To examine the associations between alcohol consumption and utility-based health-related quality of life (HRQoL), subjective quality of life (QoL), self-rated health (SRH), and mental distress.
Representative general population survey in Finland, with 5871 persons aged 30-64 years. HRQoL was measured with two health utility instruments (15D and EQ-5D), QoL and SRH were measured with RATING scales, and mental distress with a General Health Questionnaire (GHQ-12). Past alcohol problems were diagnosed with a structured psychiatric interview known as the composite international diagnostic interview (CIDI). Alcohol consumption was examined with a self-report questionnaire.
Negative associations between alcohol and well-being were observed on several measures for women consuming more than 173 g and men more than 229 g per week. Former drinkers scored worst on most measures, even in comparison to the highest drinking decile. For men, all statistically significant associations between moderate drinking and well-being disappeared when sociodemographic factors and former drinkers were controlled for. For women, moderate alcohol use associated with better SRH and EQ-5D as compared to abstainers. However, the possible health utility benefits associated with moderate alcohol consumption were of clinically insignificant magnitude.
Failure to separate former drinkers and other abstainers produces a significant bias favoring moderate drinkers. As the possible health utility benefits of moderate alcohol use were clinically insignificant, it suffices to investigate mortality, when estimating the public health impact of moderate alcohol consumption using quality-adjusted life years.
Excess mortality of depression is established for various causes of death, but evidence is scarce on alcohol-related causes. It also remains unclear whether the magnitude of the excess varies by social factors. This study aimed to quantify the contribution of alcohol-related causes of death and to assess modifying effects of socioeconomic position, employment status, and living arrangements in the excess mortality of depression.
A 14% sample of community-dwelling Finns aged 40-64 at the end of 1997 was assessed for depression, using register data on psychiatric hospital care and antidepressant use in 1996-1997. Depressed in-patients (n=897), out-patients using antidepressants (n=13,658), and non-depressed individuals (n=217,140) were followed up for cause-specific mortality in 1998-2007, distinguishing between alcohol- and non-alcohol-related deaths, and testing for variation in the excess mortality according to baseline social factors.
Depressed in- and out-patients had significant excess mortality for suicide (age-adjusted rate ratios RR=3.77 for men and RR=6.35 for women), all accidental and violent causes (RR=3.47 and RR=4.43), and diseases (RR=1.67 and RR=1.41). Of the excess, alcohol-related causes accounted for 50% among depressed men and 30% among women. Excess mortality varied little by social factors, particularly in non-alcohol-related causes. Where variation was significant, the relative excess was larger among those with higher socioeconomic position and the employed. Absolute excess was, however, larger among those with lower socioeconomic position, the unemployed, and the unpartnered.
Depression was measured indirectly by hospital and antidepressant use.
The results highlight the major role of alcohol in depression mortality.
A marked decline in suicide rates has co-occurred with increased antidepressant sales in several countries but the causal connection between the trends remains debated. Most previous studies have focused on overall suicide rates and neglected differential effects in population subgroups. Our objective was to investigate whether increasing sales of non-tricyclic antidepressants have reduced alcohol- and non-alcohol-related suicide risk in different population subgroups.
We followed a nationally representative sample of 950,158 Finnish adults in 1995-2007 for alcohol-related (n = 2,859) and non-alcohol-related (n = 8,632) suicides. We assessed suicide risk by gender and social group according to regional sales of non-tricyclic antidepressants, measured by sold doses per capita, prevalence of antidepressant users, and proportion of antidepressant users with doses reflecting minimally adequate treatment. Fixed-effects Poisson regression models controlled for regional differences and time trends that may influence suicide risk irrespective of antidepressant sales.
The number of sold antidepressant doses per capita and the prevalence of antidepressant users were unrelated to male suicide risk. However, one percentage point increase in the proportion of antidepressant users receiving minimally adequate treatment reduced non-alcohol-related male suicide risk by one percent (relative risk 0.987, 95% confidence interval 0.976-0.998). This beneficial effect only emerged among men with high education, high income, and employment, among men without a partner, and men not owning their home. Alcohol-related suicides and female suicides were unrelated to all measures of antidepressant sales.
We found little evidence that increase in overall sales or in the prevalence of non-tricyclic antidepressant users would have caused the fall in suicide rates in Finland in 1995-2007. However, the rise in the proportion of antidepressant users receiving minimally adequate treatment, possibly due to enhanced treatment compliance, may have prevented non-alcohol-related suicides among men.
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Evidence on social differentials in depression outcomes remains inconsistent. We assess social predictors of psychiatric admission for depression in a community setting.
A register-based 14% sample of community-dwelling Finns aged 40-64 at the end of 1997 was assessed for depression and psychiatric comorbidity, using register data on psychiatric hospital care and medication purchases in 1996-1997. Those with inpatient treatment for unipolar depression (n = 846), those with antidepressant treatment (n = 8,754), and those with neither (n = 222,029) were followed for psychiatric admission with a diagnosis of unipolar depression in 1998-2003. Differentials in admission rates by socioeconomic position, employment status, and living arrangements were studied using Cox proportional hazards modelling.
Among those with prior inpatient or antidepressant treatment, the material aspects of socioeconomic position increased admission risk for depression by 20-40%, even after controlling for baseline depression severity and psychiatric comorbidities, whereas education and occupational social class were unrelated to admission risk. Among inpatients, also having no partner, and among antidepressant users, being previously married and living without co-resident children increased admission risk. However, among inpatients few excess risks reached statistical significance. Among those with no inpatient or antidepressant treatment, all measures of low social position and not living with a partner predicted admission, and the factors had more predictive power in admission than among those with prior treatment.
Further studies should disentangle the mechanisms behind the higher admission risk among those with fewer economic resources and no co-resident partner.
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.
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.
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.
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.
Non-married persons are known to have poor mental health compared with married persons. Health differences between marital status groups may largely arise from corresponding differences in interpersonal social bonds. However, official marital status mirrors the social reality of persons to a decreasing extent, and living arrangements may be a better measure of social bonds. Little is known about mental health in different living arrangement groups. This study aims to establish the extent and determinants of mental health differences by living arrangement in terms of psychological distress (GHQ) and DSM-IV psychiatric disorders (CIDI).
Data were used from the nationally representative cross sectional health 2000 survey, conducted in 2000-1 in Finland. Altogether 4685 participants (80%) aged 30-64 years were included in these analyses; comprehensive information was available on measures of mental health and living arrangements. Living arrangements were measured as follows: married, cohabiting, living with other(s) than a partner, and living alone.
Compared with the married, persons living alone and those living with other(s) than a partner were approximately twice as likely to have anxiety or depressive disorders. Cohabiters did not differ from the married. In men, psychological distress was similarly associated with living arrangements. Unemployment, lack of social support, and alcohol consumption attenuated the excess psychological distress and psychiatric morbidity of persons living alone and of those living with other(s) than a partner by about 10%-50% each.
Living arrangements are strongly associated with mental health, particularly among men. Information on living arrangements, social support, unemployment, and alcohol use may facilitate early stage recognition of poor mental health in primary health care.
To assess the variation in heavy drinking and alcohol dependence by living arrangements, and the contribution of social and behavioural factors to this variation.
The Health 2000 survey is a nationally representative cross-sectional survey conducted in Finland in 2000-2001 (N = 4589 in the age-range of 30-54 years, response rate 81%).
Living arrangements; married, cohabiting, living with other(s) than a partner, and living alone. Consumption of beer, wine and spirits in the past month was converted into grams of alcohol/week, and heavy drinking was classified as > or =280 (men) and > or =140 (women) grams/week. Twelve-month prevalence of alcohol dependence was diagnosed by a mental health interview (CIDI).
As compared to the married, cohabiting and living alone associated with heavy drinking (age-adjusted OR; 95% CI: 1.71;1.17-2.49 and OR 2.15;1.55-3.00 in men; OR 1.54;0.96-2.46 and OR 1.67;1.07-2.63 in women) and alcohol dependence (OR 2.29;1.44-3.64 and OR 3.66;2.39-5.59 in men; OR 2.56;1.10-5.94 and OR 4.43;2.03-9.64 in women). Living with other(s) than a partner associated with heavy drinking. Those who cohabited without children or lived alone had the highest odds for alcohol dependence. Among both genders, adjusting for main activity and financial difficulties attenuated the odds for heavy drinking and alcohol dependence by approximately 5-30% each, and additionally among women adjusting for urbanisation attenuated the odds for heavy drinking by approximately 15-45%.
Cohabiting and living alone are associated with heavy drinking and alcohol dependence. Unemployment, financial difficulties and low social support, and among women also living in an urban area, seem to contribute to the excess risk.
Research has revealed mortality differences between marital status groups in different societies and different periods of time. Due to the increase in consensual unions, living alone and other changes in living arrangements, it is necessary to apply a more detailed classification of living arrangements that incorporates partnership situation and household composition.
We analyse mortality by cause-of-death in the total Finnish population aged 30 or over in 1996-2000. The linked register dataset includes 15.7 million person-years and 210,139 deaths.
In the working aged population, cohabiters had nearly 70% excess mortality when compared with married people. Among working aged men living with someone other than a partner and among men living alone, mortality was three times higher than among married men. Among women, mortality in these groups was close to that of cohabiters. In the older population, mortality in the other groups was 15-40% higher than among married persons. Adjusting for education, social class and employment status attenuated the mortality differences by 7-31%. Having no children was associated with excess mortality in working aged women and men in each living arrangement group. The relative differences were greatest in deaths from alcohol-related causes, followed by deaths from accidents among men and working aged women and lung cancer in women.
We observed wide mortality differences according to living arrangements, particularly among the working aged. These differences were partly explained by socioeconomic factors. Excessive alcohol use seems to be one major cause of mortality differences.
Online therapies are partly automated therapies, in which psychotherapeutic contents have been complemented with computer-aided presentational and educational contents, with a therapist giving support to the progress of the patient. As methods, these therapeutic programs incorporate therapeutic methods that have proven effective, such as remodeling of thoughts, activation of behavior and exposure, empathy, strengthening of cooperative relationship and motivation, and general support for self-reflection. For instance, online therapies already constitute part of the Finnish treatment guidelines on depression. Online therapies are available throughout Finland for the essential psychiatric illnesses.
Maternal depression increases the risk for psychiatric morbidity in offspring but the effects of paternal depression and family type are less studied.
We assessed the effects of parental antidepressant use on offspring psychiatric morbidity in various family settings.
Our register-based study followed 132637 children for incident psychiatric morbidity in 1998-2003. The highest risk for psychiatric morbidity was in children living with both parents on antidepressants or with a lone parent on antidepressants. We found little variation in the effects according to parental or offspring gender.
Parental depression as measured by antidepressant use, and single parenthood pose a risk for psychiatric morbidity in offspring.