Changes in lifestyle for psychiatric patients three years after the start of short- and long-term psychodynamic psychotherapy and solution-focused therapy.

OBJECTIVES: Lifestyle is less favourable among individuals suffering from psychiatric disorders. We studied whether psychotherapy brings along changes in lifestyle and whether these changes differ between short-term and long-term psychodynamic psychotherapy (SPP and LPP) and solution-focused therapy (SFT). METHODS: A total of 326 outpatients, 20-46 years of age, with mood or anxiety disorder were randomly assigned to LPP, SPP and SFT. The lifestyle variables considered were alcohol consumption, smoking, body mass index (BMI), leisure time exercise and serum cholesterol. The patients were monitored for three years from the start of treatment. RESULTS: During the three-year follow-up, BMI and serum cholesterol rose statistically significantly although no statistically significant trends were shown for alcohol consumption, smoking or exercise. SPP showed a disadvantage of increased alcohol consumption and serum cholesterol level when compared with LPP. SFT showed an advantage of reduced smoking in comparison with SPP. DISCUSSION: Small therapy-specific changes in lifestyle may be a result from psychotherapy treatment. These lifestyle changes are apparently more common in short-term therapy. More studies are needed to verify these findings.

Mental disorders and cause-specific mortality.

BACKGROUND: The impact of clinically diagnosed mental disorders on mortality in the general population has not been established. Aims To examine mental disorders for their prediction of cause-specific mortality. METHOD: Mental disorders were determined using the 36-item version of the General Health Questionnaire and the Present State Examination in a nationally representative sample of 8000 adult Finns. RESULTS: During the 17-year follow-up period 1597 deaths occurred. The presence of a mental disorder detected at baseline was associated with an elevated mortality rate. The relative risk in men was 1.6(95% confidence interval 1.3-1.8) and in women, 1.4 (95% Cl 1.2-1.6). In men and women with schizophrenia the relative risks of death during the follow-up period were 3.3 (95% Cl 2.3-4.9) and 2.3 (95% Cl 1.3-3.8) respectively, compared with the rest of the sample. In both men and women with schizophrenia the risk of dying of respiratory disease was increased, but the risk of dying of cardiovascular disease was increased only in men with neurotic depression. CONCLUSIONS: Schizophrenia and depression are associated with an elevated risk of natural and unnatural deaths.

Depression and anxiety in early pregnancy and risk for preeclampsia.

OBJECTIVE: To examine whether depression and anxiety in early pregnancy are associated with preeclampsia in an unselected nulliparous population. METHODS: In this prospective population-based study during pregnancy at outpatient maternity clinics in the Helsinki metropolitan area, depression was assessed by a Finnish modification of the short form of the Beck Depression Inventory and anxiety by one established question. Preeclampsia was defined as elevated blood pressure (BP) (more than 140/100 mmHg) and proteinuria (0.3 g during 24 hours or more). Age, smoking, alcohol consumption, marital status, socioeconomic status, and bacterial vaginosis were analyzed as potentially confounding factors in a multiple logistic regression analysis. RESULTS: Six hundred twenty-three consecutive nulliparous women with singleton pregnancies were studied at ten to 17 (median 12) weeks' gestation and at delivery. Of them, 28 (4.5%) women developed preeclampsia. Depression (mean Beck score 4.5, range 3-17) was observed in 185 (30%), women and anxiety was observed in 99 (16%) in early pregnancy. In multivariate analysis, after adjustment for potentially confounding factors, depression was associated with increased risk (odds ratio [OR] 2.5; 95% confidence interval [CI] 1.1, 5.4) for preeclampsia, as was anxiety (OR 3.2; 95% CI 1.4, 7.4). Either depression or anxiety, or both, were associated with increased risk (OR 3.1; 95% CI 1.4, 6.9) for preeclampsia. Bacterial vaginosis together with depression was associated with increased risk (OR 5.3; 95% CI 1.8, 15.0) for preeclampsia. CONCLUSION: Depression and anxiety in early pregnancy are associated with risk for subsequent preeclampsia, a risk further increased by bacterial vaginosis.

Depression and disability pension in Finland.

During the period 1987-1994 there has been a threefold increase in disability pensions granted to individuals with affective disorders in Finland. Possible reasons for this development include a deep economic recession, changes in the diagnostic system, and better recognition of affective disorders. Against this background, it seems relevant to ask why, over the same period, the functional capacity of depressive patients has markedly deteriorated, causing an increase in disability pensions, despite the fact that many new drugs and other treatments have become available.

Elevated lung cancer risk among persons with depressed mood.

Although it has been hypothesized that depressive persons have an excess risk of cancer, few prospective data are available. The association between depressiveness and subsequent incidence of lung cancer was studied in the nationally representative Mini-Finland Health Survey. The study population comprised 7,018 adult men and women, free from cancer at the baseline, carried out in 1978-1980. During a 14-year follow-up, 605 cancer cases occurred, of which 70 were male lung cancer patients. Mental problems and disorders were assessed at the baseline examination using standard interview techniques (General Health Questionnaire and Present State Examination). The relative risk of lung cancer between depressive persons and individuals with a normal depressiveness score was 3.32 (95% confidence interval 1.53-7.20). Neither adjustment for the potential confounding factors of age, education, geographic area, smoking, alcohol consumption, body mass index, serum cholesterol, leisure-time exercise, general health, and use of antidepressant medication nor exclusion of cancer cases occurring during the first 4 years of follow-up notably altered the results. There was a strong interaction between depressiveness and smoking. The relative risks of lung cancer between smokers and nonsmokers were 3.38 (95% confidence interval 1.09-10.52) at normal depressiveness score levels and 19.67 (95% confidence interval 2.57-150.7) at strongly elevated levels, respectively. It is possible that depressiveness modifies the effect of smoking on lung cancer risk either by biologic mechanisms or by affecting smoking behavior.

Depression and cardiovascular diseases.

We first review the associations between depression and cardiovascular diseases (CVDs). Then we examine them in the nationally representative Mini-Finland Health Survey, which covers 8,000 persons. Chronic somatic diseases and mental disorders were diagnosed using standardized methods. Cross-sectionally, CVDs and neurotic depression were associated both before and after adjustment for covariates. The strongest associations were observed in the case of severe CVDs. During a 6.6 year follow-up, the risk of CVD death and coronary death was elevated in depressed persons both with and without CVDs at entry. Much of the cross-sectional association is probably due to depression caused by CVDs. The outcome of CVD may be poorer in depressed persons. The hypothesis that depression is a cause of CVDs requires further study.

Prevalence of mental disorders among adults in Finland: basic results from the Mini Finland Health Survey.

The Mini Finland Health Survey was an extensive epidemiological study of the Finnish population aged 30 or over; the prevalence of mental disorders was one aspect studied. Prevalence of symptoms in the General Health Questionnaire as well as the prevalence of self-perceived and clinically assessed mental disorders was studied. The total prevalence of clinically assessed mental disorders was 17.4%, 14.8% in the men and 19.5% in the women. A definite disorder was observed for 11.7% of the subjects. About half of the subjects suffering from a mental disorder according to clinical assessment also reported a self-perceived disorder. Of various diagnoses, the most common were phobic and anxiety neurosis (6.2%) and neurotic depression (4.6%). The prevalence of schizophrenia was 1.3%. The highest prevalence was found in the ages 50 to 64 years. The prevalence of psychoses was highest in northern and eastern Finland, and that of neuroses in southern Finland.

Need for mental health services of the adult population in Finland: results from the Mini Finland Health Survey.

This article presents results on the self-perceived and clinically assessed met and unmet need for mental health care as indicated by the Mini Finland Health Survey, an extensive epidemiological study of the Finnish population aged 30 years or over. The prevalence of self-perceived definite or probable need for care was 6.4% in the men and 8.2% in the women. The corresponding clinical assessments were 14.5% in the men and 19.6% in the women. The need for specialist care was 7.5% in the men and 9.6% in the women. The need was greatest in the middle-aged groups. About 60% of persons in need of care were not receiving any treatment. Half of the treatment received was assessed as inadequate. The treatment situation was much better for psychoses than for neuroses, but it varied little between the different parts of the country.

Prevalence of severe dementia in Finland.

A sample of 8,000 subjects to represent the population of Finland aged 30 years and over was used to identify patients with severe dementia; 141 cases were found. The prevalence of all types of severe dementia was 1.8% in the whole study population and 6.7% in the population aged 65 years and over. The prevalence increased with advancing age to 17.3% in the age group 85 years and over. Primary degenerative dementia constituted 50% of all cases; multi-infarct and combined dementia, 39%; and secondary dementia, 11%. Fifty-seven percent of the patients lived in institutions.

A feasibility study of organizing occupational health services for farmers.

In Finland the Occupational Health Care Act of 1979 provides farmers the possibility of purchasing occupational health services. The main objective of the present study is to develop national model for the organization of occupational health services for farmers. The problems of providing and specifying occupational health services for farmers can be described by two parameters. The first is the type of farm production. The occupational health services to be provided are though to depend on the occupational health risks. The risks vary with the type of farm production, which in turn depends on the geographic location of the farm. The second parameter represents the supply of occupational services to be provided by the municipal health center. The supply has been characterized as occupational health inspections of farms, health examinations, and health education. For the optimization of the supply and the demand, the experiment consists of three models to be tested in respect to two matrices of risk. The feasibility of the models in the 2-a experiment will be evaluated by pre- and postexperimental surveys.