Childhood adversities predict strongly the use of psychotropic drugs in adulthood: a population-based cohort study of 24,284 Finns.

BACKGROUND: Exposure to adverse childhood experiences has been shown to be associated with negative health outcomes including mental health problems, but only a few studies with register-based data have used psychotropic drugs as an outcome variable. The purpose of this study is to examine whether adverse emotional childhood experiences, such as serious conflicts in the family and frequent fear of a family member, predict the use of psychotropic drugs in adulthood. In addition, the association of a child-parent relationship during childhood with the use of psychotropic drugs is studied. METHODS: The participants of the population-based Health and Social Support Study (24,284 working aged Finns) were followed up for 9 years. The information on childhood experiences and child-parent relationships was obtained from the questionnaires in 1998 and 2003. The number of psychotropic purchases (antipsychotics, drugs for bipolar disorder, antidepressants, anxiolytics, hypnotics and sedatives) was obtained from the National-Drug-Prescription-Register. Logistic and multinomial regression models were used. RESULTS: A graded association between childhood adversities and the use of psychotropic drugs was found, even after adjustments for occupational training, work status, recent life events and health behaviour. Frequent fear of a family member showed the strongest association: the OR for multiple use of antidepressants was 3.08 (95% CI 2.72 to 3.49) and 2.69 (2.27 to 3.20) for multiple use of anxiolytics. Use of psychotropic drugs was clearly increased among those with poor child-parent relationship and multiple childhood adversities. CONCLUSIONS: The results highlight the effect of environmental factors during childhood on mental health and the need for early recognition of families at risk.

Effect of smoking on use of antibacterials: a 9-year follow-up study of 24 000 working-aged Finns.

BACKGROUND: Previous studies indicate an association between tobacco smoking and infectious diseases. However, large population-based follow-up studies including both accurate measurements of smoking behaviour and confounders and a reliable register-based follow-up of infections are lacking. OBJECTIVE: To examine the effect of smoking on use of antibacterials as an indicator of infections among working-aged population. METHODS: The participants of the population-based Health and Social Support Study (24,283 working-aged Finns) were followed up for 9 years. Information on smoking behaviour and confounders was obtained from a questionnaire in 1998. Number of antibacterial purchases was obtained from the National-Drug-Prescription-Register. The association between smoking and use of antibacterials was analysed using multinomial regression models. RESULTS: A graded association between lifetime smoking as measured by pack-years and use of antibacterials was found. Compared with never-smokers, the age-adjusted OR for multiple use of antibacterials among smokers with 12 or more pack-years was 2.32 (95% CI 1.91 to 2.82) in women and 1.45 (95% CI 1.23 to 1.71) in men. The associations remained after adjustment for the following confounding factors: use of alcohol, body mass index, physical activity, socioeconomic status, hard physical work, life satisfaction, disability pension and dyspnoea. CONCLUSIONS: Smoking is associated with increased use of antibacterials. Infectious periods experienced by patients should be used as an opportunity to encourage smoking cessation.

Health-related and sociodemographic risk factors for disability pension due to low back disorders: a 30-year prospective Finnish Twin Cohort Study.

OBJECTIVES: To investigate health-related and sociodemographic risk factors for disability pensions (DP) due to low back disorders (LBD). METHODS: Questionnaire data in 1975 of the Finnish Twin Cohort Study with record linkage to information on DP due to LBD from the official pension registers during follow-up 1975 to 2004 was analyzed with Cox proportional hazard models. RESULTS: Musculoskeletal pain (Hazards Ratio [HR] = 2.36 to 2.39; 95% CI 1.97 to 2.88), smoking (HR = 1.82; 1.49 to 2.22), frequent analgesics use (HR = 1.67; 1.38 to 2.02), and presence of other chronic disease (HR = 1.44; 1.22 to 1.70) increased the risk for DP due to LBD. Years of education decreased the risk (HR = 0.81; 0.77 to 0.85). Associations remained significant when adjusted for familial background. CONCLUSIONS: Health-related and sociodemographic risk factors for DP due to LBD can be identified early in life, and they seem independent from familial effects.

The burden of symptoms predicts early retirement: a twin cohort study on fibromyalgia-associated symptoms.

OBJECTIVE: To assess whether symptoms of fibromyalgia (FM) predict disability retirement or mortality. METHODS: All Finnish Twin Cohort members and diagnosed FM-patients who had answered the same health questionnaire in 1990-1992 were studied. A sample of 10,608 working aged individuals of the cohort was classified in homogenous groups based on symptom profile with latent class analysis, using a battery of questions addressing FM-associated symptoms validated between FM-patients and twins. This resulted in three classes: no or few symptoms (LC1), some symptoms (LC2), and high load of FM-symptoms (LC3). In a 14-year follow-up, 1990-2004, information on disability retirement was obtained from official pension registers. Further linkage with Population Register Centre data for 1990-2009 yielded information on the vital status of the cohort subjects. Those with malignancies or inflammatory rheumatic diseases were excluded. RESULTS: Cumulative incidence of early disability retirement was 9.5% among all 8448 individuals (after exclusions), and 26% in LC3. Adjusted hrs for early retirement were 1.0 (reference class) in LC1, 1.5 (95%CI 1.2-1.7) in LC2, and 2.9 (2.4-3.6) in LC3 for all causes and 1.8 (1.4-2.5) in LC2 and 5.0 (3.6-6.9) in LC3 for musculoskeletal disorders. In 173,675 person-years, the high symptom class (LC3) had a 43% (95% CI 17-75%) increased overall mortality risk, which was fully accounted for by adjustment for lifestyle factors, mainly smoking. CONCLUSION: Symptoms associated with FM strongly correlate with early disability retirement. Lifestyle problems associated with high symptom load need prompt management to avoid increased risk of mortality.

Childhood adversities and quality of sleep in adulthood: A population-based study of 26,000 Finns.

OBJECTIVE: To find out if childhood adversities predict poor sleep quality in working age. METHODS: Survey data from the Health and Social Support (HeSSup) study was used (N=25,605, 59% women). Negative childhood adversities and quality of sleep in adulthood were assessed by the questionnaire in 1998. Multinomial regression models were used. RESULTS: A graded association between childhood adversities and the quality of sleep in adulthood was found. Odds ratio (OR) of poor quality of sleep for those with multiple childhood adversities (3-6) was 3.64 (95% CI 2.94-4.50). The association between childhood adversities and the quality of sleep remained significant after adjustments for work status, use of psychotropic drugs, health behaviours, recent life events and child-parent relationships. Poor quality of sleep was clearly increased among those with both poor child-mother (OR 10.4, 95% CI 6.73-16.07) or poor child-father (OR 5.4, 95% CI 3.89-7.50) relationships and multiple childhood adversities. In the analyses of specific childhood adversities, frequent fear of a family member and serious conflicts in the family showed the strongest associations. CONCLUSIONS: The strong association between childhood adversities and the quality of sleep in adulthood highlights the importance of early life circumstances on adult health. Early stage recognition, prevention and supportive measures against childhood adversities and serious family conflicts should be promoted.