Anti-rheumatic medication and salivary MMP-8, a biomarker for periodontal disease.

OBJECTIVE: To investigate the impact of anti-rheumatic medications on salivary matrix metalloproteinase (MMP)-8 levels and MMP-8/TIMP (tissue inhibitor of MMPs)-1 ratio in patients with rheumatoid arthritis (RA) and periodontal findings during a 1-year follow-up. MATERIALS AND METHODS: Salivary MMP-8 was measured by an immunofluorometric assay and TIMP-1 by an enzyme-linked immunosorbent assay of 53 patients with early untreated RA (ERA), naïve to synthetic disease modifying anti-rheumatic drugs (DMARDs), of 28 patients with chronic RA (CRA), candidates for biologic DMARDs and of 43 age- and sex-matched controls. Periodontal health was evaluated by bleeding on probing (BOP), pocket depth (PD), and periodontal inflammatory burden index (PIBI). Examinations were conducted twice for RA patients and once for controls. RESULTS: Salivary MMP-8 level and MMP-8/TIMP-1 ratio associated positively with PIBI in patients with chronic RA (MMP-8: p < 0.001 at baseline, p = 0.002 after follow-up; MMP-8/TIMP-1 ratio p < 0.001, p = 0.003, respectively) and in controls (MMP-8: p = 0.010, MMP-8/TIMP-1 ratio: p = 0.010). Salivary MMP-8 levels were highest at the early stage of RA. The used DMARDs, synthetic or biologic, did not affect salivary MMP-8 concentrations. CONCLUSIONS: The use of synthetic or biologic DMARDs did not affect salivary MMP-8 levels in RA patients regardless the duration of RA.

Activity of rheumatoid arthritis correlates with oral inflammatory burden.

To study oral health in patients with rheumatoid arthritis (RA) with emphasis on disease activity and treatment of RA. In this prospective cohort study 81 RA patients [53 early untreated RA (EURA) and 28 chronic RA (CRA) patients with inadequate response to synthetic disease modifying antirheumatic drugs (DMARDs)], underwent rheumatological [Disease Activity Score (28-joint) DAS28] and dental examinations [Total Dental Index (TDI), Decayed Missing Filled Teeth (DMFT) and Decayed Missing Filled Surfaces (DMFS)]. For controls, 43 volunteers were examined. After the examinations, EURA patients started treatment with synthetic DMARDs, oral and intra-articular glucocorticoids. CRA patients were candidates for biological DMARDs. The patients were re-examined mean 16 months later. Results were analyzed with descriptive statistics and logistic regression. TDI was higher in both RA groups at baseline compared to controls [EURA: 2 (2-3); CRA: 2 (1-3); controls 1 (1-3), p = 0.045]. DMFT [rs 0.561 (p = 0.002)] and DMFS [rs 0.581 (p = 0.001)] associated with DAS28 at baseline in CRA patients. After follow-up, DAS28 associated positively with DMFT [rs 0.384 (p = 0.016)] and DMFS [rs 0.334 (p = 0.038)] in EURA patients; as well as in CRA patients DMFT [rs 0.672 (p = 0.001)], DMFS [rs 0.650 (p = 0.001)]. RA patients already in the early phase of the disease had poorer oral health compared to controls. The caries indices associated with the activity of RA in both patient groups. Oral status may thus contribute to the development and further relate to the activity of RA.

Do predictors of return to work and recurrence of work disability due to mental disorders vary by age? A cohort study.

BACKGROUND: The extent to which predictors of return to work (RTW) and recurrence of work disability episodes vary by age group is not well understood. METHODS: We examined the associations of sociodemographic and clinical factors with RTW and recurrence after mental-disorder-related work disability episodes in a cohort of 10,496 Finnish public sector employees. Disability records were derived from national disability registers between 2005 and 2011. Effect modification by age was examined in age groups of 21-34, 35-50 and >50 years. RESULTS: A total of 16,551 disability episodes from mental disorders were recorded. The likelihood of RTW was elevated in age group 21-34 (hazard ratio (HR) = 1.36, 95% confidence interval (CI) = 1.28-1.46) and 35-50 years (HR = 1.22, 95% CI = 1.18-1.26) compared to age group >50 years. The risk of a recurrent episode of work disability was higher in age groups >50 (HR = 1.29, 95% CI = 1.09-1.52) and 35-50 years (HR = 1.20, 95% CI = 1.03-1.41) compared to the youngest age group. Employees with depressive disorders were less likely to RTW than employees with neurotic, stress-related and somatoform disorders, and this difference increased with age. Low education was associated with increased risk of recurrent work disability episode in age groups of 50 years or younger, while no such association was observed in age group >50 years. CONCLUSIONS: The importance of depressive symptoms over neurotic, stress-related and somatoform disorders as predictors of delayed RTW increases with age, whereas educational differences in the recurrence of an episode diminish by age.

Attachment to employment and education before work disability pension due to a mental disorder among young adults.

BACKROUND: We examined attachment to employment and education among young adults before they were granted a fixed-term work disability pension due to psychiatric diagnosis, and the factors associated with this attachment. METHODS: The data comprised all persons aged 18-34 who received a new-onset fixed-term disability pension compensation due to a mental disorder in Finland in 2008 (N = 1163). The data were derived from pension applications and the enclosed medical records, and were linked to employment records from a period of three years before the disability pension. We analysed the factors associated with attachment to employment or education with log-binomial regression analysis. RESULTS: Fifty percent of the participants were attached to employment or education before work disability pension. The attached were more often women; had higher basic and vocational education; had mood disorder rather than psychosis diagnosis as a primary diagnosis; and had no record of harmful alcohol use or drug use, or recorded symptoms of mental disorders already at school-age. CONCLUSIONS: The level of attachment to employment or education before work disability pension is low among young adults with mental disorders and several risk factors predict poor attachment; severe or comorbid mental disorder, early-life psychiatric morbidity, substance use, male sex, low basic education, and lacking vocational education.

Clustering of adversity in young adults on disability pension due to mental disorders: a latent class analysis.

PURPOSE: Mental disorders are the leading cause of work disability among young adults. This study examined whether distinct classes could be identified among young adults on the basis of medical history before receiving a disability pension due to a mental disorder. METHODS: Medical history was obtained from pension applications and attached medical certificates for 1163 individuals aged 18-34 years who, in 2008, received a disability pension due to a mental disorder. Using latent class analysis, 10 clinical and individual adversities and their associations with sex, age and diagnostic category were examined. RESULTS: Three classes were identified: childhood adversity (prevalence, 33%), comorbidity (23%), and undefined (44%). The childhood adversity class was characterized by adverse events and symptoms reported during childhood and it associated with depressive disorders. The comorbidity class was characterized by comorbid mental disorders, suicide attempts and substance abuse and associated with younger age and bipolar disorder. The undefined class formed no distinct profile; individuals in this class had the lowest number of adversities and it associated with psychotic disorders. CONCLUSIONS: The identification of subgroups characterized by childhood circumstances and comorbidity may help planning of prevention and support practices for young adults with mental disorders and risk of work disability.

Genome-wide scan of job-related exhaustion with three replication studies implicate a susceptibility variant at the UST gene locus.

Job-related exhaustion is the core dimension of burnout, a work-related stress syndrome that has several negative health consequences. In this study, we explored the molecular genetic background of job-related exhaustion. A genome-wide analysis of job-related exhaustion was performed in the GENMETS subcohort (n = 1256) of the Finnish population-based Health 2000 study. Replication analyses included an analysis of the strongest associations in the rest of the Health 2000 sample (n = 1660 workers) and in three independent populations (the FINRISK population cohort, n = 10 753; two occupational cohorts, total n = 1451). Job-related exhaustion was ascertained using a standard self-administered questionnaire (the Maslach Burnout Inventory (MBI)-GS exhaustion scale in the Health 2000 sample and the occupational cohorts) or a single question (FINRISK). A variant located in an intron of UST, uronyl-2-sulfotransferase (rs13219957), gave the strongest statistical evidence in the initial genome-wide study (P = 1.55 × 10(-7)), and was associated with job-related exhaustion in all the replication sets (P < 0.05; P = 6.75 × 10(-7) from the meta-analysis). Consistent with studies of mood disorders, individual common genetic variants did not have any strong effect on job-related exhaustion. However, the nominally significant signals from the allelic variant of UST in four separate samples suggest that this variant might be a weak risk factor for job-related exhaustion. Together with the previously reported associations of other dermatan/chondroitin sulfate genes with mood disorders, these results indicate a potential molecular pathway for stress-related traits and mark a candidate region for further studies of job-related and general exhaustion.

Return to work after depression-related absence by employees with and without other health conditions: a cohort study.

OBJECTIVE: Among employees with depression, diagnoses of other psychiatric and somatic conditions are common. However, few studies have examined whether the combined presence of depression and other psychiatric or somatic disorders adversely affects return to work after depression-related absence from work. METHODS: We examined the association of present and recent psychiatric and somatic conditions and return to work after depression-related absence in a cohort of 9908 Finnish public sector employees with at least one such episode. The data included a total of 14,101 episodes during the period January 2005 to December 2011. RESULTS: A total of 89% (n = 12,486) of depression-related absence episodes ended in return to work during the follow-up. For those episodes, the median length of absence was 34 days (interquartile range, 20-69 days). After adjustment for sex, age, socioeconomic status, and type of employment contract, present or recent psychiatric disorders other than depression (hazard ratio [HR] = 0.78, 95% confidence interval [CI] = 0.74-0.83), cancer (HR = 0.66, 95% CI = 0.47-0.92), diabetes (HR = 0.73, 95% CI = 0.62-0.86), cardiovascular disease (HR = 0.78, 95% CI = 0.62-0.99), hypertension (HR = 0.76, 95% CI = 0.67-0.85), musculoskeletal disorders (HR = 0.82, 95% CI = 0.77-0.87), and asthma (HR = 0.84, 95% CI = 0.75-0.94) were all associated with a lower likelihood of returning to work compared with depression episodes without other conditions. CONCLUSIONS: Among employees with depression-related absence, return to work is delayed in the presence of other psychiatric and somatic conditions. These findings suggest that other diseases should be taken into account when evaluating the outcome of depression-related absence. Randomized controlled trials are needed to examine whether integrated treatment of mental and physical disorders improves successful return to work after depression.

The role of psychiatric, cardiometabolic, and musculoskeletal comorbidity in the recurrence of depression-related work disability.

BACKGROUND: Comorbid psychiatric disorders, cardiovascular disease, chronic hypertension, diabetes, and musculoskeletal disorders are highly prevalent in depression. However, the extent to which these conditions affect the recurrence of depression-related work disability is unknown. The specific aims of the study were to investigate the extent to which comorbid other psychiatric disorders, cardiometabolic, and musculoskeletal conditions were associated with the recurrence of depression-related work disability among employees who had returned to work after a depression-related disability episode. METHODS: A cohort study of Finnish public sector employees with at least one depression-related disability episode during 2005-2011 after which the employee had returned to work (14,172 depression-related work disability episodes derived from national health and disability registers for 9,946 individuals). We used Cox proportional hazard models for recurrent events. RESULTS: Depression-related work disability recurred in 35% of the episodes that had ended in return to work from a previous episode, totaling 4,927 recurrent episodes among 3,095 (31%) employees. After adjustment for sex, age, socioeconomic status, and type of employment contract, comorbid psychiatric disorder (hazard ratio = 1.82, 95% CI 1.68-1.97), cardiovascular disease (1.39, 95% CI 1.04-1.87), diabetes (1.43, 95% CI 1.11-1.85), chronic hypertension (1.33, 95% CI 1.11-1.58), and musculoskeletal disorder (1.17, 95% CI 1.06-1.28) were associated with an increased risk of a recurrent episode compared to those without these comorbid conditions. CONCLUSIONS: Recurrence of depression-related work disability is common. Employees with comorbid psychiatric, cardiometabolic, or musculoskeletal conditions are at an increased risk of recurrent depression-related work disability episodes.

Resource-enhancing group intervention against depression at workplace: who benefits? A randomised controlled study with a 7-month follow-up.

OBJECTIVES: The aim of the present study was to investigate whether participation in a structured resource-enhancing group intervention at work would act as primary prevention against depression. The authors analysed whether the intervention resulted in universal, selected or indicated prevention. METHODS: A total of 566 persons participated in a prospective, within-organisation, randomly assigned field experimental study, which consisted of 34 workshops in 17 organisations. The participants filled in a questionnaire, were randomly assigned to either intervention (n=296) or comparison (n=324) groups and returned another questionnaire 7 months later. The intervention, lasting four half-day sessions, was delivered by trainers from occupational health services and human resources. The aim of the structured programme was to enhance participants' career management preparedness by strengthening self-efficacy and inoculation against setbacks. The comparison group received a literature package. The authors measured depressive symptoms using the short version of the Beck Depression Inventory. A high number of depressive symptoms (over 9 points) were used as a proxy for depression. RESULTS: At follow-up, the odds of depression were lower in the intervention group (OR=0.40, 95% CI 0.19 to 0.85) than in the comparison group when adjusted for baseline depressive symptoms, job strain and socio-demographics. In addition, the odds of depression among those with job strain (OR=0.15, 95% CI 0.03-0.81) at baseline were lower after the intervention. The intervention had no statistically significant effect on those with depressive symptoms (over 4 points) at baseline. CONCLUSION: The resource-enhancing group intervention appeared to be successful as universal and selective prevention of potential depression.

Living alone and antidepressant medication use: a prospective study in a working-age population.

BACKGROUND: An increasing proportion of the population lives in one-person households. The authors examined whether living alone predicts the use of antidepressant medication and whether socioeconomic, psychosocial, or behavioral factors explain this association. METHODS: The participants were a nationally representative sample of working-age Finns from the Health 2000 Study, totaling 1695 men and 1776 women with a mean age of 44.6 years. In the baseline survey in 2000, living arrangements (living alone vs. not) and potential explanatory factors, including psychosocial factors (social support, work climate, hostility), sociodemographic factors (occupational grade, education, income, unemployment, urbanicity, rental living, housing conditions), and health behaviors (smoking, alcohol use, physical activity, obesity), were measured. Antidepressant medication use was followed up from 2000 to 2008 through linkage to national prescription registers. RESULTS: Participants living alone had a 1.81-fold (CI = 1.46-2.23) higher purchase rate of antidepressants during the follow-up period than those who did not live alone. Adjustment for sociodemographic factors attenuated this association by 21% (adjusted OR = 1.64, CI = 1.32-2.05). The corresponding attenuation was 12% after adjustment for psychosocial factors (adjusted OR = 1.71, CI = 1.38-2.11) and 9% after adjustment for health behaviors (adjusted OR = 1.74, CI = 1.41-2.14). Gender-stratified analyses showed that in women the greatest attenuation was related to sociodemographic factors and in men to psychosocial factors. CONCLUSIONS: These data suggest that people living alone may be at increased risk of developing mental health problems. The public health value is in recognizing that people who live alone are more likely to have material and psychosocial problems that may contribute to excess mental health problems in this population group.

Students' school satisfaction as predictor of teachers' sickness absence: a prospective cohort study.

BACKGROUND: Although health is an important determinant of sickness absence, social relationships at the workplace may also affect levels of sick leaves. This study examined whether students' self-assessed satisfaction with school predicted sickness absence among teachers in Finnish secondary schools. METHODS: We measured school satisfaction of 17 033 students aged 14-16 years from 90 schools by a survey (the School Health Promotion Study) and aggregated school-specific scores of students' school satisfaction. For analysis, we linked these school-level data to records of sickness absence in the survey year and the following year among 2364 teachers working in the same schools (the 10-Town Study). For sickness absence longer than 9 days, we obtained diagnoses from national health registers. RESULTS: Multilevel Poisson and logistic regression models adjusted for relevant baseline covariates showed a rate ratio of 1.2 [95% confidence interval (95% CI): 1.0-1.5] for long-term (>3 days) sickness absence among teachers working in schools with two lowest thirds of student satisfaction compared with teachers in schools with high student satisfaction. The corresponding odds ratio (OR) was higher for sickness absence with a psychiatric diagnosis (OR 1.9, 95% CI: 1.1-3.2), more specifically, neurotic and stress-related disorders (OR 2.6, 95% CI: 1.2-5.9). Students' school satisfaction was not associated with teachers' short-term (1-3 days) sick leaves. CONCLUSIONS: These data suggest a link between social relationships at school, as indexed by students' school satisfaction, and teachers' sick leaves, with the strongest associations seen for absences with mental health diagnoses.

Socio-economic position and mental disorders in a working-age Finnish population: the health 2000 study.

BACKGROUND: Mental disorders are more common in people with lower socio-economic position (SEP) but it is not known which specific SEP component is most strongly linked to poor mental health. We compared the strength of associations of three SEP components-occupation, income and education-with common mental disorders in a Finnish population. METHODS: Cross-sectional analysis of a nationally representative sample of 4561 men and women aged 30-65 years. Mental disorders were assessed using the Composite International Diagnostic Interview resulting in 12-month DSM-IV diagnoses of depressive, anxiety and alcohol use disorders. Participants were classified as having low SEP if they worked in a manual occupation, lacked secondary-level education or had income below the Organisation for Economic Co-operation and Development (OECD) definition of relative poverty. RESULTS: In models comparing the simultaneous association of all three socio-economic indicators with mental disorders, low income was associated with increased risk for depressive disorder [odds ratio (OR)=1.73, 95% confidence interval (CI) =1.31-2.29] and anxiety disorder (OR=1.56, 95% CI 1.14-2.12). Manual occupational class was modestly associated with risk for alcohol use disorder (OR=1.44, 95% CI 1.06-1.95). Low income was the only socio-economic component associated with psychiatric comorbidity, that is, a combination of various disorders within the same individual (OR 2.26, 95% CI 1.52-3.37 for any combination). CONCLUSION: Low income seems to be a more important correlate of mental disorders than education or occupation in a high-income country such as Finland.

[Psychologic health effects of summer vacation and other leisure time]. / Kesäloman ja muun vapaa-ajan psyykkiset terveysvaikutukset.

Successful recovery from workload promotes well-being and functional capacity. It requires breaking away from work and restoration of resources used up at work. Even a short vacation is beneficial. Physical activity and performing tasks bringing self-pleasure will promote vacation effects towards well-being. The more loaded the worker, the longer is the necessary period of breaking away from work. Since the vacation effects towards well-being vanish quickly, it is good to allocate vacations throughout the year, taking care of having breaks and opportunities for recovery also during everyday life.

Overcrowding in psychiatric wards and physical assaults on staff: data-linked longitudinal study.

BACKGROUND: Patient overcrowding and violent assaults by patients are two major problems in psychiatric healthcare. However, evidence of an association between overcrowding and aggressive behaviour among patients is mixed and limited to small-scale studies. AIMS: This study examined the association between ward overcrowding and violent physical assaults in acute-care psychiatric in-patient hospital wards. METHOD: Longitudinal study using ward-level monthly records of bed occupancy and staff reports of the timing of violent acts during a 5-month period in 90 in-patient wards in 13 acute psychiatric hospitals in Finland. In total 1098 employees (physicians, ward head nurses, registered nurses, licensed practical nurses) participated in the study. The outcome measure was staff reports of the timing of physical assaults on both themselves and ward property. RESULTS: We found that 46% of hospital staff were working in overcrowded wards, as indicated by >10 percentage units of excess bed occupancy, whereas only 30% of hospital personnel were working in a ward with no excess occupancy. An excess bed occupancy rate of >10 percentage units at the time of an event was associated with violent assaults towards employees (odds ratio (OR) = 1.72, 95% CI 1.05-2.80; OR = 3.04, 95% CI 1.51-6.13 in adult wards) after adjustment for confounding factors. No association was found with assaults on ward property (OR = 1.06, 95% CI 0.75-1.50). CONCLUSIONS: These findings suggest that patient overcrowding is highly prevalent in psychiatric hospitals and, importantly, may increase the risk of violence directed at staff.

School neighborhood disadvantage as a predictor of long-term sick leave among teachers: prospective cohort study.

This ongoing prospective study examined characteristics of school neighborhood and neighborhood of residence as predictors of sick leave among school teachers. School neighborhood income data for 226 lower-level comprehensive schools in 10 towns in Finland were derived from Statistics Finland and were linked to register-based data on 3,063 teachers with no long-term sick leave at study entry. Outcome was medically certified (>9 days) sick leave spells during a mean follow-up of 4.3 years from data collection in 2000-2001. A multilevel, cross-classified Poisson regression model, adjusted for age, type of teaching job, length and type of job contract, school size, baseline health status, and income level of the teacher's residential area, showed a rate ratio of 1.30 (95% confidence interval: 1.03, 1.63) for sick leave among female teachers working in schools located in low-income neighborhoods compared with those working in high-income neighborhoods. A low income level of the teacher's residential area was also independently associated with sick leave among female teachers (rate ratio = 1.50, 95% confidence interval: 1.18, 1.91). Exposure to both low-income school neighborhoods and low-income residential neighborhoods was associated with the greatest risk of sick leave (rate ratio = 1.71, 95% confidence interval: 1.27, 2.30). This study indicates that working and living in a socioeconomically disadvantaged neighborhood is associated with increased risk of sick leave among female teachers.

[Burnout among health care professionals]. / Terveysammattilaisten työuupumus: erityisenä haasteena vuorovaikutus auttamistyössä.

Symptoms of burnout comprise exhaustion, cynicism, and diminished professional efficacy, as well as a feeling of impaired occupational achievement. Comprehensive Finnish studies have revealed that especially mild burnout is fairly common among clinicians and dentists. Burnout among clinicians accumulates to the public sector, to the early stages of the career, and to the specialties of psychiatry and radiology. Worker participatory methods aiming at the development of working conditions have yielded promising results in the prevention of burnout within the health care sector.

Predictors of employment in young adults with psychiatric work disability.

AIM: Mental disorders are the leading cause of work disability among young adults in the industrialized world. Factors predicting employment after long-term psychiatric work disability are largely unknown. METHODS: We linked personal and clinical information from the benefit applications and medical certificates of 1163 young adults (18-34 years) with a new-onset fixed-term psychiatric disability pension in 2008 with employment records between 2005 and 2013. The outcomes were starting employment during and being employed at the end of follow-up. RESULTS: Of the participants, 48% had been employed during and 22% were employed at the end of follow-up. Sustained employment history, university education (master's degree) and no recorded psychological symptoms in childhood were associated with both subsequent employment outcomes. Women and participants under 25 years were more likely to start employment. Depression and other mental disorders (vs psychotic diagnose) and having no comorbid mental disorders or substance abuse were associated with employment at the end of follow-up. CONCLUSIONS: Sustained employment history, university education and no recorded psychological symptoms during childhood predict a return to employment among young adults after a fixed-term psychiatric work disability pension. Pro-active interventions in psychological problems during childhood could enhance employment after a period of work disability.

Occupational burnout and medically certified sickness absence: a population-based study of Finnish employees.

OBJECTIVE: Occupational burnout is a common problem in working populations, but its association with sickness absence is poorly understood. The contribution of occupational burnout to medically certified sickness absence was examined in a population-based sample of employees. METHODS: A representative sample of 3151 Finnish employees aged 30-60 years participated in a comprehensive health study in 2000-2001, including an assessment of physician-diagnosed physical illnesses and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorders based on the Composite International Diagnostic Interview. Burnout was measured with the Maslach Burnout Inventory-General Survey. Sickness absences longer than 9 days in 2000-2001 were extracted from a register of the Social Insurance Institution of Finland. RESULTS: The occurrence of medically certified sickness absence was more prevalent among employees with burnout than among those without burnout. After adjusting for sociodemographic factors and mental and physical disorders, the odds ratio of sickness absence for severe burnout was 6.9 [95% confidence interval (95% CI)=2.7-17.8] for men and 2.1 (95% CI=1.1-4.0) for women. Among employees with mental or physical disorders, severe burnout was associated with a 7.7-fold risk of sickness absence among men and with a 2.6-fold risk among women. The duration of absence was related to burnout among men with absences, for whom severe burnout accounted for 52 excess sickness absence days during the 2-year period after adjusting for sociodemographic factors, mental disorders, and physical illnesses. CONCLUSIONS: Severe burnout is associated with a substantial excess risk of medically certified sickness absence among both men and women. This association is independent of prevalent mental disorders and physical illnesses.

Psychotherapeutic and vocational interventions among young adults with work disability due to mental disorders in Finland.

Backround: Little is known about treatment and rehabilitation received and planned among young adults with work disability due to a mental disorder. AIMS: To examine the implemented psychotherapeutic and vocational interventions and treatment plans among young adults with work disability due to a mental disorder. MATERIAL AND METHODS: Data were collected from medical records of young Finnish adults aged 18-34 with a long-term work disability history due to a mental disorder (N = 1163). The participant characteristics associated with four types of interventions were analyzed using log-binomial regression analysis. RESULTS: In total, 34% had participated in a psychotherapeutic intervention. Of the non-students, 26% had participated in vocational intervention. For 46% of the non-students, neither type of intervention was planned. Both implemented and planned psychotherapeutic interventions were associated with female sex, high education, attachment to employment, and absence of substance abuse. Low education and childhood adversity were associated with implemented vocational interventions and absence of substance abuse with planned vocational interventions. CONCLUSION AND SIGNIFICANCE: There is an unmet need for psychotherapeutic interventions among men, among those with lower socio-economic status, and among those with poor attachment to labor market. In addition, there is a lack of vocational interventions for those with high education. People with substance abuse are largely excluded from both types of interventions.