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Kujanpää T, Jäppinen S, Rantanen M, Suominen K, Pohjolainen V, Luoto R. Medication and rehabilitation of persons applying for disability pension due to depression: a register-based retrospective study from Finland. Nord J Psychiatry 2023; 77:731-736. [PMID: 37435818 DOI: 10.1080/08039488.2023.2232361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/20/2023] [Accepted: 06/28/2023] [Indexed: 07/13/2023]
Abstract
PURPOSE To investigate how drug therapies and rehabilitation options have been utilised before applying for a disability pension due to depression. METHODS A retrospective register-based study of the 3604 persons who applied for a disability pension from the Social Insurance Institution of Finland (Kela) in 2019. In Finland, disability pension is usually preceded by an incapacity for work lasting for 1 year, during which time therapeutic procedures, which were analysed here, are applied. RESULTS Approximately half (56.0%) of the applicants had reimbursed purchases of two or more antidepressants during the 12 months preceding the disability pension application. Psychotherapy was received by 13.8% and 19.2% of the applicants 1 and 5 years before application, respectively. The share of applicants receiving some form of rehabilitation 1 year before application was 24.8% and 39.0% in the 5 years preceding application. During the 4 months before application, 19.6% of the applicants had no antidepressant purchases. In total, 12.2% of the applicants had both antidepressant treatment and psychotherapy in the year preceding the application, and 9.9% had neither psychotherapy nor antidepressant treatment. CONCLUSION Before applying for disability pension, only a minority of the applicants had received effective treatment for depression in the form of psychotherapy and antidepressants. However, most of the applicants had received some form of treatment, but it appears to have been insufficient.
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Affiliation(s)
- Tero Kujanpää
- Social Insurance Institution of Finland, Helsinki, Finland
| | - Sauli Jäppinen
- Social Insurance Institution of Finland, Helsinki, Finland
| | - Matti Rantanen
- Social Insurance Institution of Finland, Helsinki, Finland
| | - Kirsi Suominen
- Social Insurance Institution of Finland, Helsinki, Finland
- Ilmarinen Mutual Pension Insurance Company, Helsinki, Finland
| | | | - Riitta Luoto
- Social Insurance Institution of Finland, Helsinki, Finland
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Halonen JI, Lallukka T, Kujanpää T, Lahti J, Kanerva N, Pietiläinen O, Rahkonen O, Lahelma E, Mänty M. The contribution of physical working conditions to sickness absence of varying length among employees with and without common mental disorders. Scand J Public Health 2020; 49:141-148. [PMID: 31960756 PMCID: PMC7917561 DOI: 10.1177/1403494820901411] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Aims: The aim was to examine whether the contribution of physical
work exposures to the risk of sickness absence (SA) is different between those
with and without common mental disorders (CMD). Methods: We used
questionnaire data on four work exposures and CMD from 6159 participants of the
Helsinki Health Study cohort with 12,458 observations from three surveys
(2000–2002, 2007 and 2012). We formed combination exposures for the work
exposures (hazardous exposures, physical workload, computer and shift work) with
CMD. Associations with SA of different length were examined with negative
binomial regression models. Results: We observed stronger
associations for CMD with SA than for the individual work exposures. The
strength of the associations for hazardous exposures and physical workload
increased with length of SA, especially when the participant also had CMD. The
strongest associations for the combined exposures were observed for SA ⩾15 days,
the rate ratios being 2.63 (95% CI 2.27–3.05) among those with hazardous
exposure and CMD, and 3.37 (95% CI 2.93−3.88) among those with heavy physical
workload and CMD. Conclusions: Employees with hazardous exposures or
physical workload combined with CMD were at the highest risk of SA compared
with those without these exposures or with only one exposure.
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Affiliation(s)
- Jaana I Halonen
- Department of Public Health, University of Helsinki, Helsinki, Finland.,Finnish Institute of Occupational Health, Helsinki, Finland
| | - Tea Lallukka
- Department of Public Health, University of Helsinki, Helsinki, Finland.,Finnish Institute of Occupational Health, Helsinki, Finland
| | - Tero Kujanpää
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Finland
| | - Jouni Lahti
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Noora Kanerva
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Olli Pietiläinen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Eero Lahelma
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Minna Mänty
- Department of Public Health, University of Helsinki, Helsinki, Finland.,City of Vantaa, Vantaa, Finland
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Halonen JI, Mänty M, Pietiläinen O, Kujanpää T, Kanerva N, Lahti J, Lahelma E, Rahkonen O, Lallukka T. Physical working conditions and subsequent disability retirement due to any cause, mental disorders and musculoskeletal diseases: does the risk vary by common mental disorders? Soc Psychiatry Psychiatr Epidemiol 2020; 55:1021-1029. [PMID: 31893288 PMCID: PMC7395011 DOI: 10.1007/s00127-019-01823-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 12/24/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Physical work exposures and common mental disorders (CMD) have been linked to increased risk of work disability, but their joint associations with disability retirement due to any cause, mental disorders or musculoskeletal diseases have not been examined. METHODS The data for exposures and covariates were from the Finnish Helsinki Health Study occupational cohort surveys in 2000-2002, 2007 and 2012. We used 12,458 observations from 6159 employees, who were 40-60 years old at baseline. CMD were measured by the General Health Questionnaire (GHQ-12, cut-off point 3+). Four self-reported work exposures (hazardous exposures, physical workload, computer and shift work) were combined with CMD and categorized as "neither", "work exposure only", "CMD only", and "both". Associations with register-based disability retirement were assessed with Cox proportional hazards models for sample survey data adjusting for confounders over 5-year follow-up. Additionally, synergy indices were calculated for the combined effects. RESULTS Those reporting CMD and high physical workload had a greater risk of disability retirement due to any cause (HR 4.26, 95% CI 3.60-5.03), mental disorders (HR 5.41, 95% CI 3.87-7.56), and musculoskeletal diseases (HR 4.46, 95% CI 3.49-5.71) when compared to those with neither. Synergy indices indicated that these associations were synergistic. Similar associations were observed for CMD and hazardous exposures, but not for combined exposures to CMD and computer or shift work. CONCLUSIONS Identification of mental health problems among employees in physically demanding jobs is important to support work ability and reduce the risk of premature exit from work due to disability.
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Affiliation(s)
- Jaana I Halonen
- Department of Public Health, University of Helsinki, 20, 00014, Helsinki, Finland.
- Finnish Institute of Occupational Health, Työterveyslaitos, 40, 00032, Helsinki, Finland.
- Finnish Institute for Health and Welfare, 30, 00271, Helsinki, Finland.
| | - Minna Mänty
- Department of Public Health, University of Helsinki, 20, 00014, Helsinki, Finland
| | - Olli Pietiläinen
- Department of Public Health, University of Helsinki, 20, 00014, Helsinki, Finland
| | - Tero Kujanpää
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, 8000, 90014, Oulu, Finland
| | - Noora Kanerva
- Department of Public Health, University of Helsinki, 20, 00014, Helsinki, Finland
| | - Jouni Lahti
- Department of Public Health, University of Helsinki, 20, 00014, Helsinki, Finland
| | - Eero Lahelma
- Department of Public Health, University of Helsinki, 20, 00014, Helsinki, Finland
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, 20, 00014, Helsinki, Finland
| | - Tea Lallukka
- Department of Public Health, University of Helsinki, 20, 00014, Helsinki, Finland
- Finnish Institute of Occupational Health, Työterveyslaitos, 40, 00032, Helsinki, Finland
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Kujanpää T, Jokelainen J, Auvinen J, Timonen M. Generalised anxiety disorder symptoms and utilisation of health care services. A cross-sectional study from the "Northern Finland 1966 Birth Cohort". Scand J Prim Health Care 2016; 34:151-8. [PMID: 27054674 PMCID: PMC4977937 DOI: 10.3109/02813432.2016.1160631] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To analyse the utilization of health care services of people who tested positive for GAD compared to those who tested negative. SETTING A cross-sectional study from the Northern Finland 1966 Birth Cohort. SUBJECTS A total of 10,282 members followed from birth in a longitudinal study were asked to participate in a follow-up survey at the age of 46. As part of this survey they filled in questionnaries concerning health care utilization and their illness history as well as the GAD-7 screening tool. Althogether 5,480 cohort members responded to the questionnaries. MAIN OUTCOME MEASURES Number of visits in different health care services among people who tested positive for GAD with the GAD-7 screening tool compared to those who tested negative. RESULTS People who tested positive for GAD had 112% more total health care visits, 74% more total physician visits, 115% more visits to health centres, 133% more health centre physician visits, 160% more visits to secondary care, and 775% more mental health care visits than those who tested negative. CONCLUSION People with GAD symptoms utilize health care services more than other people. Key Points Generalised anxiety disorder (GAD) is a common but poorly identified mental health problem in primary care. People who tested positive for GAD utilise more health care services than those who tested negative. About 58% of people who tested positive for GAD had visited their primary care physician during the past year. Only 29% of people who tested positive for GAD had used mental health services during the past year.
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Affiliation(s)
- Tero Kujanpää
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland;
- CONTACT Tero Kujanpää Center for Life Course Health Research, Faculty of Medicine, University of Oulu, P.O. Box 5000, FI-90014 University of Oulu, Oulu, Finland
| | - Jari Jokelainen
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland;
- Unit of General Practice, Oulu University Hospital, Oulu, Finland
| | - Juha Auvinen
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland;
- Unit of General Practice, Oulu University Hospital, Oulu, Finland
| | - Markku Timonen
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland;
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Porela P, Mäntylä P, Blek-Vehkaluoto M, Ilveskoski E, Juvonen T, Kujanpää T, Loimaala A, Meinander T, Mäenpää E, Romppanen H, Saraste A, Tierala JI. [Update on Current Care Guidelines. Current Care Guideline: Stable Coronary Artery Disease]. Duodecim 2015; 131:967-968. [PMID: 26237876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This guideline covers coronary heart disease symptoms, diagnosis and treatment. Stable coronary heart disease refers to a disease in, which patients have stable symptoms and evidence of ischemia or significant stenosis of coronary artery. Diagnosis is based on medical history and exercise test, which is the primary diagnostic test. Coronary angiography is in selected cases necessary to confirm the diagnosis and assess invasive treatment. Pharmacotherapy aims to improve the survival of the patient, relieve symptoms and improve quality of life. The guideline also deals with invasive treatment either with PCI or CABG.
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Kujanpää T, Ylisaukko-Oja T, Jokelainen J, Linna M, Timonen M. Comparative cost analysis of generalized anxiety disorder and major depressive disorder patients in secondary care from a national hospital registry in Finland. Nord J Psychiatry 2014; 68:306-10. [PMID: 23931684 DOI: 10.3109/08039488.2013.817605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) has shown to cause high costs to society. Earlier research indicates that generalized anxiety disorder (GAD) also causes high costs, but only limited data is available in varying settings. AIMS To analyse the secondary care costs of GAD compared with those of MDD. METHODS Retrospective database analysis from Finnish Hospital Discharge Registers (FHDR). All GAD and MDD patients diagnosed between 1 January 2007 and 31 December 2007 in FHDR were recorded and individual-level secondary care costs during a 48-month follow-up period were measured. RESULTS The total mean cost of GAD with history of MDD or some other anxiety disorder was significantly higher than that of MDD with history of GAD or some other anxiety disorder during the 48-month follow-up period. The costs of pure GAD were comparable with those of pure MDD, but after adjusting for age and sex, the costs of pure MDD were higher than those of pure GAD. CONCLUSIONS The economic burden of individual GAD patients is comparable with that of MDD patients in secondary care.
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Affiliation(s)
- Tero Kujanpää
- Tero Kujanpää, postgraduate student, University of Oulu, Institute of Health Sciences , FIN-90014 Oulu , Finland
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Kujanpää T, Ylisaukko-Oja T, Jokelainen J, Hirsikangas S, Kanste O, Kyngäs H, Timonen M. Prevalence of anxiety disorders among Finnish primary care high utilizers and validation of Finnish translation of GAD-7 and GAD-2 screening tools. Scand J Prim Health Care 2014; 32:78-83. [PMID: 24920316 PMCID: PMC4075021 DOI: 10.3109/02813432.2014.920597] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To analyse the prevalence of GAD and other anxiety disorders, as well as sensitivity and specificity of GAD-7 among high utilizers of health care. SETTING Four municipal health centres in Northern Finland. SUBJECTS A psychiatric interview was conducted for 150 high utilizers of health care. MAIN OUTCOME MEASURES Prevalence of GAD as well as sensitivity and specificity of GAD-7. RESULTS The prevalence of GAD was 4% in this study group of Finnish high utilizers of health care. The sensitivity of GAD-7 was 100.0% (95% CI 54.1-100.0) and the specificity of GAD-7 was 82.6% (95% CI 75.4-88.4) with a cut-off point of 7 or more. CONCLUSION GAD is rather common among high utilizers of primary care, although the prevalence of 4% is lower than that previously reported. GAD-7 is a valid and useful tool for detecting GAD among primary health care patients.
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Affiliation(s)
- Tero Kujanpää
- Institute of Health Sciences, University of Oulu, Oulu, Finland
| | | | - Jari Jokelainen
- Institute of Health Sciences, University of Oulu, Oulu, Finland
| | | | - Outi Kanste
- National Institute for Health and Welfare, Oulu, Finland
| | - Helvi Kyngäs
- Institute of Health Sciences, University of Oulu, Oulu, Finland
| | - Markku Timonen
- Institute of Health Sciences, University of Oulu, Oulu, Finland
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