Associations of allostatic load with sociodemographic factors, depressive symptoms, lifestyle, and health characteristics in a large general population-based sample

OBJECTIVE

We examined the associations between allostatic load (AL) and sociodemographic factors, depressive symptoms, lifestyle and health characteristics in a population-based sample of 4993 adults in Finland.

METHODS

Thirteen biomarkers were used to construct AL. High AL was defined as scoring highly in ≥4 items.

RESULTS

AL scores of 4 and above were exceeded in the age group of 45-54 years in men and 65-74 years in women. Age was the strongest predictor for belonging to the high AL score group. In addition, elevated depressive symptoms (BDI-6 ≥ 4), male sex, not engaging in physical exercise, high alcohol use and a low level of education were associated with an increased likelihood of belonging to the high AL group.

CONCLUSION

The older the participants were, the greater their AL burden was. However, AL burden increased more steeply as a function of age in men. In addition to lifestyle interventions, effective prevention strategies for depression at the population level could have a major public health impact in reducing the accumulation of AL burden.

Alcohol use associated alterations in the circulating metabolite profile in the general population and in individuals with major depressive disorder

Our aim was to evaluate whether alcohol use is associated with changes in the circulating metabolite profile similar to those present in persons with depression. If so, these findings could partially explain the link between alcohol use and depression. We applied a targeted liquid chromatography mass spectrometry method to evaluate correlates between concentrations of 86 circulating metabolites and self-reported alcohol use in a cohort of the non-depressed general population (GP) (n = 247) and a cohort of individuals with major depressive disorder (MDD) (n = 99). Alcohol use was associated with alterations in circulating concentrations of metabolites in both cohorts. Our main finding was that self-reported alcohol use was negatively correlated with serum concentrations of hippuric acid in the GP cohort. In the GP cohort, consumption of six or more doses per week was associated with low hippuric acid concentrations, similar to those observed in the MDD cohort, but in these individuals it was regardless of their level of alcohol use. Reduced serum concentrations of hippuric acid suggest that already moderate alcohol use is associated with depression-like changes in the serum levels of metabolites associated with gut microbiota and liver function; this may be one possible molecular level link between alcohol use and depression.

Negative effects in randomized controlled trials of psychotherapies and psychological interventions: A systematic review

Background: Psychotherapy is a key evidence-based method for the treatment of mental disorders. However, little research has been published on the negative effects of psychotherapies. Aims: We examined this issue through a systematic literature review of previous systematic reviews on randomized controlled trials (RCTs). Methods: We focused on previous reviews and meta-analyses on 1) RCTs examining the effectiveness of psychotherapies and 2) previous reviews and meta-analyses specifically focusing on the negative effects of psychotherapy. We included publications published in PubMed and the Cochrane Databases from the year 2000 or later. Results: Of the 1,430 relevant publications, only a small proportion (30%) mentioned negative outcomes, mostly withdrawal. Only 57 of the extracted original studies monitored potential negative effects, and only three small-scale studies indicated negative effects. Conclusions: The systematic monitoring of negative effects in psychotherapy has not been given the same attention as has been given to the benefits of therapy.

The use of dental anxiety management techniques during one-session treatment: a study on five video-recorded patient cases

OBJECTIVE

The aim was to examine what kinds of dental anxiety management techniques dentists use in the context of one-session treatment.

MATERIAL AND METHODS

The data consisted of videotaped treatment sessions for five dentally anxious adults. The treatment was conducted by two experienced dentists without formal training in the treatment of dentally anxious patients or behavioral management techniques. Theory-driven qualitative content analysis, based on the anxiety management classification of Milgrom et al. was used to identify and classify the techniques used during the treatments.

RESULTS

Altogether, diverse categories of dental anxiety management techniques were identified under the main themes of enhancing trust and control and psychological management. Techniques that fell into enhancing trust and control included the categories of 'building a trustful relationship', 'informational control', and 'behavioral control'. These techniques were used consistently throughout the sessions. Additionally, psychological management techniques were identified and classified as 'behavioral strategies: relaxing the body' and 'cognitive strategies: relaxing the mind', which were regularly used in specific situations.

CONCLUSION

The results indicate that a variety of dental anxiety management techniques were used during one-session treatments. The findings provide valuable insights for dentists in managing their patients with dental anxiety and improving their overall treatment experience.

Do Sleep Problems Explain the Association Between Work Stress and the Trajectories of Work Ability From Midlife to Pensionable Age?

OBJECTIVE

This study examined whether mid-life work stress, defined as job strain and effort-reward imbalance (ERI), predicts work ability trajectories observed 12 years preceding the individual pensionable age. In addition, the role of sleep problems as a mediator in these associations was examined.

METHODS

Survey data were collected from 2707 Finnish municipal employees.

RESULTS

Identified work ability trajectories were "stable excellent," "stable good," "moderate," and "low decreasing." Baseline job strain and ERI were associated with a greater likelihood of belonging to impaired work ability trajectories when compared with "stable good" trajectory. Baseline sleep problems explained the association of job strain by 38% and of ERI by 54%.

CONCLUSIONS

Mid-life work stress is associated with work ability in the last years preceding pensionable age. Sleep problems might be a potential mediator in these associations.

The effectiveness of a diagnostic interview and modified one-session treatment for dental anxiety in primary dental care-A pilot study

AIMS

To investigate the effectiveness of a cognitive-behavioral intervention that included either a diagnostic interview (DI) or a DI combined with modified one-session treatment (M-OST) for dental anxiety among adults in a primary care setting.

METHODS AND RESULTS

Nineteen participants were assigned to either a DI before conventional dental treatment (group T1) or DI and M-OST (group T2). The severity of dental anxiety was measured with three self-reported measures before and after the intervention: the Modified Dental Anxiety Scale (MDAS), the Index of Dental Anxiety and Fear (IDAF-4C), and the Visual Analogue Scale-Anxiety (VAS-A). Dental care attendance was enquired in a 1-year follow-up. The scores for all three scales decreased among both study groups, with the largest decrease recorded in treatment group T1 assessed with the VAS-A. A higher dental anxiety score measured before the intervention associated most significantly with a higher dental anxiety score after the intervention. At the 1-year follow-up, 82% of participants in T1 and 67% in T2 had visited a dentist.

CONCLUSION

A DI alone and combined with M-OST is potentially effective in reducing dental anxiety and in supporting the engagement of adult patients with dental treatment in primary dental care.

Occupational well-being of the work community in social and health care education during the COVID-19 pandemic-A cross-sectional study

AIM

To evaluate factors related to the occupational well-being of social and health care educators' work communities during the COVID-19 pandemic.

DESIGN

A cross-sectional study was conducted among social and health care educators in Finland 2020.

METHODS

Data (n = 552) were collected through a questionnaire containing continuous, Likert scale and categorical variables. Descriptive, exploratory factor analysis and multiple regression modelling were used for analysing the data.

RESULTS

Educators regarded their work as meaningful and experienced collegiality. Age and work experience were related to experiences on work community subscales and community occupational well-being. Personal occupational well-being and activities promoting occupational well-being on the community level were most related to experiences of the work community and its well-being. The activities that promote occupational well-being on the work community level should be emphasized.

Serum levels of carnosine may be associated with the duration of MDD episodes

BACKGROUND

Major depressive disorder (MDD) is a recurrent disorder that incurs a high societal burden. However, the etiology of MDD remains unclear. The functioning of several systems associated with the etiopathogenesis of MDD, such as inflammatory and stress systems, is partially modulated by the dipeptide carnosine.

METHODS

The study comprised 99 MDD patients and 253 non-depressed controls aged 20-71 years. Fasting serum samples were analyzed using ultra-performance liquid chromatography coupled to mass spectrometry to determine the serum levels of carnosine and its constituent, histidine. We compared these metabolites in three different settings: 1) MDD patients vs. non-depressed controls and 2) remitted vs. non-remitted MDD patients, as well as 3) changes in the metabolite levels during the follow-up period within a) the remitted group and b) the non-remitted group. In addition, we assessed the possible effect of medications on the measured metabolites.

RESULTS

We observed higher serum levels of carnosine in the MDD group compared to the control group at baseline (OR = 1.895, 95%CI = 1.223-2.937, p = 0.004). Elevated serum levels of carnosine were also associated with a longer duration of the depressive episode (Z = 0.406, p = 0.001). However, the use of any antipsychotic medication (n = 36) was associated with lowered carnosine levels (p = 0.010 for use vs. non-use). At the follow-up, remitted and non-remitted participants displayed no significant differences in their carnosine levels (Z = -0.14, p = 0.891) or histidine (Z = -1.39 p = 0.164).

CONCLUSIONS

An increase in circulating carnosine may characterize depressive episodes and may represent a protective homeostatic reaction against MDD-related oxidative stress and inflammation.

Fear, isolation and the importance of support: A qualitative study of parents' experiences of feeding a child born with esophageal atresia

OBJECTIVE

Feeding and swallowing difficulties in children are increasing due to improved survival rates of children with complex medical conditions. Despite being common complications of esophageal atresia (EA), EA related feeding difficulties have received little attention in research. Establishing positive feeding interactions and practices are important for child health and development, and for parental and child mental health. The current study aimed to investigate the parental experiences of feeding a child born with EA.

METHODS

An international online survey was developed and disseminated to parents of children born with EA, aged 0-12 years, in collaboration with a patient charity for EA. Reflexive Thematic Analysis was used to analyze the qualitative survey responses.

RESULTS

176 participants were included in the qualitative sample from a larger international online survey study, chosen by a process of selective coding. Three themes were constructed during the analysis: 1) Anxiety, trauma and loss; 2) Isolated and unsupported; and 3) Supported. The results indicated that parents of children born with EA experienced significant anxiety related to their child's swallowing and feeding difficulties and traumatic experiences during feeding, and that these led to parents feeling a sense of loss and sadness. It was also found that support, or a lack of support, within parents' social environment might mediate parental experiences of child's feeding difficulties.

CONCLUSIONS

This study highlighted the importance of support for parents of children born with EA, and suggested a need for improved guidance for feeding and swallowing difficulties.

Association between alexithymia and substance use: A systematic review and meta-analysis

Alexithymia has been associated with substance use, but the magnitude of the association has not been evaluated and sub-group differences, if any, are unknown. The aim of this meta-analysis is to systematically review the association between alexithymia and substance use (alcohol or illicit drugs). We identified studies through a systematic review of PubMed and Web of Science and obtained a total of 52 publications using the Toronto Alexithymia Scale-20 scale. Random effects meta-analysis was used to evaluate the overall and sub-group associations. Of the studies, 50 were cross-sectional and two longitudinal. Alexithymia was associated with any substance use (Cohen's d = 0.62, 95% confidence interval [CI] 0.49-0.76), with little difference between estimates for use of alcohol or illicit drugs. A stronger association was observed for the alexithymia dimension "Difficulty in Identifying Feelings" (d = 0.64, 95% CI = 0.47-0.81) and "Difficulty in Describing Feelings" (d = 0.44, 95% CI = 0.32-0.55) than for "Externally Oriented Thinking" (d = 0.19, 95% CI = 0.09-0.28). The association was stronger in studies with clinical patient populations (d = 0.83, 95% CI = 0.62-1.05) than in those investigating general or student populations, and in studies with a majority of male rather than female participants. These findings suggest a strong overall association between alexithymia and substance use and a very strong association among clinical patient populations. The association may be stronger with the emotion-related dimensions than with the cognition-related dimension of alexithymia. As nearly all the studies were cross-sectional, more longitudinal studies are needed.

Psychiatric Symptoms, Posttraumatic Growth, and Life Satisfaction Among Parents of Seriously Ill Infants: A Prospective Case-Controlled Study

We evaluated psychiatric symptoms, posttraumatic growth, and life satisfaction among the parents (n = 34) of newborns (n = 17) requiring therapeutic hypothermia or urgent surgery (interest group). Our control group included 60 parents of healthy newborns (n = 30). The first surveys were completed soon after diagnosis or delivery and the follow-up surveys 1 year later (participation rate 88% in the interest group and 70% in the control group). General stress was common in both groups but was more prevalent in the interest group as were depressive symptoms, too. Anxiety was more common in the interest group, although it showed a decrease from the baseline in both groups. Life satisfaction had an inverse correlation with all measures of psychiatric symptoms, and it was lower in the interest group in the early stage, but similar at 12 months due to the slight decline in the control group. Mothers in the interest group had more anxiety and depressive symptoms than fathers in the early stage. Mothers had more traumatic distress than fathers at both time points. Half of the parents experienced substantial posttraumatic growth at 12 months. In conclusion, the serious illness of an infant substantially affects the well-being of the parents in the early stages of illness and one year after the illness.

Children's Disclosures of Physical Abuse in a Population-Based Sample

Few studies have explored the disclosure of child physical abuse although child sexual abuse disclosure has been widely studied and debated for years. The present study explores the characteristics of child physical abuse disclosures and compares them to previously published findings on child sexual abuse disclosure from the same data. The data consist of a representative sample of 11,364 sixth and ninth graders. Participants responded to a wide variety of questions concerning experiences of violence, including child physical abuse and child sexual abuse, in the Finnish Child Victim Survey conducted in 2013. Within this sample, the prevalence of child physical abuse was 4.1%. Children reporting abuse experiences also responded to questions regarding disclosure, reactions encountered during disclosure, and potential reasons for nondisclosure. Findings show that most of the children who disclosed physical violence had disclosed to their mother. The overall disclosure rate of child physical abuse was 74%. However, only 42% had disclosed to adults, and even fewer had reported their experiences to authorities (12%). The most common reason for nondisclosure was that the youth did not consider the experience sufficiently serious to report (53%). These findings were largely in line with the child sexual abuse disclosure rates in our previous study. Analyses of variables associated with disclosing to an adult indicate that the strongest factors predicting disclosure to an adult are younger age, female gender, no previous experiences of child physical abuse, and parents knowing who their child spends her or his spare time with. Implications for further research and practice are discussed.

The association between chronotype and sleep quality among female home care workers performing shift work

There is a scarcity of evidence on the association between shift work, sleeping parameters, heart rate variability (HRV), and chronotype, i.e., morningness and eveningness. The aims of this study were to 1) compare participants with different chronotypes (morning (M), evening (E), or neither (N)) in terms of their total sleep time, sleep efficiency, and HRV parameters, taking their age into account, and 2) examine whether self-reported work-related stress, the length of the working career and years performing shift work affect this association. The participants of the study were home care workers working in two shifts in one municipality in Eastern Finland (N = 395). Of these, 52 females (mean age 42.78 y, SD 12.92 y) completed the study questionnaire and participated in physiological measurements. Several sleep-related parameters were assessed (total sleep time, sleep efficiency, number of awakenings, and length of awakening) and indices of autonomic nervous system based on HRV were calculated. The participants worked in two shifts: a morning shift (7:00-15:00 h) and an evening shift (14:00-21:30 h). All these parameters were assessed during the night before the first work shift (N1), the night before the second work shift (N2), the night before the final work shift (N3), and the night before the first day off work (N4). According to the results, 21.2% of the participants were M-types, 17.3% were E-types, and 61.5% were N-types. On average, the participants had been in working life for 18.8 years and performing shift work for 13.7 years. On night N3, E-types had a significantly shorter total sleep time and spent less time in bed compared to M- and N-types. The total sleep time of M-type and N-type participants was on average 66 minutes and 82 minutes longer, respectively, when compared to E-types on night N3. There were no statistically significant differences in actigraphy-based sleep quality parameters between M-, N-, and E-types on nights N1, N2, and N4. Our results together indicate that M- and N-type individuals may have better sleep quality than E-types, which was also reflected in HRV parameters. Further research with longitudinal study design and workplace interventions is needed to determine how the chronotype can be optimally and individually utilized to improve the health and well-being of morning-type and evening-type people. This is particularly important for both younger and older workers entering the workforce to support healthier and longer working lives.

Anxiety and Depression in Parents of Children Born with Esophageal Atresia: An International Online Survey Study

PURPOSE

Caring for a chronically ill child can be stressful and requires additional care from parents. Parental mental health and stress may impact both parental and child wellbeing, leading to maladaptive parenting practices, and interference with illness management. The aim of the study was to explore the levels of anxiety and depression in parents of children born with esophageal atresia (EA) and to investigate whether parental anxiety and depression were associated with child's medical characteristics or with parental factors.

DESIGN AND METHODS

An international online survey was developed and disseminated to parents of children born with EA, aged 0-12 years, via EA patient charity social network sites. A one-way between subjects ANOVA and post hoc statistical analyses were used to examine differences in mean scores of parental anxiety and depression between sub-groups that described child's medical characteristics and parental characteristics.

RESULTS

A total of 240 parents completed the survey from 17 different countries. Of these, nearly 70% self-reported raised levels of anxiety, whilst 38% self-reported raised levels of depression. Statistically significant differences in mean scores of parental anxiety and depression were found between sub-groups that described the child's feeding problems, parental age, and perceived support for caring, caring stress and money matters.

CONCLUSION

Child's feeding problems related to esophageal atresia, and parental factors, such as younger age, perceived lack of support for caring, caring stress, and money worries, may contribute to the increased levels of parental anxiety and depression in parents of children born with EA.

Work community factors, occupational well-being and work ability in home care: A structural equation modelling

Aim

To examine how work community factors are related to occupational well‐being and work ability, and how occupational well‐being is related to work ability.

Design

A cross‐sectional study was conducted among home care workers in one municipality in Finland.

Methods

A self‐administered survey on work and well‐being was filled out by 167 employees working two shifts in 2019. Structural equation modelling was used to analyse the association between work community factors, occupational well‐being and work ability.

Results

The only work community factor directly affecting Occupational well‐being was Information and work organization; the effect of the other two factors, Social support and Influence on work shifts, was indirect. All work community factors indirectly affected Work ability. Home care should emphasize information provision and work organization with optimal time use. This requires social support, a well‐functioning work atmosphere and providing employees with opportunities for influence and participation.

Heart rate variability and chronotype - a systematic review

There is a scarcity of evidence on the association between heart rate variability (HRV) and chronotype, i.e., morningness and eveningness. The aim of this systematic review was to examine the association between chronotype, HRV, mood and stress response. We searched PubMed, Web of Science, Scopus, Cinahl, PsycINFO and Google Scholar for peer-reviewed articles published in English between January 2000 and June 2020. A total of 11 articles met the inclusion criteria and were on study population, assessment of HRV and chronotype, main results and study limitations. Seven of the included studies were experimental and four were crossovers. The sample size varied from 9 to 221 participants, and both females and males were included. HRV was assessed using mostly time-domain and frequency-domain parameters; nonlinear parameters were used in only one study. The most used assessments for measuring chronotype were the Horne-Östberg Morningness-Eveningness Questionnaire (MEQ) and the Munich Chronotype Questionnaire (MCTQ). The results showed that chronotype was associated with HRV, but the study designs were situation-specific, focusing, for example, on the effects of shiftwork, stressful situations, exercise, or sleep deprivation on HRV. In addition, some studies showed that evening types (E-type) performed better during evening or nighttime tasks, whereas morning types (M-type) performed better during morning activities. Specifically, E-types showed decreased HRV and HRV recovery in relation to tasks performed during morning or daytime when compared to M-types. As the findings are somewhat contradictory and include some methodological limitations (e.g., small sample sizes, age groups), it is important for future studies to evaluate the association between chronotype and HRV in a longitudinal setting. In addition, further research is needed to determine how chronotype can be optimally and individually utilized to increase the health and well-being of M-type and E-type individuals.

Resilience and health-related quality of life in patients with pulmonary diseases receiving ambulatory oxygen therapy

Background

Pulmonary diseases affect health-related quality of life (HRQoL), but there are few data on patients’ adaptation to a serious illness. This study assessed resilience and its associations with HRQoL, life satisfaction, anxiety and depression in patients with pulmonary diseases receiving ambulatory oxygen therapy.

Methods

In this prospective cohort study, we enrolled 42 patients with pulmonary diseases receiving ambulatory oxygen therapy. The patients completed the following questionnaires at baseline and after one and three months; the Resilience Scale-25, the Life Satisfaction Scale-4, the 15D instrument of HRQoL, the Hospital Anxiety and Depression Scale (HADS) and the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0). To compare HRQoL, we recruited age- and gender-matched controls from the general population (n = 3574). The primary outcome was the proportion of patients with low resilience.

Results

Half (42–48%) of the patients had low resilience, which was correlated with low HRQoL, low levels of life satisfaction and higher levels of anxiety and depression. Patients had very low HRQoL compared to controls. Dissatisfaction with life increased during the 3-months follow-up, but only a few patients had anxiety or depression. Patient satisfaction with assistive technology was high; the median QUEST 2.0 score (scale 1–5) was 4.00 at baseline, 3.92 at one month and 3.88 at three months.

Conclusions

Resilience was low in half of the patients with pulmonary diseases receiving ambulatory oxygen therapy. Higher resilience was positively correlated with HRQoL and life satisfaction and negatively correlated with anxiety and depression.

Trial registration: ClinicalTrials.gov Protocol Record 507A023. Registered 17 September 2020—Retrospectively registered, https://clinicaltrials.gov/ct2/results?cond=&term=NCT04554225&cntry=&state=&city=&dist=.

Patients' multifaceted views of dental fear in a diagnostic interview

OBJECTIVES

The aim was to examine how patients describe and perceive their dental fear (DF) in diagnostic interviews.

MATERIAL AND METHODS

The sample consisted of dentally anxious patients according to the Modified Dental Anxiety Scale (MDAS), who had problems coping with conventional dental treatment. The voluntary participants (n = 7, aged 31-62 years) attended a diagnostic interview aiming to map their DF before dental treatment. The data were analysed by theory-driven qualitative content analysis. The themes consisted of the four components of DF: emotional, behavioural, cognitional, and physiological, derived from the Index of Dental Anxiety and Fear.

RESULTS

Within these four themes, treated as the main categories, 27 additional categories related to the patients' interpretations of DF were identified in three contexts: before, during and after dental treatment. 10 categories depicted difficult, uncontrollable, or ambivalent emotions; nine depicted behavioural patterns, strategies, or means; five depicted disturbing, strong, or long-lasting physiological reactions, including panic and anxiety symptoms. The remaining three categories related to cognitive components.

CONCLUSIONS

The results indicate that dental care professionals may gain comprehensive information about their patients' DF by means of four component-based diagnostic interviews. This helps them to better identify and encounter patients in need of fear-sensitive dental care.

TRIAL REGISTRATION NUMBER

NCT02919241.

Comparison of the level of allostatic load between patients with major depression and the general population

OBJECTIVE

We compared the level of allostatic load (AL) between patients with major depressive disorder (MDD) and non-depressed controls using two definitions of AL: continuous AL scores (AL index) and clinically significant high AL (≥4). We examined whether MDD was associated with AL independent of basic socioeconomic (age, sex, cohabiting status and level of education) and lifestyle factors (smoking and alcohol use).

METHODS

The MDD patient sample consisted of 177 psychiatric outpatients (mean age 33.7, SD 10.7 years), who were recruited from the Department of Psychiatry at Kuopio University Hospital, Finland, in 2016-19. The non-depressed controls (n = 228, mean age 49.8, SD 10.1 years) lived in the municipality of Lapinlahti, Finland. Ten biomarkers were used to construct the two AL variables. These indicators were systolic and diastolic blood pressure, total cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, glucose, creatinine, waist circumference, body mass index (BMI) and C-reactive protein (CRP).

RESULTS

The mean AL scores did not significantly differ between MDD patients (2.97) and non-depressed controls (3.12), thus it was not associated with MDD in univariate analysis. In multivariate models a higher AL index was associated with a 1.42 to 1.82 times higher likelihood of belonging to the MDD group. Furthermore, we found that high AL (i.e. AL ≥ 4) was associated with MDD, with the likelihood ranging between 2.27 and 2.96 compared with the non-depressed controls in multivariate models.

CONCLUSIONS

Even young adult patients with MDD appear to display clinically significant, high AL compared with non-depressed controls. Thus, it is important to pay attention to the somatic health of depressed patients in addition to their mental health.

Adverse childhood experiences and alexithymia in patients with major depressive disorder

The purpose of the article: Adverse childhood experiences (ACEs) have been postulated to negatively affect the development of emotional regulation. However, little is known about specific associations between ACEs, depressive symptoms, and alexithymia or its components [i.e. difficulty in identifying feelings (DIF), difficulty in describing feelings to others (DDF) and externally-oriented thinking (EOT)] in patients with major depressive disorder (MDD). The aims of the present cross-sectional study were to (1) compare ACEs (emotional neglect, emotional abuse, physical neglect, physical abuse, sexual abuse) between alexithymic and non-alexithymic patients with MDD; (2) explore whether specific ACEs, depressive symptoms or the interaction between sex and depressive symptoms predicted TAS-20 or its components.Materials and Methods: The study sample consisted of 186 psychiatric outpatients with MDD (aged 21-61 years, mean 33.87 years, SD 10.88) recruited from the Department of Psychiatry, Kuopio University Hospital between 2016-2019. Alexithymia and its components were assessed using the 20-item Toronto Alexithymia Scale (TAS-20). ACEs were assessed with the Trauma and Distress Scale (TADS).Results: Almost all patients with alexithymia and 80% of non-alexithymic patients reported that they had experienced emotional abuse or neglect, at least sometimes. Approximately 60% of MDD patients reported having experienced physical neglect and 30% described physical abuse. Emotional and physical abuse and neglect predicted DDF score.Conclusions: These findings suggest that among MDD patients, early experiences of emotional and physical abuse and neglect is associated with difficulties in describing feelings in adulthood.

Pain self-efficacy moderates the association between pain and somatization in a community sample

Background and aims Pain is a common condition. However, only a minority of people experiencing pain develop a chronic pain problem. Factors such as somatization, pain self-efficacy and lack of psychological well-being affect the risk of pain chronicity and pain-related disability. However, research on protective pain-related psychological factors in populations without chronic pain is scarce. We aim to examine if pain self-efficacy attenuates the associations between pain and both anxiety and somatization in a community sample. Methods In a cross-sectional study, 211 participants from a community sample responded to measures of average pain over the last 3 months, anxiety, somatization, and pain self-efficacy. The possibility of moderation effects were tested with a series of regression analyses. Results The association between pain and anxiety was not moderated by pain self-efficacy. In contrast, pain self-efficacy moderated the relation of pain and somatization. The interaction explained 3% of the variance in somatization, in addition to the independent effects of pain and self-efficacy (F(1,207)=5.65, p<0.025). Among those in the bottom quartile of pain self-efficacy, the association between pain and somatization was moderate or strong (r=0.62, p<0.01), whereas for those in the top quartile the association was modest (r=0.11, p>0.05). Conclusions The results are partly consistent with the hypothesis that pain self-efficacy attenuates the associations between pain and pain chronification risk factors in a relatively healthy community sample. Should further preferably longitudinal studies replicate the findings, the role pain self-efficacy as a protective factor needs to be explicated in theoretical models of pain chronification. Implications The findings are consistent with the notion that clinicians should promote patient's pain self-efficacy in acute and sub-acute pain conditions especially when the individual is prone to somatization. However, more prominent clinical implications require studies with longitudinal designs.

Resilience in children and their parents enduring pediatric medical traumatic stress

Due to the general lack of familiarity with the concept in the medical field, resilience is rarely considered in pediatric medical traumas. Resilience is an ability that enables recovery after adversities such as traumas, surgeries, serious health problems, or social issues. Stress from medical traumas encompasses both the psychological and physical responses of children and their families. Lack of resilience in children with medical traumatic stress may contribute to poor adjustment, slow recovery, disruptive behaviors, and psychiatric disorders. Furthermore, persistent parental distress increases the child's risk of low resilience. Consequently, these patients and their parents require early identification. This is achievable using a common stress measure such as the Perceived Stress Scale. Moreover, health care providers can screen patients' risks for low resilience, which include few social contacts, poor family functioning, and low cohesion among family members. Findings from the stress scale and screened risks could indicate the need for additional psychosocial support at the time of diagnosis of a serious illness, soon after injuries, and before and after operations. Such interventions can include decreasing distress, counseling children and their parents, and enabling strong connections to health care providers. Health care providers can help parents to minimize distress and adjust to their child's illness, thereby supporting the child's resilience, adjustment, and recovery.

Decreased serum total cholesterol is associated with a history of childhood physical violence in depressed outpatients

Associations between adverse childhood experiences (ACEs) and cholesterol in depressed patients are unclear. Therefore, we compared 78 adult outpatients with major depressive disorder (MDD) with (n = 24) or without (n = 54) experiences of physical violence in childhood. Background data were collected with questionnaires, and total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were measured from fasting blood samples. Patients with a history of childhood physical violence had lower levels of TC than the control group. No differences were observed in HDL-C, LDL-C, or low-grade inflammation levels between the two groups. In multivariate models, decreased levels of TC were associated with childhood physical violence, and these associations remained significant after adjustments for age, gender, lifestyle, metabolic condition, socioeconomic situation, psychiatric status, suicidality, low-grade inflammation, the chronicity of depression, medications used and somatic diseases. At the 8-month follow-up, the results were essentially the same when the Trauma and Distress Scale (TADS) was used as the measure of ACEs. The specific mechanisms underlying cholesterol alterations associated with ACEs are a topic for future studies. Better understanding of these mechanisms might lead to possible new interventions in the prevention of adverse health effects resulting from ACEs.

Bifrontal active and sham rTMS in treatment-resistant unipolar major depression

BACKGROUND AND AIM

Prevention of the recurrence of major depression and its residual symptoms requires effective treatment. Our aim was to study the effects of bifrontal active rTMS controlled by sham rTMS in treatment-resistant unipolar major depressive disorder (MDD).

METHODS

Thirty-seven patients with treatment-resistant MDD were randomized into two groups. One group received a total of 30 sessions of active bifrontal rTMS (10 Hz rTMS on left dorsolateral prefrontal cortex (DLPFC) and 1 Hz rTMS on right DLPFC) and the other group received bilateral sham rTMS on five days a week for six weeks.

RESULTS

Depressive symptoms significantly improved in both the groups, but without a significant group difference. Furthermore, patients with psychotic depression improved similarly to those with moderate or severe depression.

CONCLUSIONS

The results of present study indicate a large sham effect of stimulation treatment. The intensive structured treatment protocol may explain the positive outcome in both the groups. It is important to recognize, appreciate, and utilize placebo effects as a significant means of rehabilitation in psychiatric care.

Global arginine bioavailability ratio is decreased in patients with major depressive disorder

BACKGROUND

Major depressive disorder (MDD) is characterized by increased oxidative and nitrosative stress. We compared nitric oxide metabolism, i.e., the global arginine bioavailability ratio (GABR) and related serum amino acids, between MDD patients and non-depressed controls, and between remitted and non-remitted MDD patients.

METHODS

Ninety-nine MDD patients and 253 non-depressed controls, aged 20-71 years, provided background data via questionnaires. Fasting serum samples were analyzed using ultra-performance liquid chromatography coupled to mass spectrometry to determine the serum levels of ornithine, arginine, citrulline, and symmetric and asymmetric dimethylarginine. GABR was calculated as arginine divided by the sum of ornithine plus citrulline. We compared the above measures between: 1) MDD patients and controls, 2) remitted (n=33) and non-remitted (n = 45) MDD patients, and 3) baseline and follow-up within the remitted and non-remitted groups.

RESULTS

Lower arginine levels (OR 0.98, 95% CI 0.97-0.99) and lower GABR (OR 0.13, 95% CI 0.03-0.50) were associated with the MDD vs. the non-depressed group after adjustments for potential confounders. The remitted group showed a decrease in GABR, arginine, and symmetric dimethylarginine, and an increase in ornithine after the follow-up compared with within-group baseline values. The non-remitted group displayed an increase in arginine and ornithine levels and a decrease in GABR. No significant differences were recorded between the remitted and non-remitted groups.

LIMITATIONS

The MDD group was not medication-free.

CONCLUSIONS

Arginine bioavailability may be decreased in MDD. This could impair the production of nitric oxide, and thus add to oxidative stress in the central nervous system.

Comparison of early maladaptive schemas between borderline personality disorder and chronic depression

Borderline personality disorder (BPD) and chronic depression (CD) are common and challenging mental disorders. Maladaptive cognitive schemas have been proposed to increase vulnerability to both disorders. In order to elucidate the role of maladaptive cognitive schemas in BPD and CD, this study compared psychiatric outpatients with BPD (N = 30) and CD (N = 30) in terms of early maladaptive schemas (EMSs). The groups were compared using the Young Schema Questionnaire short form-extended (YSQ-S2-extended) and the 15D health status questionnaire. BPD patients showed higher endorsement on the majority of EMSs, poorer social functioning, and greater concurrent distress than CD patients. However, after controlling for concurrent effects of psychological distress, the groups did not differ in 14 out of the 18 EMSs. These findings point to significant similarities in maladaptive beliefs between the 2 disorders and do not support broad, specific patterns of EMSs associated with either disorder. The results highlight the need for further study of the role of maladaptive schemas in the development and treatment of chronic mental disorders.

The Finnish Clinical Outcome in Routine Evaluation Outcome Measure: psychometric exploration in clinical and non-clinical samples

The Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM) is a 34-item self-report measure designed to monitor changes in psychiatric patients. It has been translated into 25 languages, including Finnish. This is the first psychometric exploration of Finnish CORE-OM data. The aim of the study is to examine acceptability, internal consistency and convergent validity of the Finnish CORE-OM scores. Translation of the CORE-OM from English to Finnish was undertaken according to recommended protocols. Psychometric exploration was conducted in two samples: psychiatric patients (N = 201) and non-clinical participants (N = 209). Participation was voluntary and involved completion of all scales. Convergent validity was tested in terms of the mean score differences between clinical and non-clinical samples and correlations against the Beck Depression Inventory (BDI) and the Symptom Checklist (SCL-90). Among the clinical sample, all domains showed good or acceptable internal reliability. In the non-clinical sample, the alphas of domains were good or acceptable, with only the alphas of the Risk domain registering as low. There were no marked gender or age effects. CORE-OM scores correlated strongly with both the BDI and SCL-90, particularly in patients' data. Some possible effects of Finnish language were found. The Finnish translation of the CORE-OM is psychometrically sound and can be recommended for use in Finnish mental health and clinical settings. However, further investigation in larger and different samples will clarify the generalizability its psychometric properties. Clinical services are encouraged to contribute to the creation of a collaborative Finnish CORE practice research network.

Purine metabolism is dysregulated in patients with major depressive disorder

INTRODUCTION

The purine cycle and altered purinergic signaling have been suggested to play a role in major depressive disorder (MDD). Nevertheless, data on this topic are scarce. Based on previous studies, we hypothesized that compared with non-depressed controls, MDD patients have distinct purine metabolite profiles.

METHODS

The samples comprised 99 MDD patients and 253 non-depressed controls, aged 20-71 years. Background data were collected with questionnaires. Fasting serum samples were analyzed using ultra-performance liquid chromatography coupled to mass spectrometry (UPLC-MS) to determine seven purine cycle metabolites belonging to the purine cycle. We investigated the levels of these metabolites in three settings: (1) MDD patients vs. non-depressed controls and (2) remitted vs. non-remitted MDD patients, and also (3) within-group changes in metabolite levels during the follow-up period.

RESULTS

In logistic regression adjusted for age, gender, smoking, alcohol use, physical exercise, glycosylated hemoglobin, and high-density lipoprotein cholesterol, lower levels of inosine (OR 0.89, 95% CI 0.82-0.97) and guanosine (OR 0.32, 95% CI 0.17-0.59), and higher levels of xanthine (OR 2.21, 95% CI 1.30-3.75) were associated with MDD vs. the non-depressed group. Levels of several metabolites changed significantly during the follow-up period in the MDD group, but there were no differences between remitted and non-remitted groups.

CONCLUSIONS

We observed altered purine metabolism in MDD patients compared with non-depressed controls. Furthermore, our observations suggest that circulating xanthine may accumulate in MDD patients.

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.

Reduced serum adiponectin levels in alexithymia

OBJECTIVES

Clinical studies have demonstrated that circulating cytokine profiles may differ between alexithymic and non-alexithymic subjects. We examined whether the levels of adiponectin (μg/ml) and resistin (ng/ml) are independently related to alexithymic features in a population-based sample.

METHODS

In 2005, clinical data including laboratory assessments were obtained from a sub-sample (n = 308) of the Kuopio Depression Study general population study including subjects aged 25-64 years. Based on the Toronto Alexithymia Scale score in 1998, 1999, 2001 and 2005, a group of subjects with high alexithymic features (n = 85) was formed and compared with non-alexithymic controls (n = 206).

RESULTS

Serum adiponectin levels were significantly lower in subjects with alexithymic features than in non-alexithymic control subjects. No difference was found in resistin levels. Similarly, in a logistic regression model adjusted for age, gender and body mass index (BMI), lowered levels of adiponectin, but not resistin, were associated with an increased likelihood of belonging to the group with alexithymic features. Further adjustments for cardiovascular risk factors (i.e. smoking, BMI, metabolic syndrome, alcohol use, and coronary heart disease), depressive symptoms (Hamilton Depression Rating Scale with 17 items) and the use of antidepressants in addition to age and gender did not change these patterns.

CONCLUSIONS

Our findings suggest that a disturbed anti-inflammatory balance may characterize alexithymia. In addition, our results widen the concept of alexithymia and highlight the role of immune system alterations and stress in alexithymic individuals.

Self-reported sleep disturbance is associated with elevated levels of PAI-1 in individuals with a recorded history of depressive symptoms

BACKGROUND

The majority of depressed individuals report insomnia. Self-reported symptoms of insomnia, in particular, more strongly predict adverse health effects than the actual measured sleep time. The physiological alterations in individuals with insomnia are complex, as both autonomic and endocrine dysfunctions are present. Plasminogen activator inhibitor (PAI)-1 is a stress-related acute-phase reactant that has also been suggested to regulate the circadian rhythm and sleep patterns. It has been suggested to contribute to both depressive symptoms and sleep disorders, although data on the relationships between these parameters are scarce.

OBJECTIVE

This study examined the role of self-reported sleep disturbance and its association with PAI-1 among individuals with a history of depressive symptoms.

METHODS

Differences in the serum levels of PAI-1 between two groups (group 1: moderate to very severe sleep disturbance, n=37; group 2: mild or no sleep disturbance, n = 90) were examined in a population-based sample of individuals with a recorded history of depressive symptoms.

RESULTS

Multivariate analysis controlling for potential confounding factors (age, sex, body mass index, depression severity) showed that each 1-unit increase in PAI-1 (μg/mL) increased the likelihood for belonging to the group with moderate to very severe sleep disturbance by 23% (OR = 1.23, C.I. 95% = 1.04-1.45, p = 0.016). This statistical significance remained after additional adjustments for regular smoking and the use of sleep or lipid-lowering medication.

CONCLUSION

Our observations may further clarify the physiological alterations related to sleep disturbance in depressive individuals. In the present study, self-reported sleep disturbance in individuals with a recorded history of depressive symptoms was associated with an elevation of PAI-1. This finding may illustrate the association of subjective sleep disturbance with sympathetic activation. Our study highlights the importance of effects of perceived sleep disturbance on individual homeostasis, and may provide potential directions for research on treatment options.

Biological and other health related correlates of long-term life dissatisfaction burden

BACKGROUND

Mental health is interconnected with somatic health and can manifest itself in biological processes. Life dissatisfaction is an indicator of subjective well-being, but information on its biological correlates is scarce. The aim of this study was to investigate the biological correlates along with other health-related factors of long-term life dissatisfaction in a population-based sample.

METHODS

As part of the Kuopio Depression Study, health questionnaires were sent to a randomly selected population-based sample in 1998, 1999, and 2001. In 2005, among a clinically studied sub-sample (n = 305), the 7-year long-term life dissatisfaction burden was assessed by summing life satisfaction scores from previous health questionnaires. Several sociodemographic, health, health behavior, and biological factors were investigated in respect to their associations to categorized (low and high) and continuous (linear regression) life satisfaction burden score (higher values indicating dissatisfaction).

RESULTS

In the final linear regression model long-term life dissatisfaction burden was significantly associated with poor social support (B = 0.138; p < 0.001), marital status (i.e. living alone) (B = 0.049; p = 0.019), current smoking (B = 0.087; p < 0.001), poor sleep (B = 0.052; p = 0.001), use of statins (B = -0.052; p = 0.002) and lower serum adiponectin level (B = -0.001; p = 0.039) whereas association of metabolic syndrome was marginally nonsignificant (B = 0.029; p = 0.055).

CONCLUSION

Long-term life dissatisfaction is associated with adverse health, health behavioral, and social factors, as well as with a decreased anti-inflammatory buffer capacity, all indicating close relationships between subjective well-being and somatic morbidity.

The role of mental health, personality disorders and childhood adversities in relation to life satisfaction in a sample of general population

BACKGROUND

Mental health disorders are one of the leading causes of the disease burden globally.

AIM

The aim of this population-based study was to investigate the relationship between life satisfaction and mental health by taking into account its less studied areas, such as personality disorders and childhood adversities.

METHODS

The sample of this cross-sectional study was derived from a population-based Kuopio Depression Study performed in Eastern Finland. Health questionnaires were mailed in 1998, 1999, 2001 and 2005 including questions on several clinical factors. Questions on childhood home were asked in 1999. The inclusion criteria for the final study sample in 2005 were based on previously repeatedly (1998, 1999, 2001) reported life satisfaction, depression or alexithymic features (with/without). Psychiatric diagnoses of major depressive disorder and personality disorder were confirmed by structured clinical interview I and II for DSM-IV in 2005. Logistic regression analyses were performed to assess the studied relationships.

RESULTS

In general, the broad spectrum of poor mental health indicators was associated with concurrent life dissatisfaction. After multiple adjustments, major depressive disorder (MDD), hopelessness and mental distress remained independent correlates of life dissatisfaction, while personality disorder or self-reported childhood adversities lost their significance when these other factors were included in the model.

CONCLUSIONS

Mental health is closely interwoven with life satisfaction. Even if personality disorder and childhood adversities were significant correlates of life dissatisfaction, adverse concurrent mental symptoms and features and MDD were its strongest correlates.

Serum adipokine levels in adults with a history of childhood maltreatment

Individuals with a history of childhood maltreatment present increased rates of metabolic disturbances, but the underlying mechanisms for such phenomena are poorly understood. This study examined whether the secretion of adipokines, adipocyte-derived inflammation markers closely associated with metabolic disorders, is altered in individuals with a history of childhood maltreatment. The serum levels of inflammatory markers adiponectin and resistin were measured from 147 general population participants who had a history of adverse mental symptoms, and who also reported their experiences of childhood maltreatment. Participants with experiences of childhood maltreatment (n=30) had lowered levels of serum adiponectin (p=0.007) and resistin (p=0.028). The differences in adiponectin levels persisted in multivariate modeling with adjustments for age, gender, and body mass index (OR for each 1 standard deviation decrease in the serum adiponectin level 2.65, 95% CI 1.31-5.35, p=0.007). Additional adjustments for marital status or a diagnosis of major depressive disorder, or the exclusion of individuals using NSAIDs, oral corticosteroids, or antidepressants did not alter the results. The association between resistin levels and childhood maltreatment did not remain independent in the same models. Our findings suggest that in individuals with previously reported adverse mental symptoms, a history of childhood maltreatment is independently associated with lowered levels of the anti-inflammatory marker adiponectin. This may lead to a lowered anti-inflammatory buffer capacity, which can, in turn, increase the susceptibility to physical and psychological states characterized by pronounced pro-inflammation.

Alexithymia and tissue inflammation

BACKGROUND

Altered immune responses are seen in depression, and recent data suggest that similar changes could also be observable in alexithymia. We examined whether the inflammatory markers high-sensitivity C-reactive protein (hs-CRP) and interleukin (IL)-6 are independently related to alexithymia or its factors in a population-based sample.

METHODS

This study formed a clinical part of the Kuopio Depression (KUDEP) general population study focusing on the mental health of a general population of adults aged 25-64 years (n = 308). Alexithymia was measured using the Toronto Alexithymia Scale (TAS-20), and depressive symptoms were assessed using the Beck Depression Inventory (BDI-21).

RESULTS

The levels of IL-6 (in picograms per milliliter) and hs-CRP (in milligrams per liter) were significantly higher in alexithymic than in nonalexithymic subjects (IL-6 effect size, ES: 0.50; hs-CRP ES: 0.27). The BDI scores, hs-CRP and IL-6 explained 33.5% of the variation in TAS scores in the whole study population. According to logistic regression analysis, hs-CRP but not IL-6 increased the likelihood of belonging to the alexithymic group. This observation remained unaltered after additional adjustments for chronic inflammation-related disorders, the use of inflammation-modulating medications and depressive symptoms.

CONCLUSIONS

Our findings suggest that the association between hs-CRP and alexithymia resembles that observed in depressed patients. It is, however, independent of depressive symptoms. These findings widen our view on the stress-alexithymia concept.

Elevated levels of serum IL-5 are associated with an increased likelihood of major depressive disorder

BACKGROUND

Inflammatory mediators in both the peripheral circulation and central nervous system (CNS) are dysregulated in major depressive disorder (MDD). Nevertheless, relatively little is known about the role of the T-helper (Th)-2 effector cytokines interleukin (IL)-5 and IL-13 in MDD.

METHODS

We examined the serum levels of these cytokines and a Th-1 comparison cytokine, interferon (IFN)-γ, in 116 individuals (MDD, n = 58; controls, n = 58).

RESULTS

In our basic multivariate model controlling for the effects of potential confounders on the associations between MDD and the examined cytokines, each 1-unit increase in the serum IL-5 level increased the likelihood of belonging to the MDD group by 76% (OR 1.76, 95% CI 1.03-2.99, p = 0.04; model covariates: age, gender, marital status, daily smoking and alcohol use). The likelihood further increased in models additionally controlling for the effects of the use of antidepressants and NSAIDS, and a diagnosis of asthma. No such associations were detected with regard to IL-13 (OR 1.08, 95% CI 0.96-1.22, p = 0.22) or IFN-γ (OR 1.02, 95% CI 0.99-1.05, p = 0.23).

CONCLUSIONS

Elevated levels of IL-5, which uses the neural plasticity-related RAS GTPase-extracellular signal-regulated kinase (Ras-ERK) pathway to mediate its actions in the central nervous system (CNS), could be one of the factors underlying the depression-related changes in CNS plasticity.

Stability of alexithymia in the general population: an 11-year follow-up

OBJECTIVES

There is an ongoing debate concerning the temporal stability of alexithymia. Most previous studies have been conducted on clinical populations of psychiatric and somatic patients. However, psychiatric and somatic morbidity have been found to confound the findings so that in their presence, alexithymia appears to be less stable. Nevertheless, few general population studies have been published, and there have been no follow-ups longer than 5 years.

METHOD

In a population-based sample of middle-aged Finnish men, 755 participants completed the Toronto Alexithymia Scale (TAS)-26 at baseline and on 11-year follow-up. Absolute or mean stability refers to the extent to which scores change over time, and it was measured with group comparisons of paired samples. Relative stability refers to the consistency of relative differences in alexithymia levels among the study subjects, and it was measured with test-retest correlations.

RESULTS

Changes in the total scores and the subscales of the TAS-26 were all statistically significant but had low effect sizes (0.09-0.20) for the change-suggested absolute stability. The correlations between baseline and follow-up scores were high (ρ = 0.51-0.63), indicating relative stability. The exclusion of depressive symptoms, a history of mental illnesses, and cancer or cardiovascular diseases at baseline and at the 4- and 11-year follow-ups did not essentially alter these findings. Of the background variables, a higher age independently associated with the increase in the TAS-26 scores. Those with alexithymia at baseline were more likely to have elevated depressive symptoms at the 4- and 11-year follow-ups.

CONCLUSIONS

Both the absolute and relative stabilities of alexithymia in the general population are high, even for a long follow-up period. These results may support the assumption that alexithymia represents a stable personality trait in general. Alexithymia may increase vulnerability to depressive symptoms.

Long term life dissatisfaction and subsequent major depressive disorder and poor mental health

BACKGROUND

Poor mental health, especially due to depression, is one of the main public health problems. Early indicators of poor mental health in general population are needed. This study examined the relationship between long-term life dissatisfaction and subsequent mental health, including major depressive disorder.

METHOD

Health questionnaires were sent to a randomly selected population-based sample in 1998 and repeated in 1999 and 2001. In 2005, a clinically studied sub-sample (n = 330) was composed of subjects with (n = 161) or without (n = 169) repeatedly reported adverse mental symptoms at all three previous data collection times. Clinical symptom assessments were performed with several psychometric scales: life satisfaction (LS), depression (HDRS, BDI), hopelessness (HS), mental distress (GHQ), dissociative experiences (DES), and alexithymia (TAS). The long-term life dissatisfaction burden was calculated by summing these life satisfaction scores in 1998, 1999, 2001 and dividing the sum into tertiles. Psychiatric diagnoses were confirmed by SCID-I for DSM-IV in 2005. Logistic regression analyses were performed to assess the studied relationship.

RESULTS

The previous life dissatisfaction burden associated with adverse socio-demographic, life style and clinical factors. In adjusted logistic regression analyses, it was independently and strongly associated with subsequent major depressive disorder in 2005, even when the concurrent LS score in 2005 was included in the model. Excluding those with reported major depressive disorder in 1999 did not alter this finding.

LIMITATIONS

MDD in 1999 was based on self-reports and not on structured interview and LS data in 2001-2005 was not available.

CONCLUSIONS

The life satisfaction burden is significantly related to major depressive disorder and poor mental health, both in cross-sectional and longitudinal settings.

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.

Population-based comparison of health-related quality of life between healthy subjects and those with specific psychiatric or somatic diseases

PURPOSE

The purpose of this study was to compare health-related quality of life (HRQL) of healthy subjects and those with psychiatric or somatic diseases.

DESIGN AND METHODS

Eight dimensions of the RAND 36-Item Health Survey 1.0 (RAND-36) were investigated in a population-based sample.

FINDINGS

Scores in all 8 RAND dimensions were lower in subjects with psychiatric diagnoses than in healthy subjects. In logistic regression models, poor social functioning (odds ratio [OR] 1.07-1.12) associated with psychiatric diagnoses. Lowered energy (OR 1.06) associated with major depression, poor general health with personality disorders (OR 1.06) and heart disease (OR 1.06), and physical limitations with heart (OR 1.04) and musculoskeletal disease (OR 1.07).

PRACTICE IMPLICATIONS

Acknowledging the lowest HRQL dimensions among subjects with psychiatric diagnoses may help to promote mental, physical, and social well-being more efficiently.

Serum IL-7 and G-CSF in major depressive disorder

Major depressive disorder (MDD) has been associated with dysregulated immune systems and impaired T cell function, but data on depression-related alterations in the levels of immunomodulatory growth factors are scarce. In order to further clarify the mechanisms underlying immune system dysregulation in depressed subjects, we examined the associations between MDD and serum levels of two immunomodulatory growth factors, interleukin (IL)-7 and granulocyte-colony stimulating factor (G-CSF), in 122 subjects (MDD with long-term symptomatology, n=61; controls, n=61). The MDD subjects had lowered levels of IL-7. In a model adjusted for age, gender and body mass index, subjects in the lowest tertile of IL-7 had a 3.4-fold increased likelihood for MDD (p=0.010). Further adjustments for sleep disturbances, alcohol use, smoking, and metabolic syndrome did not alter these findings. Moreover, the exclusion of subjects with rheumatoid arthritis, coronary heart disease, or the use of non-steroidal anti-inflammatory medications or oral corticosteroids only slightly attenuated the findings. The G-CSF levels did not differ between the two groups. The lowering of the serum levels of IL-7, a regulator of T cell homeostasis, in MDD subjects may underlie the depression-related impaired T cell function.

Low serum HDL-cholesterol levels are associated with long symptom duration in patients with major depressive disorder

AIMS

The purpose of the present study was to examine whether the association between depression and the serum high-density lipoprotein cholesterol (HDL-C) is modified by symptom duration.

METHODS

Depressed patients (n = 88) and an age- and sex-matched group of healthy general population controls (n = 88) underwent a Structured Clinical Interview for DSM-IV (SCID), and depressed participants reported the duration of their symptoms. The serum levels of total cholesterol (TC), HDL-C, low-density lipoprotein cholesterol (LDL-C), triglycerides (TG) and non-HDL, and the ratios of LDL-C/HDL and TC/HDL-C were assessed.

RESULTS

Major depressive disorder (MDD) subjects with a long symptom duration (>or=3 years) had lower levels of HDL-C compared with healthy controls or MDD subjects with a symptom duration <3 years. The likelihood for long symptom duration doubled for each 0.5-mmol/L decrease in HDL-C levels in regression models adjusted for age, gender, marital status, overweight, symptom severity, alcohol consumption, smoking, physical exercise, medication use, and non-HDL-C (P < 0.05).

CONCLUSIONS

These findings suggest that a low serum HDL-C level, a risk factor for coronary heart disease, is specifically associated with long-term depressive symptomatology.

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.