Mental disorders and long-term labour market outcomes: nationwide cohort study of 2 055 720 individuals

Adolescent Psychiatric Inpatient Episodes and Subsequent Labor Market Trajectories

PURPOSE

Adolescents with psychiatric disorders are known to be more often not in education, employment, or training (NEET) in young adulthood than their peers. However, since most of the available evidence is based on cross-sectional measurement of NEET, there is less evidence on the processes underlying these differences in labor market disadvantage. We assessed these processes by examining transitions between NEET and non-NEET states across young adulthood and the differences in these transitions by adolescent psychiatric inpatient treatment.

METHODS

We used longitudinal register data on all individuals born in Finland in 1980-1984 (N = 315,508) to identify psychiatric inpatient episodes between ages 10 and 19 and NEET between ages 20 and 34. We modeled the transitions between NEET and non-NEET states and the impact of psychiatric disorders on these transitions with multistate models.

RESULTS

Individuals who had psychiatric inpatient episodes in adolescence started their labor market careers as NEET twice as often as their peers. They were also more likely to transition into NEET states and less likely to transition out of NEET. In total, individuals with a history of psychiatric episodes spent from 1.8 to 6.9 more years as NEET between the ages 20 and 34 than their peers, depending on sex, baseline NEET, and diagnostic group.

DISCUSSION

Adolescents with severe psychiatric disorders are highly vulnerable in terms of labor market outcomes throughout their early adulthood. Supportive measures are required both at the start of employment trajectories and during later career stages.

Psychotherapy duration and work disability: A prospective Finnish register study

INTRODUCTION

The influence of psychotherapy duration on common mental disorder (CMD) outcomes remains a topic of ongoing debate. Whereas most research has focused on CMD symptom change, the evidence on the psychotherapy duration of subsequent CMD-related work disability and the change in psychotropic drug purchases is scarce.

METHODS

We used a register-based cohort representing 33% of the Finnish population. The participants included working-age individuals (N = 12,047, 76% women, mean age = 36) who initiated long-term psychotherapy, between 2014 and 2017. They were followed from 2011 to 2021 and psychotherapy duration ranged from less than a year to over 3 years. We used an interrupted time series design to analyze the psychotherapy duration-dependent changes in CMD-related work disability (primary outcome, operationalized as depression or anxiety-related sickness absence, SA, days) and the annual number of psychotropic drug purchases or distinct drugs purchased (secondary outcomes).

RESULTS

There were no differences in the levels of work disability or drug purchases before the psychotherapy. We observed a decreasing level and trend in all outcomes across all psychotherapy duration groups. The largest decline in level was observed in the <1-year duration group (88% decline for SA and 43%-44% for drug purchases) while the smallest decline was in the 3+ years duration group (73% for SA and 27% for drug purchases).

CONCLUSION

Work disability outcomes and duration varied among individuals, even with similar initial mental health-related work disability or use of auxiliary psychotropic treatments. Compared to longer psychotherapy, shorter psychotherapy was associated with sharper improvements.

Subjective evaluation of home environment and levels of self-reported depression in middle to old age: Results from the HCHS study

OBJECTIVES

The immediate living environment might, like other lifestyle factors, be significantly related to mental well-being. The current study addresses the question whether five relevant subjective home environment variables (i.e., protection from disturbing nightlight, daylight entering the home, safety at home, quality of window views, and noise disturbance) are associated with levels of self-reported depression over and above well-known sociodemographic and common lifestyle variables.

METHODS

Data from the Hamburg City Health Study (HCHS) were analyzed. In N = 8757 with available PHQ-9 depression data, multiple linear regression models were computed, with demographic data, lifestyle variables, and variables describing the subjective evaluation of the home environment.

RESULTS

The model explained 15% of variance in depression levels, with ratings for the subjective evaluation of home environment accounting for 6%. Better protection from disturbing light at night, more daylight entering the home, feeling safer, and perceived quality of the window views, were all significantly associated with lower, while more annoyance by noise was associated with higher levels of self-reported depression. Results did not differ if examining a sample of the youngest (middle-aged participants: 46-50 years) versus oldest (70-78 years) participants within HCHS.

CONCLUSION

Beyond studying the role of lifestyle factors related to self-reported depression, people's homes may be important for subclinical levels of depression in middle and older age, albeit the direction of effects or causality cannot be inferred from the present study. The development of a consensus and tools for a standardized home environment assessment is needed.

Experiences of returning to work in patients with schizophrenia after treatment: A longitudinal qualitative study

BACKGROUND

Returning to work (RTW) has always been regarded as one of the important indicators to evaluate the therapeutic effect of patients with schizophrenia. The existing studies on RTW in patients with schizophrenia are mostly focused on intervention measures, and the qualitative research on RTW is very limited. The purpose of this study was to evaluate the experience of the RTW after treatment in patients with schizophrenia.

METHOD

A longitudinal qualitative study was conducted involving 24 patients with schizophrenia in China. The interviews were held at three time-points during their RTW process, (1) when patients had improved and were close to discharge, (2) within 1 month post-discharge, and (3) 6 months post-discharge. The interview recordings were transcribed by the research team, and transcripts were independently analyzed by two independent coders using reflexive thematic analysis.

RESULTS

A total of 24 patients with schizophrenia participated in 72 personal interviews. The thematic framework based on the experience of patients with schizophrenia reveals a three-phases of the process of RTW: improved, being at a loss, and job crisis. The study identified one theme of the first phase: the expectation and optimism. Two themes in the second phase: (1) psychological distress of upcoming work; (2) expectation of assistance pre-work. And four themes in the third phase: (1) tremendous pressure of RTW; (2) lack of medical and social support; (3) social status and interpersonal relationships change; and (4) high level of financial pressure.

CONCLUSION

The experience of RTW is a dynamic process with great challenges in each phase, patients with schizophrenia have been deeply affected by what they have experienced. There is an urgent need to ensure that existing community and social support is integrated into daily care to support patients with schizophrenia to RTW successful. The findings of this study also suggest relevant departments and employers should be aware of the barriers to RTW for patients with schizophrenia, and take certain measures to change the current situation.

Association of major depression, schizophrenia and bipolar disorder with thyroid cancer: a bidirectional two-sample mendelian randomized study

BACKGROUND

Major depressive disease (MDD), schizophrenia (SCZ), and bipolar disorder (BD) are common psychiatric disorders, and their relationship with thyroid cancer has been of great interest. This study aimed to investigate the potential causal effects of MDD, SCZ, BD, and thyroid cancer.

METHODS

We used publicly available summary statistics from large-scale genome-wide association studies to select genetic variant loci associated with MDD, SCZ, BD, and thyroid cancer as instrumental variables (IVs), which were quality controlled and clustered. Additionally, we used three Mendelian randomization (MR) methods, inverse variance weighted (IVW), MR-Egger regression and weighted median estimator (WME) methods, to estimate the bidirectional causal relationship between psychiatric disorders and thyroid cancer. In addition, we performed heterogeneity and multivariate tests to verify the validity of the IVs.

RESULTS

We used two-sample bidirectional MR analysis to determine whether there was a positive causal association between MDD and thyroid cancer risk. The results of the IVW analysis (OR = 3.956 95% CI = 1.177-13.299; P = 0.026) and the WME method (OR = 5.563 95% CI = 0.998-31.008; P = 0.050) confirmed that MDD may increase the risk of thyroid cancer. Additionally, our study revealed a correlation between genetic susceptibility to SCZ and thyroid cancer (OR = 1.532 95% CI = 1.123-2.088; P = 0.007). The results of the WME method analysis based on the median estimate (OR = 1.599 95% CI = 1.014-2.521; P = 0.043) also suggested that SCZ may increase the risk of thyroid cancer. Furthermore, our study did not find a causal relationship between BD and thyroid cancer incidence. In addition, the results of reverse MR analysis showed no significant causal relationships between thyroid cancer and MDD, SCZ, or BD (P > 0.05), ruling out the possibility of reverse causality.

CONCLUSIONS

This MR method analysis provides new evidence that MDD and SCZ may be positively associated with thyroid cancer risk while also revealing a correlation between BD and thyroid cancer. These results may have important implications for public health policy and clinical practice. Future studies will help elucidate the biological mechanisms of these associations and potential confounders.

The association of sociodemographic characteristics with work disability trajectories during and following long-term psychotherapy: a longitudinal register study

PURPOSE

This register-based study examined the trajectories of depression or anxiety disorder-related work disability during and following long-term psychotherapy and identified sociodemographic factors that indicate membership in different trajectory groups.

METHODS

Data were drawn from national registers (Statistics Finland, Social Insurance Institution of Finland). Participants included a random sample of Finnish working-age individuals (18-55 years) who started psychotherapy treatment between 2011 and 2014 and were followed for 5 years: 1 year before and 4 years after the onset of psychotherapy (N = 3 605 individuals; 18 025 person-observations across five time points). Group-based trajectory modeling was applied to assign individuals to work disability trajectories by the number of annual mental health-related work disability months. Multinomial logistic regression was used to examine the associations between trajectory group membership and baseline sociodemographic factors of age, gender, occupational status, and geographical area of residence.

RESULTS

Four mental health-related work disability trajectories were identified: stable very low (72%), decrease (11%), persistent low (9%) and persistent high (7%). Those with older age, female gender, lower occupational status, and living in sparsely populated geographical areas were more likely to belong to the most unfavorable trajectory group of persistent high work disability. The presence of multiple risk characteristics substantially increased the probability of belonging to the most adverse trajectory group.

CONCLUSIONS

Sociodemographic factors were associated with the course of mental health-related work disability in association with psychotherapy. Rehabilitative psychotherapy does not function as an equal support resource for work ability in all parts of the population.

Association of medication clusters and subsequent labor market marginalization in refugee and Swedish-born young adults with common mental disorders in Sweden

Little is known about the association between common mental disorders (CMD) and labor market integration among refugee and Swedish-born young adults. Socially disadvantaged patients such as refugees are more likely to discontinue their medication use prematurely. This study aimed to identify clusters of individuals with similar psychotropic medication patterns; and examine the relationship between cluster membership with labor market marginalization (LMM) in refugee and Swedish-born young adults with CMD. The study uses a longitudinal matched cohort aged 18-24 years with CMD diagnoses from Swedish registers covering 2006-2016. Dispensed psychotropic medications (antidepressants, antipsychotics, anxiolytics, sedative-hypnotics, mood stabilizers) were collected one year before and after CMD diagnosis. Clusters of patients with similar time courses of prescribed dosages were algorithmically identified. The association of cluster membership with subsequent LMM, (long-term sickness absence, SA, disability pension, DP, or long-term unemployment, UE) was assessed using Cox regression. Among 12,472 young adults with CMD, there were 13.9% with SA, 11.9% with DP, and 13.0% with UE during a mean follow-up of 4.1 years (SD 2.3 years). Six clusters of individuals were identified. A cluster with a sustained increase in all medication types yielded the highest hazard ratio (HR [95% CI]) 1.69 [1.34, 2.13] for SA and 2.63 [2.05, 3.38] for DP. The highest HRs of UE give a cluster with a concentrated peak in antidepressants at CMD diagnosis (HR 1.61[1.18, 2.18]). Refugees and Swedish-born showed similar associations between clusters and LMM. To prevent LMM, targeted support and early assessment of CMD treatment are needed for individuals with a sustained increase in psychotropic medication after CMD diagnosis and for refugees in high-risk clusters for UE characterized by a rapid lowering of treatment dosages, which could be an indicator for premature medication discontinuation.

Financial dissatisfaction in people with psychotic disorders - A short report on its prevalence and correlates in a large naturalistic psychosis cohort

Psychotic disorders have a strong negative impact on multiple aspects of daily life, including people's financial situation. This exploratory study examines the level of financial dissatisfaction and its correlates in a large cohort of people with psychotic disorders. Data from the first assessments of people with psychotic disorders (n = 5271) who were included in the Pharmacotherapy Monitoring and Outcome Survey (PHAMOUS; 2006-2020), which is conducted in the northern Netherlands, were used. The Manchester Short Assessment of Quality of Life (MANSA) was used to measure financial dissatisfaction. In addition, sociodemographic and psychiatric characteristics, substance use and global and social functioning were assessed. One-fifth to one-third of people with psychotic disorders report financial dissatisfaction, fluctuating over the year in which they were assessed. These proportions are considerably higher than in the general population. Cannabis and other substance use were associated with higher levels of financial dissatisfaction (small to medium effect). The other significant associations showed (very) small effect sizes. Therefore, we conclude that financial dissatisfaction in people with psychotic disorders appears to be relatively independent of other demographic and psychiatric characteristics, and global and social functioning. These findings are an important first step for increasing knowledge on financial dissatisfaction among people with psychotic disorders. The findings can also contribute to raising awareness about the topic for healthcare professionals working in this field.

Functioning, psychiatric symptoms and quality of life of individuals with severe mental disorders after psychiatric rehabilitation

PURPOSE

Psychiatric disorders may have a negative effect on individuals' living, forming intimate relationships, education, and employment. The aim of psychiatric rehabilitation is to promote recovery - finding ways to cope with mental disorders despite debilitating symptoms. This study aimed to explore the outcomes of accommodation, social inclusion, psychiatric symptoms, substance and service use, quality of life and subjective recovery of young adults with severe mental illness after psychiatric rehabilitation.

MATERIALS AND METHODS

The study population consisted of individuals who had been in residential psychiatric rehabilitation between the ages of 18-29 years. Data on outcomes were collected using a questionnaire after a flexible follow-up period (mean 29 months). The questionnaire was answered by 32 eligible persons. We analysed multiple outcomes and compared the proportion of persons living independently at the start, after psychiatric rehabilitation, and at the follow-up point.

RESULTS

At the start of the rehabilitation, 33%, at the end, 69%, and at follow-up, 78% lived independently. However, most had not reached competitive employment nor were studying. Cognitive symptoms were the most common psychiatric symptoms, followed by depressive symptoms. More than 80% of the sample felt that they had partly recovered from their severe mental illness.

CONCLUSION

According to the results of this study residential psychiatric rehabilitation may have positive effects on functioning and independent living at follow-up. Reaching competitive employment is difficult for persons with severe mental disorders and effective rehabilitation interventions need to be implemented. However, this study had limitations, and these results should be considered preliminary.

What happens after forensic psychiatric care? A latent class analysis of dimensions of welfare for former forensic psychiatric patients

BACKGROUND

Mentally disordered offenders are a heterogenous group regarding psychopathology as well as background factors, which makes it likely that more than one stereotypical life situation will apply to all forensic psychiatric patients following discharge. Knowledge about typical life situations would be valuable for optimising support for improving the overall life situation of these individuals. This paper investigates life situations from the perspective of level of living research and resources in terms of different welfare dimensions.

METHODS

Included were all all individuals (n = 1146) who had been discharged from forensic psychiatric care in Sweden during 2009-2018 and were included in the Swedish National Forensic Psychiatric Register. Follow-up time varied from 4 to 3644 days, (m = 1697, Md = 1685). Register data from several different registers was combined. Data was analysed using latent class analysis, and multinominal logistic regression analysis investigated what background factors were associated with class membership.

RESULTS

The results show that there are four subgroups of post-discharge life situations: the high support group, the general psychiatric needs group, the working group, and the family group. The high support group was the largest, representing 54% of the entire sample. There are background factors associated with group membership, including both age at discharge, length of stay in forensic psychiatric care and pre-index crime historical factors.

CONCLUSIONS

This study contributes to the understanding of the post-discharge lives of former forensic psychiatric patients and shows that for several subgroups, negative outcomes are rare. Knowledge about these subgroups could be drawn upon to make informed decisions about in- and outpatient forensic psychiatric care, discharge from forensic psychiatric services, and what support is offered to former forensic psychiatric patients.

Does previous sickness absence affect work participation after vocational labour market training? A difference-in-differences propensity score matching approach

BACKGROUND

Reduced work ability is relatively common among job seekers and it can hinder future labour market attachment. A commonly used measure to increase employability is the use of active labour market programmes. While vocational labour market training (LMT) has been shown to be an effective way to increase work participation among job seekers, there is still uncertainty about how LMT works in different population groups, for example, among persons with a work disability history.

METHODS

We used nationally representative Finnish register data on 16 062 LMT participants in 2008-2015 aged 25-59 with a history of sickness absence (SA) and propensity score matched participants without such history. For matching, we used information on sociodemographic and work-related factors. We used difference-in-differences analysis to investigate the differential changes in work participation before and after LMT between those with and those without SA history.

RESULTS

Having a history of SA was associated with a lower gain in work participation after LMT, but the magnitude varied by sex, employment history and follow-up time. In women, having a history of SA contributed to 3.9-6.2 percentage points smaller increase in work participation 1-3 years after LMT, depending on the employment history. In men, the corresponding numbers were 2.0-4.3 percentage points. The results were more pronounced if the SA was due to mental disorders.

CONCLUSIONS

The results indicate that work disability, especially due to mental disorders, can hamper work participation after LMT and should be considered when planning employment-enhancing measures for job seekers.

The intergenerational transmission of mental and physical health in the United Kingdom

As health is increasingly recognized as a key component of human welfare, a new line of research on intergenerational mobility has emerged that focuses on broad measures of health. We extend this research to consider two key components of health: physical health and mental health. We use rich survey data from the United Kingdom linking the health of adult children at around age 30 to their parents. We estimate that the rank-rank slope in health is 0.17 and the intergenerational health association is 0.19 suggesting relatively rapid mobility compared to other outcomes such as income. We find that while both mental and physical health have a similar degree of intergenerational persistence, parents' mental health is much more strongly associated with broad measures of adult children's health than parents' physical health. We also show that the primacy of parent mental health over physical health on children's health appears to emerge during early adolescence. Finally, we construct a comprehensive measure of welfare by combining income and health and estimate a rank-rank association of 0.27. This is considerably lower than the comparable estimate of 0.43 from the US suggesting that there is greater mobility in welfare in the UK than in the US.

Lasting scars: The impact of depression in early adulthood on subsequent labor market outcomes

A growing body of evidence indicates that poor health early in life can leave lasting scars on adult health and economic outcomes. While much of this literature focuses on childhood experiences, mechanisms generating these lasting effects-recurrence of illness and interruption of human capital accumulation-are not limited to childhood. In this study, we examine how an episode of depression experienced in early adulthood affects subsequent labor market outcomes. We find that, at age 50, people who had met diagnostic criteria for depression when surveyed at ages 27-35 earn 10% lower hourly wages (conditional on occupation), work 120-180 fewer hours annually, and earn 24% lower annual wage incomes. A portion of this income penalty (21%-39%) occurs because depression is often a chronic condition, recurring later in life. But a substantial share (25%-55%) occurs because depression in early adulthood disrupts human capital accumulation, by reducing work experience and by influencing selection into occupations with skill distributions that offer lower potential for wage growth. These lingering effects of early depression reinforce the importance of early and multifaceted intervention to address depression and its follow-on effects in the workplace.

A hard pill to swallow? Parental health shocks and children's mental health

Based on comprehensive administrative health record data from Austria, this study examines how children's mental health responds to a severe parental health shock. To account for the endogeneity of a serious parental illness, our sample is restricted to children who experience the health shock of a parent at some point in time and we exploit the timing of shocks in a dynamic DID setting. We find a positive causal effect of parental health shocks on children's mental health care utilization. Affected children have higher medical attendance for the treatment of mental illnesses, consume more psychotropic drugs, and are more likely to be hospitalized with mental and behavioral disorders. A significant increase in the utilization of antidepressants, anxiolytics, and sedatives can be observed for older children, girls and children with a white-collar family background. Our findings have important policy implications for children's access to psychotherapies and mental health care after experiencing a traumatic household event.

Population-level effectiveness of alternative approaches to preventing mental disorders in adolescents and young adults

Preventive interventions that are effective in reducing the incidence of mental disorders in adolescence and early adulthood may impact substantially on lifetime economic, educational, and health outcomes; however, relatively few studies have examined the capacity of alternative approaches to preventing youth mental disorders (specifically, universal, selective, and indicated prevention) to reduce disorder incidence at a population level. Using a dynamic model of the onset of non-specific, relatively mild symptoms and progression to more severe disease, we show that: (1) indicated preventive interventions, targeting adolescents and young adults experiencing subthreshold symptoms, may often be more effective in reducing mental disorder prevalence than universal interventions delivered to the general population (contrary to the widely accepted view that a 'high risk' prevention strategy, focussing on those individuals with the greatest risk of developing a disorder, will generally be less effective than a whole-population strategy); and (2) the ability of selective preventive interventions (targeting vulnerable, asymptomatic youth) to alter the prevalence of mental disorders is severely restricted by an inverse relationship between the prevalence of significant risk factors for mental illness and the relative risk of developing symptoms.

Work-related causes of mental health conditions and interventions for their improvement in workplaces

Mental health problems and disorders are common among working people and are costly for the affected individuals, employers, and whole of society. This discussion paper provides an overview of the current state of knowledge on the relationship between work and mental health to inform research, policy, and practice. We synthesise available evidence, examining both the role of working conditions in the development of mental disorders, and what can be done to protect and promote mental health in the workplace. We show that exposure to some working conditions is associated with an increased risk of the onset of depressive disorders, the most studied mental disorders. The causality of the association, however, is still debated. Causal inference should be supported by more research with stronger linkage to theory, better exposure assessment, better understanding of biopsychosocial mechanisms, use of innovative analytical methods, a life-course perspective, and better understanding of the role of context, including the role of societal structures in the development of mental disorders. There is growing evidence for the effectiveness of interventions to protect and promote mental health and wellbeing in the workplace; however, there is a disproportionate focus on interventions directed towards individual workers and illnesses, compared with interventions for improving working conditions and enhancing mental health. Moreover, research on work and mental health is mainly done in high-income countries, and often does not address workers in lower socioeconomic positions. Flexible and innovative approaches tailored to local conditions are needed in implementation research on workplace mental health to complement experimental studies. Improvements in translating workplace mental health research to policy and practice, such as through workplace-oriented concrete guidance for interventions, and by national policies and programmes focusing on the people most in need, could capitalise on the growing interest in workplace mental health, possibly yielding important mental health gains in working populations.

Finding normal-to-better neurocognitive indexes in individuals with schizotypal traits using a social role task

Schizophrenia patients make more errors and have longer reaction times (RTs) than healthy controls in most cognitive tasks. Deficits are also observed in subclinical participants having high scores on the schizotypal personality questionnaire (SPQ). They are accompanied by smaller amplitudes of the event-related brain potentials (ERPs) that index attention and semantic- and working-memory. These functions are thus thought to be impaired in individuals having various schizophrenia attributes (SzAs). Nevertheless, normal RTs were recently found in SzAs during a particular self-referential task where half of the stimuli were names of extraordinary social roles (e.g., genius). Each name (ordinary or extraordinary) was presented individually, and participants were asked to decide whether or not they would consider themselves performing the role at any moment of their lives. To further test an absence of cognitive deficits in this task, the ERPs elicited by names of social roles were also examined in 175 healthy participants. The absence of longer RTs in high- than in low-SPQs was replicated. Moreover, the ERPs of high SPQs had larger occipital N1s, larger P2s and larger occipital N400s than those of low SPQs while late positive potentials (LPPs) were of similar amplitudes. Such results are consistent with clinical observations of greater attention and faster processing of stimuli related to extraordinary/delusional beliefs. Further studies should test whether the cognitive deficits found in SzAs are due to the use of tasks and stimuli that are less within their focus of interest than within that of healthy controls.

Impact of mental disorders during education on work participation: a register-based longitudinal study on young adults with 10 years follow-up

BACKGROUND

Mental disorders are a leading cause of disability and a major threat to work participation in young adults. This register-based longitudinal study aims to investigate the influence of mental disorders on entering and exiting paid employment among young graduates and to explore differences across socioeconomic groups.

METHODS

Register information on sociodemographics (age, sex, migration background) and employment status of 2 346 393 young adults who graduated from secondary vocational (n=1 004 395) and higher vocational education or university (n=1 341 998) in the period 2010-2019 was provided by Statistics Netherlands. This information was enriched with register information on the prescription of nervous system medication for mental disorders in the year before graduation as a proxy for having a mental disorder. Cox proportional hazards regression models were used to estimate the influence of mental disorders on (A) entering paid employment among all graduates and (B) exiting from paid employment among graduates who had entered paid employment.

RESULTS

Individuals with mental disorders were less likely to enter (HR 0.69-0.70) and more likely to exit paid employment (HR 1.41-1.42). Individuals using antipsychotics were the least likely to enter (HR 0.44) and the most likely to exit paid employment (HR 1.82-1.91), followed by those using hypnotics and sedatives. The association between mental disorders and work participation was found across socioeconomic subgroups (ie, educational level, sex and migration background).

DISCUSSION

Young adults with mental disorders are less likely to enter and maintain paid employment. These results ask for prevention of mental disorders and for a more inclusive labour market.

Effect of onset age on the long-term outcome of early-onset psychoses and other mental disorders: a register-based Northern Finland Birth Cohort 1986 study

Psychiatric illnesses can affect the social transitions of adolescence and young adulthood, such as completing education and entering working life and relationships. However, associations between earlier onset age and long-term outcomes among those with early-onset psychoses (EOP) are unclear, as are the long-term outcomes of EOP compared to non-psychotic disorders. We used national register data of the Northern Finland Birth Cohort 1986 to detect persons with EOP and other early-onset psychiatric disorders. The long-term clinical and work-family outcomes of persons with onset age before 18 years (n = 41 psychoses, n = 495 non-psychoses) or between 18-22 years (n = 61 psychoses, n = 377 non-psychoses) were compared. Individuals with the onset of psychosis between 18-22 years had significantly more unfavourable long-term outcomes when compared to those with psychosis onset before 18 years. Persons with psychosis onset before the age of 18 years had similar outcomes to those with non-psychotic psychiatric disorder onset before 18 years regarding educational level, marital status, having children, and substance use disorders. Individuals with EOP were more often on a disability pension compared to those with other early-onset mental disorders. Adjusting for sex, educational level and substance use only slightly diluted these results. Unexpectedly, later onset age of EOP was associated with worse outcomes. Those with psychosis onset between 18-22 years of age are in a critical period, which underlines the importance of investing on interventions in this age group. Further studies on the effect of the onset age on later outcomes in EOP are needed.

Unemployment and underemployment are causes of suicide

Epidemiological studies indicate that labor underutilization and suicide are associated, yet it remains unclear whether this association is causal. We applied convergent cross mapping to test for causal effects of unemployment and underemployment on suicidal behavior, using monthly data on labor underutilization and suicide rates in Australia for the period 2004-2016. Our analyses provide evidence that rates of unemployment and underemployment were significant drivers of suicide mortality in Australia over the 13-year study period. Predictive modeling indicates that 9.5% of the ~32,000 suicides reported between 2004 and 2016 resulted directly from labor underutilization, including 1575 suicides attributable to unemployment and 1496 suicides attributable to underemployment. We conclude that economic policies prioritizing full employment should be considered integral to any comprehensive national suicide prevention strategy.

Does social disadvantage persist over generations due to an uneven distribution of mental health diagnoses? A longitudinal investigation of Finnish register data

Social disadvantages persist over generations, while the mechanisms behind the intergenerational transmission are not well understood. To fill this gap, first, we examine to what degree being diagnosed with a mental health disorder in adolescence mediate the transmission of social disadvantage. Second, we investigate whether the role of mental health varies for different outcomes. Third, we examine differences between disorder groups and gender. We exploited register data on the full Finnish population including information on mental health diagnoses (MHD) based on ICD-10 classification recorded in public specialized health care. As socioeconomic outcomes, we used offspring's (N = 511,835) records for low educational attainment, unemployment, and social assistance dependency in early adulthood. In addition to linear probability models, the g-computation method was used to simulate the degree to which reducing mental health inequalities in adolescence could narrow the differences between children of different family backgrounds. Our results show that adolescents with MHD had a higher likelihood of experiencing social disadvantage as young adults even after accounting for parental socioeconomic status and alternative health pathways. The counterfactual analysis indicated that the proportion mediated by unevenly distributed MHD was with 7.5% highest for social assistance followed by 4.2% for education and 3.2% for unemployment. The effect of mental health was modified by gender yet direction and strength varied across methods and externalizing behaviors mattered more for the intergenerational persistence than internalizing behaviors. Hypothetically reducing MHD to the level of families with high socioeconomic status might indeed lower part of the intergenerational transmission of social assistance dependency but to lesser degree of unemployment and low educational attainment. We demonstrate the need of support and services for those with MHD, especially among socially disadvantaged groups. However, social disadvantage should not be overly medicalized as family background has an important independent effect on offspring's socioeconimic outcomes.

The financial situation before and after first-time psychiatric in-patient diagnosis of schizophrenia spectrum, bipolar, and major depressive disorder

Schizophrenia spectrum, bipolar, and major depressive disorders are severe mental illnesses (SMIs) that not only entail great suffering for those affected but also major societal costs. In this study, I use administrative register data to provide a detailed picture of the financial situation of people with SMI in Sweden during a period of ±10 years around first-time psychiatric in-patient diagnosis of schizophrenia spectrum, bipolar, and major depressive disorders. Receiving a diagnosis was associated with a considerable drop in earnings, which was largely compensated for by social transfers: mainly sickness and disability insurance. However, there were also large and increasing pre-diagnosis earnings gaps, relative to matched comparison groups, especially among those with schizophrenia spectrum disorders. These gaps were to a lesser extent compensated for by social transfers. Consequently, there were permanent and increasing - due to lost earnings growth - income differentials. Hence, findings in previous studies are confirmed: even in an advanced welfare state, people with SMI - especially those with schizophrenia - have an extremely weak position on the labour market and an equally difficult financial situation.

Mortality among inpatients with bipolar disorders and COVID-19: a propensity score matching analysis in a national French cohort study

BACKGROUND

It remains unknown whether coronavirus disease 2019 (COVID-19) patients with bipolar disorders (BDs) are at an increased risk of mortality. We aimed to establish whether health outcomes and care differed between patients infected with COVID-19 with BD and patients without a diagnosis of severe mental illness.

METHODS

We conducted a population-based cohort study of all patients with identified COVID-19 and respiratory symptoms who were hospitalized in France between February and June 2020. The outcomes were in-hospital mortality and intensive care unit (ICU) admission. We used propensity score matching to control for confounding factors.

RESULTS

In total, 50 407 patients were included, of whom 480 were patients with BD. Patients with BD were 2 years older, more frequently women and had more comorbidities than controls without a diagnosis of severe mental illness. Patients with BD had an increased in-hospital mortality rate (26.6% v. 21.9%; p = 0.034) and similar ICU admission rate (27.9% v. 28.4%, p = 0.799), as confirmed by propensity analysis [odds ratio, 95% confidence interval (OR, 95% CI) for mortality: 1.30 (1.16-1.45), p < 0.0001]. Significant interactions between BD and age and between BD and social deprivation were found, highlighting that the most important inequalities in mortality were observed in the youngest [OR, 95% CI 2.28 (1.18-4.41), p = 0.0015] and most deprived patients with BD [OR, 95% CI 1.60 (1.33-1.92), p < 0.001].

CONCLUSIONS

COVID-19 patients with BD were at an increased risk of mortality, which was exacerbated in the youngest and most deprived patients with BD. Patients with BD should thus be targeted as a high-risk population for severe forms of COVID-19, requiring enhanced preventive and disease management strategies.

Home environment of 11-year-old children born to parents with schizophrenia or bipolar disorder - a controlled, 4-year follow-up study: The Danish High Risk and Resilience Study - VIA 11

BACKGROUND

The home environment has a major impact on child development. Parental severe mental illness can pose a challenge to the home environment of a child. We aimed to examine the home environment of children of parents with schizophrenia or bipolar disorder and controls longitudinally through at-home assessments.

METHODS

Assessments were conducted within The Danish High Risk and Resilience Study, a nationwide multi-center cohort study of children of parents with schizophrenia or bipolar disorder and population-based controls. The level of at-home stimulation and support was measured at age 7 (N = 508 children) and age 11 (N = 430 children) with the semi-structured HOME Inventory. Results from the 11-year follow-up study were analyzed and compared with 7-year baseline results to examine change across groups.

RESULTS

At age 11, children of parents with schizophrenia and bipolar disorder had lower levels of stimulation and support than controls (mean (s.d.) = 46.16 (5.56), 46.87 (5.34) and 49.25 (4.37) respectively, p < 0.001). A higher proportion of children with parental schizophrenia or bipolar disorder lived in inadequate home environments at age 11, compared with controls (N (%) = 24 (15.0), 12 (12.2) and 6 (3.5) respectively, p < 0.003). The changes in home environment scores did not differ across groups from age 7 to age 11.

CONCLUSIONS

Assessed longitudinally from the children's age of 7 to 11, children of parents with schizophrenia or bipolar disorder had lower levels of stimulation and support in their homes than controls. Integrated support which can target practical, economic, social and health issues to improve the home environment is indicated.

Socioeconomic position at the age of 30 and the later risk of a mental disorder: a nationwide population-based register study

BACKGROUND

A study was undertaken to examine the association between multiple indicators of socioeconomic position (SEP) at the age of 30 and the subsequent risk of the most common mental disorders.

METHODS

All persons born in Finland between 1966 and 1986 who were alive and living in Finland at the end of the year when they turned 30 were included. Educational attainment, employment status and personal total income were used as the alternative measures of SEP. Cox proportional hazards models were used to examine the association of SEP at the age of 30 with later risk of mental disorders. Additional analyses were conducted using a sibling design to account for otherwise unobserved shared family characteristics. Competing risks models were used to estimate absolute risks.

RESULTS

The study population included 1 268 768 persons, 26% of whom were later diagnosed with a mental disorder. Lower SEP at age 30 was consistently associated with a higher risk of being later diagnosed with a mental disorder, even after accounting for shared family characteristics and prior history of a mental disorder. Diagnosis-specific analyses showed that the associations were considerably stronger when substance misuse or schizophrenia spectrum disorders were used as an outcome. Absolute risk analyses showed that, by the age of 52 years, 58% of persons who had low educational attainment at the age of 30 were later diagnosed with a mental disorder.

CONCLUSIONS

Poor SEP at the age of 30 is associated with an increased risk of being later diagnosed with a mental disorder.

Joint exposure to parental cancer and income loss during childhood and the child's socioeconomic position in early adulthood: a Danish and Norwegian register-based cohort study

BACKGROUND

Parental cancer as well as economic hardship in the family during childhood can affect the child negatively. Our aim was to examine the association between the joint exposure to parental cancer and income loss in childhood and the child's socioeconomic position in early adulthood.

METHODS

We conducted a register-based prospective cohort study of children born in Denmark between 1978 and 1986 and in Norway between 1979 and 1987. The children were followed from 1 January 1994 (in Denmark) or 1995 (in Norway). Educational level and personal income were measured at age 30 years. Children who experienced parental cancer between the years they turned 8 and 16 years were identified, and exposure to income loss was measured in the same period. Adjusted multinomial logistic regression model was used to estimate relative risk ratios for the joint exposure of parental cancer and income loss during childhood.

RESULTS

Children who experienced parental cancer and an income loss during childhood had an increased risk of low education and lower income at age 30 years. The associations were weaker for children only exposed to income loss and less clear for those only exposed to parental cancer. Further, exposure to parental cancer with a severe cancer type was associated with lower educational level.

CONCLUSION

The child's educational attainment and income level in early adulthood were negatively affected by exposure to income loss in childhood, and even more so if exposed to both parental cancer and income loss. The associations with educational attainment were stronger for more severe cancer types.

Association between depression and the likelihood of having children: a nationwide register study in Finland

BACKGROUND

Depression may be associated with a lower likelihood of having children, but the findings are inconsistent. Previous population-based studies on this topic are limited.

OBJECTIVE

We examined associations between depression and the likelihood of having children, the number of children, and the parental age at first birth. We also evaluated whether these associations differ for people with low, middle, and high educational levels.

STUDY DESIGN

We conducted a nationwide register cohort study including all individuals born in Finland from 1960 to 1980 (n=1,408,951). Depression diagnoses were identified from the Care Register for Health Care (containing records of inpatient hospital episodes for the period 1969 to 2017 and of specialist outpatient visits for the period 1996 to 2017). The main outcomes-having biological children, the number of biological children, and the parental age at first birth-were identified from the Population Register of Statistics Finland and were defined either in the last year of the follow-up in 2017 or the last year alive or living in Finland. The association between depression and the likelihood of having children was examined using a logistic regression analysis; the association between depression and the number of children was evaluated using Poisson regression analyses, and the association between depression and the age at first birth was evaluated using a linear regression analysis. All analyses were conducted separately for men and women.

RESULTS

For both men and women, secondary care-treated depression was associated with a lower likelihood of having children (odds ratio, 0.66; 95% confidence interval, 0.64-0.67 for men; odds ratio, 0.84; 95% confidence interval, 0.82-0.85 for women) and with having fewer children (incidence rate ratio, 0.86; 95% confidence interval, 0.86-0.87 for men; incidence rate ratio, 0.96; 95% confidence interval, 0.96-0.96 for women). Depression was associated with a slightly lower parental age at first birth (33.1 vs 34.0; P<.001 for men; 31.3 vs 32.1; P<.001 for women). Dose-response associations between the severity of depression and a decreased likelihood of having children, as well as having fewer children, were observed. Earlier onset of depression was related to a lower likelihood of having children and to having fewer children. Among men and women in middle- and high-level educational groups, depression was associated with a lower likelihood of having children and with having fewer children. Among men with a low level of education, no associations were observed. Among women with a low level of education, depression was associated with a higher likelihood of having children and with having more children.

CONCLUSION

Both men and women with secondary care-treated depression have a lower likelihood of having children and have fewer children. Our findings suggest that depression may be one of the factors that contribute to the likelihood of having children, which should be addressed by policy makers.

The burden of somatic diseases among people with alcohol- and drug use disorders are influenced by mental illness and low socioeconomic status. A registry-based cohort study in Norway

OBJECTIVES

Persons with alcohol use disorder (AUD) and drug use disorder (DUD) have a lower life expectancy than the general population. We examined the burden of somatic diseases among persons with AUD or DUD and investigated impact of socioeconomic status (SES) and mental health disorders on the co-occurrence of somatic diseases in these groups.

METHODS

We performed a retrospective, register-based cohort study with a 6-year follow-up of persons (aged ≥18 y) with AUD (13,478) or DUD (16,659). Cox regression analyses were used to estimate hazard ratios (HRs) of somatic diseases.

RESULTS

Patients with DUD were, on average, 10 years younger at the point of diagnosis than patients with AUD. Mental illnesses were prominent in both groups (AUD: 40.5%, and DUD: 46.9% vs 3.5% in controls). Adjusting for mental disorders, the risk of all somatic diseases among the AUD and DUD groups was reduced by 30%. Some of the elevated risk of somatic diseases among persons with AUD and DUD is explained by low SES, though less than that explained by the presence of mental disorders. The diseases with highest risk among AUD patients were metabolic disorders (16.9-fold) and hypertension (14.8-fold), and among AUD patients, viral hepatitis (23.3-fold), after adjusting for low SES and mental disorders.

CONCLUSIONS

Persons with AUD had a higher risk of most somatic diseases, while those with DUD had specific risks for infections and viral hepatitis. Mental health disorders and SES adjusted the associations regarding most somatic diseases. In general, improvement of socio-economic conditions, preferably in combination with professional support to self-manage mental health problems, will reduce the risk of somatic illness in both groups. For DUD patients, available sterile user equipment will reduce the risk of viral hepatis.

Study on anxiety and depression of men who have sex with men: An application of group-based trajectory model

The prevalence of anxiety and depression is high among men who have sex with men (MSM), but limited studies focus on their development trends. This study examined the prevalence and influencing factors of anxiety and depression in HIV-negative MSM. In this study, 711 subjects were followed up every 24 weeks for 96 weeks. A group-based trajectory model was used to identify different development trends and a logistic regression model was used to explore the influencing factors of different trajectories. Low, moderate, and high anxiety groups accounted for 32.56, 56.12, and 11.32%; and low and high depression groups accounted for 73.90 and 26.10%. High anxiety was associated with a lower education degree, little HIV-related knowledge, and other characteristics (more agreed that "HIV is a threat to me/my family," had high frequency of seeking sexual partners via the Internet, had a history of sexually transmitted disease (STD), and a sense of discrimination by doctors). High depression was associated with a lower education degree, little HIV-related knowledge, being bisexual and the following characteristics: they felt that HIV infection rate of MSM around them was high, and more agreed that "HIV is a threat to me/my family," had a high frequency of seeking sexual partners through the Internet and alcohol drinking, had a history of STD, and felt being discriminated against by doctors and others. There is heterogeneity in the development trends of anxiety and depression. We need to improve intervention in the mental health of MSM, especially those with high anxiety and depression development trends.

Clinical Trial Registration

[http://www.chictr.org.cn/showproj.aspx?proj=5716], identifier [ChiCTR-TRC-13003849].

Employment trajectories until midlife in schizophrenia and other psychoses: the Northern Finland Birth Cohort 1966

PURPOSE

Psychoses are associated with poor labour market attachment, but few studies have compared schizophrenia (SZ) and other psychoses (OP). Moreover, studies on long-term employment trajectories over individuals' working life courses are lacking. We compared 30 year employment trajectory patterns in a general population sample among individuals with SZ, OP, and those with no psychosis (NP).

METHODS

Utilising the Northern Finland Birth Cohort 1966, we collected survey data on employment from ages 16 to 45 and detected individuals with register-based history of SZ (n = 62), OP (n = 87), or NP (n = 6464) until age 46. Through gender-specific latent class analyses on annual employment roles, we identified traditional, highly educated, self-employed, delayed and floundering employment trajectories with distinct socioeconomic characteristics. We addressed attrition by conducting weighted analyses.

RESULTS

Floundering trajectories were common among individuals with SZ (79% of men, 73% of women) and OP (52% of men, 51% of women). In NP, a traditional employee trajectory was most common in men (31%), and a highly educated trajectory in women (28%). A history of psychosis was associated with heightened odds ratios (ORs; 95% confidence intervals (CIs)) for floundering trajectories in both men (SZ: 32.9 (13.3-81.4); OP: 7.4 (4.0-13.9)) and women (SZ: 9.9 (4.6-21.5); OP: 3.9 (2.1-7.1)) compared to NP. Weighted analyses produced similar results.

CONCLUSION

Most individuals with SZ or OP have floundering employee trajectories reflecting an elevated risk of unemployment and part-time work until midlife. These results indicate the importance of improving labour market attachment during the early phases of psychoses.

The linkage of depressive and anxiety disorders with the expected labor market affiliation (ELMA): a longitudinal multi-state study of Danish employees

OBJECTIVE

Depressive and anxiety disorders are prevalent among employees in general. Still, knowledge regarding the contribution of these disorders to the dynamics of the labor market in terms of working time, sickness absence, and unemployment is scarce. We aim to quantify the linkage of depressive and anxiety disorders with labor market participation using the expected labor market affiliation method (ELMA), in a large sample of Danish employees.

METHODS

We combined three survey waves on occupational health with six high-quality national registers in N = 43,148 Danish employees, of which the 2012 survey contributed 29,665 person years, the 2014 survey 33,043 person years, and the 2016 survey 35,375 person years. We used the new ELMA method to estimate the multi-state transition probabilities and 2-year expected time in work, sickness absence, and unemployment. Depressive and anxiety disorders were assessed by the Major Depression Inventory and the SCL-ANX4 scales, respectively. We adjusted for multiple variables by applying inverse probability weighting in groups of gender and age.

RESULTS

Depressive and anxiety disorders among employees link to reduced labor market affiliation by significantly changed transitions probabilities between the labor markets states, viewed as reduced working time by 4-51 days (in two years), increased time in sickness absence by 6-44 days (in two years), and unemployment by 6-12 days (in two years) when compared to employees without depression or anxiety disorders. The results were most pronounced for women employees and for employees with both depression and anxiety disorders.

CONCLUSIONS

The study reveals detailed insight into what extent depression and anxiety disorders influence the labor market affiliation, in terms of the complex interrelation between working time, sickness absence, and unemployment. The study emphasizes the importance of preventing and handling depressive and anxiety disorders among employees for strengthening work participation.

Maternal genetic risk for depression and child human capital

We here address the causal relationship between the maternal genetic risk for depression and child human capital using UK birth-cohort data. We find that an increase of one standard deviation (SD) in the maternal polygenic risk score for depression reduces their children's cognitive and non-cognitive skill scores by 5 to 7% of a SD throughout adolescence. Our results are robust to a battery of sensitivity tests addressing, among others, concerns about pleiotropy and dynastic effects. Our Gelbach decomposition analysis suggests that the strongest mediator is genetic nurture (through maternal depression itself), with genetic inheritance playing only a marginal role.

Productivity loss and productivity loss costs to United States employers due to priority conditions: a systematic review

AIMS

To summarize published studies evaluating productivity loss and productivity loss costs associated with cancer, chronic lung disease, depression, pain, and cardiometabolic disease among US employees.

MATERIALS AND METHODS

A PubMed search from the past 10 years was conducted using the terms productivity, absenteeism, presenteeism, cancer, bronchitis, asthma, chronic obstructive pulmonary disease, depression, pain, heart disease, hypertension, and diabetes (limited to English-language publications and studies of adults aged 19-64). Study endpoints included annual incremental time (work hours lost and Work Productivity and Impairment [WPAI] questionnaire overall work impairment) and monetary estimates of productivity loss. Studies were critically appraised using a modified Oxford Centre for Evidence-Based Medicine (OCEBM) Quality Rating Scheme.

RESULTS

Of 2,037 records identified from the search, 183 studies were included. The most common observed condition leading to productivity loss was pain (24%), followed by cancer (22%), chronic lung disease (17%), cardiometabolic disease (16%), and depression (16%). Nearly three-quarters of the studies (n = 133, 72.7%) were case-control/retrospective cohort studies (OCEBM quality rating 3); the remainder were case series/cross-sectional studies (n = 28, 15.3%; quality rating 4), randomized clinical trials (n = 18, 9.8%; quality rating 1); and controlled trials without randomization/prospective comparative cohort trials (n = 4, 2.2%; quality rating 2). Samples sizes ranged from 18 patients to millions of patients for studies using the Medical Expenditure Panel Survey (MEPS). Most studies found employees lost up to 80 annual incremental work hours; employees with cancer and cardiometabolic disease had the greatest number of work hours lost. Overall percentage work impairment ranged from 10% to 70% and was higher for pain and depression. Annual incremental costs of lost work productivity ranged from $100 to $10,000 and were higher for cancer, pain, and depression.

LIMITATIONS

Study heterogeneity.

CONCLUSIONS

Despite some gaps in evidence for the cost of productivity loss, sufficient data highlight the substantial employer burden of lost productivity among priority conditions.

Incidence and factors associated of early non-response in first-treatment and drug-naïve patients with schizophrenia: a real-world study

Background

Schizophrenia is a severe and persistent mental condition that causes disability. For subsequent clinical care, it is extremely practical to effectively differentiate between patients who respond to therapy quickly and those who do not. This study set out to document the prevalence and risk factors for patient early non-response.

Methods

The current study included 143 individuals with first-treatment and drug-naïve (FTDN) schizophrenia. Patients were classified as early non-responders based on a Positive and Negative Symptom Scale (PANSS) score reduction of less than 20% after 2 weeks of treatment, otherwise as early responders. Clinical subgroups' differences in demographic data and general clinical data were compared, and variables related to early non-response to therapy were examined.

Results

Two weeks later, a total of 73 patients were described as early non-responders, with an incidence of 51.05%. The early non-response subgroup had significantly higher PANSS scores, Positive symptom subscale (PSS) scores, General psychopathology subscale (GPS) scores, Clinical global impression scale - severity of illness (CGI-SI) and Fasting blood glucose (FBG) levels compared to the early-response subgroup. CGI-SI and FBG were risk factors for early non-response.

Conclusion

High rates of early non-response have been seen in FTDN schizophrenia patients, and risk variables for predicting early non-response include CGI-SI scores and FBG levels. However, we need more in-depth studies to confirm the generalizable range of these two parameters.

The association between mental disorders and subsequent years of working life: a Danish population-based cohort study

BACKGROUND

Mental disorders can affect workforce participation via a range of mechanisms. In this study, we aimed to estimate the association between different types of mental disorders and working years lost, defined as the number of years not actively working or enrolled in an educational programme.

METHODS

In this population-based cohort study, we included all people aged 18-65 years (mean 38·0 [SD 13·9]) in the Danish Civil Registration System from Jan 1, 1995 to Dec 31, 2016. Information on mental disorders was obtained from the Danish Psychiatric Central Research Register and information on labour market characteristics was obtained from administrative registers. Follow-up started at age 18 years, immigration to Denmark, or on Jan 1, 1995, whichever came later; and it ended at age 65 years, death, emigration from Denmark, disability pension, voluntary early retirement, or Dec 31, 2016 (whichever came earlier). As the main outcome, we estimated working years lost for those diagnosed with any mental disorder and 24 types of mental disorders, as well as for the general population of same age and sex. We decomposed total working years lost into periods of unemployment or sick leave, disability pension, voluntary early retirement, or death. Data on ethnicity were not available through administrative registers.

FINDINGS

A total of 5 163 321 individuals, 2 642 383 men and 2 520 938 women, were followed up for 65·4 million person-years. Overall, 488 775 (9·47%) individuals were diagnosed with a mental disorder. On average, individuals with mental disorders lost an additional 10·52 (95% CI 10·48-10·57) years of working life compared with the general Danish population. Receiving a disability pension (7·54 [7·49-7·59] years) and longer periods of unemployment (2·24 [2·21-2·27] years) accounted for most of this difference.

INTERPRETATION

Our findings foreground the substantial impact of mental disorders on workforce participation. There is a need to invest in programmes that reduce the burden of working years lost and assist people with mental disorders in returning to the workforce.

FUNDING

Lundbeck Foundation and Danish National Research Foundation.

Workplace Supported Recovery from Substance Use Disorders: Defining the Construct, Developing a Model, and Proposing an Agenda for Future Research

Substance use disorders (SUDs) represent a critical public and occupational health issue. Therefore, understanding the process of SUD recovery has become an issue of growing importance among substance use and recovery professionals. Nonetheless, despite the acknowledged importance of employment for SUD recovery, little conceptual or empirical work exists on how the workplace might support or undermine SUD recovery. In this article, we address this limitation in several ways. First, to promote a better understanding of SUD recovery for occupational health researchers, we provide a brief overview of the nature of a SUD, prior definitions of SUD recovery, and general themes associated with the recovery process. Second, we develop a working definition of workplace supported recovery. Third, we present a heuristic conceptual model showing how the workplace might impact the SUD recovery process. Fourth, using this model and research from the substance use and occupational health literatures, we develop a series of general research propositions. These propositions highlight broad directions requiring more detailed conceptualization and empirical research to understand better how work conditions may support or undermine the process of employee SUD recovery. Our overarching goal is to motivate innovative conceptualization and research on workplace supported recovery from SUDs. Such research may inform the development and evaluation of workplace interventions and policies supporting SUD recovery and highlight the benefits of workplace supported SUD recovery for employees, employers, and communities. Research on this issue may allow occupational health researchers to impact a significant societal and occupational health issue.

Tourism as a Tool in Nature-Based Mental Health: Progress and Prospects Post-Pandemic

The healthcare sector recognises the role of nature in mental health. The tourism sector is equipped to take people to national parks. The conservation sector gains support from visitors. Theoretical frameworks for mental health benefits from nature tourism include: tourism destinations and activities; tourist personalities and life histories; sensory and emotional components of tourist experiences; and intensity and duration of memories. Mental health deteriorated worldwide during the COVID-19 pandemic. Recovery of global economic productivity requires immediate, accessible, affordable mental health measures at national scales, and nature-based approaches provide the best option. Different countries have adopted a variety of public, private, or voluntary mechanisms. Some focus on design of activities, others on provision of facilities. Costs and implementation depend on key research questions: marginal benefits of nature tour guides or psychologists compared to self-guided nature experiences; comparisons between repeated brief visits and one-off nature holidays; effects of biodiversity, flagship species, and scenic or wilderness quality; and differences between individuals, depending on personalities, life histories, and mental health status and symptoms.

Psychiatric Symptoms and Frequency of Eating out among Commuters in Beijing: A Bidirectional Association?

Background: Mental illness places as a distant first in global burdens, exceeding both cardiovascular and circulatory diseases, in terms of the years lived with the disability. The emergence of the new and burgeoning area of “Nutrition Psychiatry” offers promise in improving mental health with diet. Mental health and well-being are critical to commuters but rarely recieve the attention they need. This study aimed to examine the bidirectional relationship between the frequency of eating out and depression, anxiety, and stress symptoms in a sample of Beijing commuters. Methods: A total of 3337 commuters (mean (SD) age, 38.78 (10.41); 74.74% males) from the cohort study CHCN-BTH were included. The psychiatric symptoms were evaluated using a 21-item self-reported depression–anxiety–stress scale (DASS-21). A Cochran–Armitage trend chi-square test, restricted cubic spline, multiple logistic regression, multinomial logit models, and E-values were performed to estimate the associations between eating out and psychiatric symptoms in both directions. Results: A daily rate of eating out more than 50% had a higher risk for depression (OR, 95% CI: 1.68, 1.184–2.393), anxiety (1.73, 1.259–2.369), and stress (1.99, 1.191–3.329) than the individuals eating at home. A higher frequency of eating out for lunch was significantly associated with an increased risk of depression (1.78, 1.28–2.46), anxiety (1.67, 1.26–2.23), and stress (2.05, 1.31–3.22). Similar results were found when eating out for dinner with increased risks for depression 2.20 (1.59, 3.06), anxiety 1.91 (1.42, 2.59), and stress 2.61 (1.68, 4.05). There is limited evidence supporting the effects of psychiatric symptoms on the frequency of eating out in the reverse analyses. Conclusions: The frequency of eating out is positively associated with an increased risk of psychiatric symptoms, especially when eating out for lunch and dinner. People eating at home have the lowest risk of suffering psychiatric symptoms, followed by those eating in the workplace canteen. Eating at home should be considered for future recommendations for the prevention of psychiatric symptoms.

Psychiatric and neurodevelopmental diagnoses in adolescence and adulthood over-indebtedness among Finns born in 1987

BACKGROUND

Adolescence psychiatric and neurodevelopmental diagnoses are common but their link to adulthood over-indebtedness is unknown. This study aims to determine this relationship and explores the possible mediating role of upper secondary education completion.

METHODS

We analyzed the 1987 Finnish Birth Cohort, which consisted of a complete census of children born in Finland in 1987 and registered in the Medical Birth Register (n = 53 743). Records of debt payment defaults, at the age of 33, were used as a measure of over-indebtedness. Adolescent psychiatric and neurodevelopmental diagnoses at ages 13-17 were derived from the national hospital discharge register. Inverse probability treatment weighting was used to investigate the role of pre-exposure variables in this relationship, and the mediating role of upper secondary education completion.

RESULTS

Compared to unexposed individuals, those affected by an adolescent psychiatric or neurodevelopmental diagnosis had a 15 percentage points higher prevalence of over-indebtedness in adulthood. This association was more common for males and was additionally notably strong for suicidality and conduct and oppositional disorders. Controlling for measured potential confounding factors, the diagnoses were linked to a 11-percentage point (95% confidence interval 9-12) higher risk of over-indebtedness. Completing at least upper secondary education reduced this effect by some 39%.

CONCLUSION

People with psychiatric and neurodevelopmental disorders diagnosed in adolescence are at elevated risk of over-indebtedness in adulthood. Recognizing this high risk may help in efforts to prevent further debt problems. Better education may serve as a protective factor against over-indebtedness and perhaps similar other behavioural consequences.

Psychotherapy and change in mental health-related work disability: a prospective Finnish population-level register-based study with a quasi-experimental design

BACKGROUND

Mental disorders are a major cause of work disability among the working-age population. Psychotherapy has shown to be an effective treatment for mental disorders, but the evidence is mainly based on small-scale randomised trials with relatively short follow-ups. We used population-based register data to examine the association between statutory rehabilitative psychotherapy and change in depression or anxiety-related work disability.

METHODS

We drew a nationally representative sample of the working-age population (aged 18-55 in 2010). The study group comprised all those who started rehabilitative psychotherapy in 2011-2014. A total of 10 436 participants who were followed from 3 years prior to 4 years after the onset of rehabilitative psychotherapy. This resulted in 83 488 observations. The annual total number of mental health-related work disability months (0 to 12) was calculated from the total number of annual compensated sickness absence and disability pension days. A quasi-experimental interrupted time series analysis was applied.

RESULTS

The onset of rehabilitative psychotherapy marked a decline in work disability in comparison to the counterfactual trend. Specifically, a 20% decrease in the level (incidence rate ratio, IRR 0.80; 95% CI 0.76 to 0.85) and a 48% decrease in the slope (IRR 0.52; 95% CI 0.50 to 0.54) of work disability were detected in comparison to the counterfactual scenario. No significant gender differences were observed. The decline in work disability was the steepest in the oldest age group.

CONCLUSIONS

This study suggests that statutory psychotherapy may decrease work disability at the population level. However, further evidence of causal inference and the potential heterogeneity of the association is required.

Stigma towards people with mental illness in the Nordic countries - a scoping review

INTRODUCTION

Stigma affects people with mental illness globally, however, it is proposed that stigma is less prevalent in wealthier countries and that people hold more positive attitudes in Northern and Western Europe. Even so, accounts from surveys in Denmark and Sweden reveal that stigma is very much prevalent.

AIM

This scoping review aims to shed light on the body of literature regarding mental-health-related stigma in the Nordic Countries and identify knowledge gaps.

METHODS

We searched four electronic databases in December 2017 and again in June 2020. All types of empirical studies (qualitative, quantitative, and mix-methods) examining the stigma of people with mental illness were included.

RESULTS

In total, 61 studies were included. Overall, findings from the Nordic countries resemble global findings. Studies are primarily descriptive, and mostly survey studies of attitudes toward people with mental illness in the general population. Few studies focus on discrimination, and those who do, measure intended behavior in hypothetical situations rather than actual acts of discrimination in real-life situations. Studies were mostly conducted on a community or organizational level; no studies were identified on a system level. Experienced stigma and discrimination by patients, but also relatives, were a focus in one-third of the studies. Very few studies of interventions to reduce stigma and discrimination were identified.

CONCLUSION

More studies into stigma on a system or institutional level are needed. Ways to measure acts of discrimination should be invented. Furthermore, interventions to reduce stigma and discrimination should be developed, targeting all levels of society.

Parent and child mental health during COVID-19 in Australia: The role of pet attachment

Restrictions, social isolation, and uncertainty related to the global COVID-19 pandemic have disrupted the ways that parents and children maintain family routines, health, and wellbeing. Companion animals (pets) can be a critical source of comfort during traumatic experiences, although changes to family routines, such as those caused by COVID-19, can also bring about challenges like managing undesirable pet behaviours or pet-human interactions. We aimed to examine the relationship between pet attachment and mental health for both parents and their children during the COVID-19 pandemic in Australia. A total of 1,034 parents living with a child under 18 years and a cat or dog completed an online cross-sectional survey between July and October 2020. Path analysis using multivariate linear regression was conducted to examine associations between objective COVID-19 impacts, subjective worry about COVID-19, human-pet attachment, and mental health. After adjusting for core demographic factors, stronger pet-child attachment was associated with greater child anxiety (parent-reported, p < .001). Parent-pet attachment was not associated with self-reported psychological distress (p = .42), however, parents who reported a strong emotional closeness with their pet reported greater psychological distress (p = .002). Findings highlight the role of pets during times of change and uncertainty. It is possible that families are turning to animals as a source of comfort, during a time when traditional social supports are less accessible. Alternatively, strong pet attachment is likely to reflect high levels of empathy, which might increase vulnerability to psychological distress. Longitudinal evidence is required to delineate the mechanisms underpinning pet attachment and mental health.

The Contribution of a Music and Arts Rehabilitation Program to the Creative Identity, Well-Being, and Community Integration of People With Mental Health Conditions

The United Nations highlighted the importance of promoting the rights of people with mental health conditions (MHC) to education, employment, and citizenship. One related initiative in Israel is the Garage pre-academic music and arts school for individuals with musical and artistic abilities coping with MHC. This process–outcome study examined whether and how the Garage contributes to participants’ creative self-concept, mental health, alleviates loneliness, and promotes postsecondary education and work integration. It also probed the participants’ initial expectations and the extent to which these were fulfilled. Using a single-group pretest–posttest design, quantitative data on the outcome variables were collected, along with mid-test data on process variables from the Garage students ( N = 44). Supplementary qualitative data were collected at pretest on the students’ expectations. The results suggest a significant increase in creative personal identity and mental health, a decrease in loneliness, and promotion of postsecondary education and work integration. These findings were associated with persistent attendance, basic psychological needs satisfaction, and expectation fulfillment. A merged analysis indicated that the students’ qualitative expectations were generally congruent with the quantitative results. Overall, the findings show how the program corresponds to humanistic values, targets service users’ needs and rights, and promotes personal recovery and community integration.

Self-stigma among clients of outpatient psychiatric clinics: A cross-sectional survey

Self-stigma is common among people with mental disorders. A large body of research has examined associations between self-stigma and sociodemographic, clinical and psychosocial factors but the results are still conflicting. The aim of this study was to describe self-stigma among persons with affective and psychotic disorders and identify sociodemographic and clinical factors associated with experiences of self-stigma. A cross-sectional survey was performed with Finnish clients (N = 898) at 16 psychiatric clinics using self-reported questionnaires. The data were analyzed using descriptive statistics and with one-way and multi-way analysis of variance (ANOVA). The results showed that clients in community settings experience self-stigma (a total mean SSMIS-SF score of 74.8 [SD 22.3]). Having a diagnosis of an affective disorder, having a long history of mental disorder (>16 years) and the severity of depressive symptoms were the key factors associated with experiences of self-stigma. Clients living in community settings should be assessed regularly for depressive symptoms of mental disorders, and interventions should be conducted, especially at an early stage of the illness, to reduce self-stigma. Factors associated with self-stigma should be taken into account in the future development of interventions to reduce stigma.

Occupational Branch and Labor Market Marginalization among Young Employees with Adult Onset of Attention Deficit Hyperactivity Disorder-A Population-Based Matched Cohort Study

We compared labor market marginalization (LMM), conceptualized as days of unemployment, sickness absence and disability pension, across occupational branches (manufacturing, construction, trade, finance, health and social care, and education), among young employees with or without attention deficit hyperactivity disorder (ADHD) and examined whether sociodemographic and health-related factors explain these associations. All Swedish residents aged 19–29 years and employed between 1 January 2005 and 31 December 2011 were eligible. Individuals with a first ADHD diagnosis (n = 6030) were matched with ten controls and followed for five years. Zero-inflated negative binomial regression was used to model days of LMM with adjustments for sociodemographic and health-related factors. In total, 20% of those with ADHD and 59% of those without had no days of LMM during the follow-up. The median of those with LMM days with and without ADHD was 312 and 98 days. Having an ADHD diagnosis was associated with a higher incidence of LMM days (incident rate ratios (IRRs) 2.7–3.1) with no differences across occupational branches. Adjustments for sociodemographic and health-related factors explained most of the differences (IRRs: 1.4–1.7). In conclusion, young, employed adults with ADHD had a higher incidence of LMM days than those without, but there were no substantial differences between branches, even after adjusting for sociodemographic and health-related factors.

Income Disparity and Mental Wellbeing among Adults in Semi-Urban and Rural Areas in Malaysia: The Mediating Role of Social Capital

Mental illness is rising worldwide and is more prevalent among the older population. Among others, socioeconomic status, particularly income, has a bearing on the prevalence of mental health. However, little is known about the underlying mechanism that explains the association between income and mental health. Hence, this study seeks to examine the mediating effect of social capital on the association between income and mental illness. Cross-sectional data consisting of 6651 respondents aged 55 years and above were used in this study. A validated tool known as the Depression, Anxiety and Stress Scale, 21 items (DASS-21) was applied to examine mental illness, namely depression, anxiety, and stress. The Karlson, Holm, and Breen (KHB) method was employed to assess the intervening role of social capital on the association between income and mental illness. Results showed that those who disagreed in trust within the community had the highest partial mediation percentage. Those who disagreed in reciprocity, however, had the lowest partial mediation percentage, which explained the positive association between the middle 40% (M40) of the income group and depression, anxiety, and stress. Overall, the study suggests the need to increase trust and attachment within society to curb the occurrence of depression and anxiety.

The risk of outpatient mental health care service use following departure from work: a cohort register study of migrant and non-migrant women

Background

Non-workforce participation is associated with increased risk of mental disorder in the general population. Migrant women face disadvantage in the labour market but use mental health services to a lesser extent. This study investigates the risk of using mental health services following departure from the workforce among women in Norway, and if the strength of the relationship varies for migrant and non-migrant women.

Methods

Using linked registry data, we followed a cohort of 746,635 women who had a stable workforce attachment over a three-year period. We used Cox proportional hazard models to determine the risk of using outpatient mental health services (OPMH) following departure from the workforce. We included an interaction analysis to determine if the relationship differed by migrant group and length of stay and conducted subsequent stratified analyses.

Results

Departure from the workforce was associated with a 40% increased risk of using OPMH services among all women. Interaction analyses and subsequent stratified analyses indicated that departure from the workforce was associated with an increased risk of using OPMH services among non-migrant women and among women from countries outside of the European Economic Area, regardless of length of stay. For women from the European Economic Area with 2–6 years or 7–15 years in Norway, however, there was no increased risk.

Conclusions

Departure from the workforce is associated with increased risk of mental health service use, also among migrant women. Migrant women as a group, are more often temporarily employed and therefore at greater risk of falling out of the workforce and developing a mental disorder. However, women with shorter length of stays may experience greater barriers to care and service use may be a poorer indicator of actual mental disorder.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08113-z.

Social integration of people with non-psychotic mental illness over the last 2 decades: the widening gap in the adult population in Belgium

PURPOSE

Social integration is poor among people with mental illness (MI). In recent decades, many countries have developed policies to address this issue. It remains unclear, however, whether their social integration has improved over time. This study aimed to assess the evolution of the social integration of adults with moderate and severe non-psychotic MI compared to the general population without MI between 1997 and 2018 in Belgium.

METHODS

Data on the general adult population were retrieved from the Belgian Health Interview Survey in six cross-sectional waves from 1997 to 2018. Three degrees of non-psychotic MI severity were compared using the 12-items General Health Questionnaire: no MI, moderate MI, and severe MI (score < 4, 4-7, and > 7). Social integration was measured using indicators relating to employment, income, social contacts, and partnership.

RESULTS

Since 1997, the probability of being unemployed, having limited social contacts, and living on less than 60% of the median national income has been increasing among people with severe non-psychotic MI. Between 1997 and 2018, social integration increased among the general population without MI and among people with moderate non-psychotic MI, but decreased among people with severe non-psychotic MI.

CONCLUSION

The gap between the social integration of people with severe non-psychotic MI and people with moderate or no MI has widened over time, despite major reforms of mental health care and policies. Policymakers and clinical practitioners should pay more attention to supporting the social integration of people with more severe MI, particularly in relation to employability and social support.

Effect of exercise as adjuvant to energy-restricted diets on quality of life and depression outcomes: a meta-analysis of randomized controlled trials

BACKGROUND AND AIM

Obesity and related co-morbidities lead to a decrease in health-related quality of life (HRQOL) and mood. Lifestyle strategies may improve these outcomes. However, the efficacy of exercise in conjunction with a weight-loss diet on HRQOL and mood is unclear. The aim of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to examine whether the addition of exercise to energy-restricted dietary programs improves HRQOL and mood status when compared with energy-restricted diets alone in overweight and obese adults.

METHODS

Eligible RCTs were identified by searching PubMed/MEDLINE, EMBASE, ISI (Web of sciences), Scopus, and Google Scholar up to April 2021. Summary effects were derived using a random-effects model. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology.

RESULTS

The meta-analysis revealed that an energy-restricted diet plus exercise compared with an energy-restricted diet alone had no significant effects on depression (n = 6, hedges'g = - 0.04, 95% CI: - 0.28,0.20), MOS 36-Item Short-Form Health Survey (SF-36)-physical component summary scores (n = 8, weighted mean difference (WMD) = 1.51, 95% CI: - 0.16, 3.18), SF36-mental component summary scores (n = 7, WMD = 0.64, 95% CI: - 1.00, 2.28), and HRQOL disease-specific questionnaire scores (n = 5, hedges'g = 0.16, 95% CI: - 0.09, 0.40). The GRADE revealed that the quality of evidence was low for disease-specific HRQOL scores, and depression status; and high for physical and mental health assessed by SF-36.

CONCLUSION

In our sample of overweight and obese adults, no beneficial effect of adding exercise to an energy-restricted diet was found in terms of HRQOL and Depression.

Sensory and Emotional Components in Tourist Memories of Wildlife Encounters: Intense, Detailed, and Long-Lasting Recollections of Individual Incidents

To quantify the role of senses and emotions in creating memorable tourism experiences, we need measurement frameworks that match how memories are created. This study examines that process through directed-content qualitative analysis of tourist encounters with wildlife. Data are derived from: interviews with 20 experienced wildlife tourism experts in 12 countries; 3000 social media posts on tourism enterprise and wildlife encounter websites; and participant observations and records of 168 memorable encounters involving >100 wildlife species, >850 tourists, and ~10,000 h in total, ranging over five decades. Across all data sources, senses and emotions differed between tourist interests and personalities, wildlife species and behaviours, and encounter circumstances. All senses were reported, with the most frequent being sight, followed by sound and smell, and, rarely, touch or taste. Descriptions were fine-grained and complex. The emotions reported were awe, joy, wonder, delight, thrill, amazement, envy, aww (cute-emotion), surprise, elation, satisfaction, interest, boredom, disappointment, sadness, embarrassment, concern, pity, distress, disgust, anxiety, shock, alarm, fear, and panic. Some experiences generated powerful recalls persisting for decades. Short-term, intense, and finely detailed senses and emotions defined experiences, created memories, and determined satisfaction, wellbeing, and subsequent outcomes. More accurate methods are needed to measure and characterise senses, emotions, and memories in tourism experience.