Psychiatric treatment seeking and psychosocial impairment among young adults with depression

BACKGROUND: We report data on 1-year prevalence and comorbidity of depression, related impairment, treatment need, and psychiatric treatment among young adults. METHODS: A sample of young urban adults (n=245) mean age 21.8 years was screened from a baseline population of 706 high-school students and given a semistructured clinical interview to evaluate 12-month prevalence of depression, psychosocial functioning according to DSM-IV GAF scale, need for psychiatric treatment, and use of mental health services. RESULTS: One in 10 young adults suffered from depression with associated psychosocial impairment, the female-to-male-ratio being approximately 2:1. Most depressive disorders were comorbid with other DSM-IV disorders, depression usually occurring secondary to other disorders. Comorbidity was related to impairment, treatment need, and treatment contacts. Less than half of the depressed young adults had ever contacted mental health services, and less than one-third reported treatment contacts during the index episode. Males were less likely than females to report previous treatment contacts or intention to refer to mental health services for their problems, but treatment contacts during the index episode were reported equally often by both sexes. CONCLUSIONS: A minority of the severely depressed young adults with associated impairment had sought treatment. Except for subjects with dysthymia, no gender difference emerged in treatment contact rates during the 12-month depression episode. Comorbidity showed important clinical implications by its relation to severity of depression and treatment contacts.     

Wine and good subjective health

The association of subjective, self-rated suboptimal (average or poor) health with the intake of beer, wine, and liquor and alcohol intoxication was examined in a general population sample in Finland in 1992. The odds ratios were adjusted for several possible confounders with the use of logistic regression analysis. Compared with subjects who drank no wine, suboptimal health was less frequent among both men and women who imbibed 1-4 drinks of wine, and more common among men who consumed > or = 10 drinks of wine or liquor. Moderate wine drinking seems to be related to good self-rated health.     

Decreased serum selenium and magnesium levels in drunkenness arrestees

Serum levels of selenium magnesium, copper, zinc and iron were studied in chronic drunkenness arrestees and a healthy control group. The mean serum concentrations of selenium and magnesium were both significantly lower (P less than 0.01) in drunkenness arrestees than in the control subjects. The mean alcohol intake was 190 g of absolute alcohol daily in drunkenness arrestees and 14 g in controls. The erythrocyte glutathione peroxidase concentrations of the study groups did not support poor selenium intake as a principal cause of low selenium concentration in the serum.     

Alcohol sales and fatal alcohol poisonings: a time-series analysis

Aims To discover whether the number of fatal alcohol peaks during festivities characterized by unrestrained drinking and relates to sales of alcoholic beverages. Design Time‐series and cross‐sectional. Data Fatal alcohol poisonings and retail alcohol sales in Finland in 1983–99. Findings Fatal alcohol poisonings were found to peak during weekends and in the May Day, Midsummer Day and Christmas celebrations. Regression analysis of quarterly series lead to a model showing that 1% increase in the sales of spirits increases the number of fatal alcohol poisonings by 0.4%. Conclusions At the population level, increases in the sales of spirits and periods of hard drinking seem to increase deaths from alcohol poisoning. The findings could be of use in efforts to decrease hard drinking.     

Depressive symptoms in adolescence as predictors of early adulthood depressive disorders and maladjustment

OBJECTIVE: The authors examined the association between self-reported depressive symptoms in adolescence and mental well-being in early adulthood. METHOD: A questionnaire assessing psychosocial well-being was given to a group of subjects (N=651) in their last 3 years of high school (mean age=16.8 years) and again when these subjects reached early adulthood (mean age=21.8 years). Diagnostic interview data were obtained from a subgroup of the young adults (N=245). Adolescents' depressive symptoms were analyzed in relation to their early adulthood mental health outcome data. RESULTS: Depressive symptoms in adolescence predicted early adulthood depressive disorders (major depression and dysthymia), comorbidity, psychosocial impairment, and problem drinking. CONCLUSIONS: Depressive symptoms in adolescence deserve attention as a potential risk for early adulthood mental disorders.     

Major depressive episode related to long unemployment and frequent alcohol intoxication

We studied the association between two major problems--unemployment and major depressive episode--and the impact of different timing of periods of unemployment and risk factors, especially alcohol intoxication, for major depressive episode among the unemployed. Major depressive episode during the last 12 months, plus current and past employment status and frequency of alcohol intoxication, were assessed within the nationally representative, cross-sectional 1996 Finnish Health Care Survey, in which non-institutionalized individuals aged 15-75 years were interviewed by using the Short Form of the University of Michigan version of the Composite International Diagnostic Interview (the UM-CIDI Short Form). Of the 5993 subjects interviewed, 3818 (64%) were occupationally active and included in the logistic regression analysis, showing that even after adjusting for other potentially confounding variables, current unemployment was associated with major depressive episode (odds ratio, OR=1.78, 95% confidence interval, CI, 1.38-2.29). Further analysis revealed that the increased risk of major depressive episode was only related to long-term unemployment. Frequent alcohol intoxication (at least once a week) increased the risk of major depressive episode remarkably. Compared with the group "Constantly employed, no frequent alcohol intoxication", long-term unemployment with no frequent alcohol intoxication had moderately increased risk of major depressive episode (OR=1.72 (95% CI 1.29-2.30) and those with frequent alcohol intoxication had highly increased risk [OR=11.27 (95% CI 5.51-23.09) vs. OR=1.72 (95% CI 1.29-2.30]. Long-term unemployment is associated with increased risk of major depressive episode. Frequent alcohol intoxication among long-term unemployed individuals greatly increases the risk of depression.     

The 12-month prevalence and risk factors for major depressive episode in Finland: representative sample of 5993 adults

OBJECTIVE: This study reports the 12-month prevalence of major depressive episode and its risk factors in a representative nationwide sample. METHOD: A random sample of non-institutionalized Finnish individuals aged 15-75 years (N = 5993) was interviewed in 1996. Major depressive episode during the last 12 months was assessed using the Short Form of the University of Michigan version of the Composite International Diagnostic Interview (the UM-CIDI Short Form). RESULTS: The population prevalence of major depressive episode was 9.3% [95% CI 8.5,10.0], and the age-adjusted prevalences for females and males were 10.9% [95% CI 9.7,12.0] and 7.2 [95% CI 6.2,8.2], respectively. In logistic regression analyses the factors associated with major depressive episode after adjustment for age were urban residency, smoking, alcohol intoxication and chronic medical conditions. In addition, being single and obese were found to be risk factors for males. CONCLUSION: The female to male risk ratio for major depressive episode was smaller than in many previous studies. The sex-specific risk factor associations warrant further investigation into sex differences in depression.     

Alcohol and the preventive paradox: serious harms and drinking patterns

AIMS: The preventive paradox prevails if the majority of alcohol problems accrue to the lesser-drinking majority of population, not to heavy drinkers. Evidence for the paradox has been criticized for being based on self-report. The aim was to examine whether the paradox also applies to deaths and hospital admissions. DESIGN: Data from four surveys representing the Finnish population aged 15-69 years in 1969, 1976, 1984 and 1992 were pooled; those from 1969, 1976 and 1984 (n = 6726) to study alcohol-related hospital admissions and alcohol-related deaths, and those from 1984 and 1992 (n = 5558) to study self-reported problems. The former data were linked with register data on hospital admission and death up to the end of 2002. METHODS: Comparisons were made separately for men and women (1) between the 10% of population with the highest average alcohol consumption and the remaining 90% of drinkers and (2) between those who reported and those who did not report drinking to intoxication. RESULTS: A total of 3025 men and 2693 women were available for the study of self-reported problems and 2945 men and 2615 women for deaths and hospital admissions. Seventy per cent of all self-reported problems, 70% of alcohol-related hospitalizations, 64% of alcohol-related deaths and 64% of the premature life-years lost before the age of 65 occurred among the 90% of men consuming less. The respective figures for women were 64%, 60%, 93% and 98%. Drinking five or more drinks per occasion was related to more harm than not drinking that much. CONCLUSIONS: In men, the "prevention paradox" appears to apply to a broadly similar degree to hospitalizations and deaths as self-report alcohol-related problems; in women the phenomenon was apparent to a greater degree for deaths than for other markers of harm.