Treatment of anxiety disorders in the Finnish general population.
ABSTRACT Treatments for anxiety disorders in the general population are not widely investigated. We determined the proportion, type and determinants of treatment in the Finnish general population.
Within the Health 2000 Study, a representative sample (n = 6005) of adults (age > 30 years) were interviewed in 2000-2001 with the Composite International Diagnostic Interview (M-CIDI) to assess the presence of DSM-IV mental disorders during the preceding 12 months. Logistic regression models were used to examine factors influencing the type of treatment (pharmacotherapy and/or psychological treatment) and also the types of pharmacotherapy (antidepressants, anxiolytics, or sedatives and hypnotics) used for anxiety disorders.
For individuals with an anxiety disorder, 40% (95/229) currently used psychotropic medication, 23% (55/229) used antidepressants, 19% (44/229) anxiolytics and 17% (41/229) sedatives or hypnotics. Of those using health care services for mental health reasons (34%, 76/229), 80% (61/76) received pharmacotherapy. Only 45% (34/76) reported having psychological treatment, with few having more than 4 visits (27%, 20/76). Living in a semi-urban environment, retirement and high perceived disability increased the likelihood of pharmacotherapy-only treatment; higher education and comorbidity with mood disorders increased the likelihood of psychological treatment. General practitioners more often than psychiatrists provided pharmacotherapy treatment alone (67% vs. 34%, p < 0.05), particularly anxiolytics or sedatives.
Use of mental health services and psychological treatment were based on self-reports. No data on duration of pharmacotherapy was available.
Anxiety disorders remain largely untreated in the general population. Among those seeking treatment, pharmacotherapy predominates, whereas even brief psychotherapies are rare. Contrary to clinical guidelines, anxiolytics and sedatives are commonly used instead of antidepressants.
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ABSTRACT: PURPOSE: Evidence on social differentials in depression outcomes remains inconsistent. We assess social predictors of psychiatric admission for depression in a community setting. METHODS: 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. RESULTS: 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. CONCLUSIONS: Further studies should disentangle the mechanisms behind the higher admission risk among those with fewer economic resources and no co-resident partner.Social Psychiatry 05/2013; DOI:10.1007/s00127-013-0711-1 · 2.58 Impact Factor
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ABSTRACT: BACKGROUND: Physical inactivity is a major public health problem associated with an increased risk of mental health problems. The aim of this study was to examine the associations of leisure-time physical activity with subsequent psychotropic medication among middle-aged people employed at baseline. METHODS: Questionnaire survey data collected in 2000-02 among 40-60-year-old employees of the City of Helsinki (N = 8960) were linked with register data on prescribed psychotropic medication (74% gave permission to linkage). The mean follow-up time was 4.2 years. The analysis included 5961 respondents (78% women). The participants were classified into four groups according to physical activity recommendations. Cox regression analysis was used to calculate hazard ratios (HR) for the first psychotropic medication purchase. RESULTS: Leisure-time physical activity was associated with decreased risk of any psychotropic medication. After adjusting for prior psychotropic medication conditioning exercisers (HR=0.65, 95% CI 0.53-0.80), vigorously active (HR=0.83, 95% CI 0.71-0.98) and moderately active (HR=0.85, 95% CI 0.74-0.97) all showed a reduced risk of medication compared with the inactive. The associations were similar for the two main groups of psychotropic medication: antidepressants as well as sedatives and sleep medication. CONCLUSIONS: Leisure-time physical activity is potentially important for preventing mental health problems among the middle-aged.Preventive Medicine 05/2013; 57(3). DOI:10.1016/j.ypmed.2013.05.019 · 2.93 Impact Factor
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ABSTRACT: Previous studies have reported that employees in paid care work (e.g., child, health, and elderly care) have increased rates of hospitalization with depression and treatment with antidepressants. It is unclear, however, whether these findings reflect a causal effect of the work on employee mental health or a selection into these professions. We examined prevalences of antidepressant purchases during 1995-2008 in a cohort of female eldercare workers who entered their profession in 2004 (n = 1,946). These yearly prevalences were compared to those of a representative sample of the female Danish working population (n = 4,201). Trends in antidepressants prevalences were examined using generalized estimation equations. Further, to account for bias by treatment seeking, we compared self-reported depressive symptoms in 2005 measured by the mental health scale from the SF-36. Female eldercare workers had consistently higher prevalence of antidepressant treatment than the general female working population. The eldercare workers were also more likely to suffer from depressive symptoms in 2005 (standardized prevalence ratio = 1.28, 95% CI = 1.09-1.49). Prevalences of antidepressant treatment increased during follow up for both cohorts, with similar estimated odds ratios of about 1.15 per year. The trend in the antidepressant prevalences for the eldercare workers was unchanged by entering eldercare work. These findings indicate that female eldercare workers are at increased risk of depression. Further, as the trend in the antidepressant prevalences among the eldercare workers was similar before and after entering their profession, the results suggest that this increased risk is due to selection into the profession.Depression and Anxiety 07/2012; 29(7):605-13. DOI:10.1002/da.21940 · 4.29 Impact Factor