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Lahti J, Pietiläinen O, Rahkonen O, Lallukka T. Class inequalities in physical functioning trajectories before and after retirement. Eur J Public Health 2022. [PMCID: PMC9593451 DOI: 10.1093/eurpub/ckac131.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Longer work careers are discussed, but inequalities in health trajectories among employees facing retirement remain poorly understood. We examined social class trajectories in physical functioning among ageing female employees ten years before and after transition to old-age or disability retirement. Methods We used Helsinki Health Study cohort data. The baseline (2000-02) included 7168 women, aged 40-60, employed by the City of Helsinki, Finland (response 67%). Follow-ups took place in 2007, 2012 and 2017 (response 78-83%). The outcome was RAND-36 Physical Functioning subscale, range 0-100, with higher scores indicating better functioning. Social classes were upper and lower class, and covariates age, work conditions and health behaviours. Mixed-effect growth curve models were used to predict functioning scores and 95% confidence intervals (CI) 10 years before and after mandatory old-age or disability retirement. Results Old-age and disability retirees lacked class inequalities in functioning 10 years prior retirement. Towards retirement transition, functioning declined and inequalities emerged. Among old-age retirees, the predicted score was 86.1 (CI 85.2-86.9) for upper class and 82.2 (81.5-83.0) for lower class. Among disability retirees, the score was 70.3 (67.8-72.9) for upper class and 62.2 (60.4-63.9) for lower class. Among old-age retirees, functioning declined and inequalities slightly widened. Among disability retirees, the decline plateaued and inequalities narrowed. Physical work and BMI somewhat attenuated the inequalities. Conclusions Among female employees, functioning declined and class inequalities emerged towards retirement transition. Widening inequalities were seen among old-age retirees, but not among disability retirees. Preventing the decline of functioning and related inequalities would help safeguard a healthy and successful ageing among female retirees. Key messages • As functioning shows a constant decline before and after old-age retirement, there is a need for slowing down the pace of the decline. • Class inequalities in functioning tend to widen among old-age retirees; egalitarian measures are needed to turn the development to narrowing inequalities.
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Affiliation(s)
- J Lahti
- Department of Public Health, University of Helsinki , Helsinki, Finland
| | - O Pietiläinen
- Department of Public Health, University of Helsinki , Helsinki, Finland
| | - O Rahkonen
- Department of Public Health, University of Helsinki , Helsinki, Finland
| | - T Lallukka
- Department of Public Health, University of Helsinki , Helsinki, Finland
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2
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Mänty M, Kouvonen A, Nordquist H, Harkko J, Pietiläinen O, Halonen JI, Rahkonen O, Lallukka T. Physical working conditions and subsequent sickness absence: a record linkage follow-up study among 19-39-year-old municipal employees. Int Arch Occup Environ Health 2021; 95:489-497. [PMID: 34687341 PMCID: PMC8795030 DOI: 10.1007/s00420-021-01791-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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] [Received: 03/23/2021] [Accepted: 06/14/2021] [Indexed: 11/25/2022]
Abstract
Purpose Physical work exposures are associated with sickness absence among older employees. We aimed to examine if they similarly contribute to all-cause sickness absence during early and mid-careers. Methods We used questionnaire data on physical work exposures linked to register data on sickness absence from 3542 municipal employees aged 19–39 years. Follow-up for the number of sickness absence days was 12 months. Exposures to physical workload, occupational environmental hazards, and sedentary work were divided into quartiles. In addition, duration of daily exposure to heavy work was included. Negative binomial regression models were used. Results Higher exposure to physical workload or hazardous exposures was associated with a higher number of sickness absence days. The age and gender adjusted rate ratios for sickness absence days among the participants whose exposure to physical workload was in the highest exposure quartile were 2.1 (95% CI 1.8‒2.5) compared with those whose exposure was in the lowest quartile. In addition, rate ratios for sickness absence days among participants who reported that they do heavy physical work 1.1‒2.0 h, 2.1‒4.0 h or over 4 h daily were 1.6 (1.3‒1.9), 1.5 (1.3‒1.8) and 1.7 (1.5‒2.1), respectively, compared with those who reported not doing physical work. Further adjustment for lifestyle factors or health characteristics attenuated the associations only slightly. Conclusion Exposure to physically demanding work is associated with a higher number of sickness absence days among municipal employees below 40 years of age. Physical working conditions should be considered when aiming to support later work ability. Supplementary Information The online version contains supplementary material available at 10.1007/s00420-021-01791-y.
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Affiliation(s)
- M Mänty
- Department of Public Health, University of Helsinki, Helsinki, Finland. .,Unit of Strategy and Research, City of Vantaa, Vantaa, Finland.
| | - A Kouvonen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland.,Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - H Nordquist
- Department of Public Health, University of Helsinki, Helsinki, Finland.,Faculty of Social Sciences, University of Helsinki, Helsinki, Finland.,Department of Health Care and Emergency Care, South-Eastern Finland University of Applied Sciences, Kotka, Finland
| | - J Harkko
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - O Pietiläinen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - J I Halonen
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - O Rahkonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - T Lallukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
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3
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Lahti J, Harkko J, Sumanen H, Piha K, Pietiläinen O, Mänty M, Rahkonen O, Lallukka T, Kouvonen A. Does seeing a psychologist reduce sickness absence due to mental disorders? A quasi-experiment. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Mental ill-health in young adults is a major public health and work-life problem. We examined in a quasi-experimental design whether occupational psychologist appointment can reduce subsequent sickness absence due to mental disorders among young Finnish employees.
Methods
The present study was conducted among 18-39-year-old employees of the City of Helsinki using register data from the City of Helsinki and the Social lnsurance Institution of Finland. We used Wald test to compare the differences in sickness absence days due to mental disorders (ICD-10, F-diagnosed) between those treated (occupational psychologist appointment for work ability support) and the non-treated (no psychologist appointment) during a one year follow-up. The full sample (n = 2156, 84% women) consisted of employees with mental disorder diagnosed sickness absence during 2009-2014. To account for the systematic differences between the treated and non-treated, the participants were matched according to their characteristics (age, sex, occupational class, education, previous sickness absence and psychotropic medication). The matched sample included 886 participants. We excluded those with treatment before the treatment screening time (± 3 months to the end of sickness absence period), non-treated with treatment during the follow-up and those that could not be matched (lack of common support).
Results
In the full sample, the mean of sickness absence days due to mental disorders was 17.7 (95% CI, 11.4, 24.1) days for those treated (n = 240) and 23.2 (95% CI, 20.5, 25.9) days for non-treated (n = 1916), difference being non-significant. The corresponding figures in the matched sample were (16.8, 95% CI, 9.5-24.1) for those treated (n = 195) and (27.8, 95% CI, 22.6-32.9) for non-treated (n = 691), difference being statistically significant (p = 0.02).
Conclusions
This quasi-experiment suggests that seeing an occupational psychologist to support work ability may be reduce mental health related sickness absence.
Key messages
We showed that supporting work ability at an early stage may prevent sickness absence due to mental disorders. More efforts to provide early stage support for maintaining work ability may prove useful in reducing sickness absence rates in younger employees.
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Affiliation(s)
- J Lahti
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - J Harkko
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - H Sumanen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
- South-Eastern Finland University of Applied Sciences, Kotka, Finland
| | - K Piha
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - O Pietiläinen
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - M Mänty
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
- City of Vantaa, Vantaa, Finland
| | - O Rahkonen
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - T Lallukka
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - A Kouvonen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Administrative Data Research Centre (Northern Ireland), Queen’s University, Belfast, UK
- Research Institute of Psychology, SWPS University, Wroclaw, Poland
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4
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Lahti J, Mauramo E, Lahelma E, Lallukka T, Pietiläinen O, Salmela J, Salonsalmi A, Rahkonen O. Healthy behaviours and risk of all-cause mortality. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Healthy behaviours are associated with better health in general but less is known about the combined associations of multiple healthy behaviours with mortality risk. We aimed to examine the associations of combined healthy behaviours with mortality risk over a 15-year follow-up among middle-aged employees.
Methods
Survey data, collected in 2000–2002 among 40–60-year-old employees of the City of Helsinki, Finland, was linked with complete register data on mortality from Statistics Finland (response rate 67%, written informed consent for register linkages 74%). Healthy behaviours included high leisure-time physical activity, non-smoking, no binge drinking and healthy food habits. Each healthy behaviour were dichotomized and assigned a value of one for healthy and zero for unhealthy. The number of healthy behaviours were summed together (score range 0-4). Cox regression models were fitted, and the follow-up continued until the end of 2015 (n = 6336). Confounders included age, sex, marital status, socioeconomic position and self-rated health.
Results
Of the respondents, 7% reported four healthy behaviours, 27% three, 34% two, 22% one and 9% no healthy behaviours. A total of 281 deaths occurred during the follow-up. Each healthy behaviour was individually associated with a reduced mortality risk, non-smoking having the strongest and healthy diet the weakest association. The combined association showed that those without any of the healthy behaviours (HR 2.8, 95% CI 1.51-5.29) and those with only one healthy behaviour (HR 1.89, 95% CI 1.04-3.43) had a higher mortality risk than those with four healthy behaviours. Instead, those with at least two healthy behaviours were not at an increased risk of mortality.
Conclusions
A low number of healthy behaviours predicted mortality among middle-aged employees. Efforts should be made to promote multiple healthy behaviours among the middle-aged to enhance health and prevent premature mortality.
Key messages
Almost one third of the respondents had no or only one healthy behaviour. A low number of healthy behaviours was associated with an increased risk of mortality.
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Affiliation(s)
- J Lahti
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - E Mauramo
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - E Lahelma
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - T Lallukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - O Pietiläinen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - J Salmela
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - A Salonsalmi
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - O Rahkonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
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5
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Salonsalmi A, Lallukka T, Lahelma E, Pietiläinen O, Rahkonen O. Childhood adversities and chronic pain among midlife employees. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz187.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Chronic pain is common among employees. Childhood adversities are known determinants of adult health but their association with chronic pain in adulthood is largely unknown. We aimed to examine the associations between childhood adversities and chronic pain among midlife employees.
Methods
Data on seven childhood adversities and chronic pain (pain having lasted at least 3 months) were derived from the baseline survey of the Helsinki Health Study collected in 2000 to 2002 among 40 to 60-year-old employees of the City of Helsinki in Finland. The study included 8140 employees of whom 80% were women. The analyses were made by logistic regression and the results are presented as odds ratios (OR) and their 95% confidence intervals (CI). Age, gender, father’s education, own education, marital status, working conditions, sleep problems and common mental disorders were included as covariates.
Results
Economic difficulties in the childhood family (OR 1.60, 95% CI 1.41-1.81), childhood illness (1.74, 1.45-2.08), parental divorce (1.26, 1.07-1.48), parental alcohol problems (1.34, 1.18-1.52) and bullying in school or among peers (1.59, 1.37-1.89) were associated with an increased odds of chronic pain in midlife. Adjusting for father’s education, own education and marital status did not contribute to the associations. Working conditions, sleep problems and common mental disorders slightly attenuated the associations between childhood adversities and chronic pain.
Conclusions
Childhood adversities associate to chronic pain in midlife. The results suggest that promoting well-being among children might lead to less pain decades after childhood.
Key messages
Childhood adversities are associated with chronic pain in adulthood. Considering well-being among children might lead to less pain decades after childhood.
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Affiliation(s)
- A Salonsalmi
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - T Lallukka
- Finnish Institute of Occupational Health, Finnish Institute of Occupational Health, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - E Lahelma
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - O Pietiläinen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - O Rahkonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
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Mauramo E, Salmela J, Kanerva N, Lahelma E, Lallukka T, Pietiläinen O, Rahkonen O, Salonsalmi A, Lahti J. Joint associations of fruit and vegetable consumption and physical activity with mortality risk. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz187.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Fruit and vegetable consumption (FVC) and leisure-time physical activity (LTPA) are associated with better health outcomes but less is known about their joint associations with the risk of mortality. We examined the joint associations of FVC and LTPA with premature mortality among midlife and ageing municipal employees, adjusting for key covariates.
Methods
Survey data collected in 2000–2002 among 40–60-year-old employees of the City of Helsinki, Finland, were linked with complete register data on mortality from Statistics Finland (4961 women, 1373 men; response rate 67%; written consent for register linkages 74%). FVC was dichotomised into daily or non-daily, and LTPA into high (>14 MET-hours/week including vigorous exercise) or low. Covariates included age, sex, marital status, socioeconomic position, binge drinking, smoking and self-rated health. Cox regression models were fitted. The follow-up continued until the event of death or the end of 2015.
Results
A total of 281 deaths occurred during the follow-up. The mortality rate was 7.1% in men and 3.7% in women. A gender interaction was found, showing differing associations for women and men. Men with both daily FVC and high LTPA had the lowest mortality risk (HR 0.19, 95% CI 0.06-0.63) after adjusting for covariates. Men with high LTPA and non-daily FVC also had a lower mortality risk (HR 0.51, 95% CI 0.29-0.90) compared to those with non-daily FVC and low LTPA. Women with daily FVC and high LTPA had a lower mortality risk initially, but after adjusting for covariates no statistically significant associations were observed.
Conclusions
The joint associations of FVC and LTPA with premature mortality differed between women and men. This could be related to gender differences in e.g. the causes of death, and further studies are needed to clarify this. Increasing FVC and LTPA might prevent premature mortality among men.
Key messages
Fruit and vegetable consumption jointly with physical activity decreased the risk of premature mortality among men only. Further studies are needed to clarify the gender difference which could be related to for example death causes.
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Affiliation(s)
- E Mauramo
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - J Salmela
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - N Kanerva
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - E Lahelma
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - T Lallukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - O Pietiläinen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - O Rahkonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - A Salonsalmi
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - J Lahti
- Department of Public Health, University of Helsinki, Helsinki, Finland
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7
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Neupane S, Lallukka T, Pietiläinen O, Rahkonen O, Leino-Arjas P. Trajectories of musculoskeletal pain among midlife employees. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
We examined the developmental trajectories of multisite musculoskeletal pain to acquire the developmental patterns of musculoskeletal pain among midlife municipal employees and whether pain trajectories associate with common mental disorders or behaviors.
Methods
Middle-aged (44 to 67 years) municipal employees from the city of Helsinki were studied. The baseline survey was conducted in 2000-02 (N = 8960) and two follow-up surveys in 2007 (N = 7332) and 2012 (N = 6809). Repeated measurement of musculoskeletal pain in four anatomical sites was obtained. Trajectories of number of pain sites (0-4) were modeled using latent class growth analysis (n = 6527). Common mental disorders were measured using the General Health Questionnaire 12-item version (GHQ-12). Information on behavior factors, morbidity, and the socioeconomic position was obtained from the questionnaire survey. Associations of baseline factors with pain trajectories were assessed by multinomial logistic regression.
Results
We found four distinct trajectories of the number of pain sites: high (15%), increasing (24%), decreasing (20%) and low (41%). In multivariable multinomial regression model high, increasing and decreasing trajectories were strongly associated with higher odds with both medium and high common mental disorders. However, the magnitude of the association was much higher for high vs. low trajectory group due to medium (OR 3.70, 95% CI 2.81-4.89) and high (OR 5.37, 95% 4.36-6.61) common mental disorders. Mean score of common mental disorders was also highest for high trajectory group. High, increasing and decreasing trajectory group were also associated with poor behavior, having one or more musculoskeletal comorbidities and low socioeconomic position.
Conclusions
Multisite musculoskeletal pain remain persistent among midlife employees and those high trajectories of musculoskeletal pain are associated with common mental disorders, behavior, and musculoskeletal comorbidities.
Key messages
Four distinct trajectories of number of pain sites was identified among midlife municipal employees. High common mental disorders and poor behavior, as well as low socioeconomic position and musculoskeletal comorbidities were strongly associated with pain trajectories.
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Affiliation(s)
- S Neupane
- Unit of Health Sciences, Tampere University, Tampere, Finland
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - T Lallukka
- Finnish Institute of Occupational Health, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - O Pietiläinen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - O Rahkonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - P Leino-Arjas
- Finnish Institute of Occupational Health, Helsinki, Finland
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8
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Lallukka T, Kronholm E, Pekkala J, Jäppinen S, Blomgren J, Pietiläinen O, Lahelma E, Rahkonen O. Work participation trajectories in 1098748 Finns: determinants and the incidence of sickness absence. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Early exit from paid employment is a notable public health and societal challenge. Previous research has largely focused on the relationships among variables instead of the relationships among individuals with different work participation history. Person-oriented methods enable to identify latent groups of individuals who are likely to follow similar development in their work participation over time. We thus aimed to identify work participation trajectories during early and midlife careers and their social determinants. A further aim was to determine the cumulative incidence of sickness absence due to key diagnostic groups, mental disorders and musculoskeletal diseases within the trajectories.
Methods
Young (25-38 years at baseline, n = 495663) and midlife (39-52 years at baseline, n = 603085) Finnish people, working in 2004, were followed up through 2013, with registers of the Social Insurance Institution, and the Statistics Finland. The registers provided data for the outcome (work participation) and its determinants and sickness absence. Latent class growth analysis was used to identify trajectories.
Results
Three distinctive trajectories were identified: temporary exit, permanent exit, and continuously employed people. As compared to the other trajectories, those belonging to the permanent exit trajectory were more likely men, manual workers and had a lower income. The cumulative incidence of sickness absence due to mental disorders was highest in the permanent exit trajectory group. For musculoskeletal diseases, the cumulative incidence of sickness absence increased in the permanent exit trajectory mainly in the older age groups.
Conclusions
Distinct group-based trajectories of early work exit can be identified in a representative cohort of initially employed people. Focusing on the determinants of premature exit and early intervention to tackle increasing sickness absence may promote work participation particularly in the most vulnerable groups.
Key messages
Distinct trajectories of premature exit from paid employment can be identified in a nationally representative cohort of initially employed people from Finland. Focusing on the determinants and reasons of premature long-term labor market exit may help promote work participation particularly in the most vulnerable groups.
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Affiliation(s)
- T Lallukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - E Kronholm
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - J Pekkala
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - S Jäppinen
- Department of Public Health, University of Helsinki, Helsinki, Finland
- The Social Insurance Institution of Finland (Kela), Helsinki, Finland
| | - J Blomgren
- The Social Insurance Institution of Finland (Kela), Helsinki, Finland
| | - O Pietiläinen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - E Lahelma
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - O Rahkonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
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9
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Lahelma E, Pietiläinen O, Pentala-Nikulainen O, Helakorpi S, Rahkonen O. Monitoring inequalities in self-rated health over 36 years among Finnish women and men. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz187.084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Health inequalities across countries and populations are well established, but little is known about their long-term trends and even less about factors shaping the trends. We examined the magnitude of absolute and relative educational inequalities in self-rated health over 36 years among adult Finns, considering individual covariates and macro-economic fluctuations.
Methods
Data were derived from representative annual surveys in 1979-2014 among men and women and covered ages 25-64. Nine periods were used (n = 8870-14235). Our health outcome was less-than-good self-rated health and our socioeconomic indicator was completed years of education as a continuous variable. Nine time-variant sociodemographic and health-related covariates were included. Educational inequalities in self-rated health were examined by relative index of inequality (RII) and slope index of inequality (SII).
Results
Linear trends suggested stable overall development in both relative and absolute health equalities during 36 years. Period specific analyses showed that among men relative and absolute inequalities narrowed immediately after economic recession in Finland in 1993-94, and among women, inequalities narrowed during global financial crisis in 2008-09. Adjusting for covariates reduced the magnitude of inequalities throughout the nine periods, but affected little the period specific patterning of health inequalities.
Conclusions
Educational inequalities in self-rated health persisted during 36 years in Finland. While among men and women health inequalities narrowed during and after recessions, they widened soon back to the pre-recession level. The perseverance calls for powerful measures to tackle health inequalities, such as preventing unhealthy behaviours, obesity and unemployment in particular among the lower educated.
Key messages
Health inequalities have persisted in Finland over 36 years, with unhealthy behaviors and unemployment affecting their magnitude. Health inequalities narrowed during economic recessions, but widened soon back to pre-recession level.
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Affiliation(s)
- E Lahelma
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - O Pietiläinen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | | | - S Helakorpi
- National Institute for Health and Welfare, Helsinki, Finland
| | - O Rahkonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
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10
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Salonsalmi A, Pietiläinen O, Lahelma E, Rahkonen O. Childhood conditions and midlife disability retirement due to mental disorders. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky214.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - E Lahelma
- University of Helsinki, Helsinki, Finland
| | - O Rahkonen
- University of Helsinki, Helsinki, Finland
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11
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Pietiläinen O, Roos E, Roos T, Rahkonen O, Heikkinen S, Seppä K, Ryynänen H, Pietkäniemi J. Interactions of smoking, alcohol use, overweight and physical inactivity as predictors of cancer. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky214.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- O Pietiläinen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - E Roos
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - T Roos
- Department of Computer Science, University of Helsinki, Helsinki, Finland
| | - O Rahkonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | | | - K Seppä
- Finnish Cancer Registry, Helsinki, Finland
| | - H Ryynänen
- Finnish Cancer Registry, Helsinki, Finland
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12
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Pekkala J, Suur-Uski J, Blomgren J, Pietiläinen O, Rahkonen O, Mänty M. Sickness absence due to breast cancer by occupational class among Finnish women during 2005–2013. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- J Pekkala
- University of Helsinki, Helsinki, Finland
| | | | - J Blomgren
- The Social Insurance Institution of Finland, Helsinki, Finland
| | | | - O Rahkonen
- University of Helsinki, Helsinki, Finland
| | - M Mänty
- University of Helsinki, Helsinki, Finland
- Laurea University of Applied Sciences, Vantaa, Finland
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Lahti J, Kanerva N, Haaramo P, Pietiläinen O, Lahelma E, Rahkonen O, Mänty M. Healthy behaviours and health functioning: a follow-up study among middle-aged employees. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx189.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- J Lahti
- University of Helsinki, Helsinki, Finland
| | - N Kanerva
- University of Helsinki, Helsinki, Finland
| | - P Haaramo
- National Institute for Health and Welfare, Helsinki, Finland
| | | | - E Lahelma
- University of Helsinki, Helsinki, Finland
| | - O Rahkonen
- University of Helsinki, Helsinki, Finland
| | - M Mänty
- University of Helsinki, Helsinki, Finland
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Jäppinen S, Blomgren J, Pekkala J, Pietiläinen O, Lahelma E, Rahkonen O. Gender differences in diagnosis-specific sickness absence in middle-aged Finnish working population. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Jäppinen
- University of Helsinki, Helsinki, Finland
| | - J Blomgren
- The Social Insurance Institution of Finland, Helsinki, Finland
| | - J Pekkala
- University of Helsinki, Helsinki, Finland
| | | | - E Lahelma
- University of Helsinki, Helsinki, Finland
| | - O Rahkonen
- University of Helsinki, Helsinki, Finland
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Pekkala J, Rahkonen O, Pietiläinen O, Lahelma E, Blomgren J. Sickness absence due to musculoskeletal diagnoses by occupational class in Finland: a register study. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J Pekkala
- University of Helsinki, Helsinki, Finland
| | - O Rahkonen
- University of Helsinki, Helsinki, Finland
| | | | - E Lahelma
- University of Helsinki, Helsinki, Finland
| | - J Blomgren
- The Social Insurance Institution of Finland, Helsinki, Finland
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Lahelma E, Pietiläinen O, Rahkonen O, Chandola T, Hyde M, Lallukka T. Occupational class trajectories in physical health functioning among ageing female employees. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw169.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sumanen H, Pietiläinen O, Lahelma E, Rahkonen O. Short sickness absence spells and long mental sickness absence in 10-year follow-up. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw175.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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18
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Pekkala J, Blomgren J, Pietiläinen O, Lahelma E, Rahkonen O. Occupational class differences in sickness absence: a register study of 2.3 million Finns, 1995-2013. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw165.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sumanen H, Rahkonen O, Pietiläinen O, Lahelma E, Roos E, Lahti J. Educational differences in disability retirement among young employees. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv175.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lahelma E, Pietiläinen O, Rahkonen O, Lahti J, Lallukka T. Common mental disorders and cause-specific mortality among ageing employees. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv171.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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21
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Lallukka T, Pietiläinen O, Partonen T, Rahkonen O, Lahelma E. Psychotropic medication and mortality: a register-based study among Finnish women and men 1995–2013. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv174.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
OBJECTIVES Common mental disorders are prevalent among employees and may cause work disability. We aimed to examine the association between common mental disorders and disability retirement, with an emphasis on the severity of disorders and diagnostic causes for retirement. METHODS Our data were derived from the Helsinki Health Study cohort on the staff of the City of Helsinki, Finland. The baseline mail surveys were made in 2000-2002 among employees reaching ages 40, 45, 50, 55 and 60 in each year (n=8960, response rate 67%, 80% women). Disability retirement events from national registers (n=628) were followed up by the end of 2010 and linked to the baseline data. After exclusions, the number of participants was 6525. Common mental disorders were measured by the General Health Questionnaire 12-item version (GHQ-12). Covariates at baseline included sociodemographic, work-related and health-related factors. Hazard ratios (HR) and 95% CIs were calculated using Cox proportional hazards models. RESULTS Common mental disorders showed a graded association with disability retirement. For disability retirement due to any diagnostic cause, the fully adjusted HR for the GHQ-12 score 7-12 was 2.16, 95% CI 1.63 to 2.85. For disability retirement due to mental disorders the corresponding HR was 7.46, 95% CI 4.46 to 12.49. For disability retirement due to musculoskeletal diseases, the association was weaker and did not survive all adjustments. CONCLUSIONS Common mental disorders are an important antecedent of disability retirement in general and due to mental disorders in particular. Successful measures against common mental disorders may prevent disability retirement due to mental disorders.
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Affiliation(s)
- E Lahelma
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - O Pietiläinen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - O Rahkonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - T Lallukka
- Department of Public Health, University of Helsinki, Helsinki, Finland Finnish Institute of Occupational Health, Helsinki, Finland
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Lahelma E, Pietiläinen O, Ferrie J, Kivimäki M, Lahti J, Marmot M, Rahkonen O, Sekine M, Shipley M, Tatsuse T, Lallukka T. Changes over time in social class differences in smoking among employee cohorts from Britain, Finland and Japan. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku163.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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24
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Sumanen H, Pietiläinen O, Lahti J, Lahelma E, Rahkonen O. Trends in sickness absence among young municipal employees 2002-2013. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku164.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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25
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Lahelma E, Laine H, Pietiläinen O, Lallukka T, Rahkonen O. Common mental disorders and subsequent disability retirement. Eur J Public Health 2013. [DOI: 10.1093/eurpub/ckt126.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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26
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Pietiläinen O, Rahkonen O, Laaksonen M, Lahelma E. Occupational Class Inequalities in Sickness Absence after Hospitalization. Eur J Public Health 2013. [DOI: 10.1093/eurpub/ckt123.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Laine H, Saastamoinen P, Lahti J, Pietiläinen O, Rahkonen O, Lahelma E. The associations among psychosocial working conditions and change in common mental disorders: a follow up study. Eur J Public Health 2013. [DOI: 10.1093/eurpub/ckt123.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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28
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Lallukka T, Ferrie JE, Kivimäki M, Shipley MJ, Sekine M, Tatsuse T, Pietiläinen O, Rahkonen O, Marmot MG, Lahelma E. Conflicts Between Work and Family Life and Subsequent Sleep Problems Among Employees from Finland, Britain, and Japan. Int J Behav Med 2013; 21:310-8. [DOI: 10.1007/s12529-013-9301-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ingason A, Rujescu D, Cichon S, Sigurdsson E, Sigmundsson T, Pietiläinen OPH, Buizer-Voskamp JE, Strengman E, Francks C, Muglia P, Gylfason A, Gustafsson O, Olason PI, Steinberg S, Hansen T, Jakobsen KD, Rasmussen HB, Giegling I, Möller HJ, Hartmann A, Crombie C, Fraser G, Walker N, Lonnqvist J, Suvisaari J, Tuulio-Henriksson A, Bramon E, Kiemeney LA, Franke B, Murray R, Vassos E, Toulopoulou T, Mühleisen TW, Tosato S, Ruggeri M, Djurovic S, Andreassen OA, Zhang Z, Werge T, Ophoff RA, Rietschel M, Nöthen MM, Petursson H, Stefansson H, Peltonen L, Collier D, Stefansson K, St Clair DM. Copy number variations of chromosome 16p13.1 region associated with schizophrenia. Mol Psychiatry 2011; 16:17-25. [PMID: 19786961 PMCID: PMC3330746 DOI: 10.1038/mp.2009.101] [Citation(s) in RCA: 204] [Impact Index Per Article: 15.7] [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: 01/22/2023]
Abstract
Deletions and reciprocal duplications of the chromosome 16p13.1 region have recently been reported in several cases of autism and mental retardation (MR). As genomic copy number variants found in these two disorders may also associate with schizophrenia, we examined 4345 schizophrenia patients and 35,079 controls from 8 European populations for duplications and deletions at the 16p13.1 locus, using microarray data. We found a threefold excess of duplications and deletions in schizophrenia cases compared with controls, with duplications present in 0.30% of cases versus 0.09% of controls (P=0.007) and deletions in 0.12 % of cases and 0.04% of controls (P>0.05). The region can be divided into three intervals defined by flanking low copy repeats. Duplications spanning intervals I and II showed the most significant (P = 0.00010) association with schizophrenia. The age of onset in duplication and deletion carriers among cases ranged from 12 to 35 years, and the majority were males with a family history of psychiatric disorders. In a single Icelandic family, a duplication spanning intervals I and II was present in two cases of schizophrenia, and individual cases of alcoholism, attention deficit hyperactivity disorder and dyslexia. Candidate genes in the region include NTAN1 and NDE1. We conclude that duplications and perhaps also deletions of chromosome 16p13.1, previously reported to be associated with autism and MR, also confer risk of schizophrenia.
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Affiliation(s)
- A Ingason
- deCODE genetics, Reykjavík, Iceland
,Research Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Roskilde, Denmark
| | - D Rujescu
- Division of Molecular and Clinical Neurobiology, Department of Psychiatry, Ludwig-Maximilians-University and Genetics Research Centre GmbH, Munich, Germany
| | - S Cichon
- Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
,Institute of Human Genetics, University of Bonn, Bonn, Germany
| | - E Sigurdsson
- Department of Psychiatry, National University Hospital, Reykjavík, Iceland
| | - T Sigmundsson
- Department of Psychiatry, National University Hospital, Reykjavík, Iceland
| | - OPH Pietiläinen
- Department for Molecular Medicine, National Public Health Institute, Helsinki, Finland
| | - JE Buizer-Voskamp
- Department of Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
,Department of Medical Genetics and Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
| | - E Strengman
- Department of Medical Genetics and Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C Francks
- Medical Genetics, GlaxoSmithKline R&D, Verona, Italy
| | - P Muglia
- Medical Genetics, GlaxoSmithKline R&D, Verona, Italy
| | | | | | | | | | - T Hansen
- Research Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Roskilde, Denmark
| | - KD Jakobsen
- Research Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Roskilde, Denmark
| | - HB Rasmussen
- Research Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Roskilde, Denmark
| | - I Giegling
- Division of Molecular and Clinical Neurobiology, Department of Psychiatry, Ludwig-Maximilians-University and Genetics Research Centre GmbH, Munich, Germany
| | - H-J Möller
- Division of Molecular and Clinical Neurobiology, Department of Psychiatry, Ludwig-Maximilians-University and Genetics Research Centre GmbH, Munich, Germany
| | - A Hartmann
- Division of Molecular and Clinical Neurobiology, Department of Psychiatry, Ludwig-Maximilians-University and Genetics Research Centre GmbH, Munich, Germany
| | - C Crombie
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, Scotland
| | - G Fraser
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, Scotland
| | - N Walker
- Ravenscraig Hospital, Greenock, Scotland
| | - J Lonnqvist
- Department of Mental Health and Addiction, National Public Health Institute, Helsinki, Finland
| | - J Suvisaari
- Department of Mental Health and Addiction, National Public Health Institute, Helsinki, Finland
| | - A Tuulio-Henriksson
- Department of Mental Health and Addiction, National Public Health Institute, Helsinki, Finland
| | - E Bramon
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College, London, UK
| | - LA Kiemeney
- Department of Epidemiology & Biostatistics (133 EPIB)/Department of Urology (659 URO), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - B Franke
- Department of Human Genetics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - R Murray
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College, London, UK
| | - E Vassos
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College, London, UK
| | - T Toulopoulou
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College, London, UK
| | - TW Mühleisen
- Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
| | - S Tosato
- Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy
| | - M Ruggeri
- Section of Psychiatry and Clinical Psychology, University of Verona, Verona, Italy
| | - S Djurovic
- Institute of Psychiatry, University of Oslo, Oslo, Norway
,Departments of Medical Genetics and Psychiatry, Ulleval University Hospital, Oslo, Norway
| | - OA Andreassen
- Institute of Psychiatry, University of Oslo, Oslo, Norway
,Departments of Medical Genetics and Psychiatry, Ulleval University Hospital, Oslo, Norway
| | - Z Zhang
- Department of Statistics, UCLA, Los Angeles, CA, USA
| | - T Werge
- Research Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Roskilde, Denmark
| | - RA Ophoff
- Department of Medical Genetics and Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
,UCLA Center for Neurobehavioral Genetics and Department of Human Genetics, Los Angeles, CA, USA
| | | | - M Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health Mannheim, University of Heidelberg, Mannheim, Germany
| | - MM Nöthen
- Department of Genomics, Life & Brain Center, University of Bonn, Bonn, Germany
,Institute of Human Genetics, University of Bonn, Bonn, Germany
| | - H Petursson
- Department of Psychiatry, National University Hospital, Reykjavík, Iceland
| | | | - L Peltonen
- Department for Molecular Medicine, National Public Health Institute, Helsinki, Finland
,Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK
,The Broad Institute, Cambridge, MA, USA
| | - D Collier
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College, London, UK
| | | | - DM St Clair
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, Scotland
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