Immigrants' mental health service use compared to that of native Finns: a register study.

PURPOSE: Many aspects related to migration might predispose immigrants to mental health problems. Yet immigrants have been shown to underuse mental health services. The aim of this study was to compare the intensity of psychiatric care, as an indicator of treatment adequacy, between natives and immigrants living in Finland. METHODS: We used nationwide register data that included all the immigrants living in Finland at the end of 2010 (n = 185,605) and their matched controls. Only those who had used mental health services were included in the analyses (n = 14,285). We used multinomial logistic regression to predict the categorized treatment intensity by immigrant status, region and country of origin, length of residence, and other background variables. RESULTS: Immigrants used mental health services less than Finnish controls and with lower intensity. The length of residence in Finland increased the probability of higher treatment intensity. Immigrants from Eastern Europe, sub-Saharan Africa, the Middle East, and Northern Africa were at the highest risk of receiving low-intensity treatment. CONCLUSIONS: Some immigrant groups seem to persistently receive less psychiatric treatment than Finnish-born controls. Identification of these groups is important and future research is needed to determine the mechanisms behind these patterns.

Association Between Psychosocial Problems and Unhealthy Health Behavior Patterns Among Finnish Adolescents.

The aim of the study was to investigate how psychosocial problems in childhood and adolescence associate with an unhealthy health behavior pattern among adolescents in Northern Finland. The study population consisted of 4350 participants, drawn from the Northern Finland Birth Cohort 1986 Study. Health behavior patterns were assessed in adolescence and psychosocial problems in childhood and adolescence. Logistic regression analyses were performed to determine the associations. Several psychosocial problems predicted greater likelihood of engaging in unhealthy health behavior pattern. Externalizing problems in childhood predicted greater likelihood of engaging in unhealthy behavior patterns for girls. For both genders, externalizing problems and inattention in adolescence were associated with unhealthy health behavior patterns. Boys and girls with externalizing problems both in childhood and adolescence had an increased risk of unhealthy patterns. Psychosocial problems contribute to unhealthy lifestyles and should therefore be acknowledged when designing and targeting health promotion strategies aimed at adolescents.

Cross-cultural, population-based study on adolescent body image and eating distress in Japan and Finland.

This cross-sectional population-based survey compares the prevalence of self-reported body image and eating distress symptoms among adolescents in Japan and Finland, and associations between emotional/behavioral problems, body image and eating distress from a cross-cultural perspective. The study included 1,840 Japanese and 1,135 Finnish 8th grade students. The self-reported questionnaire included the Body Image and Eating Distress Scale and Strengths and Difficulties Questionnaire (SDQ). The female adolescents from both Finland and Japan reported much greater dissatisfaction with, and concern about, their bodies than the males and Japanese females expressed even higher distress than Finnish females. High levels of body image and eating distress were associated with psychiatric problems measured with the SDQ. There was a significant three-way interaction effect of body image and eating distress, gender and country with SDQ peer problems and prosocial behavior.

Immigrants' use of health care in their country of origin: the role of social integration, discrimination and the parallel use of health care systems.

AIMS: The objective of this study was to elucidate the utilisation of Russian health care by immigrants of Russian origin living in Finland (cross-border health care). The study examined the association of cross-border health care with social integration and discrimination. Moreover, it studied whether cross-border health care was used as an alternative to the host-country's healthcare system. METHODS: Data from the Finnish Migrant Health and Wellbeing Survey (Maamu) were utilised. The number of respondents of Russian origin was 545. The main analytical method was logistic regression. The outcome variable was based on a survey item on seeking physician's treatment or help abroad during the last 12 months. Social integration was measured multi-dimensionally, and the indicator was extracted by multiple correspondence analysis. Ethical approval for the study was obtained from the Ethical Committee of the Uusimaa Hospital Region. RESULTS: We found that 15.4% of the respondents had visited a physician in Russia during the last 12 months. 10.4% had experienced discrimination in Finnish health services during their stay in Finland. Stronger social integration predicted less frequent utilisation of cross-border health care. Experiences of discrimination or unfairness were associated with higher odds for seeking cross-border health care. Cross-border health care was typically used in parallel to the Finnish services. CONCLUSIONS: Our findings on integration and discrimination emphasise the importance of general integration policy as well as cultural competence in health care. Parallel use of healthcare systems entails both risks (e.g double medication, problems of follow-up) and opportunities (e.g. sense of agency), which should be further investigated.

Factors associated with cervical cancer screening participation among immigrants of Russian, Somali and Kurdish origin: a population-based study in Finland.

BACKGROUND: Previous studies revealed low participation in cervical cancer screening among immigrants compared with non-immigrants. Only a few studies about factors associated with immigrants' lower participation rates have been conducted in European countries that have universal access for all eligible women. Our study aimed to explore factors associated with cervical screening participation among women of Russian, Somali, and Kurdish origin in Finland. METHODS: We used data from the Migrant Health and Well-being Survey, 2010-2012. Structured face-to-face interviews of groups of immigrants aged 25-60 yielded 620 responses concerning screening participation in the previous five years. Statistical analysis employed logistic regression. RESULTS: The age-adjusted participation rates were as follows: among women of Russian origin 73.9% (95% CI 68.1-79.7), for Somalis 34.7% (95% CI 26.4-43.0), and for Kurds 61.3% (95% CI 55.0-67.7). Multiple logistic regressions showed that the most significant factor increasing the likelihood of screening participation among all groups was having had at least one gynecological check-up in the previous five years (Odds ratio [OR] = 6.54-26.2; p < 0.001). Other factors were higher education (OR = 2.63; p = 0.014), being employed (OR = 4.31; p = 0.007), and having given birth (OR = 9.34; p = 0.014), among Kurds; and literacy in Finnish/Swedish (OR = 3.63; p = 0.003) among Russians. CONCLUSIONS: Our results demonstrate that women who refrain from using reproductive health services, those who are unemployed and less educated, as well as those with poor language proficiency, might need more information on the importance of screening participation. Primary and occupational healthcare services may have a significant role in informing immigrant women about this importance.

Assessment of educational misclassification in register-based data on Finnish immigrants in Sweden.

AIM: In population registers, information on completed schooling is either missing or misclassified for a large proportion of newly arrived immigrants. It is unclear how quickly the information is updated and whether misclassification, i.e., that the wrong level of education is recorded, biases empirical estimates. METHODS: We use unique linked Swedish and Finnish register data to determine the extent of such mismeasurement. By running logistic regressions on zero earnings, we also illustrate how mismeasurement might influence the estimated effects of education on health or labour market outcomes. RESULTS: We find a considerable bias in estimates based on Swedish records of educational attainment during immigrants' first few years in the country. Misclassification is additionally very common, even when information on educational attainment exists. CONCLUSIONS: These findings suggest that research and policies using recently arrived immigrants' completed schooling as a determinant of socioeconomic integration need to be interpreted with care.

Real-world costs of autosomal dominant polycystic kidney disease in the Nordics.

BACKGROUND: There is limited real-world data on the economic burden of patients with autosomal dominant polycystic kidney disease (ADPKD). The objective of this study was to estimate the annual direct and indirect costs of patients with ADPKD by severity of the disease: chronic kidney disease (CKD) stages 1-3; CKD stages 4-5; transplant recipients; and maintenance dialysis patients. METHODS: A retrospective study of ADPKD patients was undertaken April-December 2014 in Denmark, Finland, Norway and Sweden. Data on medical resource utilisation were extracted from medical charts and patients were asked to complete a self-administered questionnaire. RESULTS: A total of 266 patients were contacted, 243 (91%) of whom provided consent to participate in the study. Results showed that the economic burden of ADPKD was substantial at all levels of the disease. Lost wages due to reduced productivity were large in absolute terms across all disease strata. Mean total annual costs were highest in dialysis patients, driven by maintenance dialysis care, while the use of immunosuppressants was the main cost component for transplant care. Costs were twice as high in patients with CKD stages 4-5 compared to CKD stages 1-3. CONCLUSIONS: Costs associated with ADPKD are significant and the progression of the disease is associated with an increased frequency and intensity of medical resource utilisation. Interventions that can slow the progression of the disease have the potential to lead to substantial reductions in costs for the treatment of ADPKD.

Mental health among older refugees: the role of trauma, discrimination, and religiousness.

OBJECTIVES: The aim of this study was to examine, first, how past traumatic stress and present acculturation indices, and discrimination are associated with mental health; and, second, whether religiousness can buffer the mental health from negative impacts of war trauma. METHOD: Participants were 128 older (50-80 years) Somali refugees living in Finland. They reported experiences of war trauma and childhood adversities, and filled-in questionnaires of perceived ethnic discrimination, religiousness (beliefs, attendance, and observance of Islamic faith), and symptoms of posttraumatic stress disorder (PTSD), depressive (BDI-21), psychological distress (GHQ-12), and somatization (SCL-90). RESULTS: Symptom-specific regression models showed that newly arrived refugees with non-permanent legal status and severe exposures to war trauma, childhood adversity, and discrimination endorsed greater PTSD symptoms, while only war trauma and discrimination were associated with depressive symptoms. Results confirmed that high religiousness could play a buffering role among older Somalis, as exposure to severe war trauma was not associated with high levels of PTSD or somatization symptoms among highly religious refugees. CONCLUSION: Health care should consider both unique past and present vulnerabilities and resources when treating refugees, and everyday discrimination and racism should be regarded as health risks.

Viewing oneself as a capable person - experiences of professionals working with older Finnish immigrants.

The proportion of older immigrants in the population is expected to increase in Sweden. Research indicates that older immigrants face the double burden of frailty, caused by a weaker health status, and the immigration process. Health promotion interventions can be used to prevent frailty and support healthy ageing in this population. Healthcare professionals are a crucial part of health promotion and the present study aimed to explore healthcare professionals' experiences of health in context of daily life among older immigrants to and provide a basis for the development of a health promotion intervention targeted at older immigrants. Four focus group discussions were conducted with professionals who worked with home-dwelling older people from Finland, currently living in Sweden. Participants represented a variety of healthcare professions. Data were analysed using qualitative content analysis. The healthcare professionals perceived that health in daily life was (i) connected to the view of oneself as a capable person and (ii) participants strove to maintain their own origin. The findings highlighted that when planning for health promotion interventions for older immigrants, the point of departure should be to recognise the person as a person and the background of immigration is not the first issue to address. Therefore, a person-centred health promotion intervention is recommended to open a dialogue between healthcare professionals and older immigrants, so that a common view of the intervention can be reached.

The dynamics of interminority extended contact: The role of affective and cognitive mediators.

OBJECTIVE: Research on intergroup contact and prejudice reduction has dedicated little attention to relations between minority groups. We examined whether interminority extended contact, that is, the knowledge that a member of the minority ingroup has a friend from the minority outgroup, is associated with positive outgroup attitudes. Affective (outgroup empathy and outgroup trust) and cognitive (ingroup norm) mediators were considered. METHOD: Two correlational studies were conducted. Study 1 (N = 640, 50% female, mean age = 44 years) was conducted in Bulgaria among the Bulgarian Turkish and Roma ethnic minorities, while Study 2 (N = 458, 67% female, mean age = 44 years) was conducted in Finland among Estonian and Russian immigrants. RESULTS: Path analyses showed that, over and above the effects of direct contact between the minority groups, interminority extended contact was associated with positive outgroup attitudes in both intergroup settings. These effects occurred through empathy (Study 1), trust, and ingroup norms (Study 2). CONCLUSION: The 2 studies highlight interminority extended contact as a means to promote harmonious interminority relationships and suggest the implementation of interventions based on extended contact to reduce interminority prejudice and to foster solidarity among minorities. (PsycINFO Database Record

Brief report: Sex differences in suicide rates and suicide methods among adolescents in South Korea, Japan, Finland, and the US.

Sex differences in suicide rates and suicide methods was compared among adolescents in South Korea, Japan, Finland, and the United States. This study analyzed suicide rates and suicide methods of adolescents aged 15-19 years in four countries, using the World Health Organization mortality database. Among both male and female adolescents, the most common method of suicide was jumping from heights in South Korea and hanging in Japan. In Finland, jumping in front of moving objects and firearms were frequently used by males, but not by females. In the United States, males were more likely to use firearms, and females were more likely to use poison. The male to female ratio of suicide rates was higher in the United States (3.8) and Finland (3.6) than in Korea (1.3) and Japan (1.9). Sex differences in suicide methods may contribute to differences in the suicide rates among males and female adolescents in different countries.

Unaccompanied evacuation and adult mortality: evaluating the finnish policy of evacuating children to foster care during World War II.

OBJECTIVES: I examined associations between evacuation of Finnish children to temporary foster care in Sweden during World War II and all-cause mortality between ages 38 and 78 years. METHODS: I used a Cox proportional hazards model to estimate mortality risk according to whether the individual was evacuated during childhood or not. I used within-sibling analysis to control for all unobserved socioeconomic and genetic characteristics shared among siblings. Individual-level data for Finnish cohorts born in 1933 to 1944 were derived from wartime government records, Finnish census data from 1950 and 1970, and death cause registry from 1971 to 2011. RESULTS: I found no statistically significant association between evacuation and all-cause mortality when all exposed individuals were included in the analysis. However, subgroup analysis showed that men evacuated before age 4 years had a 1.31 higher mortality risk (95% confidence interval = 1.01, 1.69) than their nonevacuated counterparts. CONCLUSIONS: In the aggregate, individuals do not have elevated mortality risk as a consequence of foster care during early childhood owing to the onset of sudden external shocks (e.g., wars).

Genetic variation in human NPY expression affects stress response and emotion.

Understanding inter-individual differences in stress response requires the explanation of genetic influences at multiple phenotypic levels, including complex behaviours and the metabolic responses of brain regions to emotional stimuli. Neuropeptide Y (NPY) is anxiolytic and its release is induced by stress. NPY is abundantly expressed in regions of the limbic system that are implicated in arousal and in the assignment of emotional valences to stimuli and memories. Here we show that haplotype-driven NPY expression predicts brain responses to emotional and stress challenges and also inversely correlates with trait anxiety. NPY haplotypes predicted levels of NPY messenger RNA in post-mortem brain and lymphoblasts, and levels of plasma NPY. Lower haplotype-driven NPY expression predicted higher emotion-induced activation of the amygdala, as well as diminished resiliency as assessed by pain/stress-induced activations of endogenous opioid neurotransmission in various brain regions. A single nucleotide polymorphism (SNP rs16147) located in the promoter region alters NPY expression in vitro and seems to account for more than half of the variation in expression in vivo. These convergent findings are consistent with the function of NPY as an anxiolytic peptide and help to explain inter-individual variation in resiliency to stress, a risk factor for many diseases.

Cancer in immigrants as a pointer to the causes of cancer.

The early cancer studies on immigrants, which started to appear some 50 years ago, showed that the incidence in cancers changes to the level of the new host country in one or two generations. These findings were fundamental to the understanding of the environmental etiology of human cancer. Many immigrant groups originate from countries with no cancer registration, and, hence, the immigrant studies may provide estimates on the indigenous cancer rates. The Swedish Family-Cancer Database has been an important source of data for immigrant studies on various diseases. The Database covers the Swedish population of the past 100 years, and it records the country of birth for each subject. A total of 1.79 million individuals were foreign born, Finns and other Scandinavians being the largest immigrant groups. Over the course of years, some 30 publications have appeared relating to cancer in immigrants. In the present article, we will review more recent immigrant studies, mainly among Swedish immigrants, on all cancers and emphasize the differences between ethnic groups. In the second part, we discuss the problem of reliable registration of cancer and compare cancer incidence among non-European immigrants with cancer incidence in countries of origin, as these have now active cancer registries. We discuss the experiences in cancer registration in Morocco and Egypt. We show the usefulness and limitations in predicting cancer incidence in the countries of origin.

[The health differences between Swedish and Finnish speakers in Finland Swedish-speaking people in Finland (circa 5 %) are somewhat healthier]. / Maamme ruotsin- ja suomenkielisen väestön terveyserot.

The health differences between Swedish and Finnish speakers in Finland Swedish-speaking people in Finland (circa 5 %) are somewhat healthier than Finnish-speaking people. This systematic review presents research results on this topic, mostly published in international journals. The differences apply more to men, and although not great, they can be observed on many levels, such as mortality, disability pensions and perceived health. The differences cannot be attributed to mere socioeconomic factors. Concomitant long-term social, cultural and biomedical mechanisms have probably been involved in the formation of the health differences. The significance of the findings would be higher if they could be applied in health promotion in a more general manner.

Socioeconomic and early-life factors and risk of being overweight or obese in children of Swedish- and foreign-born parents.

BACKGROUND: Ethnic minorities/immigrants have differential health as compared with natives. The epidemic in child overweight/obesity (OW/OB) in Sweden is leveling off, but lower socioeconomic groups and immigrants/ethnic minorities may not have benefited equally from this trend. We investigated whether nonethnic Swedish children are at increased risk for being OW/OB and whether these associations are mediated by parental socioeconomic position (SEP) and/or early-life factors such as birth weight, maternal smoking, BMI, and breastfeeding. METHODS: Data on 10,628 singleton children (51% boys, mean age: 4.8 y, born during the period 2000-2004) residing in Uppsala were analyzed. OW/OB was computed using the International Obesity Task Force's sex- and age-specific cutoffs. The mother's nativity was used as proxy for ethnicity. Logistic regression was used to analyze ethnicity-OW/OB associations. RESULTS: Children of North African, Iranian, South American, and Turkish ethnicity had increased odds for being overweight/obese as compared with children of Swedish ethnicity (adjusted odds ratio (OR): 2.60 (95% confidence interval (CI): 1.57-4.27), 1.67 (1.03-2.72), 3.00 (1.86-4.80), and 2.90 (1.73-4.88), respectively). Finnish children had decreased odds for being overweight/obese (adjusted OR: 0.53 (0.32-0.90)). CONCLUSION: Ethnic differences in a child's risk for OW/OB exist in Sweden that cannot be explained by SEP or maternal or birth factors. As OW/OB often tracks into adulthood, more effective public health policies that intervene at an early age are needed.

Socioeconomic disadvantage and indicators of risky alcohol-drinking patterns.

AIM: The purpose was to establish how the association between socioeconomic disadvantage and risky drinking depends on the indicator of risky alcohol-drinking patterns. METHODS: Alcohol-drinking Finnish men (n = 9316) and women (n = 11,888) aged 20-54 years at baseline participated in the Health and Social Support (HeSSup) postal survey in 1998. Socioeconomic disadvantage was measured by low educational level, history of previous unemployment among those currently employed, current unemployment, being on disability pension and history of experiencing financial hardships. Indicators of risky drinking were hazardous weekly intake (≥24 and ≥16 Finnish standard drinks for men and women, respectively), frequency of intoxications/drunkenness, hangovers and alcohol-induced pass-outs. The study participants were also followed up for 7 years for alcohol-specific hospitalizations and deaths. RESULTS: Socioeconomic gradient in risky drinking was observed across all indicators of risky drinking, but the gradient was relatively larger in patterns of risky drinking representing high-intensity drinking occasions such as alcohol-induced hangovers and pass-outs. No marked gender differences were observed. CONCLUSIONS: These results highlight the need to take into account the multidimensionality of risky alcohol-drinking patterns as a contributing factor in the socioeconomic gradient in alcohol use.

Inner strength in relation to age, gender and culture among old people--a cross-sectional population study in two Nordic countries.

OBJECTIVES: The theoretical framework for the study was the Model of Inner Strength, and the Inner Strength Scale (ISS)developed based on the Model was used. The aim was to examine inner strength in relation to age, gender and culture among old people in Sweden and Finland. METHOD: This study forms part of the GErontological Regional DAtabase (GERDA)-Botnia project that investigates healthy ageing with focus on the dignity, social participation and health of old people. The participants (N = 6119) were 65-, 70-, 75- and 80-year old and living in two counties in Sweden or Finland. The ISS consists of 20 items relating to four interrelated dimensions of inner strength, according to the Model of Inner Strength. The range of possible ISS scores is 20-120, a higher score denoting higher inner strength. RESULT: The result showed that the 65-year-old participants had the highest mean ISS score, with a decrease in score for every subsequent age. The lowest score was achieved by the 80-year-old participants. Women had slightly but significantly higher mean ISS scores than men. Only small differences were found between the counties. CONCLUSION: The study population came from Sweden and Finland; still, despite the different backgrounds, patterns in the distribution of inner strength were largely similar. The present study provides basic and essential information about inner strength in a population of old people.

Depression symptoms in help-seeking adolescents: a comparison between adolescents at-risk for psychosis and other help-seekers.

BACKGROUND: Depression and psychosis are severe diseases with onset in adolescence. AIMS: The aim of this study was to investigate the association between an at-risk status of psychosis and depression symptoms in adolescents. METHOD: The data were collected by an early intervention team in Finland. The PROD screen was used to assess the risk of psychosis, and Beck Depression Inventory-II was used as a measurement to assess the level of depression symptoms. Of 203 help-seeking respondents, 66 were classified as at-risk for psychosis, and 137 respondents were other help-seekers. The mean age of the subjects was 15.3 years. RESULTS: Subjects at-risk had significantly poorer scores in total scores for depression (p < 0.001), and in an item-by-item analysis, the subjects at-risk had poorer scores for sadness (p < 0.001), past failure (p = 0.001), suicidal thoughts (p < 0.001), crying (p = 0.002), agitation (p = 0.001), loss of energy (p = 0.002) and concentration difficulty (p < 0.001). In a logistic regression analysis of items that differed by risk status for psychosis, item of concentration difficulty (p = 0.038) explained the at-risk status after adjustment for sex. CONCLUSIONS: The present results suggest that subjects that are at-risk for psychosis have more depression symptoms than other help-seekers. This should be considered in the psychiatric care of adolescents.

Heterogeneity of risk within racial groups, a challenge for public health programs.

Targeting high-risk populations for public health interventions is a classic tool of public health promotion programs. This practice becomes thornier when racial groups are identified as the at-risk populations. I present the particular ethical and epistemic challenges that arise when there are low-risk subpopulations within racial groups that have been identified as high-risk for a particular health concern. I focus on two examples. The black immigrant population does not have the same hypertension risk as US-born African Americans. Similarly, Finnish descendants have a far lower rate of cystic fibrosis than other Caucasians. In both cases the exceptional nature of these subpopulations has been largely ignored by the designers of important public health efforts, including the recent US government dietary recommendations. I argue that amending the publicly-disseminated risk information to acknowledge these exceptions would be desirable for several reasons. First, recognizing low-risk subpopulations would allow more efficient use of limited resources. Communicating this valuable information to the subpopulations would also promote truth-telling. Finally, presenting a more nuanced empirically-supported representation of which groups are at known risk of diseases (not focusing on mere racial categories) would combat harmful biological race essentialist views held by the public.