. The PubMed, PsycINFO and Scopus databases were searched for original research articles published up to July 2015. Motor milestones were measured between ages 0 and 13years. Random effect meta-analysis calculated effect estimates (Hedges' g) for the association between individual motor milestones and schizophrenia risk. An electronic database and selected articles reference list search identified 5990 articles after removing duplicates. Sixty-nine full text articles were assessed for eligibility of which six were included in the review. Five studies provided sufficient data for meta-analyses. The following motor milestones were significantly associated with adult schizophrenia risk: walking unsupported (g=0.46; 95% CI 0.27-0.64; p<0.001), standing unsupported (g=0.28; 0.16-0.40; p<0.001) and sitting unsupported (g=0.18; 0.05-0.31; p=0.007). Results for the milestones 'holding head up' and 'grabbing object' were not statistically significant. Delayed walking, sitting and standing unsupported were associated with adult onset schizophrenia. The findings emphasise the importance of timely achievement of these motor milestones in childhood and can contribute to the identification of individuals at risk of psychosis.

Inclusion of Regional Body Composition Parameters Improves Bone Mineral Density Cross-Calibration Between GE Lunar Prodigy and iDXA Densitometers

Since 1989, the Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE, n = 14220) Study has followed long-term changes of bone mineral density (BMD) and body composition in women with GE Lunar devices. During the course of OSTPRE, the dual-energy X-ray absorptiometry device had to be replaced by a newer model. Then, it was essential to determine whether systematic measurement differences in BMD and body composition will occur. As a part of the OSTPRE study, BMD was measured in 54 women, whereas body composition was determined in 55 women, aged 27-71, by using both the GE Healthcare Lunar Prodigy and iDXA narrow-angle fan beam densitometers during the same visit. The total body fat mass (FM) and lean body mass (LBM) results of these scanners showed a high linear correlation (r = 0.981-0.994, p < 0.0001). However, the mean total body FM and LBM values measured by iDXA were on average 2.3% (0.5 kg, 95% confidence interval: 0.3-0.7 kg) higher and 0.8% (0.3 kg, 95% confidence interval: 0.1-0.6 kg) lower, respectively, than those measured by Prodigy. Inclusion of local soft tissue measurements (total body LBM, legs/android FM) improved the agreement of total body, total hip, and lumbar spine BMD values between the devices but not femoral neck BMD agreement. Equations, based on linear regression analyses, were derived to minimize differences between the instruments. Then, the differences in BMD and body composition measurements were negligible between Prodigy and iDXA. Using correction equations enables an objective comparison of longitudinal BMD and body composition measurements.

Interaction between parental psychosis and early motor development and the risk of schizophrenia in a general population birth cohort

Background

Delayed motor development in infancy and family history of psychosis are both associated with increased risk of schizophrenia, but their interaction is largely unstudied.

Aim

To investigate the association of the age of achieving motor milestones and parental psychosis and their interaction in respect to risk of schizophrenia.

Methods

We used data from the general population-based prospective Northern Finland Birth Cohort 1966 (n = 10,283). Developmental information of the cohort members was gathered during regular visits to Finnish child welfare clinics. Several registers were used to determine the diagnosis of schizophrenia among the cohort members and psychosis among the parents. Altogether 152 (1.5%) individuals had schizophrenia by the age of 46 years, with 23 (15.1%) of them having a parent with psychosis. Cox regression analysis was used in analyses.

Results

Parental psychosis was associated (P < 0.05) with later achievement of holding the head up, grabbing an object, and walking without support. In the parental psychosis group, the risk for schizophrenia was increased if holding the head up (hazard ratio [HR]: 2.46; degrees of freedom [df] = 1; 95% confidence interval [95% CI]: 1.07–5.66) and touching the thumb with the index finger (HR: 1.84; df = 1; 95% CI: 1.11–3.06) was later. In the group without parental psychosis, a delay in the following milestones increased the risk of schizophrenia: standing without support and walking without support. Parental psychosis had an interaction with delayed touching thumb with index finger (HR: 1.87; df = 1; 95% CI: 1.08–3.25) when risk of schizophrenia was investigated.

Conclusions

Parental psychosis was associated with achieving motor milestones later in infancy, particularly the milestones that appear early in a child's life. Parental psychosis and touching the thumb with the index finger had a significant interaction on risk of schizophrenia. Genetic risk for psychosis may interact with delayed development to raise future risk of schizophrenia, or delayed development may be a marker of other risk processes that interact with genetic liability to cause later schizophrenia.

The association between major depressive disorder, use of antidepressants and bone mineral density (BMD) in men

OBJECTIVE

Both depression and use of antidepressants have been negatively associated with bone mineral density (BMD) but mainly in studies among postmenopausal women. Therefore, the aim of this study was to investigate these relationships in men.

METHODS

Between 2006 and 2011, 928 men (aged 24-98 years) from the Geelong Osteoporosis Study completed a comprehensive questionnaire, clinical measurements and had BMD assessments at the forearm, spine, total hip and total body. Major depressive disorder (MDD) was identified using a structured clinical interview (SCID-I/NP). The cross-sectional associations between BMD and both MDD and antidepressant use were analyzed using multivariable linear regression.

RESULTS

Of the study population, 84 (9.1%) men had a single MDD episode, 50 (5.4%) had recurrent episodes and 65 (7.0%) were using antidepressants at the time of assessment. Following adjustments, recurrent MDD was associated with lower BMD at the forearm and total body (-6.5%, P=0.033 and -2.5%, P=0.033, respectively compared to men with no history of MDD), while single MDD episodes were associated with higher BMD at the total hip (+3.4%, P=0.030). Antidepressant use was associated with lower BMD only in lower-weight men (<75-110 kg depending on bone site).

CONCLUSIONS

Both depression and use of antidepressants should be taken into account as possible risk factors for osteoporosis in men.

The effect of long-term life dissatisfaction on health-related quality of life among general population subjects

The aim of this population-based study (n = 329) was to explore how long-term life dissatisfaction (LS burden) and concurrent life dissatisfaction are associated with the concurrent health-related quality of life (HRQL) (RAND-36), and how long-term life dissatisfaction predicts HRQL in the general population. The sum of the life satisfaction scores in 1998, 1999, 2001 (LS burden) and the concurrent life satisfaction score (LS) in 2005 were used to categorize the study participants into satisfied, intermediate and dissatisfied groups. Differences in RAND-36 dimensions in 2005 were investigated with respect to the LS burden and concurrent life dissatisfaction. The predictive power of the LS burden for HRQL dimensions was assessed with logistic regression models. Both a high LS burden and concurrent life dissatisfaction were strongly associated with HRQL and were risk factors for poor HRQL, regardless of its dimensions. The LS burden predicted all of the RAND-36 dimensions, except for physical functioning. Screening of life dissatisfaction can be used to identify service users whose HRQL should be further investigated. Assessment of HRQL provides information on the domains and factors that require mental health nursing intervention. This knowledge could assist mental health nurses in both the alleviation of disease consequences and promotion of well-being of service users.

Self-reported life satisfaction and alcohol use: a 15-year follow-up of healthy adult twins

AIMS

To study the bidirectional relationships between life satisfaction (LS) and alcohol use.

METHODS

Health questionnaires were administered in 1975, 1981 and 1990 to a population-based sample of healthy Finnish twins aged 18-45 at baseline (n = 14,083). These included a LS scale and three indicators for adverse alcohol use: binge drinking, passing out and high consumption (women/men ≥400/800 g/month). In longitudinal analyses, logistic regression, pair-wise case-control analyses and growth models were applied.

RESULTS

All alcohol indicators increased the age-adjusted risk of becoming dissatisfied regardless of study period [binge drinking odds ratio (OR)(1975-1990 )= 1.29; 95% confidence interval (CI) 1.12-1.50; high consumption OR(1975-1990 )= 1.60; 1.29-1.99 and passing out OR(1981-1990 )= 2.01; 1.57-2.57]. Also, the dissatisfied had an increased subsequent risk for adverse alcohol use. The risk for passing out due to drinking (OR(1975-1990 )= 1.50; 1.22-1.86) was increased regardless of study period, while high consumption (OR(1975-1981 )= 1.97; 1.40-2.77; OR(1981-1990 )= 2.48; 1.50-4.12) and binge drinking (OR(1975-1981 )= 1.37; 1.12-1.67) showed some variation by the study period. Predictions remained after multiple adjustments. Longitudinally, high consumption predicted dissatisfaction somewhat more strongly than vice versa. The change/levels within the whole range of LS and alcohol consumption were only slightly associated in the entire study population.

CONCLUSION

Life dissatisfaction and adverse alcohol use reciprocally predict each other prospectively. The heavier the alcohol use the stronger the relationship.

Factors associated with life satisfaction in a 6-year follow-up of depressive out-patients

BACKGROUND

The major goal of mental health services is to improve mental health and thus also life satisfaction. However, studies assessing factors associated with life satisfaction during recovery from depression are lacking.

METHODS

A 6-year natural follow-up of 121 depressive out-patients was carried out with questionnaires at baseline, 1/2, 1, 2 and 6 years completed. A structured diagnostic interview was conducted. Throughout the follow-up, clinical status was assessed with several psychometric scales for life satisfaction (LS), depression (BDI, HDRS), hopelessness (HS), functional ability (GAF, SOFAS) and general psychopathology (SCL).

RESULTS

Men and women did not differ in their improvement in life satisfaction. Altogether, 77% of the patients at baseline and 22% at the end were dissatisfied. Life satisfaction on 6-year follow-up was associated with baseline lower interpersonal sensitivity (SCL subscale) and concurrently being loved by someone as well as with baseline and concurrent good self-rated health and wealth. The satisfied were better off in terms of all clinical variables, regardless of the measurement time. Depressive symptoms and hopelessness were the strongest concurrent clinical correlates of LS after 6 years.

CONCLUSIONS

Mental health was strongly related to life satisfaction throughout the follow-up, while most of the non-clinical factors were not. Alleviating depression and interpersonal sensitivity and supporting social networks should be focused on in psychiatric treatment in order to improve life satisfaction among depressive patients.

Health-related quality of life among subjects with long-term mental symptoms in a population-based sample

Women have shown to have poorer health-related quality of life (HRQL) than men. The purpose of this study was to examine HRQL, its gender differences and correlates among subjects (n = 158) with long-term mental symptoms in a population-based sample. HRQL was assessed with the eight dimensions and the Physical (PCS) and Mental Component Summary (MCS) scales of RAND-36. Sociodemographic and lifestyle factors were recorded and psychometric scales were administered. Psychiatric diagnoses were confirmed with the Structured Clinical Interview for DSM-IV. HRQL was quite poor in all dimensions of RAND-36 regardless of gender. Men and women had similarly poor scores for PCS and MCS. Mental health-related factors were main correlates of HRQL and this knowledge could be used in nursing practice and in health promotion.

Serum adiponectin and resistin levels in major depressive disorder

OBJECTIVE

To examine the role of the adipose-tissue-derived low-grade inflammation markers adiponectin and resistin in major depressive disorder (MDD) in a population-based sample.

METHOD

Serum levels of adiponectin and resistin were measured from 70 DSM-IV MDD subjects and 70 healthy controls. Depression severity was assessed with the 29-item Hamilton Depression Rating Scale.

RESULTS

The MDD group had lowered serum adiponectin levels. Regression modelling with adjustments for age, gender, overweight, several socioeconomic and lifestyle factors, coronary heart disease and metabolic syndrome showed that each 5.0 microg/ml decrease in serum adiponectin increased the likelihood of MDD by approximately 20% (P = 0.01). The resistin levels correlated with atypical (P = 0.02), but not with typical depressive symptoms (P = 0.12).

CONCLUSION

Our findings suggest that the lowered adiponectin levels in MDD are depression-specific and not explained by conventional low adiponectin-related factors such as such as coronary heart disease and metabolic disorders.

Association of depressive symptoms and metabolic syndrome in men

OBJECTIVE

To explore the relationship between several indicators of depression and metabolic syndrome (MetS).

METHOD

A population-based sample with high (HMS group) or low (LMS group) levels of mental symptoms, including those of depression, in three follow-ups participated in a clinical examination in 2005 (n = 223). MetS was determined according to the NCEP criteria.

RESULTS

The prevalence of MetS was 49% in men and 21% in women. Men with MetS had higher rates of major depressive disorder than other men. They also displayed higher Hamilton Rating Scale for Depression (HDRS) scores and more often signs of suicidality. In logistic regression analyses, higher HDRS scores (OR 1.31, 95% CI 1.04-1.64) and belonging to the HMS group (OR 10.1, 95% CI 1.98-51.3) were independent associates for MetS but only in men.

CONCLUSION

The results highlight that there is an association between long-term depressive symptoms and the emergence of MetS, especially in men.

Life dissatisfaction and subsequent work disability in an 11-year follow-up

BACKGROUND

Mental disorders are associated with disability, but the long-term effects of low subjective well-being on work ability in general population are not known. In this study we investigated whether self-reported life dissatisfaction predicts work disability.

METHOD

A nationwide sample of Finnish twins aged 18-54 years (N = 22,136), unselected for health status responded to a health questionnaire with a four-item life satisfaction scale (range 4-20) covering interest, happiness, easiness and loneliness of life in 1975 and 1981. Cox regression for all subjects and conditional logistic regression for discordant twin pairs were used to compare the risk of subsequent work disability (N = 1200) (Nationwide Disability Register) between the dissatisfied and satisfied.

RESULTS

Life dissatisfaction predicted subsequent (1977-87) work disability pension due to psychiatric and non-psychiatric causes among the healthy at baseline, and that due to psychiatric causes among the ill. After controlling for age, marital status, social class and health behaviour, these risks remained significant. Repeatedly reported (1975 and 1981) life dissatisfaction was strongly associated with increased (age-adjusted) risk of subsequent (1982-87) work disability due to psychiatric and also that due to non-psychiatric causes among the healthy. When twin pairs discordant for end-point disability status were analysed, risk differences related to life satisfaction were only slightly decreased, but they did not differ significantly between monozygotic and dizygotic pairs.

CONCLUSION

Life dissatisfaction predicts subsequent work disability especially among the healthy.

Life events are important in the course of hopelessness-a 2-year follow-up study in a general population

BACKGROUND

The association between life events and hopelessness in a general population is unknown.

AIM

The aim of this study was to examine the course of hopelessness and how positive and negative life events are associated with it.

METHOD

This was a 2- year follow-up study among general population adults, excluding any with a mental disorder. The impact of 15 occasional life events during the follow-up was assessed and the course of hopelessness measured with the Beck Hopelessness Scale (HS).

RESULTS

Four percent of the study subjects with no hopelessness at baseline and 56% of those with hopelessness at baseline reported hopelessness on follow-up. In multiple logistic regression analyses, a notable worsening of the subjective financial situation was revealed as the most important life event, both in becoming hopeless during the follow-up (OR 5.07; 95% CI 2.20-11.7) and in continued hopelessness (OR 7.51, 95% CI 2.19-25.8). Moreover, considerable interpersonal conflicts at work (OR 3.29, 95% CI 1.17-9.27) were associated with becoming hopeless. However, a notable positive change in common living conditions (OR 0.16, 95% CI 0.04-0.74) was found to be a protective factor against becoming hopeless. All these variables remained significant even when adjusted for change in depression scores (BDI).

CONCLUSION

Hopelessness may be persistent in a general population. The impact of life events, especially a notable worsening of the subjective financial situation, is important in becoming or remaining hopeless.

Self-reported happiness in life and suicide in ensuing 20 years

OBJECTIVE

The aim of this study was to investigate the relationship between self-reported unhappiness and suicide.

METHODS

A sample of adult Finns unselected for health status (N = 29,067) responded to a question on happiness in life with five alternatives: very happy (15.9 %), fairly happy (63.4 %), cannot say (12.9 %), fairly unhappy (6.9 %), very unhappy (1 %). Cox regression was used to study the suicide risk.

RESULTS

From 1976 to 1995, 182 suicides occurred. At baseline, unhappiness was associated with older age, male gender, sickness, living alone, smoking, heavy alcohol consumption, physical inactivity and belonging to intermediate social class. The risk of suicide increased with decreasing happiness. The very unhappy compared with the very happy had an age-adjusted hazard ratio (HR) of 10.84 (95 % CI 3.93-29.94) for suicide. After adjusting for the above-mentioned factors this HR was 7.01 (95% CI 2.44-20.08).

CONCLUSION

Self-reported unhappiness is strongly associated with subsequent suicide in a long follow-up. Moreover, it seems to indicate also cumulative health hazards.

Gender differences in the association of adult hopelessness with adverse childhood experiences

BACKGROUND

The impact of childhood traumatic events on long-term psychological development has been widely studied. Nevertheless, little research has been carried out on possible associations between adverse childhood experiences (ACEs) and hopelessness in adulthood, and whether any gender differences exist.

AIM

The aim of this study was to examine the association between ACEs (poor relationship between parents, unhappiness of childhood home, hard parenting, physical punishment, domestic violence, alcohol abuse in primary family) and current hopelessness without any mental disorder in a general population sample.

METHOD

1598 adults (43 % were men), aged 25-64 years, completed self-report measures to assess ACEs and hopelessness by means of the Beck Hopelessness Scale (HS). Logistic regression was used to adjust for the effects of sociodemographic factors on the association between the cumulative number of ACEs and hopelessness.

RESULTS

Whereas several bivariate associations were found between ACEs and hopelessness, none of them remained significant in multivariate analysis. However, men who reported three or more ACEs were 2.79 times (95 % CI 1.17-6.63) and women 2.19 times (95 % CI 1.04-4.65) more likely to be hopeless compared with those without any ACEs. In women (OR 2.25, 95 % CI 1.01-5.00), but not in men, this relationship remained significant after adjusting for several current covariates.

CONCLUSION

Clustering of ACEs may have long-lasting effects by increasing the risk of hopelessness in adulthood, especially in women. Increased awareness of the frequency of ACEs and their subsequent consequences, such as hopelessness, may encourage health care professionals to undertake preventive work in primary and mental health care.

Life dissatisfaction as a predictor of fatal injury in a 20-year follow-up

OBJECTIVE

To investigate the role of life satisfaction (LS) in fatal injuries with special references to unintentional injuries and whether health status modifies this relationship.

METHOD

A sample of adult Finns unselected for health status (n=29 173) responded in 1975 to a LS scale. Nationwide registry for deaths was used. The dissatisfied were compared with the satisfied by Cox regression.

RESULTS

During 1976-1995, 469 fatal injuries occurred, of which 235 were unintentional. Dissatisfaction predicted fatal unintentional [hazard ratio (HR)=2.83; 95% confidence interval (CI) 1.77-4.51] and intentional injury (HR=3.26; 2.01-5.30). The risk of fatal unintentional injury was 7.8-fold (women) and 4.0-fold (men) increased in the sick and dissatisfied compared with the healthy and satisfied. A repeatedly reported dissatisfaction (1975, 1981) provided a HR of 5.17 (1.48-18.0) for unintentional injury death during 1981-1995. The found effect was partly mediated through health behavior and social situation.

CONCLUSION

Life dissatisfaction predicts both unintentional and intentional injury death.

Why do alexithymic features appear to be stable? A 12-month follow-up study of a general population

BACKGROUND

This 12-month follow-up study investigated the prevalence of alexithymia and its relationship with depression in a sample of the general population from Eastern Finland (n = 1,584).

METHODS

Alexithymia was assessed using the 20-item version of the Toronto Alexithymia Scale (TAS) and depression using the 21-item Beck Depression Inventory (BDI).

RESULTS

The prevalence of alexithymia in each study phase was similar (baseline: 9.7%; follow-up: 10.1%). Mean values of BDI, TAS-20 and subfactors of the TAS-20 also remained unchanged between the study phases. However, by using the original cutoff points, we found that a proportion of the subjects were in a different TAS-20 category on follow-up than at baseline. The mean values of BDI had not changed in those subjects who had similar alexithymia status in both phases, but increased or decreased in parallel with the change in TAS-20 score among all other subjects.

CONCLUSIONS

Our findings indicate that it is important to use a variety of viewpoints when studying changes in alexithymia status. Alexithymia appears to be a stable trait based on the similarity of the mean TAS-20 scores in separate study phases. However, when focusing on the changes in alexithymia status at the individual level, alexithymic features also appear to be state dependent and strongly related to depressive symptoms.

Depression and associated factors in coronary heart disease

OBJECTIVE

To investigate whether depression was associated with cardiac status and socio-demographic factors in patients with coronary heart disease (CHD).

METHODS

The sample consisted of 144 symptomatic patients with CHD. For screening depression the Beck Depression Inventory was administered on the day before elective coronary angiography.

RESULTS

Twenty-four per cent of patients had probable depressive disorder, but none of them had been previously identified as suffering from depression, or been treated for depression. Alexithymia and dissatisfaction with life were common in depressed patients. Logistic regression analysis showed that neither the cardiac status nor sociodemographic factors were associated with depression.

CONCLUSION

Depression is a common finding and should be looked for independently of other risk factors in patients with CHD.

Mood improvement reduces memory complaints in depressed patients

BACKGROUND

The aim was to examine associations between memory complaints, cognitive performance and mood in 174 adult, clinically depressed, neurologically healthy patients at baseline and during six months of follow-up.

METHODS

Subjective memory disturbance was assessed using the Memory Complaint Questionnaire (MCQ). Levels of cognitive function, including memory, were assessed using a battery of neuropsychological tests. Mood and personality traits were assessed using rating scales, including the Beck Depression Inventory (BDI), Hamilton Depression Rating Scale (HDRS) and the 90-item Symptom Check List (SCL-90).

RESULTS

At baseline, patients complaining of memory disturbances had higher BDI and HDRS scores than patients not complaining of memory problems. They also did less well in objective memory performances but not in other cognitive functions. Complaints of memory problems decreased during the follow-up. This change was associated with mood improvement and with reductions in other mental symptoms but not with changes in cognitive performance. In logistic regression analysis factors independently associated with MCQ change were age (OR 0.96) and BDI change (OR 1.06).

CONCLUSIONS

Subjective memory problems usually decline if depression is alleviated.

Alexithymia in patients with coronary heart disease

OBJECTIVE

The aim of this study was to investigate factors associated with alexithymia in patients (n=153) with coronary heart disease (CHD) verified by coronary angiography.

METHOD

Self-rated depression was assessed using 21-item Beck Depression Inventory (BDI) and other psychiatric symptoms with Symptom Check List-90 (SCL-90). Life satisfaction was assessed using a separate scale. The Structured Clinical Interview (SCID I and II) for DSM-III-R was used to identify mental disorders. Assessments took place 1 day before angiography.

RESULTS

Twenty-one percent of CHD patients (n=32) were assessed as being alexithymic according to the Toronto Alexithymia Scale (TAS-20). Alexithymics were more often blue-collar workers, incapable of working, dissatisfied with life, and depressed than the other CHD patients. Occurrences of mental disorders were not associated with alexithymia. Logistic regression analysis revealed that factors independently associated with alexithymia were currently or previously being a blue-collar worker (adjusted odds ratio, AOR: 4.8), self-rated depression (AOR: 3.2), and dissatisfaction with life (AOR: 2.9).

CONCLUSION

In CHD patients alexithymia was unrelated to cardiovascular risk factors or exercise capacity but was related to self-rated depression and decreased life satisfaction. Alexithymia is associated with the enhanced psychosocial burden of suffering CHD. This patient group may need more individual support and attention than other CHD patients.

Life satisfaction and suicide: a 20-year follow-up study

OBJECTIVE

The authors investigated whether self-reported life satisfaction predicted suicide over a period of 20 years (1976-1995) in adults unselected for mental health status.

METHOD

A nationwide sample of adults aged 18-64 years (N=29,173) from the Finnish Twin Cohort responded to a health questionnaire that included a life satisfaction scale (score range=4-20, with higher scores indicating greater dissatisfaction) that covered four items: interest in life, happiness, general ease of living, and feeling of loneliness. "Dissatisfied" subjects (life satisfaction score=12-20) were compared to "satisfied" subjects (score=4-6). Mortality data were derived from the national registry and analyzed with Cox regression.

RESULTS

Dissatisfaction at baseline (life satisfaction score=12-20) was associated with a higher risk of suicide throughout the 20-year follow-up period (age-adjusted hazard ratio=3.02, 95% confidence interval [CI]=1.83-4.98). The association was somewhat stronger in the first decade (hazard ratio=4.46, 95% CI=1.95-10.20) than in the second (hazard ratio=2.34, 95% CI=1.24-4.45). A dose-response relationship was also found. Men with the highest degrees of dissatisfaction (life satisfaction score=19-20) were 24.85 times as prone to commit suicide as satisfied men during the first 10 years of the follow-up period. Throughout the entire follow-up, life dissatisfaction still predicted suicide after adjusting for age, sex, baseline health status, alcohol consumption, smoking status, and physical activity (hazard ratio=1.74, 95% CI=1.02-2.97). Subjects who reported dissatisfaction at baseline and again 6 years later showed a high suicide risk (hazard ratio=6.84, 95% CI=1.99-23.50) compared to those who repeatedly reported satisfaction.

CONCLUSIONS

Life dissatisfaction has a long-term effect on the risk of suicide, and this seems to be partly mediated through poor health behavior. Life satisfaction seems to be a composite health indicator.

Self-reported life satisfaction and recovery from depression in a 1-year prospective study

OBJECTIVE

To study the relationship of a self-rated four-item life satisfaction scale (LS) to the self-rated 21-item Beck Depression Inventory (BDI) and the 17-item Hamilton Rating Scale for Depression (HAMD) and to study LS changes during recovery from depression.

METHOD

A 1-year prospective study on 188 depressive patients receiving standard psychiatric outpatient treatment; 137 of the patients had major depression.

RESULTS

LS correlated strongly with BDI and HAMD. It explained 46.6%) of the variation in BDI at baseline and 66.2% at 12 months. LS improved substantially during recovery. The main recovery occurred during the first 6 months, the change in the LS score explaining 46.5% of the change in the BDI score (P < 0.001).

CONCLUSION

Life satisfaction is strongly affected in depression, but it improves concurrently with recovery from depression. LS scale may prove useful in screening for those whose subjective wellbeing deserves attention and in assessing alleviation from depression.

Self-reported life satisfaction and 20-year mortality in healthy Finnish adults

The authors investigated the role of self-reported life satisfaction in mortality with a prospective cohort study (1976-1995). A nationwide sample of healthy adults (18-64 years, n = 22,461) from the Finnish Twin Cohort responded to a questionnaire about life satisfaction and known predictors of mortality in 1975. A summary score for life satisfaction (LS), defined as interest in life, happiness, loneliness, and general ease of living (scale range, 4-20), was determined and used as a three-category variable: the satisfied (LS, 4-6) (21%), the intermediate group (LS, 7-11) (65%), and the dissatisfied (LS, 12-20) (14%). Mortality data were analyzed with Cox regression. Dissatisfaction was linearly associated with increased mortality. The age-adjusted hazard ratios of all-cause, disease, or injury mortality among dissatisfied versus satisfied men were 2.11 (95% confidence interval (CI): 1.68, 2.64), 1.83 (95% CI: 1.40, 2.39), and 3.01 (95% CI: 1.94, 4.69), respectively. Adjusting for marital status, social class, smoking, alcohol use, and physical activity diminished these risks to 1.49 (95% CI: 1.16, 1.92), 1.35 (95% CI: 1.01, 1.82), and 1.93 (95% CI: 1.19, 3.12), respectively. Dissatisfaction was associated with increased disease mortality, particularly in men with heavy alcohol use (hazard ratio = 3.76, 95% CI: 1.61, 8.80). Women did not show similar associations between life satisfaction and mortality. Life dissatisfaction may predict mortality and serve as a general health risk indicator. This effect seems to be partially mediated through adverse health behavior.

Effect of somatic comorbidity on alleviation of depressive symptoms

OBJECTIVE

The aim of this study was to investigate whether somatic comorbidity (SC) impedes recovery from depression.

METHOD

The study design was naturalistic. Diagnosis of depression was confirmed by means of the Structured Clinical Interview for DSM-III-R (SCID). Changes in the symptom scales for those patients with somatic comorbidity (n = 75) were compared with corresponding changes in depressive patients without somatic comorbidity (n = 41) in a 6-month follow up.

RESULTS

Measured on the Hamilton and Beck scales, recovery rates of those with SC was only slightly lower to that of the others. The difference was statistically significant only in relation to the Hamilton scale. Forty-four per cent of those with SC and 42% of the other patients recovered from their depression (BDI score < 10 on follow up). Logistic regression analysis showed no independent association between recovery and somatic comorbidity.

CONCLUSIONS

Moderate somatic comorbidity has only a minor effect on recovery from depression.

Gender differences in living skills and global assessment of functioning among outpatients with schizophrenia

OBJECTIVE

The aims of this paper are to study skills in personal and domestic activities, and their associations with Global Assessment of Functioning (GAF) scale scores among outpatients with schizophrenia, and to study the impact of depressive mood on functional capacity in schizophrenia.

METHOD

Three hundred and two outpatients with DSM-III-R schizophrenia completed the 13-item Beck Depression Inventory (BDI) and a questionnaire relating to their sociodemographic characteristics, and living and working conditions. Staff members completed the GAF scale and a questionnaire relating to the patient's medical history and current treatment. This questionnaire also included the staff's assessments on patient's skills in six personal or domestic activities (personal hygiene, homemaking, management of financial affairs, shopping, decision-making, getting about).

RESULTS

Fifty-six percent of men and 33% of women (p < 0.001) with schizophrenia did not have independent skills in at least one personal or domestic activity but there was no difference in the mean GAF score between men and women. In men, the GAF score was independently and positively associated with all living skills studied and in women with homemaking, management of financial affairs, and decision-making, respectively. The BDI scores were not independently associated with functioning in personal and domestic activities except with getting about in women.

CONCLUSIONS

The GAF scale is a simple and time-saving measure for assessing overall living skills among outpatients with schizophrenia. However, assessments on the GAF scale may be biased towards poor functioning in women. Moreover, psychosocial functioning and depression should be evaluated separately.

Factors predicting psychosocial recovery in psychiatric patients

We examined factors associated with psychosocial recovery in patients receiving specialist psychiatric treatment by means of a questionnaire directed at staff and patients (n = 1084) in an extensive study performed in North Savo, Kuopio, Finland. Psychosocial recovery was considered to have taken place if the Global Assessment Scale (GAS) score had increased from the lowest estimate obtained during the preceding year by at least 28 points at the time of the study (n = 102). The remaining cases (n = 982) served as controls. In the univariate analysis of all of the patients, the factors associated with good recovery were a high level of basic education, a diagnosis of major depression and adequate social support. The opportunity to contact a therapist outside fixed treatment visits was also a factor predicting psychosocial recovery. In the multivariate analysis, independent factors predicting recovery were the high frequency of treatment contacts in cases of schizophrenia, previous hospitalization in major depression, and a high level of basic education and hospitalization in personality disorders.

Males as a high-risk group for trauma: the Finnish experience

The high incidence of trauma among young men has been observed in many countries. To better understand this risk, we analyzed male injuries and their causes in Finland. The incidence peak of medically attended trauma in men aged 15-24 years was caused by occupational and sports injuries, whereas that of hospitalizations was due to motor vehicle injuries. Age patterns of nonfatal trauma resembled those recorded in the U.S.A. However, patterns and causes of fatal trauma were very different in the two countries: early adulthood in the U.S.A. and late middle-age in Finland were the ages of highest injury mortality. The majority of deaths in young men were caused by motor vehicle injuries in the U.S.A., whereas suicides and the extremely high rate of fatal non-motor vehicle accidents, largely due to alcohol poisoning and drownings, formed the main bulk of injury mortality in Finland. Similarities in early adulthood suggest general biological factors, whereas the deviance of the middle-aged male Finns from the general pattern may indicate more specific psychosocial factors.