Risk factors for suicide in China's youth: a case-control study

BACKGROUND: Suicide is the most common cause of death among youth in China. METHOD: A case-control psychological autopsy study in 23 geographically representative disease surveillance points around China collected information from family members and close associates of 114 persons aged 15-24 years who died by suicide (cases) and 91 who died of other injuries (controls). RESULTS: Among the 114 suicides 61% were female, 88% lived in rural villages, 70% died by ingesting pesticides (most commonly stored in the home), 24% previously attempted suicide, and 45% met criteria of a mental illness at the time of death. Multivariate logistic regression identified several independent risk factors: severe life events within 2 days before death (OR 31.8, 95% CI 2.6-390.6), presence of any depressive symptoms within 2 weeks of death (OR 21.1, 95% CI 4.6-97.2), low quality of life in the month before death (OR 9.7, 95% CI 2.8-34.1), and acute stress at time of death (moderate: OR 3.1, 95% CI 0.8-11.9; high: OR 9.1, 95% CI 1.2-66.8). A significant interaction between mental illness at time of death and gender indicated that diagnosis was an important predictor of suicide in males (OR 14.0, 95% CI 2.6-76.5) but not in females (OR 0.3, 95% CI 0.0-3.6). Prior suicide attempt was related to suicide in the univariate analysis (OR 57.5) but could not be included in the multivariate model because no controls had made prior attempts. CONCLUSIONS: Suicide prevention efforts for youth in China must focus on restricting access to pesticides, early recognition and management of depressive symptoms and mental illnesses, improving resiliency, and enhancing quality of life.     

Suicide at 50 years of age and older: perceived physical illness, family discord and financial strain

BACKGROUND: Mental disorders amplify suicide risk across the lifecourse, but most people with mental disorder do not take their own lives. Few controlled studies have examined the contribution of stressors to suicide risk. METHOD: A case-control design was used to compare 86 suicides and 86 controls aged 50 years and older, matched on age, gender, race and county of residence. Structured interviews were conducted with proxy respondents for suicides and controls. RESULTS: Perceived physical illness, family discord and employment change amplified suicide risk after controlling for sociodemographic covariates and mental disorders that developed > or = 1 year prior to death/interview. Only the effect of physical illness (OR 6.24, 95% CI 1.28-51.284) persisted after controlling for all active mental disorders. CONCLUSIONS: Interventions to decrease the likelihood of financial stress and to help families manage discord and severe physical illness may effectively reduce suicides among middle-aged and older adults.     

神经症危险因素的病例对照研究

目的:广泛筛选与神经症发生有关联的人格障碍、生活事件、父母养育方式等可疑危险因素并分析其关联程度。方法:通过成组病例对照研究,用生活事件量表、父母养育方式问卷,人格诊断问卷对100名就诊于北京两家三甲精神病专科医院的神经症患者(病例组)和按照性别、年龄(±3岁)成组匹配的无精神障碍的200名上述医院的工作人员(对照组)进行自评问卷调查。结果:(1)单因素分析显示,病例组的负性生活事件得分、父亲拒绝因子得分、父亲过度保护因子得分、母亲拒绝因子得分、总体人格障碍得分均高于对照组[22.5vs.2.5,(40.4±14.1)vs.(35.4±7.9),(29.1±7.5)vs.(28.2±5.6),(40.4±13.7)vs.(36.8±8.5),(29.8±14.1)vs.(17.1±13.0);均P0.05]。(2)非条件Logistic回归分析显示,神经症发生的保护因素是正性事件(OR=0.92,95%CI:0.87～0.98);危险因素是负性事件(OR=1.06,95%CI:1.04～1.08)及总体人格障碍(OR=4.84,95%CI:2.24～10.49)。结论:正性生活事件是神经症发生的保护因素,负性生活事件和人格障碍是神经症发生的危险因素。     

Risk factors for incident HIV infection among anonymous HIV testing site clients in Santos,Brazil: 1996-1999

OBJECTIVES: To determine temporal trends in HIV infection and risk factors among persons seeking anonymous HIV testing in Santos, Brazil. METHODS: Data and sera from persons testing for HIV from 1996 to 1999 were used. Exposures were abstracted from HIV testing risk assessments. Stored HIV-positive sera were tested to identify recently acquired HIV infection using a serologic testing algorithm for detecting recent HIV seroconversion (STARHS). Independent associations between exposures and recently acquired HIV infection were determined using multivariate analyses. RESULTS: Overall, estimated HIV incidence was 2.0% (95% CI: 1.1-3.5) for the 4-year period: 1.2% (95% CI: 0.5-2.6) in women and 2.7% (95% CI: 1.3-5.0) in men. Incidence increased among women but remained stable among men. Exposures independently associated with incident infection included a history of sex work (OR= 5.4, 95% CI: 1.5-18.7), concurrent syphilis infection (OR =4.1, 95% CI: 1.4-11.9), anal sex (OR = 3.0, 95% CI: 1.3-7.1), and having an HIV-positive sexual partner (OR= 1.4, 95% CI: 1.1-1.9). CONCLUSIONS: This study further demonstrates the public health utility of using the STARHS for the assessment of emerging trends in the HIV epidemic. Results from this study will help to target appropriate prevention strategies directed toward at-risk populations in Santos.     

Suicides and serious suicide attempts: two populations or one?

BACKGROUND: Few studies have examined the extent to which populations of suicides and attempted suicides are similar, or different. This paper compares suicides and serious suicide attempts in terms of known risk factors for suicidal behaviour. METHODS: Using case-control methodology, risk factors for suicidal behaviour were examined in 202 individuals who died by suicide, 275 individuals who made medically serious suicide attempts and 984 randomly selected control subjects. Based on data from significant others, measures used spanned sociodemographic factors, childhood experiences, psychiatric morbidity and psychiatric history, exposure to recent stressful life events and social interaction. RESULTS: Multiple logistic regression identified the following risk factors that were common to suicide and serious suicide attempts: current mood disorder; previous suicide attempts; prior outpatient psychiatric treatment; admission to psychiatric hospital within the previous year; low income; a lack of formal educational qualifications; exposure to recent stressful interpersonal, legal and work-related life events. Suicides and suicide attempts were distinguished in the following ways: suicides were more likely to be male (OR = 1.9, 95% CI 1.1, 3.2); older (OR = 1.03, 95% CI 1.02, 1.04); and to have a current diagnosis of non-affective psychosis (OR = 8.5, 95% CI 2.0, 35.9). Suicide attempts were more likely than suicides to have a current diagnosis of anxiety disorder (OR = 3.5, 95% CI 1.6, 7.8) and to be socially isolated (OR = 2.0, 95% CI 1.2, 3.5). These findings were confirmed by discriminant function analysis, which identified two functions that described the three subject groups: the first function discriminated the two suicide groups from control subjects on a dimension corresponding to risk factors for suicide; the second function discriminated suicide from suicide attempt subjects on a series of factors including gender, non-affective psychosis and anxiety disorder. CONCLUSIONS: Suicides and medically serious suicide attempts are two overlapping populations that share common psychiatric diagnostic and history features, but are distinguished by gender and patterning of psychiatric disorder.     

Relation of type A behavior pattern and job-related psychosocial factors to nonfatal myocardial infarction: a case-control study of Japanese male workers and women

OBJECTIVES: To study the relation of type A behavior pattern and job-related psychosocial factors to the risk of myocardial infarction. METHODS: Study subjects comprised 290 cases (173 male workers and 117 women) of nonfatal acute myocardial infarction (AMI) and 489 controls (303 male workers and 186 women) recruited from among residents of the study area. Participation rates of cases and controls were 86% and 50%, respectively. Type A behavior pattern, job-related psychosocial factors, and other coronary risk factors were ascertained by interview using a questionnaire. Type A behavior pattern was measured by 12 questions, and job strain by the method of Karasek. Logistic regression analysis was used to calculate odds ratio and 95% confidence interval with adjustment for potential confounding variables. The relation to job strain was examined only in men. RESULTS: Type A behavior pattern was significantly associated with an increased risk of AMI in male workers (adjusted OR = 1.9, 95% CI, 1.2-2.9) and in women (adjusted OR = 2.8, 95% CI, 1.6-4.9). Although job control and job demand showed no material association with AMI, job strain, a combination of low job control and high job demand was associated with an increased risk of AMI (adjusted OR = 2.2, 95% CI, 1.1-4.5). Abbreviated type A score and job demand score were higher among nonparticipant control candidates than participant controls in male workers. CONCLUSIONS: Type A behavior pattern may be an important risk factor for AMI especially in Japanese women. The present study also revealed persons in stressful psychosocial circumstances were less likely to participate in the study.     

Suicide and attempted suicide among older adults in Western Australia

BACKGROUND: Suicide rates are high in later life. Risk factors include male sex and depressive illness. This study investigated the relationship between suicidal behaviour and contact with mental health services among the elderly in Western Australia. METHODS: Record linkage was used to obtain records of hospital admissions and mental health service contacts for all suicide attempts and deaths in the period 1980-95. Standardized incidence ratios were calculated for the elderly, general population and people with mental health service contacts. Cox regression was used to evaluated potential risk factors for elderly people who were in contact with mental health services. RESULTS: People over 60 years of age accounted for 15% of suicides and 4.6% of attempted suicides. Suicide rates were 3.3 times higher in males and 4.4 times higher in females when compared to the general population of elderly people. For attempted suicide, the rate was 5.8 times higher in males and 6.6 times higher in females with prior contact with mental health services. Highest risk of suicide was found in patients with diagnoses of affective psychoses (RR = 3.7), adjustment reaction (RR = 3.2) or depressive disorder (RR = 2.8). The diagnosis of cancer was associated with decreased risk of suicide (RR = 3.6) and attempted suicide (RR = 1.9). CONCLUSIONS: Suicide rates are high among the elderly in Western Australia. Suicide is significantly associated with the diagnosis of mood disorder. Suicide attempts are less common, and are associated most strongly with mood and personality disorders. The decreased risk of self-harm behaviour among patients with cancer warrants further investigation.     

Current psychiatric morbidity, aggression/impulsivity, and personality dimensions in child and adolescent suicide: a case-control study

OBJECTIVE: The present study was designed to evaluate psychiatric risk factors for child and adolescent suicide, and to determine the association between impulsive-aggressive and other personality traits, and suicide completion in this population. METHOD: Psychiatric diagnoses, impulsive-aggressive and other personality traits were assessed in 55 child and adolescent suicide victims and 55 community controls using semi-structured proxy-based interviews and questionnaires. RESULTS: The most significant psychiatric risk factors associated with child and adolescent suicide were depressive disorders (OR=48.414, 95% CI 6.247-375.185), substance/alcohol abuse disorder (OR=5.365, 95% CI 1.434-20.076), and disruptive disorders (OR=13.643, 95% CI 2.292-23.16). Additionally, suicide victims showed higher scores on lifetime aggression/impulsivity, and harm avoidance. However, after logistic regression, the only independent significant predictors of suicide in this age group were the presence of depressive disorders (Adjusted OR (AOR)=39.652, 95% CI 4.501-349.345), substance/alcohol abuse disorders (AOR=7.325, 95% CI 1.127-47.62), and disruptive disorders (AOR=6.464, 95% CI 1.422-29.38). LIMITATIONS: Relatively small sample size, and cross-sectional design. CONCLUSIONS: Our findings confirm the existence of a particular clinical profile of children and adolescents at high risk for suicide. Additionally, our results reinforce the need for improved understanding of the interrelationships between stressors, depression, substance/alcohol abuse disorders, disruptive disorders and personality traits/dimensions in youth suicidal behavior.     

Case-control study of risk factors for incident HIV infection in rural Uganda

OBJECTIVE: To identify risk factors associated with HIV incidence in a rural Ugandan population. DESIGN: Case-control study. METHODS: Men and women who seroconverted between 1990 and 1997 (cases) and seronegative subjects (controls) were drawn from a general population cohort of approximately 5000 adults in rural, southwestern Uganda. Information on risk factors was ascertained through a detailed interview and physical examination by clinicians who were blind to the study subjects' HIV status. All patients were interviewed within 2 years of their estimated date of seroconversion. RESULTS: Data were available on 130 men (37 cases, 93 controls) and 133 women (46 cases, 87 controls). There was a significantly higher risk of infection in men (odds ratio [OR], 6.51; 95% confidence interval [CI], 1.06-39.84) and women (OR, 4.75; 95% CI, 1.26-17.9) who were unmarried and in a steady relationship, and in men who were divorced, separated, or widowed (OR, 4.33; 95% CI, 1.32-14.25) compared with those who were married. There was a significantly higher risk of HIV infection in men (OR, 3.78; 95% CI, 1.20-11.93) and women (OR, 20.78; 95% CI, 2.94-141.2) who reported > or =5 lifetime sexual partners compared with those who reported at most 1 partner. For men, there was an increased risk of infection associated with receiving increasing numbers of injections in the 6 months prior to interview (p < .001 for trend). Women reporting sex against their will in the year prior to interview were at higher risk of infection (OR, 7.84; 95% CI, 1.29-47.86; p = .020). CONCLUSIONS: The strongest risk factor for HIV incidence in this rural Ugandan population is lifetime sexual partners. The increased risks found for women reporting coercive sex and men reporting injections require further investigation.     

Risk factors for human herpesvirus 8 seropositivity in the AIDS Cancer Cohort Study.

BACKGROUND: Cigarette smoking has been associated with a decreased risk for AIDS-related and classical KS, but whether it is associated with decreased risk of human herpesvirus 8 (HHV-8) infection is unknown. STUDY DESIGN: We evaluated factors associated with HHV-8 seropositivity in 2795 participants (132 with KS) in the National Cancer Institute AIDS Cancer Cohort, including 1621 men who have sex with men (MSM), 660 heterosexual men and 514 women. Odds ratios (OR) and 95% confidence intervals were estimated using logistic regression models. RESULTS: Among non-KS subjects, HHV-8 seropositivity was 6%, 13% and 29% among women, heterosexual men and MSM, respectively. HHV-8 seropositivity was decreased in heavier (> or =1/2 pack/day) compared to lighter smokers among women (5% versus 8%; adjusted OR (aOR) 0.4; 95% CI 0.2-0.8) and MSM (27% versus 32%; aOR 0.7; 95% CI 0.6-1.0), but not among heterosexual men (12% versus 16%; aOR 0.7; 95% CI 0.4-1.2). HHV-8 seroprevalence was increased in heavier (> or =1 drink/day) compared to lighter consumers of alcohol among women (16% versus 4%; adjusted OR 5.2; 95% CI 2.3-12), but not among MSM (33% versus 28%; aOR 1.2; 95% CI 0.9-1.6) or heterosexual men (13% versus 13%; aOR 1.1; 95% CI 0.6-2.0). In analyses adjusted for smoking and drinking, HHV-8 seropositivity was positively associated with chlamydia infection (OR=4.3; 95% CI 1.2-13) and with marital status among women p(heterogeneity)=0.03, and with hepatitis (OR=1.6; 95% CI 1.2-2.1), gonorrhea (OR=1.5; 95% CI 1.1-1.9), genital warts (OR=1.5; 95% CI 1.1-2.0) and nitrate inhalant use (OR=1.7; 95% CI 1.3-2.3) among MSM. CONCLUSIONS: Inverse association of HHV-8 seropositivity with cigarette smoking may indicate protective effect of tobacco smoke on HHV-8 infection, whereas positive associations with alcohol may reflect either behavioral factors or biological effects modulating susceptibility. Smoking and drinking may influence KS risk, at least in part, by altering the natural history of HHV-8 infection.     

Cancer and mental disorders in a national community sample: findings from the national comorbidity survey

OBJECTIVE: To determine the association between cancer (past 12 months) and mental disorders (past 12 months) among community-dwelling adults. METHODS: Data were drawn from the National Comorbidity Survey (n = 5,877), a representative household sample of adults aged 15-54 years in the United States. Multiple logistic regression analyses were used to determine the association between cancer and mental disorders, adjusting for differences in sociodemographic characteristics. RESULTS: Cancer was significantly associated with increased rates of major depression [odds ratio (OR) = 3.6, 95% confidence interval (CI) = 1.4-8.8], drug dependence (OR = 3.6, 95% CI = 1.3-9.8), simple phobia (OR = 2.5, 95% CI = 1.0-6.2) and agoraphobia (OR = 3.3, 95% CI = 1.0-10.4). These associations persisted after adjusting for major sociodemographic factors, and sex plays a significant role in the association between cancer diagnosis and mental disorder, with cancer diagnosis having a stronger influence on major depression and drug dependence in men than in women. CONCLUSIONS: Clinicians and community health workers working with cancer survivors need to be not only alert for signs of clinical depression but also of co-occurring drug dependence and certain anxiety disorders so that appropriate referrals to mental health professionals can be made.     

Factors predicting suicide among Russians in Estonia in comparison with Estonians: case-control study

Aim

To explore differences between suicide victims among Russian immigrants in Estonia and native Estonians, according to socio-demographic background, substance use pattern, and recent life events to find out immigration-specific factors predicting suicide.

Methods

The psychological autopsy study included 427 people who committed suicide in 1999 and 427 randomly selected controls matched by region, gender, age, and nationality.

Results

The only variable that differed significantly between Russian and Estonian suicide cases was substance use pattern. Logistic regression models showed that factors associated with suicide for both nationalities were substance dependence and abuse (Russians: odds ratio [OR], 12.9; 95% confidence interval [95% CI], 4.2-39.2; Estonians: OR, 8.1; 95% CI, 3.9-16.4), economical inactivity Russians: OR 5.5; 95% CI, 1.3-22.9; Estonians: OR, 3.1; 95% CI, 1.3-7.1), and recent family discord (Russians: OR, 3.2; 95% CI, 1.1-9.9; Estonians: OR, 4.5; 95%, CI, 2.1-9.8). The variables that remained significant in the final model were having no partner (Estonians: OR, 3.0; 95% CI, 1.6-5.5), being unemployed (Estonians: OR, 5.5; 95% CI, 2.0-15.4), and being an abstainer (Estonians: OR, 6.7; 95% CI, 2.5-17.6) for Estonians, and somatic illness (Russians: OR, 4.1; 95% CI, 1.4-11.7), separation (Russians: OR, 32.3; 95% CI, 2.9-364.1), and death of a close person (Russians: OR, 0.2; 95% CI, 0.04-0.7) for Russians.

Conclusion

Although the predicting factors of suicide were similar among the Estonian Russians and Estonians, there were still some differences in the nature of recent life events. Higher suicide rate among Estonian Russians in 1999 could be at least partly attributable to their higher substance consumption.Several studies compared suicide rates of immigrant population, native population in the host country, and population in the country of origin. Previous research has shown variance in the suicide rates of immigrant groups with different ethnic background, as well as different suicide rates in their home countries (1-8). Differences between suicide rates of immigrant groups and native population are not quite clear, but most of the immigrant groups have higher suicide rates than the population in their countries of origin. A number of studies found that migrants who had high suicide rates came from countries with high rates and vice versa (1,2,4,9,10).Reports from England and Wales (3), Canada (5), and Sweden (6,11) showed very high suicide rates among Russian immigrants compared with the rates of the population both in their country of origin and in the host country. Johansson et al (11) found that suicide rate of Russian male immigrants in Sweden was 201.9 per 100 000 in comparison with 41.4 in Russian men in Russia and 44.5 in Swedish men in 1986-1989.Värnik et al (12) compared suicide rates of Russians in Estonia, Estonians in Estonia, and inhabitants of Russia before (1983-1990) and after (1991-1998) Estonia gained independence. Suicide rates of Russian immigrants were lowest in the period before Estonian independence and highest in the period after reestablishing independence. In 1998, Russian and Estonian suicide rates were similar (12), but in the 1991-2001period, mean suicide rates in Estonian Russians were higher than in Estonians (38.2 and 31.9 per 100 000, respectively) (13).There is a lack of studies on specific suicide risk factors for immigrants on the individual level. As far as we know, the only study available was a psychological autopsy study on suicides of Ethiopian immigrants to Israel (14). They found that 67% of suicide victims were dissatisfied with their employment, 50% with their economic status, 44% with their marital relationships, and 53% with their fluency in the host language. However, in this study no controls were used.Since there were differences in suicide rates between Russian immigrants in Estonia and native Estonians, the purpose of the present study was to explore possible differences between suicide victims of these two main ethnic groups in Estonia according to socio-demographic background, substance use pattern, and recent life events to find out immigration-specific factors predicting suicide on the individual level.     

Factors associated with contracting sexually transmitted infections among patients in Zvishavane urban, Zimbabwe; 2007

Background

Sexually transmitted infections (STIs) remain a major public health problem in Zimbabwe. In Zvishavane, STI increased from 66 per 1,000 in 2002 to 97 per 1,000 in 2005, a 31% increase in cases.

Objective

To determine the factors associated with contracting sexually transmitted infections (STI) among patients in Zvishavane.

Methods

A frequency matched case control study was conducted. Cases were persons above 15 years diagnosed with STI at three health facilities in Zvishavane urban. Controls were patients who visited the same facilities for other ailments. We interviewed 77 cases and 154 controls.

Results

Both cases and controls were knowledgeable about STI. Risk factors for men included sex under the influence of alcohol OR=7.11 (95% CI 2.42–20.85), relationships less than one year, OR= 9.33 (95% CI 3.53–24.70), no condom use at first intercourse OR=5.17 (95% CI 1.64–16.25) and paying for sex OR= 23.65 (95% CI 6.23–89.69). For females the risk factors were non-use of condom at first intercourse OR=2.49 (95% CI 1.02–6.04) and relationships less than one year OR=3.19 (95% CI 1.41–7.23).Significant differences in attitudes were evident among cases and controls.

Conclusion

Knowledge of STI did not provide protection from STI diagnosis. Limiting the number of partners, consistent condom use, and fidelity are important for both men and women.     

Low HDL cholesterol is associated with suicide attempt among young healthy women: the Third National Health and Nutrition Examination Survey

BACKGROUND: Serum cholesterol is reported to be associated with suicidality, but studies conducted among general healthy population are rare. We examined the association between serum cholesterol and suicidality in a national sample of the general population of US. METHODS: We used the data of 3237 adults aged 17 to 39 years, who completed a mental disorder diagnostic interview and had blood specimens collected after a 12-h fast, as a part of the Third National Health and Nutrition Examination Survey, 1988-1994. The serum concentrations of total cholesterol, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were dichotomized according to the recommended levels of the National Cholesterol Education Program. A polytomous logistic regression was employed to control for covariates. RESULTS: Independent of socio-demographic variables, health risks and nutrition status, and a history of medical and psychiatric illness (including depression), a significant association between low HDL-C (< or = 40 mg/dl) and increased prevalence of suicide attempts was observed in women (OR=2.93, 95% CI=1.07-8.00). No significant evidence was found to support an association between cholesterol and suicide ideation in women. Serum cholesterol was unrelated with either suicide ideation or attempts in men. LIMITATION: The inherent limitation of cross-sectional design prevented the authors from investigating causality. CONCLUSIONS: Low HDL-C is significantly associated with suicide attempts in women. Further studies are necessary to explore the clinical application of serum cholesterol as an indicator for suicide attempts among high risk population.     

From conduct disorder to severe mental illness: associations with aggressive behaviour, crime and victimization

BACKGROUND: Conduct disorder (CD) prior to age 15 has been associated with an increased risk of aggressive behaviour and crime among men with schizophrenia. The present study aimed to replicate and extend this finding in a clinical sample of severely mentally ill men and women. METHOD: We examined a cohort of in-patients with severe mental illness in one mental health trust. A total of 205 men and women participated, average age 38.5 years. CD was diagnosed using a structured diagnostic tool. Alcohol and illicit drug use, aggressive behaviour and victimization were self-reported. Information on convictions was extracted from official criminal records. Analyses controlled for age and sex. RESULTS: CD prior to age 15 was associated with an increased risk of assault over the lifespan [odds ratio (OR) 3.98, 95% confidence interval (CI) 1.87-8.44)], aggressive behaviour in the 6 months prior to interview (OR 2.66, 95% CI 1.24-5.68), and convictions for violent crimes (OR 3.19, 95% CI 1.46-6.97) after controlling for alcohol and illicit drug use. The number of CD symptoms present prior to age 15 significantly increased the risk of serious assaults over the lifespan, aggressive behaviour in the past 6 months, and violent crime after controlling for alcohol and illicit drug use. CONCLUSIONS: Men and women with severe mental illness who have a history of CD by mid-adolescence are at increased risk for aggressive behaviour and violent crime. These patients are easily identifiable and may benefit from learning-based treatments aimed at reducing antisocial behaviour. Longitudinal, prospective investigations are needed to understand why CD is more common among people with than without schizophrenia.     

Does occupational gender segregation influence the association of effort-reward imbalance with myocardial infarction in the SHEEP study?

The objective of this study was to investigate whether occupational gender segregation moderates the association between job stress in terms of effort-reward imbalance and the risk of myocardial infarction. This analysis was conducted in 1,381 cases and 1,697 referents of the Swedish SHEEP case control study aged 45-70 years. Information on myocardial infarction and biological coronary risk factors (e.g. hypertension, blood lipids) was achieved from clinical screenings. Information on socio-demographic variables, effort-reward imbalance, behavioral coronary risk factors (e.g., smoking), and additional coronary risk factors (e.g., diabetes, family history of coronary heart disease) was derived from well-tested standardized questionnaires. After adjustment for confounders the strongest association between overcommitment (the intrinsic component of effort-reward imbalance) and risk of belonging to the myocardial infarction group was found among women in male-dominated jobs (odds ratio [OR] = 2.71, 95% CI = 1.13-6.52) as compared to the remaining group (OR = 1.52, 95% CI = 1.01-2.31). Moreover, a significant interaction between pronounced overcommitment and male domination in relation to myocardial infarction was observed among women (OR = 2.44, 95% CI = 1.05-5.67). In men, an association between the ratio of effort and reward (the extrinsic component of the model) and risk of myocardial infarction was found for the majority, that is the group not working in women-dominated jobs (OR = 1.39, 95% CI = 1.04-1.86). Despite methodological limitations, this study gives preliminary evidence of a moderating effect of occupational gender segregation on the association of effort-reward imbalance (i.e., the intrinsic model component overcommitment) with acute myocardial infarction risk among women, but not among men.     

Low prevalence of depression and anxiety is linked to statutory retirement ages rather than personal work exit: a national survey

BACKGROUND: Common mental disorder prevalence decreases substantially around the conventional retirement age for men in the UK, but trends for older women are more continuous. Prevalence changes in depression and anxiety around retirement are less clear, as is the role of risk factors. The aim of this study was to establish whether work status, age or other known risk factors account for the reduced prevalence of depressive episode and anxiety disorder around retirement ages for men and for women. METHOD: The British Psychiatric Morbidity Survey (BPMS) 2000 was analysed, including 1875 men and 2253 women aged 45-75 years. Diagnoses were from the Revised Clinical Interview Schedule (CIS-R). Logistic models were adjusted for sociodemographic factors, social network, work status, life events, physical illness and disability. RESULTS: There are marked reductions in the prevalence of depressive episode after 60 years for women [60% lower prevalence, 95% confidence interval (CI) 40-80] and 65 years for men (90% lower prevalence, 95% CI 70-100), compared to the youngest age groups. For anxiety disorder, the reduction in prevalence was 80% (95% CI 60-90) for men and 40% (95% CI 20-60) for women. In fully adjusted multivariate models, the strong association between diagnoses and age groups remained, for both genders. Work status was a significant factor for men but not for women. CONCLUSION: There is a discontinuity in the prevalence of depressive episode for both men and women, coinciding with statutory retirement ages. No studied risk factor reduced the associations between age group and disorders. This population scale recovery may provide a model for understanding non-genetic factors.     

Marital and family relations and depression in married elderly Finns.

BACKGROUND: The aim was to describe the relationships between poor marital and family relations and depression, and the predictive value of these factors for the subsequent occurrence of depression. METHODS: The population for the cross-sectional study consisted of the married elderly (N = 498) living in Aht?ri, Finland, in 1989. The series of the longitudinal study was composed of married persons nondepressed in the epidemiological study in 1984-1985, and followed up until 1989-1990 (N = 347). RESULTS: In men, impaired functional abilities (OR 5.0) and poor family relations (OR 2.9), and in women, impaired functional abilities (OR 3.9), family violence (OR 4.2), age 70 years or over (OR 3.0) and a loss of father in childhood or youth (OR 2.5) were independently related to depression. Poor marital relations tended to be related to depression in both men (OR 2.1) and women (OR 2.2). In both sexes, poor self-appreciation (OR men 3.9; women 7.1) and age 70 years or over (OR men 2.9; women 4.2), and in women, a loss of father in childhood or youth (OR 4.5) were independent predictors of subsequent depression. CONCLUSIONS: The poor marital or family relations experienced by many depressed elderly persons are usually consequences rather than predictors of depression. Family violence may be a consequence of depression or even a risk factor for depression. CLINICAL IMPLICATIONS: Problems in spouse pairs and families should be inquired and solved when treating depressed elderly persons. LIMITATIONS OF THE STUDY: Due to the unknown validity of the measure concerning marital relations, the results are suggestive.     

Older age and markers of inflammation are strong predictors of clinical events in women with asymptomatic carotid lesions

OBJECTIVE: Limited information exists regarding the association between markers of inflammation, such as high-sensitivity C-reactive protein (hs-CRP) and fibrinogen, and adverse events in postmenopausal women with subclinical atherosclerosis. Therefore, we investigated the prognostic impact of traditional risk factors and inflammation on adverse cardiac events in women with asymptomatic carotid lesions. DESIGN: We studied 250 postmenopausal women who were free of cardiovascular disease. Traditional cardiovascular risk factors were investigated, and laboratory analysis included measurement of plasma lipids, fibrinogen, and hs-CRP. The early phases of carotid atherosclerosis were assessed by B-mode ultrasonography. Women were asked about symptoms or a previous history of coronary artery disease and were followed for a period of 5 years. RESULTS: We found that the increment in age (in quintiles) was significantly associated with higher incidence of current smokers (P = 0.0286), hypertension (P = 0.0230), family history of coronary artery disease (P = 0.0216), dyslipidemia (P = 0.0330), and higher levels of fibrinogen (P = 0.0158). Moreover, older women had a higher prevalence of carotid lesions (P < 0.0001). After the follow-up, cardio- and cerebrovascular events were registered in 22% of the women. Using multivariate analysis, we observed that older age (odds ratio [OR], 1.7; 95% CI, 1.3-2.2; P < 0.0001), fibrinogen (OR, 1.6; 95% CI, 1.2-2.0; P < 0.0001), the presence of carotid lesions (OR, 2.0; 95% CI, 1.4-3.0; P = 0.0002), and hs-CRP (OR, 1.3; 95% CI, 1.2-2.0; P = 0.0175) were predictors of adverse events during the follow-up. CONCLUSIONS: Adverse events occurred more frequently in women with higher levels of fibrinogen and hs-CRP. The significance of these results requires confirmation in other studies, but they may have important implications for screening subjects at risk for cardiovascular disease and identifying candidates for anti-inflammatory therapy.     

Gender differences in morbidity and health care utilization among adult obstructive sleep apnea patients

STUDY OBJECTIVE: To explore gender differences in morbidity and total health care utilization 5 years prior to diagnosis of obstructive sleep apnea (OSA). DESIGN: Case-control study; patients were recruited between January 2001 and April 2003. SETTING: Two university-affiliated sleep laboratories. PATIENTS: 289 women (22-81 years) with OSA were matched with 289 men with OSA for age, body mass index (BMI), and apnea-hypopnea index (AHI). All OSA patients were matched 1:1 with healthy controls by age, geographic area, and primary physician. MEASUREMENTS AND RESULTS: Women with OSA compared to men with OSA have lower perceived health status and Functional Outcomes of Sleep Questionnaire score (54.5% vs. 28.4%, P <0.05 and 67.5+/-21.4 vs. 76+/-20.1, P <0.05, respectively). Compared to men with OSA, women with OSA have higher risk of hypothyroidism (OR 4.7; 95% CI, 2.3-10) and arthropathy (OR 1.6, 95% CI, 1.1-2.2) and lower risk for CVD (OR 0.7; 95% CI, 0.5-0.91). Compared to controls, both women and men with OSA had 1.8 times higher 5-year total costs (P <0.0001). Compared to men with OSA, expenditures for women with OSA are 1.3 times higher (P <0.0001). The multiple logistic regression (adjusting for BMI, AHI) revealed that age (OR 1.04; 95% CI, 1.01-1.07), antipsychotic and anxiolytic drugs (OR 2.3; 95% CI, 1.2-4.4), and asthma (OR 2.4; 95% CI, 1.1-5.6) are independent determinants for "most costly" OSA women. CONCLUSION: Compared to men with similar OSA severity, women are heavier users of health care resources. Low FOSQ score and poor perceived health status in addition to overuse of psychoactive drugs are associated with high health care utilization among women with OSA.