Publications by authors named "Sami Pirkola"

83 Publications

Poor respiratory health outcomes associated with high illness worry and alexithymia: Eleven-year prospective cohort study among the working-age population.

J Psychosom Res 2022 04 4;155:110751. Epub 2022 Feb 4.

Department of Health, Finnish Institute for Health and Welfare, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Finland.

Objective: Poor respiratory health outcomes have been associated with poorer physical health and higher psychological distress. The aim of this study was to investigate whether illness worry, alexithymia or low sense of coherence predict i) the onset of new respiratory disease, ii) respiratory symptoms or iii) lung function among the working-age population, independently of comorbidity mood-, anxiety, or alcohol abuse disorders.

Methods: The study was conducted among a nationally representative sample of the Finnish population (BRIF8901) aged 30-54 years (N = 2310) in 2000-2001 and was followed up in 2011. Individuals with a diagnosed respiratory disease or a severe psychiatric disorder at baseline were excluded. Lung function was measured by a spirometry test and psychiatric disorders were diagnosed using a structured clinical interview. Structured questionnaires were used to measure self-reported respiratory symptoms and diseases, illness worry, alexithymia, and sense of coherence.

Results: High illness worry predicted an 11-year incidence of asthma (OR 1.47, 95% CI 1.09-1.99, p = 0.01). Alexithymia predicted shortness of breath (OR 1.32, 95% CI 1.13-1.53, p < 0.01) and 11-year incidence of COPD (OR 2.84, 95% CI 1.37-5.88, p < 0.01), even after several adjustments for physical and mental health. Psychological dispositions did not associate with lung function in 2011.

Conclusions: In the general population, psychological factors that modify health behaviour predicted adverse respiratory health outcomes independently of lung function after 11 years of follow-up. This indicates that considering them part of personalized treatment planning is important for promoting health-related behaviour among the working-age population.
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http://dx.doi.org/10.1016/j.jpsychores.2022.110751DOI Listing
April 2022

Internet-delivered cognitive behavioral therapy (iCBT) for common mental disorders and subsequent sickness absence: a systematic review and meta-analysis.

Scand J Public Health 2022 Feb 4:14034948221075016. Epub 2022 Feb 4.

Faculty of Social Sciences, University of Helsinki, Finland.

Aim: The study aimed to critically review and synthesize the best available evidence about the effectiveness of therapist-guided internet-delivered cognitive behavioral therapy (iCBT) in terms of reducing sickness absence (SA).

Methods: We searched Medline (PubMed), Embase, PsycInfo, CINAHL, and Cochrane Central (up to November 2020) for English language peer-reviewed papers that described randomized controlled trials of therapist-guided iCBT compared with usual treatment for SA in adults with common mental disorders. Eligible studies were assessed with the Cochrane Risk of Bias 1 tool, meta-analysis was conducted using a random-effects model, and standardized mean differences (SMD) with 95% confidence intervals (CI) were reported. A subgroup analysis investigated potential moderating variables (diagnosis, SA at baseline, and estimated accuracy of self-report).

Results: We identified 2788 references, of which 68 remained after the completion of the systematic screening process. A hand search of reference lists yielded no additional studies. The full texts of these 68 studies were appraised critically, and 11 were deemed to be suitable for a meta-analysis. SA was similar for iCBT and usual treatment groups (SMD: 0.02, 95% CI, -0.08 to 0.11), and remained similar even after the removal of two studies in which the recall time was over 3 months (SMD: 0.00, -0.11 to 0.12). Similar SA levels in intervention and control groups at 6-month and 12-month follow-up were observed in studies of participants with depression symptoms.

Conclusions:
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http://dx.doi.org/10.1177/14034948221075016DOI Listing
February 2022

Contextual and mental health service factors in mental disorder-based disability pensioning in Finland - a regional comparison.

BMC Health Serv Res 2021 Oct 11;21(1):1081. Epub 2021 Oct 11.

Faculty of Social Sciences (Unit of Health Sciences), Tampere University, Tampere, Finland.

Background: We investigated the regional differences in all mental disorder disability pensions (DP) between 2010 and 2015 in Finland, and separately in mood disorders and non-affective psychotic disorder DP. We also studied the contribution of several district-level contextual and mental health service factors to mental disorder DP.

Methods: Subjects were all those granted mental disorder DP for the first time between 2010 and 2015 in Finland (N = 36,879). Associations between the district-level contextual and mental health service factors and regional DP risks collected from the year 2015 were studied with negative binomial regression analysis in the Finnish hospital districts. The population number on the age (18 to 65 years), gender, occupational status and residential hospital district of the Finnish population from 2015 was used as exposure in the model.

Results: Significant differences in the regional mental disorder DP risks between and within hospital districts did not appear to follow the traditional Finnish health differences. A lower risk of DP was associated with contextual indicators of higher regional socioeconomic level. Furthermore, population density as a proxy for access to mental health services indicated a higher regional DP risk for lower density in all mental (IRR 1.10; 95% CI 1.06-1.14) and mood disorder (IRR 1.12; 95% CI 1.08-1.16) DP. Both the highest and the lowest regional numbers of all mental health outpatient visits were associated with a higher DP risk in all mental and mood disorder DP, whereas particularly low regional numbers of inpatient treatment periods and of patients were associated with a lower risk of DP.

Conclusions: In this comprehensive population-level study, we found evidence of significant regional variation in mental disorder DP and related district-level factors. This variation may at least partly relate to differences in regional mental health service systems and treatment practices. Adapting to the needs of the local population appears to be indicated for both regional mental health service systems and treatment practices to achieve optimal performance.
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http://dx.doi.org/10.1186/s12913-021-07099-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8507374PMC
October 2021

Factors behind a remarkable increase in adolescent psychiatric inpatient treatment between 1980 and 2010 - a nationwide register study.

Nord J Psychiatry 2022 Feb 29;76(2):120-128. Epub 2021 Jun 29.

Department of Adolescent Psychiatry, Tampere University Hospital, Tampere, Finland.

Purpose: This register-based study aimed to evaluate trends in adolescent psychiatric inpatient care using nationwide data from three consecutive decades.

Methods: The study population ( 17,112) comprised all Finnish citizens aged 13-17 receiving their first-ever psychiatric inpatient treatment between 1980 and 2010 in Finland. Information on inpatient care in the psychiatric hospital was obtained from the Hospital Discharge Register and the Care Register for Health Care, which contains data on all patients discharged from all Finnish inpatient psychiatric health services.

Results: Inpatient admissions remained relatively stable until the early 1990s, after which a steady increase was seen, peaking in 2008 and more marked among females than males. In males, there was an increase in inpatient care episodes for externalizing disorder or mood disorder, and in females for mood disorder. Duration of first inpatient care decreased over time, but level of functioning on admission remained stable or even deteriorated. Females, patients first admitted in the 1980s or diagnosed with schizophrenia were more likely to be re-hospitalized during adolescence.

Conclusions: We reported an increase in adolescent psychiatric inpatient care from the latter half of the 1990s up to 2010, which could be explained by societal and policy changes. In particular, as the study period progressed a significant increase was seen in admissions of females and a global reduction of length of stay (LOS) with no concomitant increase in re-hospitalizations.
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http://dx.doi.org/10.1080/08039488.2021.1939780DOI Listing
February 2022

Childhood adversities are associated with shorter leukocyte telomere length at adult age in a population-based study.

Psychoneuroendocrinology 2021 08 21;130:105276. Epub 2021 May 21.

Research Programs Unit, Molecular Neurology, Biomedicum-Helsinki, University of Helsinki, Finland; SleepWell Research Program, Faculty of Medicine, University of Helsinki, P.O. Box 21, 00014, Finland; Department of Psychology and Logopedics, University of Helsinki, Finland; Neuroscience Center, Helsinki Institute of Life Science HiLIFE, University of Helsinki, Finland. Electronic address:

Telomeres are repeat sequences and an associated protein complex located at the end of the chromosomes. They shorten with every cell division and are regarded markers for cellular aging. Shorter leukocyte telomere length (LTL) has been observed in many complex diseases, including psychiatric disorders. However, analyses focusing on psychiatric disorders are mainly based on clinical samples and the significance of shorter LTL on the population level remains uncertain. We addressed this question in a population-based sample from Finland (N = 7142). The survey was performed and the blood samples were collected in 2000-2001 to assess major public health problems and their determinants. DSM-IV diagnoses of major psychiatric illnesses were obtained by interview using the Composite International Diagnostic Interview. Information regarding their risk factors, including the number of self-reported childhood adversities, recent psychological distress, and sleep difficulties was collected by questionnaires. LTL was measured by qPCR. None of the studied psychiatric illnesses, sleep difficulties, or recent psychological distress associated with LTL. However, individuals with three or more childhood adversities had shorter LTL at adult age (β = -0.006, P = 0.005). Also, current occupational status was associated with LTL (β = -0.03, P = 0.04). These effects remained significant after adjusting for known LTL-associated lifestyle or sociodemographic factors. In conclusion, relatively common childhood adversities were associated with shorter LTL at adult age in a nationally representative population-based cohort, implying that childhood adversities may cause accelerated telomere shortening. Our finding has potentially important implications as it supports the view that childhood adversities have an impact on psychological and somatic well-being later in life.
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http://dx.doi.org/10.1016/j.psyneuen.2021.105276DOI Listing
August 2021

Socioeconomic factors in disability retirement due to mental disorders in Finland.

Eur J Public Health 2020 12;30(6):1218-1224

Faculty of Social Sciences, Tampere University, Tampere, Finland.

Background: Previous research has identified low socioeconomic status (SES) as an epidemiological risk factor for early retirement and disability pension (DP) due to mental disorders. This study aims to examine these associations in greater detail, with separate consideration of the risk factors for mood disorders (F30-39) and non-affective psychotic disorder (F20-29) DP.

Methods: In this case-control setting the subjects (N = 36 879) were all those granted DP due to a mental disorder for the first time between 2010 and 2015 in Finland. All the subjects were matched with three controls for their gender, age and hospital district (N = 94 388). Three measures of dimensions of SES were used: education, income and occupational status, as well as family type as a control factor. Differences between DP recipients and controls, and between diagnostic groups, were studied using calculated characteristics and conditional logistic regression models.

Results: DP recipients often lived alone and had low educational and income levels. These characteristics were more prominent in non-affective psychotic disorder than in mood disorder DP. In white-collar occupational groups, the risk of DP was greater compared with blue-collar workers. Students were associated with the highest level of risk for all mental and mood disorder DPs.

Conclusions: We found evidence of SES factors associating with mental disorder-related severe loss of working and studying ability in a disorder-specific way. Notably, white-collar workers had an increased risk of mental disorder DP. This could be related to the psychosocially demanding contemporary working life in non-manual work.
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http://dx.doi.org/10.1093/eurpub/ckaa132DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7733043PMC
December 2020

Diagnostic conversion from unipolar depression to bipolar disorder, schizophrenia, or schizoaffective disorder: A nationwide prospective 15-year register study on 43 495 inpatients.

Bipolar Disord 2020 09 22;22(6):582-592. Epub 2020 May 22.

Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Objective: To examine temporal patterns and predictors for diagnostic conversion from unipolar depression (UD) to bipolar disorder (BD), schizophrenia, and schizoaffective disorder (SAD).

Methods: A prospective nationwide register-based cohort (n = 43 495) of all first psychiatric hospitalizations due to UD during 1996-2011 was followed up to 15 years. We used cumulative incidence function (CIF) analyses and the Fine-Gray subdistribution model to define the cumulative incidence of the conversions and subdistribution hazard ratios (SHRs) for predictors.

Results: The overall 15-year cumulative incidence of conversion was 11.1% (95% CI 10.7-11.6): 7.4% (95% CI 7.0-7.8) for BD, 2.5% (95% CI 2.3-2.7) for schizophrenia, and 1.3% (95% CI 1.1-1.4) for SAD. The highest crude incidence rate emerged during the first year. Psychotic depression predicted higher conversion risk to BD (SHR = 2.0, 95% CI 1.5-2.7), schizophrenia (SHR = 5.3, 95% CI 3.3-8.7), and SAD (SHR = 10.6, 95% CI 4.0-28.4) than mild depression. Female sex, greater overall disturbance, and comorbid personality disorder predicted conversion to BD, whereas young age and male sex to psychotic disorders.

Conclusions: Among patients with first hospitalization due to UD, approximately one in nine converts to another major psychiatric disorder during 15 years, with the highest risk occurring within the first year. Patients with psychotic depression are particularly vulnerable for conversion to other major psychiatric disorders. Conversion to psychotic disorders occurs earlier than to BD. Males are at higher risk for progression to psychotic disorders, whereas females, patients with recurrent depressive episodes, severe disturbance of overall functioning, and personality disorder are at higher risk for converting to BD.
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http://dx.doi.org/10.1111/bdi.12929DOI Listing
September 2020

Association of Income With the Incidence Rates of First Psychiatric Hospital Admissions in Finland, 1996-2014.

JAMA Psychiatry 2020 03;77(3):274-284

Faculty of Social Sciences, Tampere University, Tampere, Finland.

Importance: The association between income and mental health has long been a question of interest. Nationwide register data provide means to examine trends and patterns of these associations.

Objectives: To compare income-specific trends in the incidence rates of first psychiatric hospital admissions and to evaluate whether an income gradient exists in the incidence rates at all levels of household income.

Design, Setting, And Participants: This population-based open cohort study used linked registry data from nationwide Finnish Hospital Discharge and Statistics Finland population registers to determine annual incidence rates of first psychiatric hospital admissions. All Finnish citizens (N = 6 258 033) living in the country at any time from January 1, 1996, through December 31, 2014, contributed to 96 184 614 person-years at risk of first inpatient treatment for mental disorders. The analyses were conducted from August 1, 2018, through September 30, 2019.

Exposures: Equivalized disposable income, sex, age group, reduction in income decile in the previous 3 years, urbanicity, educational level, and living alone status.

Main Outcomes And Measures: Annual percentage changes in the age-standardized incidence rates and incidence rate ratios (IRRs).

Results: Altogether, 186 082 first psychiatric inpatient treatment episodes occurred (93 431 [50.2%] men), with overall age-standardized incidence rates per 1000 person-years varying from 1.59 (95% CI, 1.56-1.63) in 2014 to 2.11 (95% CI, 2.07-2.15) in 2008. In the highest income deciles, a continuous mean decrease per year of 3.71% (95% CI, 2.82%-4.59%) in men and 0.91% (95% CI, 0.01%-1.80%) in women occurred throughout the study period, in contrast to the lowest deciles, where the trends first increased (1.31% [95% CI, 0.62%-2.01%] increase in men from 1996 to 2007 and 5.61% [95% CI, 2.36%-8.96%] increase in women from 1996 to 2001). In the adult population, an income gradient was observed at all levels of household income: the lower the income decile, the higher the adjusted IRRs compared with the highest decile. The IRRs in the lowest decile varied from 2.94 (95% CI, 2.78-3.11) to 4.46 (95% CI, 4.17-4.76). In other age groups, the gradient did not persist at the highest income deciles. Diagnosis-specific income gradient was steepest in schizophrenia and related psychotic disorders, with estimated IRRs of the lowest income decile of 5.89 (95% CI, 5.77-6.02).

Conclusions And Relevance: In this cohort study, clear negative income gradient in the incidence rates of first hospital-treated mental disorders was observed in the adult population of Finland. These findings suggest that reduction in the use of inpatient care has not taken place equally between different income groups.
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http://dx.doi.org/10.1001/jamapsychiatry.2019.3647DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6990744PMC
March 2020

Employment Status and Personal Income Before and After Onset of a Severe Mental Disorder: A Case-Control Study.

Psychiatr Serv 2020 03 14;71(3):250-255. Epub 2019 Nov 14.

Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki (Hakulinen, Elovainio); National Institute for Health and Welfare, Helsinki (Hakulinen, Elovainio, Arffman, Lumme, Keskimäki, Manderbacka); Faculty of Social Sciences, Tampere University, Tampere, Finland (Suokas, Pirkola, Keskimäki); Pirkanmaa Hospital District, Tampere, Finland (Pirkola); School of Business and Economics, University of Jyväskylä, Jyväskylä, Finland (Böckerman); Labour Institute for Economic Research, Helsinki (Böckerman).

Objective: Individuals with severe mental disorders have an impaired ability to work and are likely to receive income transfer payments as their main source of income. However, the magnitude of this phenomenon remains unclear. Using longitudinal population cohort register data, the authors conducted a case-control study to examine the levels of employment and personal income before and after a first hospitalization for a serious mental disorder.

Methods: All individuals (N=50,551) who had been hospitalized for schizophrenia, other nonaffective psychosis, or bipolar disorder in Finland between 1988 and 2015 were identified and matched with five randomly selected participants who were the same sex and who had the same birth year and month. Employment status and earnings, income transfer payments, and total income in euros were measured annually from 1988 to 2015.

Results: Individuals with serious mental disorders had notably low levels of employment before, and especially after, the diagnosis of a severe mental disorder. Their total income was mostly constituted of transfer payments, and this was especially true for those diagnosed as having schizophrenia. More than half of all individuals with a serious mental disorder did not have any employment earnings after they received the diagnosis.

Conclusions: The current study shows how most individuals in Finland depend solely on income transfer payments after an onset of a severe mental disorder.
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http://dx.doi.org/10.1176/appi.ps.201900239DOI Listing
March 2020

Effectiveness of internet-delivered cognitive behavioural therapy in reducing sickness absence among young employees with depressive symptoms: study protocol for a large-scale pragmatic randomised controlled trial.

BMJ Open 2019 11 5;9(10):e032119. Epub 2019 Nov 5.

Department of Public Health, University of Helsinki, Helsinki, Finland.

Introduction: Depression is a highly prevalent condition with typical onset in early adulthood. Internet-delivered cognitive behavioural therapy (iCBT) is a promising cost-effective and more widely available alternative to face-to-face CBT. However, it is not known whether it can reduce sickness absence in employees showing depressive symptoms. The randomised controlled trial component of the DAQI (Depression and sickness absence in young adults: a quasi-experimental trial and web-based treatment intervention) project aims to investigate if iCBT is effective in reducing sickness absence compared with care as usual (CAU) among young employees with depressive symptoms in primary care provided in an occupational health setting.

Methods And Analysis: This study will use a randomised controlled single-centre service-based trial of an existing iCBT programme (Mental Hub iCBT for Depression) to evaluate whether or not this treatment can reduce the number of sickness absence days in public sector employees aged 18-34 years who present at the occupational health service with mild depressive symptoms (score ≥9 on the Beck Depression Inventory-IA). Control participants will be offered CAU, with no constraints regarding the range of treatments. The active condition will consist of seven weekly modules of iCBT, with support from a web therapist. Primary outcome will be participants' all-cause sickness absence as indicated in employer's and national administrative records up to 6 months from study entry. Secondary outcomes relating to long-term sickness absence (over 11 calendar days) for mental and musculoskeletal disorders and psychotropic medication use will be obtained from the Finnish Social Insurance Institution's administrative records; and short sickness absence spells (up to 11 calendar days) will be extracted from employer's records. Analyses will be conducted on an intention-to-treat basis.

Ethics And Dissemination: The Coordinating Ethics Committee of the Hospital District of Helsinki and Uusimaa has approved the study (HUS/974/2019). The results will be published in peer-reviewed scientific journals and in publications for lay audience.

Trial Registration Number: ISRCTN10877837.
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http://dx.doi.org/10.1136/bmjopen-2019-032119DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6858165PMC
November 2019

Tanning dependence and seasonal affective disorder are frequent among sunbathers but are not associated.

Psychiatry Res 2019 02 18;272:387-391. Epub 2018 Dec 18.

Tampere University, Faculty of Medicine and Health Technology, 33521 Tampere, Finland; Tampere University Hospital, Department of Dermatology and Venereology, 33521, Tampere, Finland.

Ultraviolet radiation (UVR) is a known risk factor for skin cancers. Those who are tanning dependent seek out UVR exposure. Many tanners have expressed symptoms of seasonal affective disorder (SAD), but conclusive evidence of a connection with tanning dependence is lacking. We evaluated the frequency of tanning dependence or abuse and symptoms of SAD among Finnish sunbathers and analysed whether phenomena are associated which could indicate a common biological mechanism. Sunbathing related tanning dependence/abuse among Finnish sunbathers were assessed using the Structured Interview for Tanning Abuse and Dependence measure (SITAD), and symptoms of SAD were assessed with the Seasonal Pattern Assessment Questionnaire (SPAQ). Of 229 sunbathers, 8% (n = 18) were classified as tanning-dependent, and 26% (n = 59) were classified as tanning abusers. Additionally, 16% (n = 37) met the criteria for SAD, and 26% (n = 60) met the criteria for subsyndromal seasonal affective disorder (S-SAD), but there was no significant association between tanning dependence or abuse and SAD or S-SAD. Sunbathing dependence or abuse and SAD/S-SAD were frequent among sunbathers, and they may promote sun-seeking risk behaviour. However, within this sample, tanning dependence and SAD/S-SAD were not associated.
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http://dx.doi.org/10.1016/j.psychres.2018.12.090DOI Listing
February 2019

A Comparison of Mental Health Care Systems in Northern and Southern Europe: A Service Mapping Study.

Int J Environ Res Public Health 2018 05 31;15(6). Epub 2018 May 31.

VIDEA Lab, Centre for Mental Health Research, Australian National University, 63 Eggleston Rd, Acton ACT 2601, Australia.

Mental health services (MHS) have gone through vast changes during the last decades, shifting from hospital to community-based care. Developing the optimal balance and use of resources requires standard comparisons of mental health care systems across countries. This study aimed to compare the structure, personnel resource allocation, and the productivity of the MHS in two benchmark health districts in a Nordic welfare state and a southern European, family-centered country. The study is part of the REFINEMENT (Research on Financing Systems' Effect on the Quality of Mental Health Care) project. The study areas were the Helsinki and Uusimaa region in Finland and the Girona region in Spain. The MHS were mapped by using the DESDE-LTC (Description and Evaluation of Services and Directories for Long Term Care) tool. There were 6.7 times more personnel resources in the MHS in Helsinki and Uusimaa than in Girona. The resource allocation was more residential-service-oriented in Helsinki and Uusimaa. The difference in mental health personnel resources is not explained by the respective differences in the need for MHS among the population. It is important to make a standard comparison of the MHS for supporting policymaking and to ensure equal access to care across European countries.
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http://dx.doi.org/10.3390/ijerph15061133DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6024953PMC
May 2018

Identifying Local and Centralized Mental Health Services-The Development of a New Categorizing Variable.

Int J Environ Res Public Health 2018 05 31;15(6). Epub 2018 May 31.

Turku University Hospital and University of Turku, Kiinanmyllynkatu 4-8, FI-20520 Turku, Finland.

The challenges of mental health and substance abuse services (MHS) require shifting of the balance of resources from institutional care to community care. In order to track progress, an instrument that can describe these attributes of MHS is needed. We created a coding variable in the European Service Mapping Schedule-Revised (ESMS-R) mapping tool using a modified Delphi panel that classified MHS into centralized, local services with gatekeeping and local services without gatekeeping. For feasibility and validity, we tested the variable on a dataset comprising MHS in Southern Finland, covering a population of 2.3 million people. There were differences in the characteristics of services between our study regions. In our data, 41% were classified as centralized, 37% as local without gatekeeping and 22% as local services with gatekeeping. The proportion of resources allocated to local services varied from 20% to 43%. Reclassifying ESMS-R is an easy way to compare the important local vs. centralized balance of MHS systems globally, where such data exists. Further international studies comparing systems and validating this approach are needed.
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http://dx.doi.org/10.3390/ijerph15061131DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6025394PMC
May 2018

The association of psychological factors and healthcare use with the discrepancy between subjective and objective respiratory-health complaints in the general population.

Psychol Med 2019 01 20;49(1):121-131. Epub 2018 Mar 20.

Finnish Institute of Occupational Health,Helsinki,Finland.

Background: We examined the prevalence of self-perceived respiratory symptoms (SRS) in the absence of any objective findings of respiratory pathology, and the association of such prevalence with psychological factors and healthcare use in the general population.

Methods: The study was conducted among a nationally representative sample of Finnish adults (BRIF8901). Respiratory functioning was measured by a spirometry test. Structured questionnaires were used to measure SRS, physician visits and psychological factors of alexithymia, sense of coherence, illness worry and common mental disorders. Individuals with a diagnosed respiratory disease or a severe psychiatric disorder, determined in a diagnostic interview, were excluded, giving a sample comprising 4544 participants.

Results: Twenty-six per cent of the general population and 36% of those with no diagnosed severe psychiatric disorder or respiratory disease experienced SRS despite a normal spirometry result. Psychological factors were associated with SRS (0.0001 < p < 0.032), and on the number of physician visit explaining 42.7% of the difference in visits between individuals with and without SRS, respectively. Illness worry was associated most strongly with SRS [odds ratio (OR) 1.29, 95% confidence interval (CI) 1.19-1.41, p < 0.0001] and higher numbers of physician visits (OR 1.35, CI 1.32-1.38, p < 0.00001), even after several adjustments.

Conclusions: Respiratory symptoms without objective findings are common in the general population. The study results underline the role of psychological factors in the reporting of respiratory symptoms and the associated medical burden, thereby indicating the functional nature of the symptomatology.
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http://dx.doi.org/10.1017/S0033291718000582DOI Listing
January 2019

The association of psychological factors and healthcare use with the discrepancy between subjective and objective respiratory-health complaints in the general population.

Psychol Med 2019 01 20;49(1):121-131. Epub 2018 Mar 20.

Finnish Institute of Occupational Health,Helsinki,Finland.

Background: We examined the prevalence of self-perceived respiratory symptoms (SRS) in the absence of any objective findings of respiratory pathology, and the association of such prevalence with psychological factors and healthcare use in the general population.

Methods: The study was conducted among a nationally representative sample of Finnish adults (BRIF8901). Respiratory functioning was measured by a spirometry test. Structured questionnaires were used to measure SRS, physician visits and psychological factors of alexithymia, sense of coherence, illness worry and common mental disorders. Individuals with a diagnosed respiratory disease or a severe psychiatric disorder, determined in a diagnostic interview, were excluded, giving a sample comprising 4544 participants.

Results: Twenty-six per cent of the general population and 36% of those with no diagnosed severe psychiatric disorder or respiratory disease experienced SRS despite a normal spirometry result. Psychological factors were associated with SRS (0.0001 < p < 0.032), and on the number of physician visit explaining 42.7% of the difference in visits between individuals with and without SRS, respectively. Illness worry was associated most strongly with SRS [odds ratio (OR) 1.29, 95% confidence interval (CI) 1.19-1.41, p < 0.0001] and higher numbers of physician visits (OR 1.35, CI 1.32-1.38, p < 0.00001), even after several adjustments.

Conclusions: Respiratory symptoms without objective findings are common in the general population. The study results underline the role of psychological factors in the reporting of respiratory symptoms and the associated medical burden, thereby indicating the functional nature of the symptomatology.
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http://dx.doi.org/10.1017/S0033291718000582DOI Listing
January 2019

Distinctive use of newer and older antidepressants in major geographical areas: A nationally representative register-based study.

J Affect Disord 2018 03 3;229:358-363. Epub 2018 Jan 3.

Finnish Institute of Occupational Health, PO Box 310, 70101 Kuopio, Finland; School of Social Policy, Sociology and Social Research, University of Kent, United Kingdom.

Background: It is unknown whether newer, mainly selective serotonin reuptake inhibitors, and older tricyclic antidepressants are used similarly regardless of the geographical area of residence and education.

Methods: We included four randomly sampled cohorts of the Finnish working aged population (n = 998,540-1,033,135). The sampling (Dec 31st in 1995, 2000, 2004 and 2010) resulted in non-overlapping time windows where each participant was followed up for four years for the first antidepressant use. Using Cox proportional hazards models, we examined whether the hazard of antidepressant use differed between the capital area and three other areas (Southern, Western and Northern/Eastern Finland). Educational differences were examined using four sub-groups: capital area/high education (reference category); other areas/high education; capital area/low education; and other areas/low education.

Results: Hazard ratios for the use of newer antidepressants were significantly lower in all other areas compared to the capital area after adjustment for age, sex, marital status, employment status, education, income, and area-level unemployment. Findings remained consistent in all time windows, differences increasing slightly. In the sub-group analysis those with low education had the lowest level of use in all areas, also within the capital area. The results were opposite for older antidepressants in all but the last time window.

Limitations: Some degree of unmeasured confounding and exposure misclassification is likely to exist.

Conclusions: Newer antidepressants were more commonly used in the capital than in the other areas, and among those with high versus low education. These differences in antidepressant use suggest socioeconomic inequalities in the mental health treatment quality.
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http://dx.doi.org/10.1016/j.jad.2017.12.102DOI Listing
March 2018

Growth after late-preterm birth and adult cognitive, academic, and mental health outcomes.

Pediatr Res 2017 May 5;81(5):767-774. Epub 2017 Jan 5.

Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland.

Background: Late-preterm birth (at 34-36 wk gestation) increases the risk of early growth faltering, poorer neurocognitive functioning, and lower socio-economic attainment. Among early-preterm individuals, faster early growth benefits neurodevelopment, but it remains unknown whether these benefits extend to late-preterm individuals.

Methods: In 108 late-preterm individuals, we examined if weight, head, or length growth between birth, 5 and 20 months' corrected age, and 56 mo, predicted grade point average and special education in comprehensive school, or neurocognitive abilities and psychiatric diagnoses/symptoms at 24-26 y of age.

Results: For every 1 SD faster weight and head growth from birth to 5 mo, and head growth from 5 to 20 mo, participants had 0.19-0.41 SD units higher IQ, executive functioning score, and grade point average (95% confidence intervals (CI) 0.002-0.59 SD), and lower odds of special education (odds ratio (OR) = 0.49-0.59, 95% CIs 0.28-0.97), after adjusting for sex, gestational age, follow-up age, and parental education. Faster head growth from 20 to 56 mo was associated with less internalizing problems; otherwise we found no consistent associations with mental health outcomes.

Conclusion: Faster growth during the critical early period after late-preterm birth is associated with better adult neurocognitive functioning, but not consistently with mental health outcomes.
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http://dx.doi.org/10.1038/pr.2016.276DOI Listing
May 2017

Regional Correlates of Psychiatric Inpatient Treatment.

Int J Environ Res Public Health 2016 12 5;13(12). Epub 2016 Dec 5.

Unit for Mental Health, National Institute for Health and Welfare (T.H.L.); Mannerheimintie 168, Helsinki FI-00270, Finland.

Current reforms of mental health and substance abuse services (MHS) emphasize community-based care and the downsizing of psychiatric hospitals. Reductions in acute and semi-acute hospital beds are achieved through shortened stays or by avoiding hospitalization. Understanding the factors that drive the current inpatient treatment provision is essential. We investigated how the MHS service structure (diversity of services and balance of personnel resources) and indicators of service need (mental health index, education, single household, and alcohol sales) correlated with acute and semi-acute inpatient treatment provision. The European Service Mapping Schedule-Revised (ESMS-R) tool was used to classify the adult MHS structure in southern Finland (population 1.8 million, 18+ years). The diversity of MHS in terms of range of outpatient and day care services or the overall personnel resourcing in inpatient or outpatient services was not associated with the inpatient treatment provision. In the univariate analyses, sold alcohol was associated with the inpatient treatment provision, while in the multivariate modeling, only a general index for mental health needs was associated with greater hospitalization. In the dehospitalization process, direct resource re-allocation and substituting of inpatient treatment with outpatient care per se is likely insufficient, since inpatient treatment is linked to contextual factors in the population and the health care system. Mental health services reforms require both strategic planning of service system as a whole and detailed understanding of effects of societal components.
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http://dx.doi.org/10.3390/ijerph13121204DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5201345PMC
December 2016

How size matters: exploring the association between quality of mental health services and catchment area size.

BMC Psychiatry 2016 08 12;16:289. Epub 2016 Aug 12.

Mental Health Unit, National Institute for Health and Welfare (THL), Mannerheimintie 170, FI-00270, Helsinki, Finland.

Background: The diversity of mental health and substance abuse services (MHS) available to service users is seen as an indicator of the quality of the service system. In most countries MHS are provided by a mix of public, private and third sector providers. In Finland, officially, the municipalities are responsible for organizing the services needed, but the real extent and roles of private and third sector service providers are not known. Our previous study showed that the catchment area population size was strongly associated with diversity of mental health services. It is not known whether this was due to some types of services or some provider types being more sensitive to the size effect than others. The aim of this study was to investigate the association between area population size and diversity of mental health services, i.e. which types of services and which service providers' contributions are sensitive to population size.

Methods: To map and classify services, we used the ESMS-R. The diversity of services was defined as the count of main types of care. Providers were classified as public, private or third sectors.

Results: The diversity of outpatient, residential and voluntary services correlated positively with catchment area population size. The strongest positive correlation between the size of population and services available was found in third sector activities followed by public providers, but no correlation was found for diversity of private services. The third sector and public corporations each provided 44 % of the service units. Third sector providers produced all self-help services and most of the day care services. Third sector and private companies provided a significant part (59 %) of the residential care service units.

Conclusions: Significant positive correlations were found between size of catchment area population and diversity of residential, outpatient and voluntary services, indicating that these services concentrate on areas with larger population bases. The third sector seems to significantly complement the public sector in providing different services. Thus the third sector be needs to be functionally integrated with other MHS services to achieve a diversified and integrated service system.
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http://dx.doi.org/10.1186/s12888-016-0992-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4983042PMC
August 2016

Excess Mortality in Patients with Severe Mental Disorders in 1996-2010 in Finland.

PLoS One 2016 24;11(3):e0152223. Epub 2016 Mar 24.

Department of Health and Social Care Systems, Health and Social Systems Research Unit, National Institute for Health and Welfare, Helsinki, Finland.

Unselected population-based nationwide studies on the excess mortality of individuals with severe mental disorders are scarce with regard to several important causes of death. Using comprehensive register data, we set out to examine excess mortality and its trends among patients with severe mental disorders compared to the total population. Patients aged 25-74 and hospitalised with severe mental disorders in 1990-2010 in Finland were identified using the national hospital discharge register and linked individually to population register data on mortality and demographics. We studied mortality in the period 1996-2010 among patients with psychotic disorders, psychoactive substance use disorders, and mood disorders by several causes of death. In addition to all-cause mortality, we examined mortality amenable to health care interventions, ischaemic heart disease mortality, disease mortality, and alcohol-related mortality. Patients with severe mental disorders had a clearly higher mortality rate than the total population throughout the study period regardless of cause of death, with the exception of alcohol-related mortality among male patients with psychotic disorders without comorbidity with substance use disorders. The all-cause mortality rate ratio of patients with psychotic disorders compared to the total population was 3.48 (95% confidence interval 2.98-4.06) among men and 3.75 (95% CI 3.08-4.55) among women in the period 2008-10. The corresponding rate ratio of patients with psychoactive substance use disorders was 5.33 (95% CI 4.87-5.82) among men and 7.54 (95% CI 6.30-9.03) among women. Overall, the mortality of the total population and patients with severe mental disorders decreased between 1996 and 2010. However, the mortality rate ratio of patients with psychotic disorders and patients with psychoactive substance use disorders compared to the total population increased in general during the study period. Exceptions were alcohol-related mortality among patients with psychoactive substance use disorders and female patients with psychotic disorders, as well as amenable mortality among male patients with psychotic disorders. The mortality rate ratio of persons with mood disorders compared to the total population decreased. The markedly high mortality amenable to health care intervention among patients with severe mental disorders found in our study suggests indirectly that they may receive poorer quality somatic care. The results highlight the challenges in co-ordinating mental and somatic health services.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0152223PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4807083PMC
August 2016

Use of psychiatric medications in schizophrenia and other psychoses in a general population sample.

Psychiatry Res 2016 Jan 10;235:160-8. Epub 2015 Nov 10.

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

The information on the use of psychiatric medications in general population-based samples is limited. Our aim was to analyse the use of psychiatric medications and factors associated with antipsychotic use in psychoses in a general population sample. Fifty-five persons with schizophrenia, 21 with bipolar psychosis or psychotic depression and 20 with other psychoses from the Northern Finland Birth Cohort 1966 were examined at about 43 years of age. The frequency of use and dosage of psychiatric medication and the factors associated with the use of antipsychotics were analysed. Antipsychotics were used by 85% of schizophrenia, 65% of bipolar psychosis or psychotic depression and 62% of other psychoses cases; antidepressants were used by 22%, 60% and 33%; and benzodiazepines by 42%, 35% and 10%, respectively. In all the diagnostic groups, higher symptom scores and a higher number of hospital days were associated with the use of antipsychotics. In schizophrenia and other psychoses, poorer social and occupational functioning, and in other psychoses, female gender and lower education were also associated with the use of antipsychotics. Our results may partly indicate that, especially in schizophrenia, the effectiveness of antipsychotics is not as good as expected.
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http://dx.doi.org/10.1016/j.psychres.2015.11.013DOI Listing
January 2016

Seasonal variation in affective and other clinical symptoms among high-risk families for bipolar disorders in an Arctic population.

Int J Circumpolar Health 2015 19;74:29671. Epub 2015 Nov 19.

National Institute of Health and Welfare, Helsinki, Finland.

Background: In bipolar disorder (BD), seasonality of symptoms is common and disturbances in circadian rhythms have been reported.

Objectives: We identified high-penetrance families in a geographically restricted area in Northern Fennoscandia and studied the seasonal variation of clinical symptoms among BD subjects and their healthy relatives.

Design: We explored the clinical characteristics of subjects living in Northern Fennoscandia, with extreme annual variation in daylight. Among known indigenous high-risk families for BD, we compared the affected ones (N=16) with their healthy relatives (N=15), and also included 18 healthy non-related controls from the same geographical area. Seasonal fluctuation in clinical measures was followed up at the 4 most demarcated photoperiodic time points of the annual cycle: around the summer solstice and autumn equinox in 2013, the winter solstice in 2013/2014, and the spring equinox in 2014. In the baseline, lifetime manic symptoms [Mood Disorder Questionnaire (MDQ)] and morningness-eveningness questionnaire type (MEQ) were registered, whereas in the follow-up, depressive [Beck Depression Inventory (BDI)] and distress [General Health Questionnaire (GHQ-12)] symptoms and alcohol consumption and sleep were recorded.

Results: Possibly indicative or statistically significant differences in symptoms between the affected subjects and their healthy relatives were the BDI winter (13.3 vs. 2.6, t=-2.51, p=0.022) and spring scores (12.6 vs. 3.2, t=-1.97, p=0.063) and GHQ winter (4.2 vs. 0.82, t=-2.08, p=0.052) and spring scores (3.8 vs. 0.82, t=-1.97, p=0.063). Scores were higher among the affected subjects, exceeding a possibly diagnostic threshold (10 and 3) at all the time points, and without the notable seasonality which was observed among the healthy relatives. In the overall population, MDQ and MEQ scores had an inverse correlation (-0.384, significant at 0.016), indicating increased lifetime manic behaviour among "the night owl" chronotype subjects.

Conclusions: In an Arctic population sample, we found different seasonal fluctuation in mood and distress symptoms and sleep duration scores between subjects with bipolar spectrum disorders and their healthy relatives. Despite the relatively small sample size, the results indicate that the symptoms and signs of BD relate to a disturbance in seasonal variation. Seasonal variation can be considered as an interesting endophenotype for BD and a promising target for further genetic studies.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4654770PMC
http://dx.doi.org/10.3402/ijch.v74.29671DOI Listing
January 2017

[Update on Current Care Guideline: Depression].

Duodecim 2015 ;131(3):280-1

Treatment of depression is based on comprehensive diagnostic, clinical and psychosocial evaluation. Brief psychotherapies (cognitive, interpersonal, psychodynamic or problem-solving) are effective in mild to moderate depression; antidepressants in mild to severe, and electroconvulsive therapy in severe or psychotic. Combining antidepressants and psychotherapy is more effective than either alone. After the acute phase, antidepressants should be continued for six months to prevent relapses, and maintenance treatment considered after three lifetime episodes. Primary care is responsible for treatment of mild to moderate depressions; developing psychiatric consultation services and use of nurse case managers are recommended.
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September 2015

Concordance between Composite International Diagnostic Interview and self-reports of depressive symptoms: a re-analysis.

Int J Methods Psychiatr Res 2015 Sep 3;24(3):213-25. Epub 2015 Jul 3.

Institute of Behavioural Sciences, University of Helsinki, Finland.

Concordance between sum scores of self-reported depressive symptoms and structured interview diagnoses has been studied extensively, but are these the best attainable self-report-based predictions for interview diagnoses? We maximized the cross-validated concordance between World Health Organization's Composite International Diagnostic Interview (CIDI) diagnosis and Beck's Depression Inventory (BDI), and General Health Questionnaire (GHQ), from the viewpoint of exploratory statistics, re-analysing Health 2000 general-population sample of adults over 30 years in mainland Finland (N = 5200-5435). BDI sum-score prediction of CIDI diagnosis could be superseded by using (1) weighted sums of items, (2) classification trees constructed from items, or (3) a single item. Best solution (2) yielded cross-validated Youden's Index 0.757 [standard error (SE) = 0.001, sensitivity = 0.907, specificity = 0.851], improving the concordance to 1.07-fold (1.18-fold for 12-month diagnosis). A single-item solution was best for the GHQ. All positive predictive values remained low (0.09-0.31). Thus, CIDI-to-questionnaire concordance can be improved by using all information in the questionnaires instead of just sum scores, but latent-trait theory for questionnaires is incompatible with interview diagnoses (single item achieved better concordance than summing all). Self-reports have low predictive value for CIDI diagnoses in the general population, but better in settings with higher major depressive disorder (MDD) base rates. Copyright © 2015 John Wiley & Sons, Ltd.
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http://dx.doi.org/10.1002/mpr.1478DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6878410PMC
September 2015

Is there an independent association between burnout and increased allostatic load? Testing the contribution of psychological distress and depression.

J Health Psychol 2016 08 4;21(8):1576-86. Epub 2014 Dec 4.

National Institute for Health and Welfare, Finland Lapland Hospital District, Finland University of Oulu, Finland Helsinki University Central Hospital, Finland University of Tampere, Finland.

Burnout has been suggested to be related to depression. We examined the relationship between burnout and allostatic load, and whether this association is independent of psychological distress and depression. We measured burnout psychological distress, depression, and allostatic load in 3283 participants. Higher burnout (β = 0.06, p =0.003) and cynicism (β = 0.03, p = 0.031) and decreased professional efficacy (β = 0.03, p = 0.007) were related to higher allostatic load independent of age, sex, education, occupation and psychological distress. Depression, however, explained 60 percent of the association. Burnout is related to higher allostatic load, and this association partly overlaps with co-occurring depression.
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http://dx.doi.org/10.1177/1359105314559619DOI Listing
August 2016

Prevalence and correlates of major depressive disorder and dysthymia in an eleven-year follow-up--results from the Finnish Health 2011 Survey.

J Affect Disord 2015 Mar 8;173:73-80. Epub 2014 Nov 8.

National Institute for Health and Welfare, Department of Health, Functional Capacity and Welfare, Helsinki, Finland.

Background: Up-to-date epidemiological data on depressive disorders is needed to understand changes in population health and health care utilization. This study aims to assess the prevalence of major depressive disorder (MDD) and dysthymia in the Finnish population and possible changes during the past 11 years.

Methods: In a nationally representative sample of Finns aged 30 and above (BRIF8901), depressive disorders were diagnosed with the Composite International Diagnostic Interview (M-CIDI) in 2000 and 2011. To account for nonresponse, two methods were compared: multiple imputation (MI) utilizing data from the hospital discharge register and from the interview in 2000 and statistical weighting.

Results: The MI-corrected 12-month prevalence of MDD was 7.4% (95% CI 5.7-9.0) and of dysthymia was 4.5% (95% CI 3.1-5.9), whereas the corresponding figures using weights were 5.4% (95% CI 4.7-6.1) for MDD and 2.0% (95% CI 1.6-2.4) for dysthymia. Women (OR 2.33, 95% CI 1.6-3.4) and unmarried people (OR 1.54, 95% CI 1.2-2.0) had a higher risk of depressive disorders. There was a significant increase in the prevalence of depressive disorders during the follow-up period from 7.3% in 2000 to 9.6% in 2011. Prevalences were two percentage points higher, on average, when using MI compared to weighting. Hospital treatments for depressive disorders and other mental disorders were strongly associated with nonparticipation.

Limitations: The CIDI response rate dropped from 75% in 2000 to 57% in 2011, but this was accounted for by MI and weighting.

Conclusions: Depressive disorders are a growing public health concern in Finland. Non-participation of persons with severe mental disorders may bias the prevalence estimates of mental disorders in population-based studies.
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http://dx.doi.org/10.1016/j.jad.2014.10.015DOI Listing
March 2015

Does primary care mental health resourcing affect the use and costs of secondary psychiatric services?

Int J Environ Res Public Health 2014 Aug 26;11(9):8743-54. Epub 2014 Aug 26.

Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Mannerheimintie 170, FI-00270 Helsinki, Finland.

Collaborative care models for treatment of depression and anxiety disorders in primary care have been shown to be effective. The aim of this study was to investigate at the municipal level to what extent investment in mental health personnel at primary care health centres in the study area is reflected in the costs and use of secondary psychiatric services. Furthermore, we analysed whether the service provision and use of secondary psychiatric care correlates with the socioeconomic indicators of need. We found significant variation in the amount of mental health personnel provided at the health centres, uncorrelated with the indicators of need nor with the costs of secondary psychiatric care. The amount of mental health nurses at the health centres correlated inversely with the number of secondary psychiatric outpatient visits, whereas its relation to inpatient days and admission was positive. The costs of secondary psychiatric care correlated with level of psychiatric morbidity and socioeconomic indicators of need. The results suggest that when aiming at equal access of care and cost-efficiency, the primary and secondary care should be organized and planned with integrative collaboration.
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http://dx.doi.org/10.3390/ijerph110908743DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4198988PMC
August 2014

Size matters - determinants of modern, community-oriented mental health services.

Int J Environ Res Public Health 2014 Aug 19;11(8):8456-74. Epub 2014 Aug 19.

Department of Mental Health and Substance Abuse Service, National Institute for Health and Welfare, Mannerheimintie 170, FI-00270 Helsinki, Finland.

Governances, structures and contents of mental health services are being reformed across countries. There is a need for data to support those changes. The aim of this study was to explore the quality, i.e., diversity and community orientation, and quantity, i.e., personnel resources, of mental health and substance abuse services (MHS) and evaluate correlation between population needs and quality and quantity of MHS. The European Service Mapping Schedule-Revised (ESMS-R) was used to classify mental health and substance abuse services in southern Finland. Municipal-level aggregate data, local data on unemployment rate, length of education, age of retirement, proportion of single households, alcohol sales and a composite mental health index were used as indicators of population mental health needs. Population size correlated strongly with service diversity, explaining 84% of the variance. Personnel resources did not associate with diversity or community orientation. The indicators of mental health services need did not have the expected association with quality and quantity of services. In terms of service organization, the results may support larger population bases, at least 150,000 adult inhabitants, when aiming for higher diversity.
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http://dx.doi.org/10.3390/ijerph110808456DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4143871PMC
August 2014

Size matters - determinants of modern, community-oriented mental health services.

Int J Environ Res Public Health 2014 Aug 19;11(8):8456-74. Epub 2014 Aug 19.

Department of Mental Health and Substance Abuse Service, National Institute for Health and Welfare, Mannerheimintie 170, FI-00270 Helsinki, Finland.

Governances, structures and contents of mental health services are being reformed across countries. There is a need for data to support those changes. The aim of this study was to explore the quality, i.e., diversity and community orientation, and quantity, i.e., personnel resources, of mental health and substance abuse services (MHS) and evaluate correlation between population needs and quality and quantity of MHS. The European Service Mapping Schedule-Revised (ESMS-R) was used to classify mental health and substance abuse services in southern Finland. Municipal-level aggregate data, local data on unemployment rate, length of education, age of retirement, proportion of single households, alcohol sales and a composite mental health index were used as indicators of population mental health needs. Population size correlated strongly with service diversity, explaining 84% of the variance. Personnel resources did not associate with diversity or community orientation. The indicators of mental health services need did not have the expected association with quality and quantity of services. In terms of service organization, the results may support larger population bases, at least 150,000 adult inhabitants, when aiming for higher diversity.
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http://dx.doi.org/10.3390/ijerph110808456DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4143871PMC
August 2014
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