What characterizes persons with poor mental health? A nationwide study in Denmark.

BACKGROUND: The aim of the study was to identify and characterize groups with poor mental health defined by the SF-12 Mental Component Summary (MCS-12) scale. METHODS: The study is based on the Danish Health and Morbidity Survey 2005 and includes 10,082 participants (16 years or older). Data were analysed by means of logistic regression models. RESULTS: Men and women with poor mental health are characterized by being single, having a long-term illness, not being able to rely on help from others in case of illness and by feeling that family and friends demand too much of them. Men with poor mental health were further characterized by being a heavy smoker, and having a BMI below 25. Women with poor mental health were further characterized by being 16-44 years old and sedentary in leisure time. CONCLUSIONS: The prevalence of poor mental health is higher among women than men, and different factors characterize men and women with poor mental health. The present findings support the notion that both socio-demographics and lifestyle factors are independently related with poor mental health. We suggest taking into account all these areas of life when planning activities to prevent poor mental health and when promoting mental health.

The Danish National Cohort Study (DANCOS).

INTRODUCTION: The Danish National Cohort Study (DANCOS) is a nationally representative public health survey based on linkage of information in the repeated Danish Health Interview surveys, 1986-2005, to the national Danish registers on health and welfare. It facilitates studies of self-reported health behaviour and utilisation of healthcare services by subgroups and analysis of non-response bias. RESEARCH TOPICS: DANCOS data are utilised in a variety of analyses presented here by a few examples that emphasise the impact of modifiable risk factors on public health, description of non-response bias, and the epidemiology of chronic pain and of osteoarthritis. Examples of DANCOS-based results are shown for each of the four topics. Smoking results in 24% of all deaths and, compared to other risk factors for public health, smoking accounts for the highest number of years of life lost. For non-response the mortality is higher among non-respondents than among respondents, but no significant bias on healthcare estimates can be seen. On average individuals with chronic pain had 12.8 contacts per year to the primary healthcare sector compared with 7.3 for individuals without. For osteoarthritis it is estimated that in 2020 there will be 22,600 incident cases. CONCLUSION: DANCOS is a public health survey linked with registers with many research possibilities. With this article we hope to stimulate further interest in the survey.

Readiness to change level of physical activity in leisure time among physically inactive Danish adults.

AIMS: The study examined readiness to change the level of physical activity in leisure time among physically inactive adults, the sociodemographic, lifestyle-related and social factors associated with readiness to change, and finally the various kinds of help to become more physically active required by people who are ready to change and by those not ready to change. MATERIALS AND METHODS: Data were derived from the national representative Danish Health Interview Survey 2005 and included 9,160 physically inactive persons between 16 and 79 years of age. Data were analysed using multiple logistic regression and multiple correspondence analysis. RESULTS: In all, 52 % of the physically inactive respondents stated they were ready to change their level of physical activity. Men had higher odds of being ready to change than women. Readiness to change decreased with age and increased with increasing levels of education. Those ready to change led an active and social lifestyle characterized by considerable health-oriented engagement, while the opposite characterised those not ready to change. Those ready to change wanted help to become more physically active in the form of e.g. opportunities for physical activity at work or help and support from the family. Those not ready to change wanted help from a general practitioner or did not want help at all. CONCLUSIONS: Those ready to change and those not ready to change were characterized by very different sociodemographic, lifestyle-related and social factors. This knowledge will benefit prevention initiatives and elucidates the necessity of targeting the initiatives.

Agreement between self-reported data on medicine use and prescription records vary according to method of analysis and therapeutic group.

OBJECTIVE: This study compared national self-reported data on medicine use and national prescription records at the individual level. STUDY DESIGN AND SETTING: Data from the nationally representative Danish health survey conducted in 2000 (n=16,688) were linked at the individual level to national prescription records covering 1999-2000. Kappa statistics and 95% confidence intervals were calculated. RESULTS: Applying the legend time method to medicine groups used mainly on a chronic basis revealed good to very good agreement between the two data sources, whereas medicines used as needed showed fair to moderate agreement. When a fixed-time window was applied for analysis, agreement was unchanged for medicines used mainly on a chronic basis, whereas agreement increased somewhat compared to the legend time method when analyzing medicines used as needed. CONCLUSION: Agreement between national self-reported data and national prescription records differed according to method of analysis and therapeutic group. A fixed-time window is an appropriate method of analysis for most therapeutic groups.

Six year follow-up of health status changes in Danish adults with suicide tendency in 1994.

The purpose of this study was to determine whether suicidal ideation and/ or suicide attempts have any long-term health effects. The relationship between suicidal thoughts and/or a previous suicide attempt in 1994 and the presence of suicidal ideation in 2000 was analyzed. We found that health status in 1994 differed significantly between the groups with and without suicidal ideation or a previous suicide attempt and that the differences persisted or even deepened (not significant) after 6 years. Further, people who had suicidal ideation or a suicide attempt in 1994 had a significantly greater risk (OR = 7.4) of having suicidal ideation in 2000 than people who had not.

Indicators associated with suicidal ideation and suicide attempts among 16-35-year-old Danes: a national representative population study.

In this study indicators associated with suicidal ideation and suicide attempts in a nationwide representative sample (N=3184) of Danes aged 16-35 years were examined. The study was cross-sectional and had three aims: (1) to draw a profile of persons with and without suicidal tendency established on a combined quartered variable on current suicidal thoughts and/or ever attempted suicide; (2) to explore whether the different suicidal tendencies constitute a severity continuum; and (3) to identify factors of significance for suicidal tendency. Factors included were demographic characteristics, living conditions, social network, external health risks, lifestyle, health-related quality of life, symptoms, morbidity, and illness behavior. A continuum hypothesis was not supported, as the multiple logistic regression analysis showed no clear gradient in the different forms of suicidal tendency. Cohabitation status (single, p < 0.0001), exposure to violent threats (p < 0.0001), exposure to sexual abuse (p < 0.0001), being a daily smoker (p < 0.0001), doing nothing to stay healthy (p < 0.0004), poor mental health (p < 0.0001), mental symptoms within the past 2 weeks (p = 0.0003), contact with psychologist (p < 0.0001), and absence from work due to illness (p = 0.005) were indicators significantly related to suicidal tendency.

Measuring well-being rather than the absence of distress symptoms: a comparison of the SF-36 Mental Health subscale and the WHO-Five Well-Being Scale.

The health status questionnaire Short-Form 36 (SF-36) includes subscales measuring both physical health and mental health. Psychometrically, the mental health subscale contains a mixture of mental symptoms and psychological well-being items, among other things, to prevent a ceiling effect when used in general population studies. Three of the mental health well-being items are also included in the WHO-Five well-being scale. In a Danish general population study, the mental health subscale was compared psychometrically with the WHO-Five in order to evaluate the ceiling effect. Tests for unidimensionality were used in the psychometric analyses, and the sensitivity of the scales in differentiating between changes in self-reported health over the past year has been tested. The results of the study on 9,542 respondents showed that, although the WHO-Five and the mental health subscale were found to be unidimensional, the WHO-Five had a significantly lower ceiling effect than the mental health subscale. The analysis identified the three depression symptoms in the mental health subscale as responsible for the ceiling effect. The WHO-Five was also found to be significantly superior to the mental health subscale in terms of its sensitivity in differentiating between those persons whose health had deteriorated over the past year and those whose health had not. In conclusion, the WHO-Five, which measures psychological well-being, reflects aspects other than just the absence of depressive symptoms.

Do age and social relations moderate the relationship between self-rated health and mortality among adult Danes?

It is well established that self-rated health (SRH) predicts mortality even after controlling for a wide range of factors. We explored the extent to which age and social relations (structural and functional) influenced the relationship between SRH and mortality (after 13 years follow-up) in a representative sample of adult Danes (N=6693). After controlling for socioeconomic status, illness, and lifestyle variables, we found that age moderated the SRH-mortality relationship such that it was present for respondents under 55 but absent for respondents over 56. In addition, weaker structural (but not functional) social relations increased mortality directly but neither structural nor functional social relations moderated the SRH-mortality relationship. We discuss the theoretical and practical implications of these findings.

Self-reported oral hygiene practices among adults in Denmark.

OBJECTIVES: To assess the present level of oral hygiene practices in the Danish adult population aged 16 or above, in particular to analyse how self-care practices in terms of oral hygiene habits and cleaning of dentures are affected by socio-economic factors, dental status, actual dental visiting habits, and the experience of oral health care during school years. BASIC RESEARCH DESIGN AND PARTICIPANTS: A cross-sectional study of 5802 persons, randomly sampled amongst the Danish population aged 16 years or above. Data were collected by means of personal interviews and self-administered questionnaires. The response rate was 66%. RESULTS: Toothbrushing twice-a-day was reported by 68% of the dentates while 32% brushed their teeth once-a-day or less frequent. Daily use of toothpicks was reported by 28% while daily use of dental floss was reported by 11%. Oral hygiene habits were more frequent amongst women. Toothbrushing twice-a-day was related to regular dental visits, dental care during school years, and a high level of education. Daily use of toothpicks was more common among females and older persons. Regular dental visits, having 20 or more teeth in situ, and regular dental service through school years were predictors for daily use of toothpicks. Amongst denture wearers, one-third cleaned their dentures twice-a-day. Frequency of denture cleaning was significantly associated with gender, age, number of teeth left, and educational level. CONCLUSION: Intensive population-directed strategies for oral health education should be considered in order to further improve the oral hygiene practices of the entire population.

Changing dentate status of adults, use of dental health services, and achievement of national dental health goals in Denmark by the year 2000.

OBJECTIVES: This study analyzes the current profile of dentate status and use of dental health services among adults in Denmark at the turn of the millennium, assesses the impact on dentate status of sociodemographic factors and use of dental health services in adulthood and in childhood, and highlights the changes over time in dental health conditions among adults. Finally, the intention of the study was to evaluate the Danish dental health care system's level of achievement of the official goals for the year 2000 as formulated by the World Health Organization and the National Board of Health. The subjects of this study included a national representative sample of 16,690 Danish citizens aged 16 years and older (response rate=74.2%). A subsample (n=3,818) took part in a survey of dental care habits in childhood and prevalence of removable dentures; 66 percent of persons selected responded. METHODS: Personal interviews were used to collect information on dentate status, use of dental health services and living conditions; data on dental care habits in childhood and prevalence of removable dentures were collected by self-administered questionnaires. RESULTS: In all, 8 percent of interviewed persons were edentulous, while 80 percent had 20 or more natural teeth. At age 65-74 years, 27 percent were edentulous and 40 percent had 20 teeth or more; 58 percent wore removable dentures. Dentate status and prevalence of dentures were highly related to educational background and income, particularly for older age groups. Among persons interviewed, 80 percent paid regular dental visits and visits were most frequent among persons of high education and income. At age 35-44 years 95 percent had participated in regular dental care in childhood compared to 49 percent of 65-74-year-olds. Multivariate analyses revealed that sociobehavioral factors had significant effects on dentate status. CONCLUSIONS: Compared to similar studies carried out in 1987 and 1994, the present survey indicates a positive trend of improved dentate status in adult Danes in general and regular use of dental health services increased considerably over time. The WHO goals for better dental health by the year 2000 were achieved for 35-44-year-olds, whereas the goal of more people with functional dentitions at age 65 years or older was not achieved. It remains a challenge to the Danish dental health system to help even out the social inequalities in dental health.

Social gradient in life expectancy and health expectancy in Denmark.

OBJECTIVES: Health status of a population can be evaluated by health expectancy expressed as average lifetime in various states of health. The purpose of the study was to compare health expectancy in population groups at high, medium and low educational levels. METHODS: Health interview data were combined with life table figures using Sullivan's method. RESULTS: Life expectancy was 4.3 years longer for 30-year-old men with a high educational level than for those with a low level. At age 30, the proportion of expected lifetime in self-rated good health was 67.7%, 76.1% and 82.3% for men with a low, medium and high educational level, respectively. Among women, life expectancy differed by 2.7 years between low and high educational level, and the proportion of expected lifetime in self-rated good health was 62.5% at the low and 80.5% at the high educational level. CONCLUSIONS: Educational level and life expectancy are clearly related. The social gradient in terms of health expectancy is even greater than that in terms of life expectancy.

[Children with ear disorders who are treated by reflexologists or general practitioners]. / Børn, der på grund af ørelidelser bliver behandlet af zoneterapeut henholdsvis praktiserende laege.

INTRODUCTION: The aim of the study was to describe similarities and differences in health, quality of life, and diagnosed morbidity in 0-6 year-old children whose parents contact either a reflexologist or a general practitioner (GP) due to their child's ear disorder. MATERIAL AND METHODS: A total of 98 children who received reflexology treatment and 57 children who received treatment by a GP were included. Reflexologists and GPs described the child's symptoms, the parents completed a questionnaire about health status and ear disorders and a specialist examined and diagnosed the child. RESULTS: The most prevalent symptoms were colds and troubled sleep and the least prevalent were inflammation of the throat and poor spoken language. Parents in the reflexology group considered their children to be more ill than parents in the GP group (measured by number of ear disorders, number of antibiotic treatments, number of sickness days during the past year and the duration of the acute ear disorder). Furthermore, parents in the reflexology group reported that their children had more physical discomfort, more activity limitations and more emotional problems than children treated by GPs and the parents themselves were also more troubled by the ear disorder. The specialist examination showed no differences between the two groups of children, neither according to tympanometry nor according to diagnosis. DISCUSSION: According to a medical evaluation there was no difference in morbidity between children treated by a reflexologist and a GP. According to the parents' evaluation, children in reflexology treatment were more ill and their health-related quality of life was more affected by the ear disorder than that of children treated by a GP.

[Disability-free life expectancy among 60-year-olds in Denmark]. / Tresårige danskeres forventede levetid uden funktionsindskraenkning.

INTRODUCTION: Life expectancy can be expressed as average expected lifetime in different health states. The purpose of the study was to estimate disability-free life expectancy, i.e. average lifetime without disabilities, in Denmark and in the counties of Denmark and evaluate the relation between life expectancy and the proportion of disability-free life expectancy. MATERIAL AND METHODS: Prevalence rates of disability (in terms of walking, walking on stairs, carrying 5 kg, reading, hearing and speaking) derived from the Danish Health Interview Survey 2000 were combined with life-table data and disability-free life expectancy was calculated by Sullivan's method. RESULTS: In 2000 expected lifetime of 60-year-old men and women was 18.8 years and 22.0 years respectively and disability-free life expectancy was 14.7 years for both sexes corresponding to 78.4% and 66.6% of the remaining lifetime for men and women respectively. Differences in disability-free life expectancy between counties ranged from zero to three years. In counties with the highest life expectancy among women they tended to have a higher proportion of life years with disabilities, but there was no correlation between life expectancy and the proportion of disability-free life expectancy for men. DISCUSSION: The results may illustrate theories about the relation between increased lifetime and quality of life in terms of health. Increased total lifetime for women prolongs the proportion of expected lifetime with disability ("expansion of morbidity"), whereas for men no correlation was found ("dynamic equilibrium").

Change in the prevalence of obesity and use of health care in Denmark: an observational study.

PURPOSE: The purpose of this study was to examine the influence of the increasing prevalence of obesity on the development of health care utilization in Denmark in the period 1987-2005. PATIENTS AND METHODS: From a random sample of adult Danes (19,142 women and 18,335 men) who participated in the Danish Health Interview Surveys in 1987, 1994, 2000, and 2005, self-reported data on type of health care utilization within the previous 3 months and on height and weight were obtained. RESULTS: Adjusted odds ratios (ORs) showed that an increased use of health care among obese men compared with those of normal weight was pronounced and significant for those aged 45-64 years, whereas it was weaker and borderline significant for those aged 25-44 and 65+ years. Among obese men, there was an increasing use of health care until 2005. Among women, there was also an increased use of health care among the obese women in comparison with the normal weight women. An increase in the use of health care was found among obese women during 1987-2000, followed by a leveling of utilization during 2000-2005. CONCLUSIONS: In conclusion, this study showed that the increase in health care utilization in Denmark could, in part, be attributed to an increase in prevalence of obesity and to an increase in health care utilization among obese men in particular.

Obesity and prevalence of risk behaviour for eating disorders among young Danish women.

AIMS: Danish women aged 16-29 from two nationwide, representative, cross-sectional interview/questionnaire surveys from 2000 and 2005 are analyzed for trends in prevalence of risk behaviour for developing eating disorders and associations to BMI and age. METHODS: Participants completed the Danish Health Interview Survey and an 8-item screen, RiBED-8, for risk behaviour for eating disorders. To analyze how the prevalence of risk behaviour depends on age, BMI, and year of survey, logistic regression analyses were applied. On acceptance of no interaction, the effect of each variable was tested and described using odds ratios with 95% confidence intervals. RESULTS: Women aged 16-19 or with a BMI of>25 had the greatest chance of reporting risk behaviour for eating disorders. However, many women in their 20s also had risk behaviour. Prevalence of risk behaviour for eating disorders did not change from 2000 to 2005. CONCLUSIONS: The shared risk factors for obesity and eating disorders require further investigation for development of collaborative prevention and treatment strategies that should also be directed towards young women in their 20s as well as young teenagers.