Publications by authors named "Jouko Miettunen"

232 Publications

Age of first alcohol intoxication and psychiatric disorders in young adulthood - A prospective birth cohort study.

Addict Behav 2021 Jul 11;118:106910. Epub 2021 Mar 11.

Department of Psychiatry, University of Turku, Turku, Finland; Addiction Psychiatry Unit, Department of Psychiatry, Turku University Hospital, Turku, Finland.

Objective: Early onset of alcohol use is associated with an increased risk of substance use disorders (SUD), but few studies have examined associations with other psychiatric disorders. Our aim was to study the association between the age of first alcohol intoxication (AFI) and the risk of psychiatric disorders in a Finnish general population sample.

Methods: We utilized a prospective, general population-based study, the Northern Finland Birth Cohort 1986. In all, 6,290 15-16-year old adolescents answered questions on AFI and were followed up until the age of 33 years for psychiatric disorders (any psychiatric disorder, psychosis, SUD, mood disorders and anxiety disorders) by using nationwide register linkage data. Cox-regression analysis with Hazard Ratios (HR, with 95% confidence intervals (CI)) was used to assess the risk of psychiatric disorders associated with AFI.

Results: Statistically significant associations were observed between AFI and any psychiatric disorder, psychosis, SUDs, and mood disorders. After adjustments for other substance use, family structure, sex and parental psychiatric disorders, AFIs of 13-14 years and ≤12 years were associated with SUD (HR = 5.30; 95%CI 2.38-11.82 and HR = 6.49; 95%CI 2.51-16.80, respectively), while AFI ≤ 12 years was associated with any psychiatric disorder (HR = 1.59; 95%CI 1.26-2.02) and mood disorders (HR = 1.81; 95%CI 1.22-2.68). After further adjustments for Youth Self Report total scores, AFI ≤ 14 was associated with an increased risk of SUD and AFI ≤ 12 with an increased risk of any psychiatric disorder.

Conclusions: We found significant associations between the early age of first alcohol intoxication, later SUD and any psychiatric disorder in a general population sample. This further supports the need for preventive efforts to postpone the first instances of adolescent alcohol intoxication.
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http://dx.doi.org/10.1016/j.addbeh.2021.106910DOI Listing
July 2021

Infant motor development and physical activity and sedentary time at midlife.

Scand J Med Sci Sports 2021 Mar 17. Epub 2021 Mar 17.

Center for Life Course Health Research, University of Oulu, Oulu, Finland.

This study investigated whether the timing of infant motor development is associated with self-reported and accelerometer-measured physical activity (PA) and sedentary time (ST) in midlife. This population-based study consisted of 4098 people born in 1966 in Northern Finland (NFBC 1966). Data on nine infant motor developmental milestones included making sounds, holding up the head, grabbing objects, turning from back to tummy, sitting without support, standing with support, walking with support, standing without support, and walking without support. At the age of 46, PA at leisure time and sitting time was self-reported. PA and ST were also measured with a wrist-worn Polar Active accelerometer that was instructed to be worn on the non-dominant hand 24 h/d for 14 days. A multiple linear regression analysis was used to analyze the association between infant motor development and PA and ST in midlife. Later infant motor development was weakly associated with higher accelerometer-measured light PA, but not with moderate-to-vigorous PA. Later infant locomotor development was associated with lower accelerometer-measured ST (β -0.07, p = 0.012) and lower self-reported sitting time at work (β -0.06, p = 0.004) in women. In conclusion, later infant motor development was associated with higher light PA and lower sedentary time at middle age. PA is a multifactorial behavior influenced by various factors from early childhood to midlife. Further research is required before more general conclusions can be drawn.
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http://dx.doi.org/10.1111/sms.13954DOI Listing
March 2021

Pregnancy Risk Factors as Predictors of Offspring Cerebrovascular Disease: The Northern Finland Birth Cohort Study 1966.

Stroke 2021 Apr 25;52(4):1347-1354. Epub 2021 Feb 25.

Center for Life Course Health Research (M.K., J.M., M.P.), University of Oulu, Finland.

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http://dx.doi.org/10.1161/STROKEAHA.120.031618DOI Listing
April 2021

Early-Life Risk Factors for Breast Cancer - Prospective Follow-up in the Northern Finland Birth Cohort 1966.

Cancer Epidemiol Biomarkers Prev 2021 Apr 9;30(4):616-622. Epub 2021 Feb 9.

Center for Life Course Health Research, University of Oulu, Oulu, Finland.

Background: While some risk factors for breast cancer have been confirmed, less is known about the role of early biological and social risk factors for breast cancer in adult life.

Methods: In a prospective follow-up in the Northern Finland Birth Cohort 1966 consisting of 5,308 women, 120 breast cancers were reported via national registers by the end of 2018. Early risk factors were examined with univariate and multivariate analyses using Cox regression analysis. The main results are reported with HRs and their 95% confidence intervals (CI).

Results: In the multivariate-adjusted models, women whose mothers lived in urban areas (HR, 1.68; 95% CI, 1.13-2.51) during pregnancy, were low educated (HR, 2.40; 95% CI, 1.30-4.45), and had been diagnosed with breast cancer (HR, 1.97; 95% CI, 1.09-3.58) had a higher risk for breast cancer in adult life. Lower BMI at the age of 14 associated nonsignificantly with the risk of breast cancer (Mann-Whitney test, = 0.087). No association between birth size and breast cancer risk in adult life was found.

Conclusions: Early-life residence and socioeconomic conditions may have an impact on developing breast cancer in women in adult life. All breast cancer cases of this study were relatively young, and most of them are assumed to be premenopausal.

Impact: This study is one of a few prospective birth cohort studies to examine early-life socioeconomic factors and breast cancer risk in adult life. This study is limited due to small number of cases.
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http://dx.doi.org/10.1158/1055-9965.EPI-20-1442DOI Listing
April 2021

Early Adversity and Emotion Processing From Faces: A Meta-analysis on Behavioral and Neurophysiological Responses.

Biol Psychiatry Cogn Neurosci Neuroimaging 2021 Jan 21. Epub 2021 Jan 21.

Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland. Electronic address:

Background: Although the link between early adversity (EA) and later-life psychiatric disorders is well established, it has yet to be elucidated whether EA is related to distortions in the processing of different facial expressions. We conducted a meta-analysis to investigate whether exposure to EA relates to distortions in responses to different facial emotions at three levels: 1) event-related potentials of the P100 and N170, 2) amygdala functional magnetic resonance imaging responses, and 3) accuracy rate or reaction time in behavioral data.

Methods: The systematic literature search (PubMed and Web of Science) up to April 2020 resulted in 29 behavioral studies (n = 8555), 32 functional magnetic resonance imaging studies (n = 2771), and 3 electroencephalography studies (n = 197) for random-effect meta-analyses.

Results: EA was related to heightened bilateral amygdala reactivity to sad faces (but not other facial emotions). Exposure to EA was related to faster reaction time but a normal accuracy rate in response to angry and sad faces. In response to fearful and happy faces, EA was related to a lower accuracy rate only in individuals with recent EA exposure. This effect was more pronounced in individuals with exposure to EA before (vs. after) the age of 3 years. These findings were independent of psychiatric diagnoses. Because of the low number of eligible electroencephalography studies, no conclusions could be reached regarding the effect of EA on the event-related potentials.

Conclusions: EA relates to alterations in behavioral and neurophysiological processing of facial emotions. Our study stresses the importance of assessing age at exposure and time since EA because these factors mediate some EA-related perturbations.
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http://dx.doi.org/10.1016/j.bpsc.2021.01.002DOI Listing
January 2021

Identifying causative mechanisms linking early-life stress to psycho-cardio-metabolic multi-morbidity: The EarlyCause project.

PLoS One 2021 21;16(1):e0245475. Epub 2021 Jan 21.

Empirica Communication and Technology Research, Bonn, Germany.

Introduction: Depression, cardiovascular diseases and diabetes are among the major non-communicable diseases, leading to significant disability and mortality worldwide. These diseases may share environmental and genetic determinants associated with multimorbid patterns. Stressful early-life events are among the primary factors associated with the development of mental and physical diseases. However, possible causative mechanisms linking early life stress (ELS) with psycho-cardio-metabolic (PCM) multi-morbidity are not well understood. This prevents a full understanding of causal pathways towards the shared risk of these diseases and the development of coordinated preventive and therapeutic interventions.

Methods And Analysis: This paper describes the study protocol for EarlyCause, a large-scale and inter-disciplinary research project funded by the European Union's Horizon 2020 research and innovation programme. The project takes advantage of human longitudinal birth cohort data, animal studies and cellular models to test the hypothesis of shared mechanisms and molecular pathways by which ELS shapes an individual's physical and mental health in adulthood. The study will research in detail how ELS converts into biological signals embedded simultaneously or sequentially in the brain, the cardiovascular and metabolic systems. The research will mainly focus on four biological processes including possible alterations of the epigenome, neuroendocrine system, inflammatome, and the gut microbiome. Life-course models will integrate the role of modifying factors as sex, socioeconomics, and lifestyle with the goal to better identify groups at risk as well as inform promising strategies to reverse the possible mechanisms and/or reduce the impact of ELS on multi-morbidity development in high-risk individuals. These strategies will help better manage the impact of multi-morbidity on human health and the associated risk.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0245475PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7819604PMC
January 2021

The clinical characterization of the patient with primary psychosis aimed at personalization of management.

World Psychiatry 2021 Feb;20(1):4-33

Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA.

The current management of patients with primary psychosis worldwide is often remarkably stereotyped. In almost all cases an antipsychotic medica-tion is prescribed, with second-generation antipsychotics usually preferred to first-generation ones. Cognitive behavioral therapy is rarely used in the vast majority of countries, although there is evidence to support its efficacy. Psychosocial interventions are often provided, especially in chronic cases, but those applied are frequently not validated by research. Evidence-based family interventions and supported employment programs are seldom implemented in ordinary practice. Although the notion that patients with primary psychosis are at increased risk for cardiovascular diseases and diabetes mellitus is widely shared, it is not frequent that appropriate measures be implemented to address this problem. The view that the management of the patient with primary psychosis should be personalized is endorsed by the vast majority of clinicians, but this personalization is lacking or inadequate in most clinical contexts. Although many mental health services would declare themselves "recovery-oriented", it is not common that a focus on empowerment, identity, meaning and resilience is ensured in ordinary practice. The present paper aims to address this situation. It describes systematically the salient domains that should be considered in the characterization of the individual patient with primary psychosis aimed at personalization of management. These include positive and negative symptom dimensions, other psychopathological components, onset and course, neurocognition and social cognition, neurodevelopmental indicators; social functioning, quality of life and unmet needs; clinical staging, antecedent and concomitant psychiatric conditions, physical comorbidities, family history, history of obstetric complications, early and recent environmental exposures, protective factors and resilience, and internalized stigma. For each domain, simple assessment instruments are identified that could be considered for use in clinical practice and included in standardized decision tools. A management of primary psychosis is encouraged which takes into account all the available treatment modalities whose efficacy is supported by research evidence, selects and modulates them in the individual patient on the basis of the clinical characterization, addresses the patient's needs in terms of employment, housing, self-care, social relationships and education, and offers a focus on identity, meaning and resilience.
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http://dx.doi.org/10.1002/wps.20809DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7801854PMC
February 2021

Leisure-time physical activity is associated with socio-economic status beyond income - Cross-sectional survey of the Northern Finland Birth Cohort 1966 study.

Econ Hum Biol 2021 May 2;41:100969. Epub 2021 Jan 2.

Department of Economics, Accounting and Finance, University of Oulu, P.O. Box 4600, FIN-90014, University of Oulu, Finland.

We apply neoclassical economic modelling augmented with behavioral aspects to provide a detailed empirical investigation into indicators of socio-economic status (SES) as determinants of leisure-time physical activity. We utilize the data from the Northern Finland Birth Cohort 1966 obtained at the most recent time point during 2012-2014 (response rate 67 %), at which time the participants were approximately 46 years old. Our final study sample consists of 3,335 employed participants (1520 men, 1815 women; 32.3 % of the target population). We apply logistic regression methods for estimating how the probability of being physically active is related to various indicators of socio-economic status, taking into account physical activity at work and individual lifestyle, family- and health-related factors. Overall, our findings show that belonging to a higher socio-economic group, whether defined by income level, educational attainment, or occupational status, is associated with higher leisure-time physical activity. However, when we analyze different socio-economic groups, defined in terms of education, income and occupation, separately, we find that income is not a significant determinant of leisure-time physical activity within any of the particular SES groups. Further, we find that leisure-time physical activity is negatively associated with higher screen time (i.e., watching TV and sitting at a computer), and other aspects of unhealthy lifestyle, and positively associated with self-assessed health. In addition, we note that proxies for individual motivational factors and childhood physical activity, such as the grade point average and the grade achieved in physical education when leaving basic education, are strongly correlated with leisure-time physical activity in middle age among men, but not among women. Our results are in line with behavioral economics reasoning that social comparisons and environments affect behaviors. We emphasize the importance of considering behavioral economic factors when designing policies to promote physical activity.
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http://dx.doi.org/10.1016/j.ehb.2020.100969DOI Listing
May 2021

Return to the labour market in schizophrenia and other psychoses: a register-based Northern Finland Birth Cohort 1966 study.

Soc Psychiatry Psychiatr Epidemiol 2021 Jan 5. Epub 2021 Jan 5.

Center for Life Course Health Research, Faculty of Medicine, University of Oulu, P.O. Box 5000, 90014, Oulu, Finland.

Purpose: The prospects and predictors of returning to the labour market after long-term work disability in psychoses are unclear. Our aim was to study the proportion and characteristics of persons with schizophrenia and other psychoses who return to the labour market after receiving a disability pension.

Methods: In this 50-year follow-up study in the Northern Finland Birth Cohort 1966 (NFBC1966), national registers on demographics, care, and disability pensions were used to detect and characterize individuals who had been on a disability pension for psychiatric reasons. We compared individuals with schizophrenia (SZ, n = 223) or other psychoses (OP, n = 200) to those with non-psychotic psychiatric disorders (NP, n = 1815) regarding demographics and end of pension by cross-tabulations and logistic regression.

Results: Of the 170 (74%) persons with SZ who had been on disability pension for a psychiatric reason, 15 (9%) returned to the labour market. Corresponding percentages were 19% for OP and 28% for NP. In SZ, being married, a later onset age of psychosis, and better school performance, and in OP and NP, having children predicted returning to the labour market. In all groups, a shorter length of the latest disability pension associated with returning to the labour market.

Conclusion: Although rare, it is possible to return to the labour market after a disability pension due to psychosis. Factors predicting a return to the labour market could be taken into account when planning rehabilitation.
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http://dx.doi.org/10.1007/s00127-020-02009-1DOI Listing
January 2021

Editorial: Have We Got Better in Making Our Schizophrenia Patients Better?

Front Psychiatry 2020 27;11:618417. Epub 2020 Nov 27.

Department of Psychiatry, Weill Cornell Medicine, Cornell University White Plains, New York, NY, United States.

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http://dx.doi.org/10.3389/fpsyt.2020.618417DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7728736PMC
November 2020

Cumulative incidences of hospital-treated psychiatric disorders are increasing in five Finnish birth cohorts.

Acta Psychiatr Scand 2021 02 24;143(2):119-129. Epub 2020 Nov 24.

Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland.

Objective: The aim of this study was to explore changes in the incidences of childhood and early adulthood hospital-treated psychiatric disorders in five large Finnish birth cohorts of individuals born between 1966 and 1997.

Methods: The five birth cohorts were as follows: Northern Finland Birth Cohort 1966 (NFBC 1966) and 1986 (NFBC 1986), 1987 Finnish Birth Cohort (FBC 1987) and 1997 (FBC 1997), and Finnish 1981 Birth Cohort Study (FBCS 1981). Incidences of hospital-treated psychiatric disorders in each cohort were calculated separately for males (N = 71,209) and females (N = 65,190). Poisson regression was used to test difference in proportions of psychiatric disorders in wide range of diagnosis classes separately in childhood and adolescence, and early adulthood.

Results: The total incidences of psychiatric disorders in childhood and adolescence among males has increased in the birth cohorts over decades (Incidence Rate Ratio, IRR = 1.04 (1.04-1.05); p < 0.001). Similar result was seen among females (IRR = 1.04 (1.03-1.04); p < 0.001). In early adulthood, there was significant increase among females (IRR = 1.04 (1.03-1.05); p < 0.001), but among males, the change was not significant (IRR = 0.99 (0.99-1.00), p = 0.051).

Conclusions: The main finding was that the cumulative incidence of hospital-treated psychiatric disorders increased over the decades in Finland. The increasing trend in hospital-treated psychiatric disorders in early adulthood was detected in females but not in males. In the youngest cohorts, the cumulative incidence of hospital-treated psychiatric disorders was at the same level in males and females, whereas in oldest cohort, males had higher incidence than females.
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http://dx.doi.org/10.1111/acps.13247DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7894526PMC
February 2021

Maternal and infant prediction of the child BMI trajectories; studies across two generations of Northern Finland birth cohorts.

Int J Obes (Lond) 2021 Feb 11;45(2):404-414. Epub 2020 Oct 11.

Center for Life Course Health Research, University of Oulu, Oulu, Finland.

Background/objective: Children BMI is a longitudinal phenotype, developing through interplays between genetic and environmental factors. Whilst childhood obesity is escalating, we require a better understanding of its early origins and variation across generations to prevent it.

Subjects/methods: We designed a cross-cohort study including 12,040 Finnish children from the Northern Finland Birth Cohorts 1966 and 1986 (NFBC1966 and NFBC1986) born before or at the start of the obesity epidemic. We used group-based trajectory modelling to identify BMI trajectories from 2 to 20 years. We subsequently tested their associations with early determinants (mother and child) and the possible difference between generations, adjusted for relevant biological and socioeconomic confounders.

Results: We identified four BMI trajectories, 'stable-low' (34.8%), 'normal' (44.0%), 'stable-high' (17.5%) and 'early-increase' (3.7%). The 'early-increase' trajectory represented the highest risk for obesity. We analysed a dose-response association of maternal pre-pregnancy BMI and smoking with BMI trajectories. The directions of effect were consistent across generations and the effect sizes tended to increase from earlier generation to later. Respectively for NFBC1966 and NFBC1986, the adjusted risk ratios of being in the early-increase group were 1.08 (1.06-1.10) and 1.12 (1.09-1.15) per unit of pre-pregnancy BMI and 1.44 (1.05-1.96) and 1.48 (1.17-1.87) in offspring of smoking mothers compared to non-smokers. We observed similar relations with infant factors including birthweight for gestational age and peak weight velocity. In contrast, the age at adiposity peak in infancy was associated with the BMI trajectories in NFBC1966 but did not replicate in NFBC1986.

Conclusions: Exposures to adverse maternal predictors were associated with a higher risk obesity trajectory and were consistent across generations. However, we found a discordant association for the timing of adiposity peak over a 20-year period. This suggests the role of residual environmental factors, such as nutrition, and warrants additional research to understand the underlying gene-environment interplay.
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http://dx.doi.org/10.1038/s41366-020-00695-0DOI Listing
February 2021

Parental somatic illnesses and their association with prodromal symptoms of psychosis among offspring.

Schizophr Res 2020 10 15;224:190-192. Epub 2020 Sep 15.

Center for Life Course Health Research, University of Oulu, P.O. Box 5000, 90014 Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, 90014 Oulu, Finland.

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http://dx.doi.org/10.1016/j.schres.2020.08.020DOI Listing
October 2020

Frequent Alcohol Intoxication and High Alcohol Tolerance During Adolescence as Predictors of Mortality: A Birth Cohort Study.

J Adolesc Health 2020 11 29;67(5):692-699. Epub 2020 Aug 29.

Department of Psychiatry, University of Turku, Turku, Finland; Addiction Psychiatry Unit, Department of Psychiatry, Turku University Hospital, Turku, Finland.

Purpose: Long-term prospective studies evaluating the health burden that is consequent to adolescent drinking are needed. The aim of this study was to examine the predictive associations between self-reported alcohol tolerance and frequent intoxication at age 15-16 years and the risk of death by age 33 years.

Methods: A sample (n = 6,615; 49.3% males) of the Northern Finland Birth Cohort Study 1986 was studied. Self-reported alcohol tolerance (drinks needed to feel intoxicated) and frequency of alcohol intoxication at age 15-16 years were analyzed along with background variables and data regarding subsequent psychiatric diagnoses. Categories were formed for both predictive variables from self-reported tolerance and frequency of intoxication in mid-adolescence. Cox regression was used to calculate hazard ratios (HRs) with 95% confidence interval (95% CI) for death by age 30 years.

Results: By the age of 33 years, of all 6,615 participants, 53 (.8%) were deceased. The HR for death by age 33 years was 3.08 (95% CI 1.17-8.07) among adolescents with high alcohol tolerance compared with adolescents without alcohol use or intoxication. The frequency of alcohol intoxication was also associated with mortality; HR 2.05 (95% CI 1.01-4.16) for those who had been intoxicated one to two times and HR 3.02 (95% CI 1.21-7.54) for those who had been intoxicated three or more times in the past 30 days compared with adolescents without intoxication.

Conclusions: High self-reported alcohol tolerance and frequent alcohol intoxication during mid-adolescence significantly predicted death by age 33 years. These behaviors carry long-term repercussions with respect to premature loss of life. Substantial efforts should be made to diminish this mortality risk.
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http://dx.doi.org/10.1016/j.jadohealth.2020.07.034DOI Listing
November 2020

Association of age at first drink and first alcohol intoxication as predictors of mortality: a birth cohort study.

Eur J Public Health 2020 12;30(6):1189-1193

Department of Psychiatry, University of Turku, Turku, Finland.

Background: More information on the health-related repercussions of age at onset of adolescent drinking is needed. The aim of this study was to examine the associations between self-reported age at first drink and age at first alcohol intoxication with the risk of death by age 30.

Methods: The sample (n = 6564; 49.1% males) included all participants of the Northern Finland Birth Cohort Study 1986 (NFBC1986) for whom the two measures of adolescent drinking were available. Self-reported age at onset of first drink and first alcohol intoxication were analyzed along with background variables and data regarding subsequent psychiatric diagnoses. Adolescents were dichotomized into those reporting age at first drink and age at first intoxication before or after age 14. Cox regression was used to calculate hazard ratios (HRs) with 95% confidence interval (95% CI) for death by age 30.

Results: By the age of 30, 0.7% (n = 47) of all 6564 participants were deceased. In the multivariable models, male gender and a history of illicit substance use in adolescence were associated with both all-cause mortality and mortality due to accidents or suicide. After controlling for confounding variables, age at first alcohol intoxication was associated with all-cause mortality (HR 2.33; 95% CI 1.04-5.20) as well as death due to accidents or suicide (HR 2.99; 95% CI 1.11-8.05).

Conclusions: Earlier age at first intoxication carries long-term repercussions with respect to premature loss of life. Efforts should be made targeting the prolongation of initiating binge drinking in adolescence to diminish this mortality risk.
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http://dx.doi.org/10.1093/eurpub/ckaa134DOI Listing
December 2020

Author's reply.

Br J Psychiatry 2020 08;217(2):458

Center for Life Course Health Research, University of Oulu; and Medical Research Center Oulu, Oulu University HospitalFinland.

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http://dx.doi.org/10.1192/bjp.2020.28DOI Listing
August 2020

Lower parental socioeconomic status in childhood and adolescence predicts unhealthy health behaviour patterns in adolescence in Northern Finland.

Scand J Caring Sci 2020 Jul 14. Epub 2020 Jul 14.

Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.

Objectives: To determine the association between parental socioeconomic status in childhood and adolescence and unhealthy health behaviour patterns among adolescents in Northern Finland.

Methods: The sample, drawn from the Northern Finland Birth Cohort 1986 Study, consisted of 15- to 16-year-old adolescents (n = 4305). Data on socioeconomic status and health behaviours were based on questionnaires collected from cohort members and their parents during the former's childhood and adolescence. Logistic regression served to assess the association.

Results: Controlling for all other factors in the model, several socioeconomic factors were found to be significant predictors of unhealthy health behaviour patterns. In childhood, father's low and medium education for boys, and mother's low or medium education as well as fathers' unemployment for girls predicted greater likelihood of engaging in unhealthy behaviour patterns. For both genders, having a stay-at-home mother in childhood (and for boys also in adolescence) protected from unhealthy health behaviour patterns. For boys, mother's and for girls, fathers' low occupational education in adolescence increased the risk of developing unhealthy patterns.

Conclusions: In the development of effective health prevention strategies, it is important to identify children and adolescents who are at risk of developing lifestyle diseases.
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http://dx.doi.org/10.1111/scs.12888DOI Listing
July 2020

Understanding the cumulative risk of maternal prenatal biopsychosocial factors on birth weight: a DynaHEALTH study on two birth cohorts.

J Epidemiol Community Health 2020 11 24;74(11):933-941. Epub 2020 Jun 24.

Center for Life Course Health Research, University of Oulu, Oulu, Finland

Background: There are various maternal prenatal biopsychosocial (BPS) predictors of birth weight, making it difficult to quantify their cumulative relationship.

Methods: We studied two birth cohorts: Northern Finland Birth Cohort 1986 (NFBC1986) born in 1985-1986 and the Generation R Study (from the Netherlands) born in 2002-2006. In NFBC1986, we selected variables depicting BPS exposure in association with birth weight and performed factor analysis to derive latent constructs representing the relationship between these variables. In Generation R, the same factors were generated weighted by loadings of NFBC1986. Factor scores from each factor were then allocated into tertiles and added together to calculate a cumulative BPS score. In all cases, we used regression analyses to explore the relationship with birth weight corrected for sex and gestational age and additionally adjusted for other factors.

Results: Factor analysis supported a four-factor structure, labelled closely to represent their characteristics as 'Factor1-BMI' (body mass index), 'Factor2-DBP' (diastolic blood pressure), 'Factor3-Socioeconomic-Obstetric-Profile' and 'Factor4-Parental-Lifestyle. In both cohorts, 'Factor1-BMI' was positively associated with birth weight, whereas other factors showed negative association. 'Factor3-Socioeconomic-Obstetric-Profile' and 'Factor4-Parental-Lifestyle' had the greatest effect size, explaining 30% of the variation in birth weight. Associations of the factors with birth weight were largely driven by 'Factor1-BMI'. Graded decrease in birth weight was observed with increasing cumulative BPS score, jointly evaluating four factors in both cohorts.

Conclusion: Our study is a proof of concept for maternal prenatal BPS hypothesis, highlighting the components snowball effect on birth weight in two different European birth cohorts.
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http://dx.doi.org/10.1136/jech-2019-213154DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7577640PMC
November 2020

Early exposure to social disadvantages and later life body mass index beyond genetic predisposition in three generations of Finnish birth cohorts.

BMC Public Health 2020 May 18;20(1):708. Epub 2020 May 18.

Center for Life Course Health Research, University of Oulu, P.O.Box 5000, Fin-90014, Oulu, Finland.

Background: The study aimed to explore the association between early life and life-course exposure to social disadvantage and later life body mass index (BMI) accounting for genetic predisposition and maternal BMI.

Methods: We studied participants of Helsinki Birth Cohort Study born in 1934-1944 (HBCS1934-1944, n = 1277) and Northern Finland Birth Cohorts born in 1966 and 1986 (NFBC1966, n = 5807, NFBC1986, n = 6717). Factor analysis produced scores of social disadvantage based on social and economic elements in early life and adulthood/over the life course, and was categorized as high, intermediate and low. BMI was measured at 62 years in HBCS1934-1944, at 46 years in NFBC1966 and at 16 years in NFBC1986. Multivariable linear regression analysis was used to explore associations between social disadvantages and BMI after adjustments for polygenic risk score for BMI (PRS BMI), maternal BMI and sex.

Results: The association between exposure to high early social disadvantage and increased later life BMI persisted after adjustments (β = 0.79, 95% CI, 0.33, 1.25, p < 0.001) in NFBC1966. In NFBC1986 this association was attenuated by PRS BMI (p = 0.181), and in HBCS1934-1944 there was no association between high early social disadvantage and increased later life BMI (β 0.22, 95% CI -0.91,1.35, p = 0.700). In HBCS1934-1944 and NFBC1966, participants who had reduced their exposure to social disadvantage during the life-course had lower later life BMI than those who had increased their exposure (β - 1.34, [- 2.37,-0.31], p = 0.011; β - 0.46, [- 0.89,-0.03], p = 0.038, respectively).

Conclusions: High social disadvantage in early life appears to be associated with higher BMI in later life. Reducing exposure to social disadvantage during the life-course may be a potential pathway for obesity reduction.
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http://dx.doi.org/10.1186/s12889-020-08763-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7236362PMC
May 2020

Associations between Childhood and Adolescent Emotional and Behavioral Characteristics and Screen Time of Adolescents.

Issues Ment Health Nurs 2020 Aug 13;41(8):700-712. Epub 2020 May 13.

Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.

The correlations between emotional and behavioral problems and increased screen time among young people has been highlighted in the literature. This study examined both longitudinal and cross-directional associations between the degree of childhood and adolescent emotional and behavioral problem characteristics and a higher level of daily screen time in adolescence using an extensive population study. Questionnaires providing data on a representative cohort sample (the Northern Finland Birth Cohort 1986 Study, NFBC 1986; n = 6479; 3101 males) were completed at birth, in childhood, and in adolescence. Male gender, and self-reported behavioral issues (such as a higher degree of hyperactivity/distractibility problems at the beginning of formal schooling and adolescent rule-breaking problems), predicted higher daily screen time in adolescence, after controlling for confounding factors. Higher levels of anxious-depression symptoms among adolescents were inversely related to them having elevated daily digital screen time. Individual behavioral tendencies at the start of formal schooling and later in adolescence may predict higher screen time among young people.
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http://dx.doi.org/10.1080/01612840.2020.1725195DOI Listing
August 2020

Parental Alcohol Use and the Alcohol Misuse of their Offspring in a Finnish Birth Cohort: Investigation of Developmental Timing.

J Youth Adolesc 2020 Aug 6;49(8):1702-1715. Epub 2020 May 6.

Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.

There is a positive association between parental alcohol use and the alcohol use of their offspring. It is less clear whether this relation exists at different developmental periods. The purpose of the current study was to examine the associations between parental alcohol use at two developmental periods (prenatal and adolescence) and the alcohol misuse of their offspring at two developmental periods (adolescence and young adulthood). Data from the Northern Finland Birth Cohort 1986 (NFBC1986; n = 6963; 51% of offspring were girls) were used. The NFBC1986 is a population-based study of individuals born during a 1-year period in Finland. Multi-informant (parent, teacher, and youth) and multi-method (surveys and population registers) data were collected at four developmental periods (prenatal, childhood, adolescence, and young adulthood). The findings indicated that parents' alcohol use was stable from the prenatal period to adolescence. Mothers' and fathers' (based on mothers' perceptions) alcohol use during the prenatal period and adolescence were directly related to adolescents' heavy drinking. Prenatal alcohol use by mothers and fathers were related to young adults' alcohol use disorder indirectly (but not directly) through mothers' and fathers' alcohol use during adolescence and then through adolescents' heavy drinking. The results suggest that early and ongoing screening for alcohol use by mothers and fathers could help identify individuals at risk for heavy drinking and alcohol-related problems during adolescence and young adulthood.
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http://dx.doi.org/10.1007/s10964-020-01239-5DOI Listing
August 2020

The effects and safety of telerehabilitation in patients with lower-limb joint replacement: A systematic review and narrative synthesis.

J Telemed Telecare 2020 Apr 21:1357633X20917868. Epub 2020 Apr 21.

Research Group of Medical Imaging, Physics and Technology, University of Oulu, Finland.

Introduction: As the number of patients undergoing primary lower-limb joint replacement has risen continuously, hospital-based healthcare resources have become limited. Delivery of any ongoing rehabilitation needs to adapt to this trend. This systematic literature aimed to examine the effects and safety of telerehabilitation in patients with lower-limb joint replacement.

Methods: A systematic review of randomized controlled trials was conducted according to procedures by the Joanna Briggs Institute. Studies published prior to February 2020 were identified from Medline Ovid, Scopus, Ebsco Databases and Web of Science. Reference lists of relevant studies were also manually checked to find additional studies. Two researchers conducted study selection separately. The Joanna Briggs Institute Critical Appraisal Checklist for Randomized Controlled Trials was used to evaluate the quality of the relevant studies published. A narrative synthesis was used to report the results whereas effect sizes were estimated for different outcomes.

Results: Nine studies with 1266 patients were included. Study quality was predominantly affected by the lack of blinding. The patients who completed telerehabilitation showed an improvement in physical functioning that was similar to that of patients completing conventional in-person outpatient physical therapy without an increase in adverse events or resource utilization. The effect of telerehabilitation on physical functioning, however, was assessed as heterogeneous and moderate- to low-quality evidence.

Discussion: Telerehabilitation is a practical alternative to conventional in-person outpatient physical therapy in patients with lower-limb joint replacement. However, more robust studies are needed to build evidence about telerehabilitation.
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http://dx.doi.org/10.1177/1357633X20917868DOI Listing
April 2020

The effectiveness of web-based mobile health interventions in paediatric outpatient surgery: A systematic review and meta-analysis of randomized controlled trials.

J Adv Nurs 2020 Apr 13. Epub 2020 Apr 13.

Department of Children and Women, Medical Research Center, Oulu University Hospital, Oulu, Finland.

Aims: To evaluate the effectiveness of web-based mobile health interventions on paediatric patients and their parents in the day surgery context, where the primary outcome was children's pre-operative anxiety and secondary outcomes were postoperative pain and parents' anxiety and satisfaction with entire course of the day surgery.

Design: A systematic review and meta-analysis of randomized controlled trials.

Data Sources: CENTRAL, CINAHL, Scopus, Ovid MEDLINE, and Web of Science were systematically searched without time limits (up to December 2018).

Review Methods: Studies were appraised using the Cochrane risk of bias tool. A random effect meta-analysis of children's pre-operative anxiety was performed.

Results: Eight studies with a total of 722 patients were included in the analysis. The effectiveness of web-based mobile health interventions, including age-appropriate videos, web-based game apps, and educational preparation games made for the hospital environment, was examined in pre-operative settings. A meta-analysis (N = 560 children) based on six studies found a statistically significant reduction in pre-operative anxiety measured by the Modified Yale Pre-operative Anxiety Scale with a moderate effect size. Three studies reported parental satisfaction.

Conclusion: Web-based mobile health interventions can reduce children's pre-operative anxiety and increase parental satisfaction. Web-based mobile health interventions could be considered as non-pharmacological distraction tools for children in nursing. There is not enough evidence regarding the effectiveness of reducing children's postoperative pain and parental anxiety using similar interventions.

Impact: Web-based mobile health interventions reduce children´s pre-operative anxiety and could therefore be considered as non-pharmacological distraction tools for children in nursing.
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http://dx.doi.org/10.1111/jan.14381DOI Listing
April 2020

Early environmental factors and somatic comorbidity in schizophrenia and nonschizophrenic psychoses: A 50-year follow-up of the Northern Finland Birth Cohort 1966.

Eur Psychiatry 2020 02 21;63(1):e24. Epub 2020 Feb 21.

Center for Life Course Health Research, University of Oulu, Oulu, Finland.

Background: We studied the cumulative incidence of physical illnesses, and the effect of early environmental factors (EEFs) on somatic comorbidity in schizophrenia, in nonschizophrenic psychosis and among nonpsychotic controls from birth up to the age of 50 years.

Methods: The sample included 10,933 members of the Northern Finland Birth Cohort 1966, of whom, 227 had schizophrenia and 205 had nonschizophrenic psychosis. Diagnoses concerning physical illnesses were based on nationwide registers followed up to the end of 2016 and classified into 13 illness categories. Maternal education and age, family type at birth and paternal socioeconomic status were studied as EEFs of somatic illnesses.

Results: When adjusted by gender and education, individuals and especially women with nonschizophrenic psychosis had higher risk of morbidity in almost all somatic illness categories compared to controls, and in some categories, compared to individuals with schizophrenia. The statistically significant adjusted hazard ratios varied from 1.27 to 2.42 in nonschizophrenic psychosis. Regarding EEFs, single-parent family as the family type at birth was a risk factor for a higher somatic score among men with schizophrenia and women with nonschizophrenic psychosis. Maternal age over 35 years was associated with lower somatic score among women with nonschizophrenic psychosis.

Conclusions: Persons with nonschizophrenic psychoses have higher incidence of somatic diseases compared to people with schizophrenia and nonpsychotic controls, and this should be noted in clinical work. EEFs have mostly weak association with somatic comorbidity in our study.
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http://dx.doi.org/10.1192/j.eurpsy.2020.25DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7315879PMC
February 2020

Interventions to improve nurses' job satisfaction: A systematic review and meta-analysis.

J Adv Nurs 2020 Jul 29;76(7):1498-1508. Epub 2020 Mar 29.

Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.

Aims: To identify current best evidence on the types of interventions that have been developed to improve job satisfaction among nurses and on the effectiveness of these interventions.

Design: The systematic review is a quantitative systematic review and meta-analysis following a profile-likelihood random-effects model.

Data Sources: CINAHL, Medic, and Pubmed (Medline).

Review Methods: PICOS eligibility criteria were used to select original studies published between 2003-2019. The articles were screened by title (N = 489), abstract (N = 61), and full-text (N = 47). A total of 20 articles remained after the full-text screening process and further assess on risk of bias. The screening process was conducted by two authors independently and finally agreed together. A meta-analysis was performed to determine how the identified interventions influence nurses' job satisfaction.

Results: The interventions were primarily educational and consisted of workshops, educational sessions, lessons, and training sessions. The postintervention differences between intervention and control groups in meta-analysis revealed that two interventions significantly improved nurses' job satisfaction. Notably, the spiritual intelligence training protocol and Professional Identity Development Program were found to be effective in improving job satisfaction.

Conclusion: Healthcare organizations and managers should consider implementing effective interventions to improve nurses' job satisfaction and reduce turnover. The results reported in this study highlight that nurse managers should focus on organizational strategies that will foster the intrinsic motivation of employees.

Impact: The current nursing shortage and increased turnover intentions are proving to be a global problem. For this reason, it is imperative that nurse managers plan strategies to improve nurses´ job satisfaction. The effective interventions detected in this study are a first step for developing human resource strategies for healthcare organizations. These findings propose that extrinsic factors (e.g., salary and rewards) will never be as effective in maintaining job satisfaction as intrinsic factors (e.g., spiritual intelligence, professional identity, and awareness).
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http://dx.doi.org/10.1111/jan.14342DOI Listing
July 2020

Parental socioeconomic status, adolescents' screen time and sports participation through externalizing and internalizing characteristics.

Heliyon 2020 Feb 17;6(2):e03415. Epub 2020 Feb 17.

Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.

The socioeconomic status of parents is reportedly closely related to the digital screen usage and physical inactivity levels of children and adolescents. Internalizing and externalizing behavior characteristics may be linked to these associations and explain them. The purpose of the present study was to investigate the effects of parents' socioeconomic status (SES) on youths' total screen time along with physical inactivity through internalizing and externalizing behavior characteristics. Thus, we examined associations between parents' socioeconomic status (using scores based on several indicators) and adolescents' total digital screen exposure and physical inactivity level, together with the potentially predicting role of the adolescents' internalizing and externalizing behavior. For this, we assessed the internalizing and externalizing problem characteristics, total screen time exposure, physical inactivity level and parental socioeconomic status of a large cohort sample of Finnish adolescents (the Northern Birth Cohort, 1986 comprised 2899 males and 3059 females). The present study includes data collected in two phases, in 1985-1986 and 2000-2001. Path modeling suggests that a low SES of parents was directly associated with adolescents' physical inactivity level, while externalizing characteristics were a significant and additional contributing factor in adolescents' level of screen exposure in both genders. Gender moderated the relationship between adolescents' internalizing and externalizing characteristics and physical inactivity levels. The results also suggest that parents' socioeconomic status constitutes a risk factor in relation to media screen exposure only in female adolescents. Implications of the findings are discussed.
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http://dx.doi.org/10.1016/j.heliyon.2020.e03415DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7029175PMC
February 2020

Parental death due to natural death causes during childhood abbreviates the time to a diagnosis of a psychiatric disorder in the offspring: A follow-up study.

Death Stud 2020 Feb 17:1-10. Epub 2020 Feb 17.

Center for Life Course Health Research, University of Oulu, Oulu, Finland.

Parental death before adulthood has been shown to increase offspring's risk of poor health and adverse social consequences. In a sample of 422 subjects with parental death (334 (79.1%) due to natural causes), and 6172 matched controls, those with parental death were given a diagnosis of a psychiatric disorder up to 28 years of age earlier than their controls (10-year survival proportions: 88.6% vs. 93.1%,  = 0.001). Our findings indicate that psychosocial support must be provided as early as when a parent falls ill, especially with those illnesses that are the most common causes of death in the population.
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http://dx.doi.org/10.1080/07481187.2020.1725928DOI Listing
February 2020

Early childhood and adolescent risk factors for psychotic depression in a general population birth cohort sample.

Soc Psychiatry Psychiatr Epidemiol 2020 Sep 13;55(9):1179-1186. Epub 2020 Feb 13.

Center for Life Course Health Research, University of Oulu, Oulu, Finland.

Background And Purpose: In the group of severe mental disorders, psychotic depression (PD) is essentially under-researched. Knowledge about the risk factors is scarce and this applies especially to early risk factors. Our aim was to study early childhood and adolescent risk factors of PD in a representative birth cohort sample with a follow-up of up to 50 years.

Methods: The study was carried out using the Northern Finland Birth Cohort 1966 (NFBC 1966). We used non-psychotic depression (NPD) (n = 746), schizophrenia (SZ) (n = 195), psychotic bipolar disorder (PBD) (n = 27), other psychoses (PNOS) (n = 136) and healthy controls (HC) (n = 8200) as comparison groups for PD (n = 58). We analysed several potential early risk factors from time of birth until the age of 16 years.

Results: The main finding was that parents' psychiatric illness [HR 3.59 (1.84-7.04)] was a risk factor and a high sports grade in school was a protective factor [HR 0.29 (0.11-0.73)] for PD also after adjusting for covariates in the multivariate Cox regression model. Parental psychotic illness was an especially strong risk factor for PD. The PD subjects had a parent with psychiatric illness significantly more often (p < 0.05) than NPD subjects. Differences between PD and other disorder groups were otherwise small.

Conclusions: A low sports grade in school may be a risk factor for PD. Psychiatric illnesses, especially psychoses, are common in the parents of PD subjects. A surprisingly low number of statistically significant risk factors may have resulted from the size of the PD sample and the underlying heterogeneity of the etiology of PD.
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http://dx.doi.org/10.1007/s00127-020-01835-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7471190PMC
September 2020

Association Between Psychosocial Problems and Unhealthy Health Behavior Patterns Among Finnish Adolescents.

Child Psychiatry Hum Dev 2020 10;51(5):699-708

Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.

The aim of the study was to investigate how psychosocial problems in childhood and adolescence associate with an unhealthy health behavior pattern among adolescents in Northern Finland. The study population consisted of 4350 participants, drawn from the Northern Finland Birth Cohort 1986 Study. Health behavior patterns were assessed in adolescence and psychosocial problems in childhood and adolescence. Logistic regression analyses were performed to determine the associations. Several psychosocial problems predicted greater likelihood of engaging in unhealthy health behavior pattern. Externalizing problems in childhood predicted greater likelihood of engaging in unhealthy behavior patterns for girls. For both genders, externalizing problems and inattention in adolescence were associated with unhealthy health behavior patterns. Boys and girls with externalizing problems both in childhood and adolescence had an increased risk of unhealthy patterns. Psychosocial problems contribute to unhealthy lifestyles and should therefore be acknowledged when designing and targeting health promotion strategies aimed at adolescents.
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http://dx.doi.org/10.1007/s10578-020-00967-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7518991PMC
October 2020

Population-based Data at Ages 31 and 46 Show Decreased HRQoL and Life Satisfaction in Women with PCOS Symptoms.

J Clin Endocrinol Metab 2020 06;105(6)

Department of Obstetrics and Gynecology, PEDEGO Research Unit and Medical Research Centre Oulu and PEDEGO Research Unit, Oulu, University Hospital of Oulu, University of Oulu, Oulu, Finland.

Context: Polycystic ovary syndrome (PCOS) is associated with decreased health-related quality of life (HRQoL), but longitudinal data beyond the reproductive years are lacking, and the impact of isolated PCOS symptoms is unclear.

Objective: To study generic HRQoL using the 15D questionnaire, life satisfaction, and self-reported health status in women with PCOS symptoms at ages 31 and 46 years.

Design: A longitudinal assessment using the Northern Finland Birth Cohort 1966.

Setting: General community.

Participants: The 15D data were available for women reporting isolated oligo-amenorrhea (OA; at age 31 years, 214; and 46 years, 211), isolated hirsutism (H; 31 years, 211; and 46 years, 216), OA + H (PCOS; 31 years, 74; and 46 years, 75), or no PCOS symptoms (controls; 31 years, 1382; and 46 years, 1412). Data for life satisfaction and current health status were available for OA (31 years, 329; and 46 years, 247), H (31 years, 323; and 46 years, 238), PCOS (31 years, 125; and 46 years, 86), control (31 years, 2182; and 46 years, 1613) groups.

Intervention(s): None.

Main Outcome Measure(s): 15D HRQoL, questionnaires on life satisfaction, and self-reported health status.

Results: HRQoL was lower at ages 31 and 46 in women with PCOS or H than in the controls. PCOS was an independent risk factor for low HRQoL, and the decrease in HRQoL in PCOS was similar to that of women with other chronic conditions, such as asthma, migraine, rheumatoid arthritis, and depression. The risk for low HRQoL in PCOS remained significant after adjusting for body mass index, hyperandrogenism, and socioeconomic status. Mental distress was the strongest contributing factor to HRQoL. PCOS was also associated with a risk for low life satisfaction and a 4-fold risk for reporting a poor health status.

Conclusions: Women with PCOS present with low HRQoL, decreased life satisfaction, and a poorer self-reported health status up to their late reproductive years. Assessments and interventions aiming to improve HRQoL in PCOS should be targeted beyond the fertile age.
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http://dx.doi.org/10.1210/clinem/dgz256DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7150615PMC
June 2020