Nuorten aikuisten masennus- ja ahdistuneisuushäiriöt : hoitoon hakeutuminen, hoidon asianmukaisuus ja ennuste Suomessa

According to epidemiological studies, depressive and anxiety disorders are common, often chronic or recurrent, but under-recognized and undertreated. The incidence of these disorders peaks in late adolescence and early adulthood, when they may be particularly harmful, since they often limit social, occupational and academic functioning. Therefore, recognition and adequate treatment of these disorders at this age period are especially important. The aims of this study were to describe adequate treatment and outcome of depressive and anxiety disorders in a Finnish general population sample of young adults. Data were derived from the Mental Health in Early Adulthood in Finland (MEAF) study which is a follow-up study of Health 2000 young adult sample, a nationally representative two-stage cluster sample of 1894 Finns aged 18 to 29 years. The follow-up of the MEAF study was carried out as a part of the Health 2011 study. The baseline assessment was conducted in 2003–2005, and the follow-up in 2011. This study showed that 76% of young adults with lifetime depressive disorders had had contact with the healthcare system, and 41% of them had received minimally adequate treatment. Women, and those with a substance use disorder, had visited a physician at least once more often than others, while having major depressive disorder was related to visits with a physician at least four times a year. Women had also had psychotherapy more often than men. A history of suicidality and lower education were related to dropping out from treatment. Treatment was adequate for 42% of those with a lifetime history of anxiety disorder (excluding those with only a specific phobia), and 71% of them had sought treatment. Comorbid personality disorder was related to benzodiazepine use, and comorbid substance use with antidepressant or buspirone medication lasting for at least two months. Those who were currently married or cohabiting were less likely than others to have visited a physician at least four times a year. In the follow-up study, 23% of those with a lifetime depressive and/or anxiety disorder at baseline had these disorders in 2011, whereas the corresponding figure was 10% for those with no DSM-IV diagnosis at baseline. Those with a history of depressive and/or anxiety disorder had poorer self-estimated quality of life and lower level of education compared to the control group in the follow-up. Sociodemographic factors, treatment, or cognitive factors at baseline did not predict persistence/recurrence of depressive and anxiety disorders or quality of life among those affected, but hypomanic features at baseline were associated with worse self-estimated quality of life in the follow-up. These results show that young people sought treatment more often than in previous studies, but the lack of adequate treatment was an ongoing problem. The prognosis of depressive and anxiety disorders is relatively favorable, since three-quarters of young adults with a lifetime history of these disorders recovered after 6-8 years of follow-up. However, these disorders had an impact on the level of education of affected people in the long term. In the future, barriers to adequate treatment in the healthcare system should be investigated and interventions to remove them should be launched. It is also important that educational policy supports the continuity of education for young people with mental disorders during, and also after, acute episodes.Epidemiologisten tutkimusten mukaan masennus- ja ahdistuneisuushäiriöt ovat yleisiä, usein kroonisia tai uusiutuvia, mutta alidiagnosoituja ja -hoidettuja. Näiden häiriöiden ilmaantuvuus on korkeimmillaan myöhäisnuoruudessa ja varhaisaikuisuudessa, jolloin ne voivat hoitamattomina olla erityisen haitallisia rajoittaessaan mahdollisesti yksilön psykososiaalista, akateemista ja ammatillista kehitystä. Siksi niiden tunnistaminen ja asianmukainen hoito tässä ikäryhmässä olisi erityisen tärkeää. Tässä tutkimuksessa selvitettiin nuorten aikuisten masennus- ja ahdistuneisuushäiriöiden hoidon asianmukaisuutta ja ennustetta Suomessa. Tutkimuksen aineisto saatiin Nuorten aikuisten terveys ja psyykkinen hyvinvointi (NAPS) -tutkimuksesta, joka on Terveys 2000 -väestötutkimuksen 18–29-vuotiaiden nuorten aikuisten aineiston (N=1894) syventävä seurantatutkimus, joka toteutettiin vuosina 2003–2005. Pitkäaikaisseurannassa käytettiin Terveys 2011 -tutkimuksessa kerättyjä tietoja. Tutkimus osoitti, että elämänaikaisen masennushäiriö-diagnoosin saaneista nuorista aikuisista 76 %:lla oli ollut kontakti terveydenhoitojärjestelmään ja 41 % oli saanut asianmukaista hoitoa viimeisimmän masennusjaksonsa aikana. Naisilla ja päihdehäiriöstä kärsivillä oli muita useammin vähintään yksi lääkärikäynti ja vakavaa masennustilaa sairastavilla vähintään neljä lääkärikäyntiä vuoden aikana. Naisilla hoitoon oli kuulunut myös tukea antavia keskustelukäyntejä useammin kuin miehillä. Itsemurhaa yrittäneet ja vähemmän koulutetut keskeyttivät hoitonsa muita todennäköisemmin. Ahdistuneisuushäiriöitä sairastaneista (poissuljettuina ne, joilla määräkohteinen pelko oli ainoa ahdistuneisuushäiriö-diagnoosi) nuorista aikuisista 71 %:lla oli ollut kontakti terveydenhoitojärjestelmään ja 42 % oli saanut asianmukaista hoitoa viimeisimmän hoitojaksonsa aikana. Persoonallisuushäiriöllä oli yhteys bentsodiatsepiinien käyttöön, kun taas päihdehäiriö oli yhteydessä yli kaksi kuukautta kestävään masennuslääkkeen tai buspironin käyttöön. Parisuhteessa olevilla oli muita harvemmin vähintään neljä lääkärikäyntiä vuoden aikana. Elämänaikaisen masennus- ja/tai ahdistuneisuushäiriö-diagnoosin perustutkimuksen aikana saaneista 23 %:lla oli näitä häiriöitä myös vuonna 2011, kun vastaava luku oli 10 % niistä, jotka eivät olleet saaneet mitään mielenterveyshäiriö-diagnoosia. Pitkäaikaisseurannassa häiriöistä kärsineillä oli matalampi koulutustaso ja heikompi itsearvioitu elämänlaatu kuin vertailuryhmässä. Sosiodemografiset tekijät, saatu hoito tai kognitiivinen suoriutuminen eivät ennustaneet masennus- tai ahdistuneisuushäiriön pysyvyyttä/uusiutumista tai sairastuneiden elämänlaatua, mutta perustutkimuksen aikaisilla maanistyyppisillä oireilla oli yhteys heikompaan elämänlaatuun pitkäaikaisseurannassa. Tulokset osoittavat, että nuoret aikuiset olivat hakeneet hoitoa masennus- ja ahdistuneisuushäiriöihin useammin kuin aiemmissa tutkimuksissa, mutta hoidon asianmukaisuudessa oli edelleen puutteita. Näiden häiriöiden ennuste on suhteellisen suotuisa, koska yli kolme neljännestä elämänaikaisen diagnoosin saaneista oli toipunut 6–8 vuoden seurannan jälkeen. Häiriöillä oli kuitenkin vaikutusta sairastuneiden koulutustasoon pitkällä tähtäimellä. Jatkossa tulisi perehtyä ja puuttua syihin, jotka estävät asianmukaisen hoidon toteutumisen terveydenhuollossa. Olisi myös tärkeää tukea mielenterveyden häiriöistä kärsivien koulutuksen jatkuvuutta kuntoutumisen aikana ja sen jälkeen

Treatment adequacy of anxiety disorders among young adults in Finland

Background: Anxiety disorders are common in early adulthood, but general population studies concerning the treatment adequacy of anxiety disorders taking into account appropriate pharmacological and psychological treatment are scarce. The aims of this study were to examine treatments received for anxiety disorders in a Finnish general population sample of young adults, and to define factors associated with receiving minimally adequate treatment and with dropping out from treatment. Methods: A questionnaire containing several mental health screens was sent to a nationally representative two-stage cluster sample of 1894 Finns aged 19 to 34 years. All screen positives and a random sample of screen negatives were invited to a mental health assessment including a SCID interview. For the final diagnostic assessment, case records from mental health treatments for the same sample were obtained. This article investigates treatment received, treatment adequacy and dropouts from treatment of 79 participants with a lifetime anxiety disorder (excluding those with a single specific phobia). Based on all available information, receiving antidepressant or buspirone medication for at least 2 months with at least four visits with any type of physician or at least eight sessions of psychotherapy within 12 months or at least 4 days of hospitalization were regarded as minimally adequate treatment for anxiety disorders. Treatment dropout was rated if the patient discontinued the visits by his own decision despite having an adequate treatment strategy according to the case records. Results: Of participants with anxiety disorders (excluding those with a single specific phobia), 41.8 % had received minimally adequate treatment. In the multivariate analysis, comorbid substance use disorder was associated with antidepressant or buspirone medication lasting at least 2 months. Those who were currently married or cohabiting had lower odds of having at least four visits with a physician a year. None of these factors were associated with the final outcome of minimally adequate treatment or treatment dropout. Participants with comorbid personality disorders received and misused benzodiazepines more often than others. Conclusions: More efforts are needed to provide adequate treatment for young adults with anxiety disorders. Attention should be paid to benzodiazepine prescribing to individuals with personality disorders.Peer reviewe

Treatment received and treatment adequacy of depressive disorders among young adults in Finland

Peer reviewe

Outcome of depressive and anxiety disorders among young adults: Results from the Longitudinal Finnish Health 2011 Study

<p><b>Purpose of the study:</b> We investigated the outcomes and outcome predictors of depressive and anxiety disorders in a general population sample of young adults with a lifetime history of these disorders.</p> <p><b>Materials and methods:</b> The study sample was derived from a nationally representative two-stage cluster sample of Finns aged 19–34 years. The original study was carried out in 2003–2005, and the follow-up in 2011. We investigated participants diagnosed with a depressive or anxiety disorder based on a SCID interview (excluding those with only a single specific phobia) (DAX-group, <i>N</i> = 181). The control group included those with no DSM-IV- diagnosis (N = 290). They were followed up with the M-CIDI interview assessing 12-month depressive and anxiety disorders in 2011.</p> <p><b>Results:</b> In 2011, 22.8% of the DAX-group was diagnosed with a depressive or anxiety disorder compared to 9.8% of the control group. Education was lower and quality of life worse in the DAX-group than in the control group. Those participants of the DAX-group who received a diagnosis in 2011 had poorer quality of life than those in remission, which emphasizes the influence of a current disorder on the quality of life. Higher score in the Mood Disorder Questionnaire (MDQ) at baseline predicted poorer quality of life in 2011.</p> <p><b>Conclusions:</b> Thus, depressive and anxiety disorders were persistent/recurrent in one quarter of participants, significantly affecting education and quality of life<b>.</b> Young adults with these disorders need support to achieve their academic goals.</p

Additional file 4: Table S3. of Treatment adequacy of anxiety disorders among young adults in Finland

Sociodemographic factors, comorbid disorders, benzodiazepine use and misuse during the most intensive treatment episode for anxiety disorders. (DOC 96 kb

Additional file 5: Table S4. of Treatment adequacy of anxiety disorders among young adults in Finland

Variables associated with treatments received during the most intensive treatment period for anxiety disorders. (DOC 79 kb

Additional file 6: Table S5. of Treatment adequacy of anxiety disorders among young adults in Finland

Variables associated with benzodiazepine use during the most intensive treatment period for anxiety disorders. (DOC 48kb