Spiritual and religious beliefs as risk factors for the onset of major depression: an international cohort study

BACKGROUND

Several studies have reported weak associations between religious or spiritual belief and psychological health. However, most have been cross-sectional surveys in the U.S.A., limiting inference about generalizability. An international longitudinal study of incidence of major depression gave us the opportunity to investigate this relationship further.

METHOD

Data were collected in a prospective cohort study of adult general practice attendees across seven countries. Participants were followed at 6 and 12 months. Spiritual and religious beliefs were assessed using a standardized questionnaire, and DSM-IV diagnosis of major depression was made using the Composite International Diagnostic Interview (CIDI). Logistic regression was used to estimate incidence rates and odds ratios (ORs), after multiple imputation of missing data.

RESULTS

The analyses included 8318 attendees. Of participants reporting a spiritual understanding of life at baseline, 10.5% had an episode of depression in the following year compared to 10.3% of religious participants and 7.0% of the secular group (p<0.001). However, the findings varied significantly across countries, with the difference being significant only in the U.K., where spiritual participants were nearly three times more likely to experience an episode of depression than the secular group [OR 2.73, 95% confidence interval (CI) 1.59–4.68]. The strength of belief also had an effect, with participants with strong belief having twice the risk of participants with weak belief. There was no evidence of religion acting as a buffer to prevent depression after a serious life event.

CONCLUSIONS

These results do not support the notion that religious and spiritual life views enhance psychological well-being.

Personality traits and eating habits in a large sample of Estonians

OBJECTIVES

Diet has health consequences, which makes knowing the psychological correlates of dietary habits important. Associations between dietary habits and personality traits were examined in a large sample of Estonians (N = 1,691) aged between 18 and 89 years.

METHOD

Dietary habits were measured using 11 items, which grouped into two factors reflecting (a) health aware and (b) traditional dietary patterns. The health aware diet factor was defined by eating more cereal and dairy products, fish, vegetables and fruits. The traditional diet factor was defined by eating more potatoes, meat and meat products, and bread. Personality was assessed by participants themselves and by people who knew them well. The questionnaire used was the NEO Personality Inventory-3, which measures the Five-Factor Model personality broad traits of Neuroticism, Extraversion, Openness, Agreeableness, and Conscientiousness, along with six facets for each trait. Gender, age and educational level were controlled for.

RESULTS

Higher scores on the health aware diet factor were associated with lower Neuroticism, and higher Extraversion, Openness and Conscientiousness (effect sizes were modest: r = .11 to 0.17 in self-ratings, and r = .08 to 0.11 in informant-ratings, ps < 0.01 or lower). Higher scores on the traditional diet factor were related to lower levels of Openness (r = -0.14 and -0.13, p < .001, self- and informant-ratings, respectively).

CONCLUSIONS

Endorsement of healthy and avoidance of traditional dietary items are associated with people's personality trait levels, especially higher Openness. The results may inform dietary interventions with respect to possible barriers to diet change.

Associations of high-risk behaviour and HIV status with HIV knowledge among persons in Tallinn, Estonia

AIM

The aim of this study was to determine the associations between the level of HIV knowledge, HIV-related risk behaviours, and HIV status among persons receiving voluntary counselling and testing services in Tallinn, Estonia.

DESIGN

A cross-sectional study design was used.

METHODS

A total of 772 subjects completed a 47-item questionnaire gathering information on demographics, HIV-related risk behaviours, and HIV-related knowledge. Participant's HIV status was determined by an anonymous rapid test. Only incident HIV cases were included in regression analyses. An analysis of covariance (ANCOVA) modelling evaluated associations between HIV knowledge and high-risk behaviours while multivariable logistic regression assessed association between HIV status and HIV knowledge.

RESULTS

The final ANCOVA model indicates that HIV risk behaviours are significantly associated with HIV knowledge (p = 0.01). Compared to participants with no identified high-risk behaviour, the adjusted mean score of HIV knowledge was higher among persons sharing injection equipment (p = 0.05), and persons engaging in unprotected heterosexual intercourse (p = 0.03); there was no statistical difference observed among men engaging in unprotected sex with other men. Women had higher mean scores than men (p = 0.01) and persons of ''other'' ethnicities had a higher mean knowledge score than ethnic Estonians (p = 0.01) and Russians (p < 0.01). Logistic regression indicated that mean knowledge was higher among participants who tested HIV positive (OR = 1.42; 95% CI = 1.12-1.87).

CONCLUSIONS

In this sample, higher knowledge scores were not associated with lower infection rates. These results indicate the importance of targeting all high-risk groups in HIV prevention and education programmes.

Modernizing the Estonian farmhouse, redefining the family, 1880s-1930s

In the nineteenth century, the transition from a Baltic-German-controlled manor-and-serf economy to individually owned farmsteads transformed all aspects of life including the spatial organization and form of farmhouses in the western provinces of Tsarist Russia. Agricultural experts and social reformers discussed how to update the traditional threshing-room dwelling house (rehielamu) into a healthy dwelling for successful farmers and, after the Estonian War of Independence, for new settlers. Using material culture such as contemporary plans, I show that changing household relationships, in addition to economic and technological factors, helped to transform the ancient rehielamu into a modern dwelling.

The role of alcohol in suicide: a case-control psychological autopsy study

BACKGROUND

The purpose of the study was to estimate the proportion of alcohol abuse and dependence (AAD) among suicides and controls, and to compare the incidence of AAD documented by clinicians with diagnoses derived from a research protocol.

METHOD

AAD according to DSM-IV was diagnosed on the basis of interviews with relatives of people who committed suicide and with controls. A total of 427 people who committed suicide during one year were paired by region, gender, age and nationality with controls randomly selected from general practitioners' lists.

RESULTS

Alcohol abuse was found in 10% and alcohol dependence in 51% of suicide cases. The corresponding figures for controls were 7% and 14% respectively. AAD was a statistically significant predictor of completed suicides, while abstinence was a significant predictor for female suicides and former use a significant predictor for older male suicides. AAD was diagnosed in 68% of male and 29% of female suicides. Middle-aged (35-59 years) males who committed suicide had the highest risk of alcohol dependence. Among suicide cases only 29% had received a lifetime diagnosis of AAD, against 23% of controls.

CONCLUSIONS

AAD was significantly more prevalent among suicides than controls. Overall, the proportion of male suicides affected by alcohol was the same in the present psychological autopsy study as in our previous findings for Estonia on the aggregate level, while the share of female suicides with an AAD diagnosis was dramatically higher on the individual level. AAD is markedly underdiagnosed by general practitioners and clinicians.

Extermination of the Gypsies in Estonia during World War II- popular images and official policies

A discussion of Nazi anti-Gypsy policy in Estonia needs to center on local interpretation and implementation of RSHA and RKO orders. Contradictions between various German instructions, which often discriminated among sedentary and itinerating Gypsies, created a state of confusion that increased chances for survival. Since in Estonia Sonderkommando 1a of the German Security Police exercised oversight rather than itself carrying out atrocities, the destruction of the Gypsy community in Estonia proceeded at a pace slower than elsewhere in Eastern Europe. Interested in exploiting slave labor, the German Security Police in Estonia did not consider liquidation of the Gypsies a priority. Acculturated to traditional anti-Gypsy prejudices and burdened by their own wartime travails, the majority of Estonians remained indifferent when Estonian police deported Gypsies.

[Diversity of mitochondrial DNA haplotypes in ethnic populations of the Volga-Ural region of Russia]

The mtDNA polymorphism was analyzed in eight ethnic groups (N = 979) of the Volga-Ural region. Most mtDNA variants belonged to haplogroups H, U, T, J, W, I, R, and N1 characteristic of West Eurasian populations. The most frequent were haplogroups H (12-42%) and U (18-44%). East Eurasian mtDNA types (A, B, Y, F, M, N9) were also observed. Genetic diversity was higher in Turkic than in Finno-Ugric populations. The frequency of mtDNA types characteristic of Siberian and Central Asian populations substantially increased in the ethnic groups living closer to the Urals, a boundary between Europe and Asia. Geographic distances, rather than linguistic barriers, were assumed to play the major role in distribution of mtDNA types in the Volga-Ural region. Thus, as concerns the maternal lineage, the Finno-Ugric populations of the region proved to be more similar to their Turkic neighbors rather than to linguistically related Balto-Finnish ethnic groups.

The frequency of C282Y and H63D mutations in Hemochromatosis gene in native Estonians

Four hundred and forty two adult individuals of Estonian nationality were examined in different regions of Estonia for the C282Y and H63D HFE mutations to determine the allele and genotype frequencies. The sample consisted only of those people whose at least four grandparents were born in Estonia, and have lived settled in the same region. The study was carried out using the PCR technique and restriction analysis for C282Y and H63D mutations respectively. For the C282Y mutation the frequency of heterozygotes was 6.6% and homozygotes 0.2%, giving allele frequency 0.035. The allele frequency for the H63D mutation was 0.136, and the frequency of homo- and hetero-zygotes 1.6% and 24.0% respectively.

Ethnic attitudes in relation to ethnic pride and ethnic differentiation

A comparison of 4 subsamples with the Ethnic Identity Scale (developed for the present study) yielded 2 relatively independent facets of ethnic identity: ethnic pride and belonging (EP) and ethnic differentiation (ED). First, the distinction between EP and ED increased understanding of how age and immigration status affect changes in ethnic identity. In a comparison of Estonians living in Sweden with those living in Estonia, only ED was affected by emigration and contacts with other ethnic groups, although both EP and ED were positively correlated with age. Second, the distinction between EP and ED increased understanding of earlier and seemingly contradictory findings about the connection between ethnic identity and ethnic attitudes. In the present study, EP was not correlated with ethnic attitudes, but, for 2 majority groups, ED was positively correlated with negative evaluations of out-groups. The authors also discuss the role of group status and relationships with the target nation in understanding the relationship between ethnic identity and ethnic attitudes.

Do recorded doses overestimate true doses received by Chernobyl cleanup workers? Results of cytogenetic analyses of Estonian workers by fluorescence in situ hybridization

Studies of workers who were sent to Chernobyl after the 1986 reactor accident are being conducted to provide a better understanding of the effects of chronic low-dose radiation exposures. A crucial component to these investigations is an accurate assessment of the radiation doses received during the cleanup activities. To provide information on biological measurements of dose, fluorescence in situ hybridization (FISH) with whole-chromosome painting probes has been applied to quantify stable chromosome aberrations (translocations and insertions) among a defined cohort of 4,833 cleanup workers from Estonia. Cytogenetic analysis of 48-h lymphocyte cultures from 118 Estonian cleanup workers (10.3 cGy mean recorded dose; 25 cGy maximum), 29 Estonian population controls and 21 American controls was conducted by three laboratories. More than 258,000 painted metaphases were evaluated. Overall, we observed lower translocation frequencies than has been reported in previous studies using FISH among Chernobyl cleanup workers. In our data, a clear association with increased levels of translocations was seen with increasing age at blood drawing. There was no correlation, however, between aberration frequency and recorded measurements of physical dose or any category of potential high-dose and high-dose-rate exposure such as being sent to Chernobyl in 1986, working on the roof near the damaged nuclear reactor, working in special zones or having multiple tours. In fact, the translocation frequency was lower among the exposed workers than the controls, though not significantly so. To estimate the level of effect that would have been expected in a population of men having an average dose of approximately 10 cGy, blood from six donors was exposed to low-LET radiation, and more than 32,000 metaphases were scored to estimate dose-response coefficients for radiation-induced translocations in chromosome pairs 1, 2 and 4. Based on these results, we estimate that had this group of 118 men received an average whole-body dose of 10-11 cGy, as chronic or acute exposures, an increase in the mean frequency of chromosome translocations of more than 40-65% would have been observed in their lymphocytes compared to findings in nonirradiated controls. In spite of evaluating more than a quarter of a million metaphases, we were unable to detect any increase in the mean, median or range in chromosome aberrations in lymphocyte cultures from a group of Estonian men who took part in the cleanup of the Chernobyl nuclear power site and those who did not. We conclude that it is likely that recorded doses for these cleanup workers overestimate their average bone marrow doses, perhaps substantially. These results are consistent with several negative studies of cancer incidence in Chernobyl cleanup workers and, if borne out, suggest that future studies may not be sufficiently powerful to detect increases in leukemia or cancer, much less distinguish differences between the effects of chronic compared to brief radiation exposures.

Prevalence of Raynaud's phenomenon in 2 ethnic groups in the general population of Estonia

OBJECTIVE

To compare the prevalence of Raynaud's phenomenon (RP) in 2 genetically different ethnic groups in Estonia: Estonians, who are Finno-Ugric people, and Slavs, who are Indo-European people, and to investigate the risk factors of RP.

METHODS

A random sample of 5248 Estonians and 4341 Slavs were surveyed by mail questionnaire (Phase I) for suspected RP. A subsample of 1739 subjects was interviewed and examined (Phase II) to make a formal diagnosis of RP, using the color charts, and to collect additional pertinent information.

RESULTS

Of these 1739 subjects examined in Phase II, 226 women and 162 men were diagnosed to have RP. The age adjusted prevalence of RP was significantly higher among Slavs (women 11.4 +/- 1.3%, men 13.0 +/- 1.6%) compared to Estonians (women 7.8 +/- 1.0%, p = 0.023; men 8.2 +/- 1.5%, p = 0.031). Based on logistic regression analysis, the diagnosis of RP among women was associated with a Slavic ethnic origin, the presence of connective tissue disorders or cardiovascular diseases, a family history of RP, a history of dysphagia and frostbite, smoking, and a lower body mass index (BMI). Among men RP was associated with manual work, vibrating tool use, a history of frostbite and injuries to the fingers. older age, and a lower BMI.

CONCLUSION

Our results revealed a significant difference in the prevalence of RP between 2 ethnic groups living in the same geographic region. The risk factors associated with RP show considerable sex differences, RP being mostly constitutional in women and occupational in men.

Cancer survival in Estonian migrants to Sweden

OBJECTIVE

To quantify the eventual extra loss of life incurred to cancer patients in Estonia compared with those in Sweden that was possibly attributable to differences in society.

DESIGN

Population based survival of cancer patients in Estonia was compared with that of Estonian immigrants to Sweden and that of all cancer patients in Sweden. The cancer sites studied were female breast and ovary, male lung and prostate, and male and female stomach and colon.

SETTING

Data on incident cases of cancer were obtained from the population based Swedish and Estonian cancer registries.

PARTICIPANTS

Data from Estonian patients in Sweden, Estonian patients in Estonia, and patients from the total Swedish population were included in the study.

MAIN RESULTS

Differences in survival among the three populations, controlling for follow-up time and age at diagnosis, were observed in breast, colon, lung, ovarian, and prostate cancers. The survival rates of Estonians living in Sweden and the total population of Sweden were better than that of the Estonians living in Estonia. For cancers of the breast and prostate, the excess mortality in the older age group (75 and above) was much greater in Estonia than in the other populations.

CONCLUSIONS

Most differences in cancer survival between Estonian and Swedish populations studied could be attributed to a longer delay in diagnosis, and also to inferior treatment (including access to treatment) in Estonia compared with Sweden. Estonia's lag in socioeconomic development, particularly in its public health organisation and funding, is probably the main source of the differences observed.

The Estonian study of Chernobyl cleanup workers: I. Design and questionnaire data

Nearly 2% of the male population of Estonia aged 20-39 years were sent to Chernobyl to assist in the cleanup activities after the reactor accident. A cohort of 4,833 cleanup workers was assembled based on multiple and independent sources of information. Information obtained from 3,704 responses to a detailed questionnaire indicated that 63% of the workers were sent to Chernobyl in 1986; 54% were of Estonian and 35% of Russian ethnicity; 72% were married, and 1,164 of their 5,392 children were conceived after the Chernobyl disaster. The workers were less educated than their counterparts in the general population of Estonia, and only 8.5% had attended university. Based on doses entered in worker records, the mean dose was 11 cGy, with only 1.4% over 25 cGy. Nearly 85% of the workers were sent as part of military training activities, and more than half spent in excess of 3 months in the Chernobyl area. Thirty-six percent of the workers reported having worked within the immediate vicinity of the accident site; 11.5% worked on the roofs near the damaged reactor, clearing the highly radioactive debris. The most commonly performed task was the removal and burial of topsoil (55% of the workers). Potassium iodide was given to over 18% of the men. The study design also incorporates biological indicators of exposure based on the glycophorin A mutational assay of red blood cells and chromosome translocation analyses of lymphocytes; record linkage with national cancer registry and mortality registry files to determine cancer incidence and cause-specific mortality; thyroid screening examinations with ultrasound and fine-needle biopsy; and cryopreserved white blood cells and plasma for future molecular studies. Comprehensive studies of Chernobyl cleanup workers have potential to provide new information about cancer risks due to protracted exposures to ionizing radiation.

Retrospective dose estimates in Estonian Chernobyl clean-up workers by means of FISH

The present study deals with retrospective estimation of radiation doses, among Estonian Chernobyl clean-up workers, by means of scoring stable translocations using the FISH technique. All persons investigated in this study were sent to the area in 1986 and the majority of them were selected to be among those with the presumably highest exposure doses. In spite of the selection the estimated average dose is between 0.2-0.3 Gy, thus not clearly above the officially permitted dose level of 0.25 Gy. Due to unforseen conditions during transport of the blood samples, both the number of persons available for analysis and the number of metaphases available for scoring were substantially reduced. However, unless this selection is linked with the potential aberration frequency of the cells involved, no bias is expected.

Cancer incidence in Estonian migrants to Sweden

Cancer incidence in Estonians who took refuge in Sweden in 1944-1945 has been compared with that in the total Swedish population and that among Estonians in Estonia in 1974-1985 using data from the Swedish and the Estonian countrywide population-based cancer registries. The vast majority of the Estonian immigrants studied had been living in Sweden for 30 years when the follow-up with respect to cancer incidence started in this investigation. In spite of the long residence in Sweden, differences in cancer incidence could be observed between these immigrants and the total Swedish population. The age-standardized incidence of stomach cancer was higher in the Estonian migrants than in the total Swedish population (SIR = 1.6 and 2.1 for males and females, respectively). Breast cancer incidence was lower in the migrant women (SIR = 0.75) and lung cancer incidence higher in migrant men (SIR = 1.5). An increased incidence of colorectal cancer was also found for both sexes in the migrant population (SIR = 1.4 for both males and females). A comparison between Estonians in Estonia and the total Swedish population revealed that the cancer incidence for the Estonians was lower than expected at age 70 and over. Male lung cancer and stomach cancer showed a higher incidence in the Estonian population than in the Swedish and in the migrant populations. The migrant population showed an intermediate incidence relative to Estonians in Estonia and the entire Swedish population. The colon-cancer risk in Estonian migrants to Sweden was higher than the risk for Estonians in Estonia and for the Swedish population. This contrasts with most findings in the present and other studies on intermediate risks of migrants compared to the risks in the country of origin and in the new country of residence.

Populational polymorphisms in silver staining of nucleolus organizer regions (NORs) in human acrocentric chromosomes

The Ag stainability of the nucleolus organizer region (NOR) was studied in the acrocentric chromosomes identified by Q banding of cultured lymphocytes in 41 karyotypically normal persons (33 males and 8 females) originating from southeast Estonia. The data obtained are compared with those established earlier for a combined Vienna-Ulm population of 51 karyotypically normal persons (see Mikelsaar et al., 1977a). Significant differences between the two populations in the frequency and patterns of Ag-positive NORs were found. The following findings were most striking: the frequency of Ag-positive NORs in chromosome 14 and in the totals was significantly lower in the Estonian population than in the Vienna-Ulm population (P less than 0.01). The average modal number of Ag-positive NORs per individual was 7.8 in the Estonian population and 8.7 in the Vienna-Ulm sample (P less than 0.01). If the data of the two populations were combined the frequency of positive NORs was significantly (P less than 0.05) lower in chromosome 22 than in 13, 15, and 21, but not 14.