Body dissatisfaction and dieting among Finnish adolescents: a 20-year population-based time-trend study

Body image has an important role in the health and development of adolescents. Body dissatisfaction and dieting can become chronic and continue into adulthood. There is a lack of recent, comprehensive studies on ongoing trends on body dissatisfaction. This study assessed time-trend changes in self-reported body dissatisfaction and dieting among Finnish adolescents at four assessment points. Representative samples of adolescents (N = 6660) aged 13-16 years participated in school-based, cross-sectional studies in 1998 (N = 1458), 2008 (N = 2044), 2014 (N = 1809), and 2018 (N = 1349), respectively. The studies were similar in design, methodology, and geographical recruitment areas. Body dissatisfaction and dieting were assessed with a questionnaire including items derived from the DSM-IV criteria for anorexia and bulimia nervosa. From 1998 to 2018, dieting and fears related to gaining weight decreased among females. Body dissatisfaction reduced among females, and their wishes to become thinner became less prevalent. Consuming large amounts of food at one time consistently decreased among females and males and there were no changes in the rates of willful vomiting. The number of females in the 90th percentile with the most severe symptoms decreased. The results indicate that body dissatisfaction and disturbed dieting improved among females during the 20-year study. Despite these positive developments, the overall level of symptoms among females remained substantial, indicating that females have much higher levels of body dissatisfaction and dieting than males.

Accessible mental well-being intervention for adolescents in school settings: a single-group intervention study using a pretest-post-test design

BACKGROUND

A growing number of adolescents seek treatment for mental health problems, a circumstance that stresses the importance of implementing accessible treatment options. This study evaluates the impacts of brief, mental well-being intervention for adolescents in a school environment. As mental health interventions are often targeted at specific disorders, we sought a comprehensive approach to reach adolescents with a range of mental health symptoms.

METHODS

Single-group intervention study with a pretest-posttest design was utilized and conducted in lower, upper secondary, and vocational schools on adolescents ages 12-18 who sought medical attention for mental health symptoms. The cut-off point for inclusion was ≥ 14, for the Young Persons Clinical Outcomes for routine Evaluation (YP-CORE) measurement. The intervention included six face-to-face visits implemented by psychiatric nurses who received a 3-day training course. The impacts were evaluated after 6 weeks (n = 87) and again at 6 months (n = 68) and assessed using the YP-CORE, Beck Depression Inventory (BDI-II) and Overall Anxiety Severity and Impairment Scale (OASIS).

RESULTS

The participants reported significant levels of mental distress at baseline with a YP-CORE mean score = 21.48, a BDI-II mean score = 23.60, OASIS mean score = 10.98. Post-intervention results at 6 weeks for the primary outcome YP-CORE showed a significant (p < .001) mean score decrease of - 3.82, a medium effect size d = .627. For participants attending upper secondary and vocational schools the YP-CORE scores changed significantly from baseline to 6-weeks (p = .005) and from baseline to 6-months (p < .001). Long-term outcomes at 6-months showed a - 1.14 decrease (p = non-significant), effect size d = .175. After the 6-week intervention, 12% of the participants were assessed as not requiring additional visits.

CONCLUSIONS

This easily accessible intervention in a school setting indicated improvement for those participants with mild to moderate mental disorder symptoms and attending upper secondary and vocational schools. After the 6-week intervention, significant positive effects were observed. Participants reported substantial levels of mental distress at the baseline, which could contribute to the decline of symptoms and need for extended care during the 6 months follow-up. Trial registration Retrospectively registered with Clinicaltrials.gov identifier NCT05356949.

The nature of co-morbid psychopathology in adolescents with gender dysphoria

Gender-referred adolescents (GR) have been reported to present with considerable psychiatric symptomatology compared to their age-peers. There is, however, little research on how they compare to adolescents referred due to mental health problems (MHR). We set out to compare psychopathology in adolescents referred to our specialized gender identity unit (n = 84) and adolescents referred to a general adolescent psychiatric clinic (n = 293) in a university hospital setting in Finland. Of the GR adolescents, 40.9% had not received any psychiatric diagnosis during adolescence. Eating disorders were less common in the GR than in the MHR group, but otherwise the prevalences of disorders did not differ statistically significantly. At the symptom level, the GR adolescents displayed significantly more suicidal ideation and talk and less alcohol abuse and eating disorder symptoms than did the MHR adolescents, but otherwise their symptom profiles were comparable. Additionally, the GR adolescents had significantly fewer total externalizing symptoms than did the MHR adolescents. Adolescents seeking gender affirming treatments present with psychiatric symptoms and disorders comparable to those seen among adolescent psychiatric patients. Medical gender affirming care may not be a sufficient intervention for treating psychiatric comorbidities of adolescents with gender dysphoria.

Time trends in treated incidence, sociodemographic risk factors and comorbidities: a Finnish nationwide study on anxiety disorders

Introduction

Anxiety disorders (ADs) are common in childhood and adolescence and global estimates suggest they affect 6.5% of individuals under 19 years of age.Yet, there has been a lack of research on time trends and socio-demographic risks for children and adolescents who receive treatment for ADs.

Objectives

We aim to fill gaps in our knowledge by examining a nationwide sample of Finnish children and adolescents diagnosed in specialized healthcare settings.

Methods

We used register data of all singleton children born in Finland from 1992-2006 and diagnosed with ADs from 1998-2012. Changes in time trends in incidence were studied by dividing the study sample into three cohorts by birth years: 1992-1996, 1997-2001 and 2002-2006. The 22,388 individuals with ADs were matched with 76,139 controls. Nested case-control design was used to study the socio-demographic risk factors.

Results

Comparing the 1992-1996 and 2002-2006 cohorts showed the cumulative incidence of treated ADs at the age of 10 increased from 0.3% to 1.2% (females) and 0.46% to 1.9% (males). Subjects had higher odds of being diagnosed with an AD if mothers had low SES (OR 1.49, 95% CI 1.42-1.58) and were single parents (OR 1.99, 95% CI 1.84-2.15) at birth. Unipolar depression was the most common psychiatric comorbidity (31.2%).

Conclusions

ADs diagnosed by specialized services increased from 1998-2012 in both genders. This could indicate real increase in overall ADs, an increase in seeking treatment or both phenomena. The findings on maternal socioeconomic status and single parenting help improve understanding of environmental risk for anxiety disorders among children and adolescents.

Disclosure

No significant relationships.

Time trends in treated incidence, sociodemographic risk factors and comorbidities: a Finnish nationwide study on anxiety disorders

BACKGROUND

There has been a lack of research about the time trends and socio-demographic risk factors for children and adolescents who receive treatment for anxiety disorders. This study aimed to fill these gaps in our knowledge by examining a nationwide sample of Finnish children and adolescents diagnosed in specialized healthcare settings.

METHODS

This study comprised national register data of all singleton children born in Finland from 1992-2006 who were diagnosed with anxiety disorders from 1998-2012. The changes in time trends in incidence were studied by dividing the study sample into three cohorts by birth years: 1992-1996, 1997-2001 and 2002-2006, who were followed up until the age of 20, 15 and 10 years, respectively. The 22,388 individuals with anxiety disorders were age and gender matched with 76,139 controls from the general population. Logistic regression was used to examine the socio-demographic risk factors and anxiety disorders in the entire sample. Comorbid disorders were examined in the oldest birth cohort (1992-1996 born).

RESULTS

Comparing the 1992-1996 and 2002-2006 cohorts showed that the cumulative incidence of treated anxiety disorders at the age of 10 increased from 0.3 to 1.2% among females and 0.46 to 1.9% among males. Subjects had higher likelihood for being diagnosed with an anxiety disorder if their mothers had low maternal socio-economic status class at birth (OR 1.53, 95% CI 1.45-1.61) compared to higher SES class, and marital status was single at the time of birth (OR 2.02, 95% CI 1.87-2.17) compared to married or in a relationship. They had lower risk of anxiety disorders diagnosis if born in rural (OR 0.82, 95% CI 0.79-0.86) or semi-urban areas (OR 0.79, 95% CI 0.76-0.82) when compared to urban residence. There was a wide range of psychiatric comorbidities, and unipolar depression was the most common (31.2%).

CONCLUSION

Anxiety disorders diagnosed by specialized Finnish services increased from 1998-2012 in both genders. This could indicate a real increase in overall anxiety disorders or an increase in treatment seeking. The findings on maternal socioeconomic status and single parenting improve the recognition of the environmental risk factors for anxiety disorders among children and adolescents.

Relative Age and the Use of Second-Generation Antipsychotics from 7 to 17 Years of Age: A Population-Based Register Study

Objective: The youngest children in a classroom have a higher risk of attention-deficit/hyperactivity disorders (ADHDs) and depression than their relatively older peers. However, there has been a lack of research on how relative age is related to second-generation antipsychotic (SGA) medication use. Methods: This study used the Finnish National Prescription Register data and comprised all 669,726 Finnish children and adolescents aged 7-17 in 2018. We extracted data for those who were dispensed SGAs (risperidone, quetiapine, aripiprazole, and olanzapine) and ADHD medication (methylphenidate, atomoxetine, dexamphetamine, and lisdexamfetamine). Odds ratios (OR) and 95% confidence intervals (CI) were calculated for medication dispensed to schoolchildren born from January to April (the relatively oldest), May to August, and September to December (the relatively youngest). Dispensed prescriptions were a proxy for medication use. Results: SGAs were dispensed to 9146 (1.4%) individuals in 2018. Their use was lower among girls aged 12-17 years born from September to December than January to April (OR 0.89; 95% CI 0.83-0.97), with no association between SGA use and birth month among boys. However, younger relative age was associated with combined SGA and ADHD medication, which was used by 2556 (0.4%) of the cohort: 2074 (0.6%) boys and 482 (0.1%) girls. The OR was 1.27 for boys aged 12-17 born from September to December (95% CI 1.10-1.46), compared with January to April. The OR for girls born from May to August was 1.35 (95% CI 1.04-1.76) and from September to December it was 1.33 (95% CI 1.02-1.74), compared with January to April. Conclusions: A novel discovery of this study was that using both SGA and ADHD medication at the age of 12-17 years was more common among the youngest subjects in a school year than their relatively older peers.

Multi-center nationwide study on pediatric psychiatric inpatients 2000-2018: length of stay, recurrent hospitalization, functioning level, suicidality, violence and diagnostic profiles

Inpatient treatment is an important part of child and adolescent psychiatric (CAP) care. This nationwide study explores the changes in length of stay, recurrent hospitalization, functioning level, suicidality, violence and diagnoses of CAP inpatients in Finland in 2000, 2011 and 2018. We obtained comprehensive questionnaire data on each study year from 93 to 95% of all CAP wards in Finland. We split the 1276 inpatients into two age groups in each study year: under 13 and 13-18. The median length of stay in inpatient treatment decreased from 82.0 days in 2000 to 20.5 days in 2018 (p < 0.001) and recurrent hospitalization increased from 38 to 46%. General functioning, which was evaluated by the Children's Global Assessment Scale, deteriorated by an average of six points between 2000 and 2018. Violent threats decreased from 21.5 to 16.6% and violent acts decreased from 26.9 to 20.3%. Suicidal threats decreased from 42.6 to 23.3% in those aged under 13 and remained stable among those aged 13-18. In the 13-18 group, there was an increase in the diagnoses of ADHD, from 5.0 to 16.9% and depression, from 25.1 to 41.7%. However, psychosis decreased from 23.2 to 12.6% in the older age group. In the whole cohort, anxiety disorders increased from 7.6 to 15.6%. The overall picture does not show that CAP inpatients have become more disturbed. While the general functioning of CAP inpatients deteriorated somewhat over the 2000-2018 study period, symptoms of suicidality and violence remained stable or decreased. There was also a continuous increase in short-term treatment.

Risk for Premature Mortality and Intentional Self-harm in Autism Spectrum Disorders

To examine the risk for premature mortality and intentional self-harm in autism spectrum disorders (ASD). Based on a national birth cohort. Children born in 1987-2005, diagnosed with ASD by 2007 (n = 4695) were matched with four non-ASD subjects (n = 18,450) and followed until 2015 for mortality and intentional self-harm. The risk among ASD subjects was elevated only for natural cause of death. The risk for intentional self-harm was increased in the unadjusted analyses, but decreased to non-significant after adjusting for comorbid psychiatric disorders. ASD subjects are at increased risk for premature mortality due to natural causes of death. While ASD subjects die of suicide and present with more self-harm, the association is explained by comorbid psychiatric disorders.

The Effectiveness of Individual Mental Health Interventions for Depressive, Anxiety and Conduct Disorder Symptoms in School Environment for Adolescents Aged 12-18-A Systematic Review

Background: Mental health problems are a major health issue for children and adolescents around the world. The school environment allows adolescents to be reached comprehensively and on a low threshold, making it a potential environment for mental health interventions. The aim of this review was to describe interventions delivered by health-care workers in school environment for individual adolescents aged 12-18 with mental health problems and to assess the effectiveness of these interventions. Methods: This systematic review was conducted in adherence with the PRISMA guidelines. Altogether 349 studies were screened and 24 of them were included in full text assessment. Eight studies were included in the qualitative synthesis. Only in three studies the intervention was compared to another intervention or the study setting included a control group. Five of the interventions were based on cognitive-behavioral therapy and three on other approaches. In seven studies, one of the main response variables was based on assessment of depressive symptoms and/or a depressive disorder. The quality of the studies was limited with notable risk for bias for some studies. Results: Based on reported symptom reductions, for most of the interventions, the results were good. Symptom reductions were also typically achieved in a rather low number of sessions (12 or less) supporting the feasibility of these type of interventions in school environment. However, the lack of use of control groups and actual comparisons between the interventions, limit the possibility to draw firm conclusions regarding their effectiveness and thus, the results should be interpreted with caution. Confirming the effectiveness of the studied interventions requires more robust evidence and thus, improving the quality of studies in the school environment is encouraged.

Ten-year changes in the psychosocial well-being, psychopathology, substance use, suicidality, bullying, and sense of coherence of 18-year-old males: a Finnish population-based time-trend study

We studied Finnish 18-year-old males attending obligatory military call-up assessments in 1999 (n = 2340) and 2009 (n = 4309) on time-trend changes in psychosocial well-being, psychopathology, substance use, suicidality, bullying, and sense of coherence. Subjects filled in questionnaires, including the Young Adult Self-Report (YASR) for psychopathology and the Orientation to Life Questionnaire (SOC-13) for sense of coherence. The prevalence of minor mental health problems in the last 6 months decreased from 22.3% in 1999 to 18.6% in 2009 (OR 0.8, 95% CI 0.7-0.9), whereas severe mental health problems remained stable. Suicidal thoughts decreased from 5.7 to 3.7% (OR 0.6, 95% CI 0.5-0.8). The use of illicit drugs decreased from 6.0 to 4.7% (OR 0.8, 95% CI 0.6-0.95), but being drunk at least once a week increased from 10.3 to 13.4% (OR 1.3, 95% CI 1.0-1.5). Attention problems increased in YASR syndrome domains (mean score 2.9 vs 3.2, p < 0.001) and so did somatic complains (mean score 1.7 vs 1.9, p = 0.005). The SOC-13 scores remained stable. The percentage of males who had studied during the past 6 months increased from 91.4 to 93.4% (OR 1.3, 95% CI 1.1-1.6), while being employed decreased from 64.9 to 49.4% (OR 0.5, 95% CI 0.5-0.6). The positive findings included reductions in the prevalence of suicidal thoughts and the use of illicit drugs, but being drunk at least once a week increased. Self-reported somatic problems and attention problems increased. Despite changes in society and family structures, there were only minor overall changes in psychopathology.

Prenatal and perinatal risk factors for anxiety disorders among children and adolescents: A systematic review

BACKGROUND

Prenatal and perinatal risk factors for anxiety disorders have rarely been studied, even though they are highly prevalent in children and adolescents. It is important to identify the common risk factors, so that targeted preventive care and early interventions can be provided.

METHODS

A systematic review of the PubMed and PsycInfo databases was conducted to 25 October 2019, according to the Preferred Reporting Items of Systematic Reviews and Meta-analyses guidelines. The protocol was registered on the Prospective Register of Systematic Reviews and the quality assessment was carried out using the Joanna Briggs tools.

RESULTS

The review identified 31 studies from eight countries, including three register studies. Cohort sizes ranged from 69 to 89,404 and diagnoses cases ranged from 4 to 7867. Although various risk factors had been researched, only few of them had been repeatedly studied and the findings were highly inconsistent. The associations between the different risk factors and anxiety disorders seemed weak compared to many other psychiatric disorders, but preterm birth and maternal somatic illnesses may increase the risk for anxiety disorders in offspring.

LIMITATIONS

The studies varied considerably by study design, risk factors and anxiety disorders studied, sample sizes and follow up periods.

CONCLUSIONS

Prenatal and perinatal risk factors for anxiety disorders have been under-researched, compared to other psychiatric disorders. Our systematic review found weak links to prenatal events, but flagged up preterm birth and maternal somatic illnesses as possible avenues for future research.

Time trends in the incidence of diagnosed depression among people aged 5-25 years living in Finland 1995-2012

Background: Knowledge of time trends for depression is important for disease prevention and healthcare planning. Only a few studies have addressed these questions regarding the incidence and cumulative incidence of diagnosed depression from childhood to early adulthood and findings have been inconclusive. Aim: The aim of this national register-based Finnish study was to report the time trends of the age-specific and gender-specific incidence and cumulative incidence of diagnosed depression. Methods: The study sample included all 1,245,502 singletons born in Finland between 1 January 1987 and 31 December 2007 and still living in Finland at the end of 2012. The participants were divided into three cohorts by birth year: 1987-1993, 1994-2000 and 2001-2007. Depression diagnoses (ICD-9: 2961; ICD-10: F32, F33) given in 1995-2012 were available and identified from the Care Register for Health Care. Results: Ten percent of the females and five percent of the males were diagnosed with depression in specialized services by age 25 years. The cumulative incidence of depression by age 15 years rose from 1.8% (95% CI 1.8-1.9) to 2.9% (95% CI 2.8-3.0) in females and from 1.0% (95% CI 1.1-1.2) to 1.6% (95% CI 1.6-1.7) in males when the cohorts born 1987-1993 and 1994-2000 were compared. Conclusions: A larger proportion of young people in Finland are diagnosed with depression in specialized services than before. This can be due to better identification, more positive attitudes to mental health problems and increased availability of the services.

Suicidality among child and adolescent psychiatric inpatients: time trend study comparing 2000 and 2011

Child and adolescent inpatient treatment has faced major changes since the year 2000, including shorter inpatient stays and a greater use of psychotropic drugs. This study explored changes and correlates of suicidal threats and suicide acts among inpatients, by comparing Finnish cross-sectional surveys from 2000 to 2011. A questionnaire that explored the background, diagnosis and treatment characteristics of inpatients was sent to all child and psychiatric wards in Finland. The data collection was carried out on specified days in 2000 and 2011. We received comprehensive data on 504 patients from 64/69 (93%) wards in 2000 and on 412 patients from 75/79 (95%) wards in 2011. The Spectrum of Suicidal Behaviour Scale was used to explore suicidality. The prevalence of suicidality did not change in this nationwide study: suicidal threat rates were 38% in 2000 and 37% in 2011, and suicide attempts in both years were 11%. The prevalence of suicidal acts was higher among girls and teenagers, while low general functioning, defined as Children's Global Assessment Scale scores of under 30, was associated with both suicidal threats and acts. Violent acts were associated with both suicidal threats and acts in 2000, but not in 2011. Despite changes in treatment practices and shorter inpatient stays, the prevalence of suicidality in child and adolescent inpatient treatment remained unchanged in Finland in 2000 and 2011.

Time trends of Finnish adolescents' mental health and use of alcohol and cigarettes from 1998 to 2014

This study reports time-trend changes in self-reported mental health problems, smoking, and alcohol habits among Finnish adolescents over a 16-year period using three cross-sectional studies with similar designs, methodologies, and geographical recruitment areas. There were 4508 participants with a mean age of 14.4 years (range 13-18) in 1998 (n = 1449), 2008 (n = 1560), and 2014 (n = 1499). The information they provided on their mental health was measured with the Strengths and Difficulties Questionnaire and they were also asked questions about their alcohol and smoking habits. The findings showed that from 1998 to 2014 females reported less hyperactivity and conduct problems and males reported fewer peer problems and better prosocial skills. The only mental health problem that showed a significant increase was emotional symptoms among females. Smoking and alcohol use consistently decreased in males and females during the 16-year period. Our findings suggest that overall adolescent's self-reported mental health problems were either stable or falling, indicating increased well-being. The decreased smoking indicates that anti-smoking campaigns have been successfully changing teenagers' attitudes towards smoking. The important finding is that self-reported emotional symptoms had increased in females. This may indicate an increase or earlier onset of affective disorders.

National time trend changes in psychotropic medication of child and adolescent psychiatric inpatients across Finland

BACKGROUND

There have been no comprehensive studies on trends in psychotropic medication use in child and adolescent inpatient settings. The aim of this nationwide study was to report changes in the psychotropic medication given to child and adolescent psychiatric inpatients across Finland and the factors associated with those changes.

METHODS

We asked the psychiatrist responsible for each inpatient to complete a questionnaire that included questions about the pharmacological treatment and background information. The data were collected on all inpatients on one selected study day in 2000 and 2011. Changes in the use of regular psychotropic medication were studied by comparing the data on 504 patients in 2000 and 412 patients in 2011.

RESULTS

The study showed that there had been a significant increase in the use of psychotropic medication from 2000 to 2011. According to the multivariate analysis, the increase in psychotropic medication was associated with the study year (in 2000 39%, in 2011 58%), but could not be explained by changes in diagnostic profiles, age distribution, suicidality, violence or the Children's Global Assessment Scale scores. The use of combined psychotropic medication increased from 9% in 2000 to 25% in 2011. The increase in the use of antipsychotics among child inpatients was particularly noteworthy, with an increase from 10% to 32%.

CONCLUSIONS

There is a need for evidence-based studies to clarify recommendations for indications and treatment practices when using psychotropic medication in children and adolescents. Cross-cultural studies of the use of psychotropic medication are warranted.

Changes in the clinical features of child and adolescent psychiatric inpatients: a nationwide time-trend study from Finland

BACKGROUND

Few studies have focused on the recent trends in clinical features child and adolescent inpatient.

AIMS

This study focuses on the change in the characteristics of child and adolescent psychiatric inpatients in Finland.

METHODS

The data collection was carried out on selected study days in 2000 and 2011. Questionnaires were sent to the psychiatrists of all child and adolescent wards in Finland.

RESULTS

By comparing the data obtained in 2000 (n = 504) and 2011 (n = 412), several changes were found: the percentage of girls in adolescent wards grew and the diagnoses of depression, anxiety disorders, attention deficit hyperactivity disorder and eating disorders increased. In contrast, the diagnoses of psychosis and conduct or oppositional disorders decreased. General functioning was evaluated with the Childreńs Global Assessment Scale (CGAS). There were no changes in the distribution of CGAS scores among child inpatients, whereas among adolescents the share of inpatients with lowest CGAS scores (1-30) increased significantly. The mean length of stay dropped.

CONCLUSIONS

The growing percentage of girls in adolescent wards is associated with an increase in diagnoses that are more prevalent among girls than boys, namely depression, anxiety, and eating disorders. The changes in the distribution of diagnoses may be due to changes in diagnostic or referral practices, or reflect true changes in the prevalence of disorders among children and adolescents in need of inpatient treatment. The share of adolescent inpatients with the poorest general functioning has increased. The observed shortening in inpatient treatment time seems to be a result of changes in treatment practices.

Optimism and pessimism as predictors of initiating and ending an antidepressant medication treatment

BACKGROUND

The personality variables optimism and pessimism are potential risk factors for disorders commonly treated with antidepressants.

AIMS

To evaluate optimism and pessimism as predictors of initiating and ending an antidepressant treatment.

METHODS

Data consisted of 29,930 public sector employees with no record of diagnosed depression. Optimism and pessimism were measured using the Revised Life Orientation Test (LOT-R) at baseline. The data of purchases of antidepressants were from the national Drug Prescription Register.

RESULTS

During the mean follow-up of 4.4 years, 1681 participants initiated and of them 1288 ended an antidepressant treatment lasting at least 100 days. In the adjusted model, high optimism was associated with a lower likelihood of starting antidepressant medication treatment (hazard ratios, HR, 0.67, 95% CI 0.62-0.73) and a higher likelihood of stopping the treatment (HR = 1.18, 95% CI 1.08-1.30). High pessimism was associated with a higher likelihood of starting antidepressant medication treatment (HR = 1.27, 95% CI 1.16-1.38) and a lower likelihood of stopping it (HR = 0.89, 95% CI 0.80-0.98). These associations remained after optimism score was adjusted for pessimism and vice versa or those with symptoms of mental health problems at baseline were removed from the analyses.

CONCLUSIONS

Low optimism and high pessimism are independently associated with an increased likelihood of initiating antidepressant medication treatment, but with a decreased likelihood of ending it during the follow-up.

Low level of optimism predicts initiation of psychotherapy for depression: results from the Finnish Public Sector Study

BACKGROUND

The patient's personality may be one of the many factors that contribute to the decision to initiate a certain treatment for depression. The aim of this study was to examine whether dispositional optimism and pessimism play a role in the initiation of psychotherapy as the treatment for new-onset depression in previously nondepressed public sector employees.

METHODS

This prospective observational cohort study included 38,717 (mean age: 45 years; 76% female) public sector employees who responded to a survey in 1997, 2000-2001 and/or 2004 and had no history of depression at cohort entry. Dispositional optimism and pessimism were assessed via the revised Life Orientation Test and linked to individual records of indicators of depression onset in comprehensive national health registers, and of long-term psychotherapy for depression in particular.

RESULTS

During a mean follow-up of 4.0 years, 1,616 (4%) incident cases of depression were observed. Of them, 79 started long-term, state-subsidized psychotherapy for depression. A 1-unit increase in mean optimism score was associated with a 38% lower likelihood of initiating psychotherapy as a treatment for depression and a 32% lower likelihood of depressive disorder in general during follow-up. Pessimism score was not associated with initiation of psychotherapy for depression, but a 1-unit increase in pessimism score was associated with a 28% increase in the likelihood of depressive disorder. These findings were robust to adjustments for demographics, health risk behaviors and somatic diseases at baseline.

CONCLUSION

This study suggests that although both low optimism and high pessimism increase the risk for depression, only low optimism influences the initiation of psychotherapy as a treatment modality for depression. This could imply that depressed patients with low optimism should receive more attention in the beginning of the depressive episode than patients with high optimism.

Optimism and pessimism as predictors of work disability with a diagnosis of depression: a prospective cohort study of onset and recovery

BACKGROUND

Personality characteristics are assumed to affect to the vulnerability to depression and its outcomes. The aim of this study was to examine optimism and pessimism as predictors of depression-related work disability and subsequent return to work.

METHODS

We conducted a prospective cohort study of 38,214 public sector employees with no record of diagnosed depression. Optimism and pessimism were measured using the Revised Life Orientation Test (LOT-R). Records of long-term (>90 days) work disability with a diagnosis of depression and subsequent return to work until the end of 2005 were obtained from the national health registers.

RESULTS

During the mean follow-up of 4.0 (SD=2.3) years, 287 employees encountered work disability with a diagnosis of depression. Of them, 164 (57%) returned to work during the follow-up. One unit increase in the optimism mean score (range 1-4) was associated with a 25% lower risk of work disability due to depression and a 37% higher probability of returning to work after a work disability period when adjusted for age and sex. In the fully-adjusted model hazard ratios per one unit increase in optimism were 0.79 (95% CI 0.66-0.96) for work disability and 1.30 (95% CI 1.01-1.66) for return to work. The pessimism mean score (range 1-4) was only associated with a lower probability of returning to work (fully-adjusted HR per one unit increase 0.66, 95% Cl 0.49-0.88).

CONCLUSION

The level of optimism was a stronger predictor of work disability with a diagnosis of depression than the level of pessimism, while both optimism and pessimism predicted returning to work.

Personality traits and recovery from major depressive disorder

OBJECTIVE

To study the correlation of personality traits measured by the Temperament and Character Inventory (TCI) with the prognosis of major depressive disorder in patients treated with either fluoxetine or short-term psychodynamic psychotherapy in a randomized comparative study.

METHOD

35 patients with DSM IV-defined major depressive disorder of mild or moderate severity were randomized to receive either short-term psychodynamic psychotherapy or fluoxetine treatment for 16 weeks. Prior to beginning of the therapy, patients were assessed with TCI. The Hamilton Depression Rating Scale (HDRS) was used as the outcome measure completed at the baseline and follow-up at 4 months.

RESULTS

In the combined group (n=35), Harm Avoidance was associated with the severity of the depression measured by the HDRS at the baseline (P=0.01) and baseline Self-Directedness with the HDRS at 4 months follow-up (P=0.03). In the fluoxetine treatment group, Reward Dependence (P=0.03), Self-Directedness (P=0.01) and Cooperativeness (P=0.02) at the baseline associated with HDRS at 4 months follow-up. No statistically significant associations between personality traits and depression scores at the follow-up were found in the patients treated with psychotherapy.

CONCLUSION

In this whole cohort of depressive patients, baseline high Self-Directedness predicted higher depression scores after 4 months of treatment. In the fluoxetine treatment group, subjects with high baseline Reward Dependence, Self-Directedness or Cooperativeness were likely more severely depressed at the 4 months follow-up. We suggest that associations between personality traits and remaining depressive symptoms after 4 months treatment with fluoxetine could be caused by the potential differences in the placebo effect.

Does defense style or psychological mindedness predict treatement response in major depression?

BACKGROUND

The aim of this study was to define the impact of defense style and psychological mindedness (PM) on the prognosis of major depressive disorder (MDD) in patients treated with either fluoxetine (FLX) or short-term psychodynamic psychotherapy (STPP) in a randomized comparative study.

METHOD

50 patients with MDD received either STPP or FLX treatment for 16 weeks. The Hamilton Depression Rating Scale (HDRS) was the outcome measure completed at baseline and in the follow-ups at 4- and 12-months. Patients completed the Psychological Mindedness Scale (PMS) and the Defense Style Questionnaire at the baseline.

RESULTS

In the FLX group recovery measured by the decrease in the HDRS during the 4-month follow-up associated with baseline mature defense style (r=-.59, P=.015). There were no correlations between the PMS-scores and the outcome measures in either treatment groups nor defense status and the outcome in the STPP group.

CONCLUSION

Mature defense style predicts good response to FLX therapy in major depression. This association was not found in the psychotherapy group. The results may imply that patients with immature defenses benefit relatively more from brief psychotherapy than medication. PM measured by the PMS was not useful in predicting recovery in MDD.