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ABSTRACT: Psychiatric co-morbidity is often inadequately controlled for in studies on cognitive functioning in depression. Our recent study established no major deficits in cognition among young adults with a history of pure unipolar depression. The present study extends our previous work by examining the effects of psychiatric co-morbidity and other disorder characteristics on depression-related cognitive functioning.
Performance in verbal and visual short-term memory, verbal long-term memory and learning, attention, processing speed, and executive functioning was compared between a population-based sample aged 21-35 years with a lifetime history of unipolar depressive disorders (n=126) and a random sample of healthy controls derived from the same population (n=71). Cognitive functioning was also compared between the subgroups of pure (n=69) and co-morbid (n=57) depression.
The subgroups of pure and co-morbid depression did not differ in any of the cognitive measures assessed. Only mildly compromised verbal learning was found among depressed young adults in total, but no other cognitive deficits occurred. Received treatment was associated with more impaired verbal memory and executive functioning, and younger age at first disorder onset with more impaired executive functioning.
Psychiatric co-morbidity may not aggravate cognitive functioning among depressed young adults. Regardless of co-morbidity, treatment seeking is associated with cognitive deficits, suggesting that these deficits relate to more distress.
Psychological Medicine 06/2009; 40(1):29-39. · 6.16 Impact Factor
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J Suvisaari,
T Aalto-Setälä,
A Tuulio-Henriksson,
T Härkänen,
S I Saarni,
J Perälä,
M Schreck,
A Castaneda,
J Hintikka,
L Kestilä,
S Lähteenmäki,
A Latvala,
S Koskinen,
M Marttunen, H Aro,
J Lönnqvist
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ABSTRACT: The effect of mental disorders may be particularly detrimental in early adulthood, and information on mental disorders and their correlates in this age group is important.
A questionnaire focusing on mental health was sent to a nationally representative two-stage cluster sample of 1863 Finns aged 19 to 34 years. Based on a mental health screen, all screen-positives and a random sample of screen-negatives were asked to participate in a mental health assessment, consisting of the Structured Clinical Interview for DSM-IV (SCID-I) interview and neuropsychological assessment. We also obtained case-notes from all lifetime mental health treatments. This paper presents prevalences, sociodemographic associations and treatment contacts for current and lifetime mental disorders.
Forty percent of these young Finnish adults had at least one lifetime DSM-IV Axis I disorder, and 15% had a current disorder. The most common lifetime disorders were depressive disorders (17.7%) followed by substance abuse or dependence (14.2%) and anxiety disorders (12.6%). Of persons with any lifetime Axis I disorder, 59.2% had more than one disorder. Lower education and unemployment were strongly associated with current and lifetime disorders, particularly involving substance use. Although 58.3% of persons with a current Axis I disorder had received treatment at some point, only 24.2% had current treatment contact. However, 77.1% of persons with a current Axis I disorder who felt in need of treatment for mental health problems had current treatment contact.
Mental disorders in young adulthood are common and often co-morbid, and they may be particularly harmful for education and employment in this age group.
Psychological Medicine 06/2008; 39(2):287-99. · 6.16 Impact Factor
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ABSTRACT: There is evidence for cognitive dysfunction in unipolar depression among middle-aged and elderly patients, but cognitive functioning among depressed young adults has scarcely been systematically investigated. The aims of the present study were to examine cognitive functioning among depressed young adults identified from the general population and to determine whether cognitive deficits vary as a function of different disorder characteristics, such as severity and age at onset.
Performance in verbal and visual short-term memory, verbal long-term memory and learning, attention, processing speed, and executive functioning was compared between a population-based sample of 21-35-year-olds with a lifetime history of non-psychotic unipolar depressive disorders without psychiatric comorbidity (n=68) and healthy controls derived from the same population (n=70).
Depressed young adults were not found to be impaired in any of the assessed cognitive functions, except for some suggestion of mildly compromised verbal learning. Nevertheless, younger age at depression onset was associated with more impaired executive functioning.
The results may slightly underestimate of the true association between depression and cognitive impairments in the young adult population due to possible dropout of participants. Additionally, the problem of multiple testing was not entirely corrected.
The findings from this study indicate that a lifetime history of non-psychotic unipolar depressive disorders among young adults without psychiatric comorbidity may be associated only with minimal cognitive deficits, even when some residual depressive symptoms are prevalent. However, early-onset depression may represent a more severe form of the disorder, associated with more cognitive dysfunction.
Journal of Affective Disorders 03/2008; 110(1-2):36-45. · 3.52 Impact Factor
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ABSTRACT: We aimed to evaluate the diagnostic accuracy of a highly structured diagnostic interview in relation to a semi-structured diagnostic procedure. We compared the World Health Organization Composite International Diagnostic Interview Short Form (CIDI-SF) in diagnosing major depressive episode (MDE) to consensus diagnoses based on the SCAN interview (Schedules for Clinical Assessment in Neuropsychiatry).
Subjects comprised a follow-up sample of 239 20-24-year-old former high-school students who were administered the SCAN and immediately thereafter the CIDI-SF. Concordance was estimated for 12-month MDE, using different cut-points of the CIDI-SF and for any affective disorders.
Correspondence between instruments was moderate for MDE (kappa = 0.43, sensitivity 0.71, specificity 0.82), but better for any affective disorder (kappa = 0.60, sensitivity 0.70, specificity 0.90). Most false negatives suffered from their depression as much as those correctly identified by the CIDI-SF. False negativity was mainly due to not endorsing the stem questions of the CIDI-SF. Of the false positives almost half had an affective disorder other than MDE.
The CIDI-SF seems to function best in identifying a broader category of affective disorders. It could be useful in large-scale community surveys where more extensive psychiatric interviews are not feasible.
Psychological Medicine 11/2002; 32(7):1309-14. · 6.16 Impact Factor
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ABSTRACT: There is discrepancy in findings on spousal concordance for major depression. Here we report the risk of depression and its determinants in spouses of persons with or without depression, taking into account several known risk factors for major depression.
A random sample of non-institutionalized Finnish individual aged 15-75 years was interviewed in the 1996 National Health Care Survey. The sample included 1708 male-female spouse pairs. Major depressive episode (MDE) during the last 12 months was assessed using the Short Form of the University of Michigan version of the Composite International Diagnostic Interview (the UM-CIDI Short Form). Risk factors were assessed in the same interview.
Factors associating with MDE were spouse's MDE, own alcohol intoxication at least once a week and own chronic medical conditions. In addition, there was a strong association between female's current smoking and male's MDE, independently of other risk factors and spousal MDE. The association of MDE with spouses's MDE was not affected by taking into account other assessed risk factors (own or spouse's).
The results indicate elevated spouse concordance for MDE independent of the risk factors assessed in the present study.
Psychological Medicine 03/2002; 32(2):363-7. · 6.16 Impact Factor
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ABSTRACT: Antidepressant use has increased in the last decade, but whether depression continues to be undertreated is unknown. The authors investigated the prevalence of antidepressant treatment and its predictors in a recent general population sample of depressed subjects.
As part of the Finnish Health Care Survey, in 1996 a representative sample of Finns (N=5,993) aged 15-75 years underwent a standardized face-to-face interview that used the DSM-III-R criteria for major depressive episode.
Only 13% of subjects with a major depressive episode during the preceding 12 months (70 of 557) reported current use of an antidepressant. In logistic regression models, use of psychiatric services for depression, regular use of any other medication, more than 1 month of sick leave, and smoking were associated with antidepressant treatment.
Most depressed subjects in 1996 in Finland were not receiving antidepressant treatment despite the several-fold increase in antidepressant use in the 1990s.
American Journal of Psychiatry 01/2002; 158(12):2077-9. · 12.54 Impact Factor
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ABSTRACT: This study set out to estimate the 12-month prevalence of DSM-III-R major depressive episode (MDE) and to analyse factors associating with psychosocial impairment, episode duration, phenomenology and symptom severity in a representative general population sample of adolescents (15-19-year-olds) and young adults (20-24-year-olds).
The Finnish Health Care Survey '96 (FINHCS '96) was a cross-sectional nationwide epidemiological study. A random sample of 509 adolescents and 433 young adults was interviewed in 1996. MDE was assessed by University of Michigan Composite Diagnostic Interview Short-Form.
The 12-month prevalence of MDE was 5.3 % for adolescents (females 6.0%, males 4.4%) and 9.4% for young adults (females 10.7%, males 8.1%). When moderate psychosocial impairment was included in case definition, the prevalences were lowered by 20-25%. Increased impairment was associated with drunkenness at least twice a month, a higher mean number of depressive symptoms and impaired concentration. The median episode duration was 1 month. No factors associating with duration were found. With the exception of symptoms related to appetite being more common among females than males, the phenomenology of MDE was mainly independent of age and gender.
Episodes of major depression among adolescents and young adults in the general population are short but often associated with psychosocial impairment, especially if frequent drunkenness coexists.
Psychological Medicine 11/2001; 31(7):1169-79. · 6.16 Impact Factor
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ABSTRACT: This study investigated the associations of cigarette smoking and alcohol intoxication with major depressive episode.
Major depressive episode during the past 12 months was assessed in a national representative cross sectional study using the Short Form of the University of Michigan version of the Composite International Diagnostic Interview (the UM-CIDI Short Form).
A random sample of 5993 non-institutionalised Finnish people aged 15-75 years was interviewed as a part of the 1996 Finnish Health Care Survey.
In logistic regression models the factors associated with major depressive episode in the past 12 months were smoking 10 or more cigarettes daily (odds ratio (OR) 2.26; 95% confidence intervals (95% CI) 1.68, 3.04) and alcohol intoxication at least once a week (OR 2.99; 95%CI 1.70, 5.25). Their effects were independent of each other, and remained significant even after adjusting for other major risk factors (marital status, education, unemployment and chronic diseases). The attributable proportion (a measure of the impact of the risk factors of the disease on the population) for daily smoking of 10 or more cigarettes was 0.15, and for alcohol intoxication at least once a week 0.04.
Cigarette smoking and alcohol intoxication seem to be important risk factors for major depressive episode. In this population the impact of smoking was greater.
Journal of Epidemiology & Community Health 09/2001; 55(8):573-6. · 3.19 Impact Factor
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ABSTRACT: This study reports the 12-month prevalence of major depressive episode and its risk factors in a representative nationwide sample.
A random sample of non-institutionalized Finnish individuals aged 15-75 years (N = 5993) was interviewed in 1996. Major depressive episode during the last 12 months was assessed using the Short Form of the University of Michigan version of the Composite International Diagnostic Interview (the UM-CIDI Short Form).
The population prevalence of major depressive episode was 9.3% [95% CI 8.5,10.0], and the age-adjusted prevalences for females and males were 10.9% [95% CI 9.7,12.0] and 7.2 [95% CI 6.2,8.2], respectively. In logistic regression analyses the factors associated with major depressive episode after adjustment for age were urban residency, smoking, alcohol intoxication and chronic medical conditions. In addition, being single and obese were found to be risk factors for males.
The female to male risk ratio for major depressive episode was smaller than in many previous studies. The sex-specific risk factor associations warrant further investigation into sex differences in depression.
Acta Psychiatrica Scandinavica 10/2000; 102(3):178-84. · 4.22 Impact Factor
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ABSTRACT: Knowledge of working capacity from adolescence until adulthood among severely disturbed in-patients is scarce.
In a follow-up study of 61 adolescent in-patients, we studied associations between being on a disability pension 20 years after hospitalisation, and the patients' psychopathology and treatment-related factors during the hospitalisation and seven-year follow-up.
Of the former in-patients, 27% had not been on a disability pension, 20% had short-term pension periods, and 53% were pensioned. Subjects whose overall psychosocial functioning had improved and who had not utilised in-patient services until the seven-year follow-up, had a better prognosis in terms of working capacity. Half of the subjects who had not been on pension during the follow-up had received a diagnosis of conduct disorder at discharge, and half of those pensioned had a psychotic disorder.
The patients' level of psychosocial functioning and capability to work in young adulthood were associated with long-term prognosis in terms of working capacity. Adolescence seems to be the critical time for intensive psychiatric care combined with vocational rehabilitation programmes.
The British Journal of Psychiatry 03/1998; 172:159-63. · 6.62 Impact Factor
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ABSTRACT: Changes in psychosocial functioning during out-patient treatment among 73 adolescent male and 100 female subjects, aged 12 to 19 years, were studied. The mean number of total treatment sessions was 15 sessions among the severely impaired and 14 sessions among the moderately impaired patients. The level of psychosocial functioning improved among the severely impaired (Global Assessment Scale (GAS) at treatment entry 3.9 vs. 4.7 at the last session, 95% CI, -1.085 to -0.577) and the moderately impaired patients (GAS 5.5 vs. 6.0, 95% CI, -0.682 to -0.355). The improvement was highly dependent on the psychiatric diagnosis. The level of psychosocial impairment improved in about two-thirds of subjects with adjustment and non-comorbid mood disorders, in about one-third of those with non-comorbid personality disorders, and in about a quarter of those with disruptive disorders. Careful diagnostic evaluation and assessment of psychosocial functioning are essential elements in the development of adolescent psychiatric services.
Acta Psychiatrica Scandinavica 10/1997; 96(3):217-24. · 4.22 Impact Factor
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ABSTRACT: We examined the prevalence of depressive disorders and associated factors in the general population in Finland using the Computer-Assisted Telephone Interview (CATI) method. A total of 2293 (71%) of 3250 individuals randomly drawn from the population registry and representing the adult population of Finland in the age group 25-79 years were interviewed by telephone in autumn 1994. The interview included a short form of the University of Michigan version of the Composite International Diagnostic Interview (UM-CIDI) generating probability diagnoses of DSM-III-R major depressive episode and dysthymia. The age-adjusted 6-month prevalence was 4.1% for major depressive episode and 1.7% for current dysthymia; depressive mood during the preceding month was reported in 17% of cases. Major depressive episodes and depressive mood were significantly more prevalent among females than males. In the logistic regression analyses, factors associated with the depressive disorders were found to vary somewhat depending on sex and type of disorder. Only about 50% of those with major depressive episode or dysthymia reported a self-perceived need for mental health services.
Acta Psychiatrica Scandinavica 09/1997; 96(2):122-8. · 4.22 Impact Factor
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ABSTRACT: As part of a nation-wide psychological autopsy we examined the differences in DSM-III-R mental disorders, recent life events and other characteristics between urban (n = 143) and rural (n = 85) completed suicides in a random sample of 229 cases from the National Suicide Prevention Project in Finland for the period 1987-1988. Psychoactive substance use disorders (48% vs. 34%), cluster B personality disorders (24% vs. 9%) and psychiatric comorbidity (66% vs. 42%) were found more commonly among urban than rural suicides. Urban suicides were also more often reported to be preceded by a recent separation (25% vs. 8%), whereas rural suicide victims tended to have lacked a close companion of the opposite sex (36% vs. 18%) and to have had physical disorders (56% vs. 40%). Overall, urban and rural suicides may vary with regard to the prevalence of some mental disorders, their comorbidity, and physical disorders, as well as the preceding life situation. This variation may also imply the need for differences in strategies for suicide prevention in each setting.
Acta Psychiatrica Scandinavica 05/1997; 95(4):297-305. · 4.22 Impact Factor
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ABSTRACT: As part of a nation-wide psychological autopsy we examined the differences in DSM-III-R mental disorders, recent life events and other characteristics between urban (n=143) and rural (n=85) completed suicides in a random sample of 229 cases from the National Suicide Prevention Project in Finland for the period 1987-1988. Psychoactive substance use disorders (48% vs. 34%), cluster B personality disorders (24% vs. 9%) and psychiatric comorbidity (66% vs. 42%) were found more commonly among urban than rural suicides. Urban suicides were also more often reported to be preceded by a recent separation (25% vs. 8%), whereas rural suicide victims tended to have lacked a close companion of the opposite sex (36% vs. 18%) and to have had physical disorders (56% vs. 40%). Overall, urban and rural suicides may vary with regard to the prevalence of some mental disorders, their comorbidity, and physical disorders, as well as the preceding life situation. This variation may also imply the need for differences in strategies for suicide prevention in each setting.
Acta Psychiatrica Scandinavica 03/1997; 95(4):297 - 305. · 4.22 Impact Factor
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ABSTRACT: Suicidal adolescent out-patients were compared with non-suicidal subjects with respect to background factors, psychopathology and treatment received. Data for suicidal ideation, suicide attempts, psychiatric diagnoses (DSM-III-R) and other patient-related factors were collected prospectively during treatment of 122 male and 138 female out-patients aged 12-22 years. In total, 42% of subjects displayed suicidal tendencies, and 18% had attempted suicide. According to polychotomous regression, mood disorder, previous psychiatric treatment and low level of psychosocial functioning at treatment entry were associated with suicide attempts and with suicidal ideation for both sexes. Suicidal patients were more often receiving psychotropic medication and had more total appointments (mean number 15 vs. 9) than non-suicidal patients. Suicidal and non-suicidal patients kept their scheduled appointments to the same extent (66% vs. 65%). Treatments which meet the needs of disordered suicidal adolescents need to be developed.
Acta Psychiatrica Scandinavica 03/1997; 95(2):100-7. · 4.22 Impact Factor
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ABSTRACT: The main purpose of the study was to evaluate the notion that the association between sex and depression is partly mediated by differences in coping styles. The study is based on questionnaire data from 890 female and 766 male Finnish 22-year-old young adults. Of the 12 ways of coping presented, self-blame, venting anger on others, seeking comfort in sweets and drinking beer were positively, and the others negatively, associated with depression; these were called dysfunctional and functional ways of coping, respectively. Women resorted much more often than men to dysfunctional ways of coping, except drinking. They also scored lower on personal resilience and showed more depressive symptoms. The sex difference in depressiveness was eliminated when dysfunctional coping was taken into account.
Social Science [?] Medicine 12/1996; 43(10):1453-60. · 2.70 Impact Factor
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ABSTRACT: Mortality among 156 males and 122 females referred to an out-patient adolescent psychiatric clinic in a Finnish town between 1984 and 1989 was examined. During the follow-up (mean duration 6 years; range 0-6.3 years for the deceased, 0.6-10.3 years for the survivors), 16 male subjects but no females had died. Among those who had died, the mode of death was suicide in 11 cases. The mortality for any cause for males was 10.3% and that for suicide was 7.1%. All male victims had similar high levels of individual and familial disturbances. Current suicidal ideation and suicide attempts, poor psychosocial functioning and a recommendation for psychiatric hospital treatment during the index treatment were associated with male mortality/suicidality. A high risk for mortality for several years after psychiatric treatment was found. It is concluded that, in clinical settings, perceived current suicidal tendencies should be assessed carefully.
Acta Psychiatrica Scandinavica 08/1996; 94(1):60-6. · 4.22 Impact Factor
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ABSTRACT: The mediating factors between childhood experience of parental divorce and subsequent depression in young adulthood were assessed in a follow-up study of one Finnish urban age cohort from the age of 16 to 22 (n = 1656). Depression was found to be more common among the offspring of divorced families. Low self-esteem at age 16 was an indicator of vulnerability to depression in young adulthood irrespective of family background or gender. Among girls the long-term impact of divorce was mediated via low self-esteem and lack of closeness to father. When the relationship with the father was close, no excess risk of depression was found among girls from divorced families. Conversely, in boys no statistical connection between low self-esteem or unsatisfactory relationship with parents and depression after parental divorce was found.
Acta Psychiatrica Scandinavica 02/1996; 93(1):20-6. · 4.22 Impact Factor
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Jouko Lönnqvist, H. Aro,
M. Heikkinen,
H. Heilä,
M. Henriksson,
E. Isometsä,
K. Kuurne,
M. Marttunen,
A. Ostamo,
M. Pelkonen,
S. Pirkola,
J. Suokas,
K. Suominen
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ABSTRACT: Outlines research plans concerning 4 series of studies on suicide and suicide prevention. Studies have or will be conducted on (1) suicide (e.g., and schizophrenia, prevention in general and psychiatric hospitals, and alcoholism, and physical illness), (2) attempted suicide (e.g., gender differences, epidemiology, unemployment, mental disorders, clinical outcome), (3) suicidal behavior, and (4) suicide mortality among adolescent psychiatric patients. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Crisis The Journal of Crisis Intervention and Suicide Prevention 10/1995; 16(4):162-175. · 1.09 Impact Factor
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ABSTRACT: Social mobility among patients with schizophrenia or major affective disorder was compared with that among the general population.
Mobility was studied retrospectively from 1970 to 1987. Socio-economic status (SES) was defined by occupation as in the population census (upper white-collar, lower white-collar, blue-collar, entrepreneur, farmer, unemployed). All patients aged 30-60 years at discharge (2901 men and 3620 women) in 1987-88 in Finland were included in the study. The SES structure of the general population was used for comparisons.
Among patients with schizophrenia there was a constant downward drift, commonly to unemployment. This risk was higher among men than women. In the youngest age group a marked decline from the parents' social status was observed. Among patients with major affective disorder the distribution of SES in 1970 was similar to that of the general population. By 1987, a downward drift was again observed, mainly to unemployment regardless of the initial SES group. The number of patients in occupational categories were usually 30-50% lower than expected.
Schizophrenic patients had a high risk of social drop-out. Among patients with major affective disorder the downward drift was much less.
The British Journal of Psychiatry 07/1995; 166(6):759-67. · 6.62 Impact Factor
