Search

Soili Törmälehto,1 Tanja Svirskis,2 Timo Partonen,3 Erkki Isometsä,2 Sami Pirkola,4 Marianna Virtanen,1,5 Reijo Sund6 1School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland; 2Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; 3Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland; 4Faculty of Social Sciences, University of Tampere and Pirkanmaa Hospital District, Tampere, Finland; 5Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; 6Institute of Clinical Medicine, University of Eastern Finland, Kuopio, FinlandCorrespondence: Soili Törmälehto, School of Educational Sciences and Psychology C/O Institute of Clinical Medicine, University of Eastern Finland, P.O. Box 1627, Kuopio, FI-70211, Finland, Email soili.tormalehto@uef.fiPurpose: To examine seasonal patterns of hospital admissions due to mood and psychotic disorders and to investigate whether the admission rates show variation according to the seasonal daylength (photoperiods).Patients and Methods: A retrospective nationwide register-based cohort of all psychiatric admissions (N=978,079) during 1987– 2017 in Finland was utilized. The smoothed time-series of adjusted ratio of observed and expected (O/E) daily counts were estimated to examine seasonal variation. The mean O/E with 95% confidence intervals (CI) was used to study the admission rates by photoperiods. The calendar days were classified into the 71-day photoperiods based on the daylength (long/summer, short/winter, equal/spring, equal/fall) and the pace of change in daylength (slowly/rapidly increasing/decreasing daylength).Results: Manic episodes peaked in summer during the long (mean O/E=1.10, 95% CI=1.06– 1.13) and slowly decreasing (1.09, 1.06– 1.13) photoperiods and had a nadir in winter during the slowly increasing (0.93, 0.89– 0.98) photoperiod. Admissions for unipolar depressive (UPD) episodes peaked in autumn and in spring at the end of the rapidly decreasing (1.03, 1.02– 1.04) and increasing (1.03, 1.01– 1.04) photoperiod, and dropped in summer during the long and slowly decreasing (0.95, 0.94– 0.96) photoperiods. Bipolar depressive (BPD) and mixed episodes signaled excess admissions in autumn and in spring. Admissions for schizophrenia were higher than expected from summer to early-autumn, during the long and slowly decreasing photoperiods (1.02, 1.02– 1.03), and lower than expected in other seasons, especially in mid-spring during the rapidly increasing photoperiod (0.98, 0.98– 0.99).Conclusion: The study indicates the seasonality and photoperiodicity of mental disorders, especially for manic episodes. The seasonal pattern is similar between schizophrenia and manic episodes, and between UPD, BPD, and mixed episodes.Keywords: seasonal variation, photoperiod, hospital admission, mood disorders, bipolar disorder, schizophrenia

Objective: To examine the associations between an onset of serious mental disorders before the age of 25 with subsequent employment, income and education outcomes. Methods: Nationwide cohort study including individuals (n = 2 055 720) living in Finland between 1988–2015, who were alive at the end of the year they turned 25. Mental disorder diagnosis between ages 15 and 25 was used as the exposure. The level of education, employment status, annual wage or self‐employment earnings, and annual total income between ages 25 and 52 (measurement years 1988–2015) were used as the outcomes. Results: All serious mental disorders were associated with increased risk of not being employed and not having any secondary or higher education between ages 25 and 52. The earnings for individuals with serious mental disorders were considerably low, and the annual median total income remained rather stable between ages 25 and 52 for most of the mental disorder groups. Conclusions: Serious mental disorders are associated with low employment rates and poor educational outcomes, leading to a substantial loss of total earnings over the life course. [ABSTRACT FROM AUTHOR]

Objective: To examine longitudinally risk factors for suicide in depression, and gender differences in risk factors and suicide methods. Method: We linked data from (i) The Finnish Hospital Discharge Register, (ii) the Census Register of Statistics Finland, and (iii) Statistics Finland's register on causes of deaths. All 56 826 first‐hospitalized patients (25 188 men, 31 638 women) in Finland in 1991–2011 with a principal diagnosis of depressive disorder were followed up until death (2587 suicides) or end of the year 2014 (maximum 24 years). Results: Clinical characteristics (severe depression adjusted hazard ratio [AHR] 1.19 [95% CI 1.08–1.30]; psychotic depression AHR 1.45 [1.30–1.62]; and comorbid alcohol dependence AHR 1.26 [1.13–1.41]), male gender (AHR 2.07 [1.91–2.24]), higher socioeconomic status and living alone at first hospitalization were long‐term predictors of suicide deaths. Highest risk was associated with previous suicide attempts (cumulative probability 15.4% [13.7–17.3%] in men, 8.5% [7.3–9.7%] in women). Gender differences in risk factors were modest, but in lethal methods prominent. Conclusion: Sociodemographic and clinical characteristics at first hospitalization predict suicide in the long term. Inpatients with previous suicide attempts constitute a high‐risk group. Despite some gender differences in risk factors, those in lethal methods may better explain gender disparity in risk. [ABSTRACT FROM AUTHOR]

Objectives: To estimate total and cause-specific mortality after international peacekeeping deployments among the Finnish military peacekeeping personnel in comparison to the general population of similar age and sex. Design: A register-based study of a cohort of military peacekeeping personnel in 1990–2010 followed for mortality until the end of 2013. Causes of death were obtained from the national Causes of Death Register. The standardised mortality ratio (SMR) for total and cause-specific mortality was calculated as the ratio of observed and expected number of deaths. Setting: Finland (peacekeeping operations in different countries in Africa, Asia and in an area of former Yugoslavia in Europe). Participants: 14 584 men and 418 women who had participated in international military peacekeeping operations ending between 1990 and 2010. Interventions: Participation in military peacekeeping operations. Main outcome: Total and cause-specific mortality. Results: 209 men and 3 women died after their peacekeeping service. The SMR for all-cause mortality was 0.55 (95% CI 0.48 to 0.62). For the male peacekeeping personnel, the SMR for all diseases was 0.44 (95% CI 0.35 to 0.53) and for accidental and violent deaths 0.69 (95% CI 0.57 to 0.82). The SMR for suicides was 0.71 (95% CI 0.53 to 0.92). Conclusions: Even though military peacekeeping personnel are working in unique and often stressful conditions, their mortality after their service is lower compared with the general population. Military peacekeeping personnel appear to be a selected population group with low general mortality and no excess risk of any cause of death after peacekeeping service. [ABSTRACT FROM AUTHOR]

BackgroundResults of adulthood mental health of those born late-preterm (34 + 0–36 + 6 weeks + days of gestation) are mixed and based on national registers. We examined if late-preterm birth was associated with a higher risk for common mental disorders in young adulthood when using a diagnostic interview, and if this risk decreased as gestational age increased.MethodA total of 800 young adults (mean = 25.3, s.d. = 0.62 years), born 1985–1986, participated in a follow-up of the Arvo Ylppö Longitudinal Study. Common mental disorders (mood, anxiety and substance use disorders) during the past 12 months were defined using the Composite International Diagnostic Interview (Munich version). Gestational age was extracted from hospital birth records and categorized into early-preterm (<34 + 0, n = 37), late-preterm (34 + 0–36 + 6, n = 106), term (37 + 0–41 + 6, n = 617) and post-term (⩾42 + 0, n = 40).ResultsThose born late-preterm and at term were at a similar risk for any common mental disorder [odds ratio (OR) 1.11, 95% confidence interval (CI) 0.67–1.84], for mood (OR 1.11, 95% CI 0.54–2.25), anxiety (OR 1.00, 95% CI 0.40–2.50) and substance use (OR 1.31, 95% CI 0.74–2.32) disorders, and co-morbidity of these disorders (p = 0.38). While the mental disorder risk decreased significantly as gestational age increased, the trend was driven by a higher risk in those born early-preterm.ConclusionsUsing a cohort born during the advanced neonatal and early childhood care, we found that not all individuals born preterm are at risk for common mental disorders in young adulthood – those born late-preterm are not, while those born early-preterm are at a higher risk. Available resources for prevention and intervention should be targeted towards the preterm group born the earliest. [ABSTRACT FROM PUBLISHER]

Aims: To examine the associations between alcohol consumption and utility-based health-related quality of life (HRQoL), subjective quality of life (QoL), self-rated health (SRH), and mental distress. Methods: Representative general population survey in Finland, with 5871 persons aged 30-64 years. HRQoL was measured with two health utility instruments (15D and EQ-5D), QoL and SRH were measured with RATING scales, and mental distress with a General Health Questionnaire (GHQ-12). Past alcohol problems were diagnosed with a structured psychiatric interview known as the composite international diagnostic interview (CIDI). Alcohol consumption was examined with a self-report questionnaire. Results: Negative associations between alcohol and well-being were observed on several measures for women consuming more than 173 g and men more than 229 g per week. Former drinkers scored worst on most measures, even in comparison to the highest drinking decile. For men, all statistically significant associations between moderate drinking and well-being disappeared when sociodemographic factors and former drinkers were controlled for. For women, moderate alcohol use associated with better SRH and EQ-5D as compared to abstainers. However, the possible health utility benefits associated with moderate alcohol consumption were of clinically insignificant magnitude. Conclusions: Failure to separate former drinkers and other abstainers produces a significant bias favoring moderate drinkers. As the possible health utility benefits of moderate alcohol use were clinically insignificant, it suffices to investigate mortality, when estimating the public health impact of moderate alcohol consumption using quality-adjusted life years. [ABSTRACT FROM AUTHOR]

Background: Adversities in the early mother-infant relation pose a hypothetical risk for addiction. We studied the association between very early separation and later development of substance use disorder.Method: A follow-up study was performed of subjects temporarily isolated from their family immediately after birth to adequate nursing homes in order to protect them against morbidity and mortality for tuberculosis. The average separation time was 7 months. The index cohort consisted of 3,020 subjects born in 1945-1965. For every index subject, two reference subjects were matched for sex, year of birth and place of birth. We were able to obtain the SES of the family of origin as recorded in 1971 from Statistics Finland. Finnish Hospital Discharge Register was used to identify subjects with substance use disorder arising from childhood to middle age, between January 1,1971 and December 31, 1998.Results: The 28-year cumulative incidence of alcohol use disorders was 4.2% in the index cohort and 3.1% in the reference cohort (rate ratio, RR 1.4, 95% CI 1.1-1.8). The incidences of hospital-treated drug abuse or dependence were 0.6% and 0.2% (RR 2.5, 95% CI 1.2-5.1), respectively. The differences in socioeconomic status of the family of origin did not explain the differences found.Conclusions: Substance use disorders were more prevalent among subjects temporarily separated at birth from their mothers because of tuberculosis in the family than in the reference cohort. While risks experienced during pregnancy, delivery and childhood are alternative explanations, this result suggests that very early temporal separation from the mother at birth may have had unfavourable but modest effects on later psychological development, including vulnerability to addiction. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This study analyzed trends in suicides occurring after a psychiatric hospitalization during more than a decade of significant structural changes in mental health services in Finland-that is, deinstitutionalization, downsizing of inpatient care, and decentralization. METHODS: Retrospective register data on completed suicides and psychiatric inpatient treatments were collected for the periods 1985-1991 and 1995-2001, representing service provision before and after significant structural changes. The data were used to produce an estimate for a change in postdischarge suicide risk. RESULTS: In both periods, a fifth of suicide victims had been psychiatrically hospitalized within the preceding year. Among persons hospitalized, the risk of suicide was greater in 1985-1991 than in 1995-2001 for both one week after discharge (risk ratio [RR]=1.50, 95% confidence interval [CI]=1.38-1.62) and one year after discharge (RR=1.25, CI=1.19-1.30). When types of disorders were analyzed separately, the relative risk of suicide one year postdischarge for those hospitalized in the earlier period was greater for patients with schizophrenia (RR=1.26, CI=1.17-1.36) and patients with affective disorders (RR=1.60, CI=1.48-1.73). In parallel with general development of inpatient psychiatric services, in 1995-2001 the inpatient treatment periods preceding suicides were significantly shorter (a mean+/-SD of 45+/-340 days in 1995-2001, compared with a mean of 98+/-558 days in 1985-1991), the number of individual patients treated in the hospital for schizophrenia spectrum disorders was lower (26% compared with 36%), and the number treated for affective disorders was higher (45% compared with 35%). CONCLUSIONS: The restructuring and downsizing of mental health services was not associated with any increase in suicides immediately (one week) or one year postdischarge. Instead, the risk of these suicides decreased significantly between the two time periods among several diagnostic categories. Although the role of psychiatric hospitalization in general may have changed over time, patients who are hospitalized now may be less suicidal after discharge. Our results indicate, in terms of postdischarge suicides, that the downsizing of psychiatric hospitals has been a success. However, there is still a substantial need for better recognition of suicidal risk among psychiatric patients. [ABSTRACT FROM AUTHOR]

Abstract Background The characteristics of victims of immediate post-discharge suicides are not well known. We explored these characteristics for the purposes of better recognition and preventive efforts of potential immediate post-discharge suicides. Methods Suicides from a Finnish nationwide register were linked with preceding periods of psychiatric inpatient treatment. Characteristics of suicides within a week of discharge were compared to those occurring later after discharge. Results Compared to other previously hospitalised suicide victims, those committing suicide within a week of discharge were more often female, unmarried, had a higher grade of education and a diagnosis of schizophrenia spectrum or affective disorder, tended to use more drowning and jumping from heights as the methods for suicide and had gained a smaller improvement in psychological functioning during hospitalization. Conclusion These characteristics indicate a more severe psychopathology, relatively poorer level of functioning, less global response to hospitalisation, and a more frequent choice of lethal and easily available method for suicide. Potentially suicidal psychiatric patients should be better recognized and an immediate follow-up arranged if it is decided they be discharged.