Association of medication clusters and subsequent labor market marginalization in refugee and Swedish-born young adults with common mental disorders in Sweden.

Little is known about the association between common mental disorders (CMD) and labor market integration among refugee and Swedish-born young adults. Socially disadvantaged patients such as refugees are more likely to discontinue their medication use prematurely. This study aimed to identify clusters of individuals with similar psychotropic medication patterns; and examine the relationship between cluster membership with labor market marginalization (LMM) in refugee and Swedish-born young adults with CMD. The study uses a longitudinal matched cohort aged 18-24 years with CMD diagnoses from Swedish registers covering 2006-2016. Dispensed psychotropic medications (antidepressants, antipsychotics, anxiolytics, sedative-hypnotics, mood stabilizers) were collected one year before and after CMD diagnosis. Clusters of patients with similar time courses of prescribed dosages were algorithmically identified. The association of cluster membership with subsequent LMM, (long-term sickness absence, SA, disability pension, DP, or long-term unemployment, UE) was assessed using Cox regression. Among 12,472 young adults with CMD, there were 13.9% with SA, 11.9% with DP, and 13.0% with UE during a mean follow-up of 4.1 years (SD 2.3 years). Six clusters of individuals were identified. A cluster with a sustained increase in all medication types yielded the highest hazard ratio (HR [95% CI]) 1.69 [1.34, 2.13] for SA and 2.63 [2.05, 3.38] for DP. The highest HRs of UE give a cluster with a concentrated peak in antidepressants at CMD diagnosis (HR 1.61[1.18, 2.18]). Refugees and Swedish-born showed similar associations between clusters and LMM. To prevent LMM, targeted support and early assessment of CMD treatment are needed for individuals with a sustained increase in psychotropic medication after CMD diagnosis and for refugees in high-risk clusters for UE characterized by a rapid lowering of treatment dosages, which could be an indicator for premature medication discontinuation.

Mental health over nine months during the SARS-CoV2 pandemic: Representative cross-sectional survey in twelve waves between April and December 2020 in Austria.

BACKGROUND: There is accumulating evidence about detrimental impacts of the pandemic on population mental health, but knowledge on risk of groups specifically affected by the pandemic and variations across time is still limited. METHODS: We surveyed approximately n=1,000 Austrian residents in 12 waves between April and December 2020 (n=12,029). Outcomes were suicidal ideation (Beck Suicidal Ideation Scale), depressive symptoms (Patient Health Questionnaire-9), anxiety (Hospital Anxiety Depression Scale), and domestic violence. We also assessed the perceived burden from the pandemic. Demographic and Covid-19 specific occupational and morbidity-related variables were used to explain outcomes in multivariable regression analyses, controlling for well-established risk factors of mental ill-health, and variations over time were analyzed. RESULTS: Young age, working in healthcare or from home, and own Covid-19 illness were consistent risk factors controlling for a wide range of known mental health risk factors. Time patterns in the perceived burden from Covid-19-related measures were consistent with the time sequence of restrictions and relaxations of governmental measures. Depressive and anxiety symptoms were relatively stable over time, with some increase of depression during the second phase of lockdowns. Domestic violence increased immediately after both hard lockdowns. Suicidal ideation decreased slightly over time, with a low during the second hard lockdown. Mental health indicators for women and young people showed some deterioration over time, whereas those reporting own Covid-19 illness improved. LIMITATIONS: Data from before the pandemic were not available. CONCLUSIONS: Among mental health outcomes, increases in domestic violence and, to some smaller extent, depressive symptoms, appeared most closely related to the timing of hard lockdowns. Healthcare staff, individuals working from home, those with Covid-19, as well as young people and women are non-traditional risk groups who warrant heightened attention in prevention during and in the aftermath of the pandemic.

Effects of media stories featuring coping with suicidal crises on psychiatric patients: Randomized controlled trial.

BACKGROUND: Accumulating evidence suggests beneficial effects of media stories featuring individuals mastering their suicidal crises, but effects have not been assessed for psychiatric patients. METHODS: We randomized n = 172 adult psychiatric patients (n = 172, 97.1% inpatients) to read an educative article featuring a person mastering a suicidal crisis (n = 92) or an unrelated article (n = 80) in a single-blind randomized controlled trial. Questionnaire data were collected before (T1) and after exposure (T2) as well as 1 week later (study end-point, T3). The primary outcome was suicidal ideation as assessed with the Reasons for Living Inventory; secondary outcomes were help-seeking intentions, mood, hopelessness, and stigmatization. Differences between patients with affective versus other diagnoses were explored based on interaction tests. RESULTS: We found that patients with affective disorders (n = 99) experienced a small-sized reduction of suicidal ideation at 1-week follow up (mean difference to control group [MD] at T3 = -0.17 [95% CI -0.33, -0.03], d = -0.15), whereas patients with nonaffective diagnoses (n = 73) experienced a small-sized increase (T2: MD = 0.24 [95% CI 0.06, 0.42], d = 0.19). Intervention group participants further experienced a nonsustained increase of help-seeking intentions (T2: MD = 0.53 [95% CI 0.11, 0.95], d = 0.19) and a nonsustained deterioration of mood (T2: MD = -0.14 [95% CI -0.27, -0.02], d = -0.17). CONCLUSIONS: This study suggests that patients with affective disorders appear to benefit from media materials featuring mastery of suicidal crises. More research is needed to better understand which patient groups are at possible risk of unintended effects.

Adolescents' Perspective on Their Sexual Knowledge and the Role of School in Addressing Emotions in Sex Education: An Exploratory Analysis of Two School Types in Austria.

Sex education for adolescents should include building knowledge on the emotional, social and physical aspects of sexuality. This study aimed to find out how adolescents from two different school types perceived their own knowledge on sexual matters, the importance they placed on sex education in school, and how well they felt that emotional, social and physical issues were raised within the frame of sex education. A cross-sectional 74-item questionnaire survey was conducted among adolescents (n = 198, age 13-16 years) from two secondary schools and one polytechnic school in Austria. From the linear regression analyses, secondary school students felt more knowledgeable on sexual matters than polytechnic students (beta = -0.288, p = .005). Secondary school students had more knowledge on the biology of sexuality but were less informed of the emotional aspects and other topics masturbation [mean score (SD)] [2.42(1.24) vs 3.42(1.44); p < .001], forms of sexual contact [2.81(1.08) vs 3.54(1.22), p = .006] and dealing with love and sexual feelings in relationships [2.68(1.19) vs 3.33(2.60); p = .030] than polytechnic students. While teachers were considered important providers of sex education, a more varied and practical means of learning was desired. Sex education should allow for the interplay between fact and emotion using varied teaching and learning strategies.

Period effects in the risk of subsequent labour market marginalisation in young suicide attempters.

Background: Suicide attempt in young age is associated with subsequent labour market marginalisation, but little is known about how marginalisation is affected by changes in suicide attempt rates and social insurance legislation and by age differences. Methods: Prospective cohort study based on register linkage of > 2.4 million Swedish residents per birth cohort, aged 19-40 years in 1999; 2004 and 2009, respectively, and followed up for 4 years. Suicide attempters treated in inpatient care in the three years preceding study entry (n > 7000 per cohort) were compared with the general population of the same age without attempt (1987 to end of follow-up). Hazard ratios (HR) and 95% confidence intervals for long-term unemployment (>180 days), sickness absence (>90 days) and disability pension were calculated with Cox regression, adjusted for several risk markers. Additional analyses were stratified by age (below/above 30 years). Results: Across all cohorts, suicide attempt was associated with subsequent labour market marginalisation. Estimates were generally highest for disability pension [e.g. 2009 cohort: adjusted (a) HR = 2.7], followed by sickness absence (2009 cohort: aHR = 2.3) and unemployment (2009 cohort: aHR = 1.5). aHRs were higher in the 2004 and 2009 cohorts compared with the 1999 cohort. For disability pension, for example, aHRs were 2.39, 3.90 and 2.68 for the 1999, 2004 and 2009 cohorts, respectively. Stratification revealed marginal age differences. Conclusion: It seems to have become more difficult for suicide attempters to establish themselves on the labour market in later cohorts, which might result from changes in social insurance regulations. There were no considerable age differences.

Labour market marginalisation subsequent to suicide attempt in young migrants and native Swedes.

PURPOSE: This study aimed to compare young individuals who differed in terms of birth region and history of suicide attempt regarding socio-demographic and healthcare factors, and with regard to their risks of subsequent unemployment, sickness absence and disability pension. METHODS: Prospective cohort study based on register linkage of 2,801,558 Swedish residents, aged 16-40 years in 2004, without disability pension and with known birth country, followed up 2005-2011. Suicide attempters treated in inpatient care during 2002-2004 (N = 9149) were compared to the general population of the same age without attempt 1987-2011 (N = 2,792,409). Hazard ratios (HR) and 95% confidence intervals (CIs) for long-term unemployment (>180 days), sickness absence (>90 days), and disability pension were calculated with Cox regression, adjusted for several risk markers. RESULTS: Compared to Swedish natives with suicide attempt, migrants of non-Western origin with attempt received less specialised mental healthcare. Distinct differences between native Swedes and migrants were present for the three labour market outcomes, but differences between migrant subgroups were inconsistent. As compared to native Swedes without attempts, non-European migrants with suicide attempt had adjusted HRs and CIs for subsequent unemployment 2.8 (2.5-3.1), sickness absence 2.0 (1.7-2.3) and disability pension 2.2 (1.8-2.6). Respective estimates for natives with suicide attempt were 2.0 (1.9-2.1); 2.7 (2.6-2.9) and 3.4 (3.2-3.6), respectively. CONCLUSIONS: Migrant suicide attempters receive less specialised mental health care before their attempt than native Swedes, and their marginalzation patterns are different. Healthcare and policy makers need to take the differential risk profile for migrant and native populations into account.

Predictors of psychological improvement on non-professional suicide message boards: content analysis.

BACKGROUND: Suicide message boards have been at the core of debates about negative influences of the Internet on suicidality. Nothing is currently known about communication styles that may help users to psychologically improve in these settings. METHOD: In all, 1182 archival threads with 20 499 individual postings from seven non-professional suicide message boards supporting an 'against-suicide', 'neutral' or 'pro-suicide' attitude were randomly selected and subject to content analysis. Initial needs of primary posters (i.e. individual who open a thread), their psychological improvement by the end of the thread, their responses received and indicators of suicidality were coded. Differences between 'pro-suicide', 'neutral' and 'against suicide' boards, and correlations between primary posters and respondents in terms of suicidality were assessed. Logistic regression was used to test associations with psychological improvement. RESULTS: 'Pro-suicide' boards (n = 4) differed from 'neutral' (n = 1) and 'against-suicide' (n = 2) boards in terms of communicated contents. Indicators of suicidality correlated moderately to strongly between primary posters and respondents on 'pro-suicide' message boards, but less on other boards. Several communicative strategies were associated with psychological improvement in primary posters, including the provision of constructive advice [adjusted odds ratio (aOR) 4.10, 95% confidence interval (CI) 2.40-7.03], active listening (aOR 1.60, 95% CI 1.12-2.27), sympathy towards the poster (aOR 2.22, 95% CI 1.68-2.95) and provision of alternatives to suicide (aOR 2.30, 95% CI 1.67-3.18). CONCLUSIONS: Respondents resemble primary posters with regard to suicidality in 'pro-suicide' boards, which may hinder psychological improvement. Still, opportunities to intervene in these settings using simple communication techniques exist and need to be taken and evaluated.

Understanding weekly cycles in suicide: an analysis of Austrian and Swiss data over 40 years.

BACKGROUND: Seasonal as well as weekly cycles in suicide have been described, replicated and poorly understood for a long time. In Western countries, suicides are typically least frequent on weekends and most frequent on Mondays and Tuesdays. To improve understanding of this phenomenon a strategy is required which focuses on anomalous findings beyond the regular patterns. Here, we focused on instances where the weekly suicide patterns disappear or are interrupted. METHODS: We used data from Swiss and Austrian mortality statistics for the periods 1969-2010 and 1970-2010, respectively. First, the data were cross-tabulated by days of the week and the available socio-demographic information (sex, age, religious affiliation and region). Second, time series of cumulated daily frequencies of suicide were analysed by seasonal Autoregressive Integrated Moving Average (ARIMA) models which included intervention effects accounting for Easter and Pentecost (Whit) holidays. RESULTS: First, the cross tabulations showed that weekly cycles may be smoothed above all in young persons and smoothed in drowning, jumping and car gas exhaustion suicides. Second, the ARIMA analyses displayed occasional preventive effects for holidays Saturdays and Sundays, and more systematic effects for holiday Mondays. There were no after effects on Tuesdays following holiday Mondays. CONCLUSIONS: In general, the weekend dip and the Monday backlog effect in suicide show striking similarities to the Advent season effect and are interpretable within the same template. The turning points between low and high frequencies possibly provide promising frames for the timing of prevention activities.

Socio-economic determinants of health behaviours across age groups: results of a cross-sectional survey.

BACKGROUND: The aim of this study was to analyse the impact of different socio-economic variables on the lifestyle factors, like lack of physical activity, diet rich in meat, and smoking, across sex and age groups in the general Austrian population to formulate more targeted public health measures. METHODS: The Austrian Health Interview Survey 2006-07 contains data of 15,474 people, representative for the general population. Statistical analyses included linear and logistic regression models. RESULTS: Lack of physical activity was more prevalent in women, while unhealthy nutrition and daily smoking were more prevalent in men. Overall, profession was the strongest predictor for health behaviour in men, while the educational level played the most significant role in women. Subjects in higher age groups had a more healthy nutrition and were less likely to smoke, but had a higher chance for lack of physical activity. DISCUSSION: Socio-economic factors predict lifestyle choices differently in different age groups. For example, in men, the highest percentage of daily smokers was found in the middle age, while the youngest age group was the one that smoked the most in women. Furthermore, the educational level had a reverse effect on women in the oldest age group, where those with tertiary education smoked three times more than those with less education. Our results emphasise the importance of taking a holistic approach towards health, including educational, cultural and age-specific policies to improve the overall health status and health equality of a population.

Characteristics of police officer suicides in the Federal Austrian Police Corps.

BACKGROUND: Suicide rates among police officers may be high because of strong occupational stressors. AIMS: This study examined the suicide rate and suicide characteristics among police officers in the Federal Austrian Police Force. METHODS: All suicides among policemen during the period 1996-2006 were analyzed retrospectively on the basis of personalized police record files from all Austrian police departments. Information on sex, age, marital status, children, region, method and place of suicide, suicide notes, position, and length of service was extracted from these files. The general Austrian population, adjusted for sex and age composition, served as the comparison group. RESULTS: The suicide rate among male police officers was 30.2/100,000 (SD 11.0), which was comparable to the suicide rate in the adjusted general population (30.5/100,000; SD 2.9). The female police officer suicide rate was 1.8/100,000, while the corresponding suicide rate of the adjusted female general population was 12.5/100,000 (SD 1.7). Firearms were the most frequent suicide method (77.8%), and the incidence of suicide notes was 30.8%. CONCLUSIONS: Suicide rates among police officers seem comparable to those of the age-adjusted general population. Given the healthy-worker effect, these results still suggest an increased risk of suicide among police officers. These findings should stimulate further research on stressors and risk factors for suicide among officers and should also encourage departments to increase awareness regarding suicidal signs among officers.

[Hearing impairment : successful communication as the main source of positive experiences]. / Schwerhörigkeit : Gelungene Kommunikation als Hauptquelle positiver Erfahrungen.

BACKGROUND: In recent years some studies could show that besides the negative effects of stressful encounters resulting from disorders and handicaps, positive experiences can also be made. The aim of this study was to determine which strategies can help persons with hearing impairments to gain positive experiences. MATERIALS AND METHODS: A questionnaire in the German language consisting of the Trier Personality Inventory and a German translation of a questionnaire designed to measure the positive experiences in life with acquired hearing impairment was distributed to persons with acquired hearing impairment, who were recruited from hearing aid audiologists and ear nose and throat physicians. RESULTS: Persons with hearing impairments showed no differences to the general population with respect to their personality profile. Positive experiences are significantly more common by successful communication behavior than by other strategies. CONSEQUENCES: Successful communication helps persons with hearing impairments to gain positive experiences.

Influence of psychotherapist density and antidepressant sales on suicide rates.

OBJECTIVE: Antidepressant sales and suicide rates have been shown to be correlated in industrialized countries. The aim was to study the possible effects of psychotherapy utilization on suicide rates. METHOD: We assessed the impact of antidepressant sales and psychotherapist density on suicide rates between 1991 and 2005. To adjust for serial correlation in time series, three first-order autoregressive models adjusted for per capita alcohol consumption and unemployment rates were employed. RESULTS: Antidepressant sales and the density of psychotherapists in the population were negatively associated with suicide rates. CONCLUSION: This study provides evidence that decreasing suicide rates were associated with both increasing antidepressant sales and an increasing density of psychotherapists. The decrease of suicide rates could reflect a general improvement in mental health care rather than being caused by antidepressant sales or psychotherapist density alone.