National trends in main causes of hospitalization: a multi-cohort register study of the finnish working-age population, 1976-2010

Occupational class and the changing patterns of hospitalization for affective and neurotic disorders: a nationwide register-based study of the Finnish working-age population, 1976-2010

PURPOSE

This study aimed to examine the long-term changes and socioeconomic disparities in hospitalization for affective and neurotic disorders among the Finnish working-age population from 1976 to 2010.

METHODS

Register-based study, consisting of a 5-year follow-up of 3,223,624 Finnish working-age (18-64-year old) individuals in seven consecutive cohorts. We calculated the hazard ratios of psychiatric hospitalization for different occupational classes using Cox regression models.

RESULTS

The risk of hospitalization for affective and neurotic disorders increased in all occupational classes after the economic recession in the 1990s, and then decreased in the 2000s. Before the 2000s, the risk was the highest among manual workers. In the 2000s the disparities between upper-level non-manual employees and other occupational classes increased. Hospitalization rates remained high among female manual workers and non-manual lower-level employees.

CONCLUSIONS

This study revealed important similarities and differences between occupational classes in terms of long-term changes in hospitalization for affective and neurotic disorders. The results suggest that the labor market changes and healthcare reforms during the 1990s and 2000s in Finland have been more beneficial for higher than for lower occupational classes.

Drivers' psychiatric disorders and fatal motor vehicle accidents in Finland

Relatively little is known about fatal motor vehicle accidents (FMVA) involving drivers with psychiatric disorders. In this study of all drivers killed in FMVAs in Finland between 1990 and 2011, we aimed to study drivers' death rate trends in FMVAs, with special focus on drivers with a history of psychiatric disorders. Prevalence of drivers' hospital treated psychiatric disorders, and characteristics of drivers with psychiatric disorders were also studied. For the purpose of this study, three national registers were accessed. Drivers' hospital treated psychiatric disorders were screened in a five-year period prior to death. Drivers with (n = 425) and without (n = 3856) psychiatric disorders were compared, female and male drivers separately. The main outcome measure was any psychiatric disorder in drivers within the five-year timescale. Socio-demographic factors, use of intoxicants and medication at the time of death, recent adverse life events, and drivers' physical and emotional states were used as covariates in the statistical analyses. During the study period, death rates increased for females with psychiatric disorders, and decreased for females without psychiatric disorders. Death rates for males with psychiatric disorders decreased between the years 1990-2000 and 2007-2011, and increased between the years 2000-2007. Death rates decreased over the whole study period in males without psychiatric disorders. Alcohol related disorders and affective disorders were the most prevalent hospital treated psychiatric disorders among drivers involved in FMVAs. Use of medications at the time of death, and committing suicide in traffic both associated with being a driver with psychiatric disorders involved in FMVAs for both genders. As FMVAs involving drivers with psychiatric disorders have increased, a more focused and detailed evaluation of the driving performance of drivers with psychiatric disorders is recommended. These evaluations should also be extended to drivers with non-psychotic disorders.