Psyykkinen oireilu Suomessa 1979 – 2003 : kehitys, sosioekonomiset erot ja merkitys kuolleisuuserojen selittäjänä

Mental health problems have shown to be highly prevalent and associated with socio-economic factors in populations worldwide. Persistent or increasing health inequalities are a common phenomenon, however, few studies have explored socioeconomic differences in mental health over time. Psychological distress refers to non-specific psychopathology, which includes symptoms such as depression, insomnia and stress. Psychological distress is prevalent (5 - 48%) and known to be associated with lower quality of life, mental and physical morbidity and mortality. Moreover, psychological distress has been proposed as one probable explanation in mediating the socio-economic gradient in health and mortality. Few studies have examined prevalence trends in psychological distress and changes in socio-economic differences in psychological distress over time, or the contribution of psychological distress to the socio-economic differences in cause-specific mortality. This study aimed to explore these topics. The database was Health Behaviour and Health among the Finnish Adult Population -survey (AVTK, 1979 - 2002) linked with Statistics Finland socio-economic register data, and the Finnish Cause of Death Register follow-up. Outcome measures for psychological distress included self-reported depression, insomnia and stress. Socio-economic status was measured by education, employment status and household income. Mortality data consisted of suicide, accidents and violence, alcohol-related causes of death and coronary heart disease mortality. The overall prevalence of psychological distress was 14 - 20%. Insomnia and stress increased among both genders, whereas depression decreased among women. Socio-economic differences were demonstrated in all psychological distress measures. High risk groups for psychological distress were the unemployed, retired respondents (<65 years) and those with no partner. Those with the lowest household incomes experienced more depression and stress. However, some of the associations were curvilinear and converse. Most notably, stress was most common among the highest educated. Socio-economic differences in psychological distress did not change substantially over time. Depression, insomnia and extremely high stress accounted for some of the socio-economic differences in unnatural but not in CHD mortality. The increase in the prevalence of insomnia and stress, and persistent socio-economic differences in psychological distress present a perceptible public health challenge. However, reversed gradients, especially in stress, should be considered in detail. Improvement of psychological distress in certain socio-economic groups may reduce some of the socio-economic differences, particularly in unnatural mortality.Eurooppalaisissa tutkimuksissa yli neljäsosalla väestöstä on todettu mielenterveyden häiriöitä ja niiden olevan yleisempiä alimmissa sosioekonomisissa ryhmissä. Pysyväisluonteisia tai kasvavia terveyseroja on havaittu jo vuosikymmenten ajan, mutta tutkimuksia liittyen sosioekonomisten erojen muutokseen mielenterveyden näkökulmasta on niukasti. Psyykkisellä oireilulla tarkoitetaan yleisluonteisia mm. masennus-, stressi- ja unettomuusoireita. Oireilun tiedetään olevan yleistä, yhteydessä elämänlaatuun, fyysiseen ja psyykkiseen sairastavuuteen sekä kuolleisuuteen. Psyykkisen oireilun on lisäksi otaksuttu olevan eräs terveys- ja kuolleisuuseroja selittävä tekijä. Tämän tutkimuksen tarkoituksena on ollut tuottaa uutta tietoa psyykkisen oireilun vaihtelusta, psyykkisen oireilun sosioekonomisten erojen kehityksestä yli parin vuosikymmenen aikana sekä lisäksi tutkia psyykkisen oireilun osuutta sosioekonomisten kuolleisuuserojen selittäjänä. Aineisto on Suomalaisen aikuisväestön terveyskäyttäytyminen ja terveys (AVTK) -tutkimus (1979 - 2002), johon on liitetty Tilastokeskuksen sosioekonomista asemaa sekä kuolemansyitä koskevat rekisteriaineistot. Psyykkisen oireilun osoittimina olivat itseraportoitu masentuneisuus, unettomuus ja stressi, ja sosioekonomisen aseman mittareina koulutus, työmarkkina-asema ja kotitalouden tulot. Kuolemansyittäinen tarkastelu sisälsi itsemurhat, tapaturma-, väkivalta-, ja alkoholikuolemat sekä sepelvaltimotautikuolemat. Psyykkistä oireilua esiintyi 14 - 20% vastaajista. Stressi ja unettomuus lisääntyivät molemmilla sukupuolilla, sitä vastoin masentuneisuuden osuus väheni naisilla. Masentuneisuutta, unettomuutta ja stressiä oli enemmän erityisesti työttömillä ja eläkeläisillä (< 65 vuotta), ja ilman parisuhdetta elävillä. Alimmassa tuloryhmässä oli lisäksi enemmän masentuneisuutta ja stressiä. Kaikki tarkastellut yhteydet eivät kuitenkaan olleet yhdensuuntaisia ja suoraviivaisia. Huomattavaa on, että stressi oli yleisempää korkeammin koulutetuilla. Yleisesti ottaen psyykkisen oireilun sosioekonomiset erot eivät muuttuneet merkittävästi tarkastelujaksolla 1979 - 2002. Psyykkinen oireilu selitti jonkin verran ei-luonnollisiin kuolemansyihin, mutta ei sepelvaltimotautikuolleisuuteen liittyvistä sosioekonomisista eroista. Havaittu unettomuuden ja stressin kasvu, sekä pysyväisluonteiset sosioekonomiset erot ovat kansanterveydellinen haaste. Stressiin liittyvät käänteiset sosioekonomiset erot tulisi ottaa yksityiskohtaisemman tarkastelun kohteeksi. Psyykkisen oireilun väheneminen tietyissä sosioekonomisissa ryhmissä voisi mahdollisesti kaventaa sosioekonomisia kuolleisuuseroja, erityisesti ei-luonnollisten kuolemien osalta

Työn psykososiaaliset tekijät ja mielenterveys

Only abstract. Paper copies of master’s theses are listed in the Helka database (http://www.helsinki.fi/helka). Electronic copies of master’s theses are either available as open access or only on thesis terminals in the Helsinki University Library.Vain tiivistelmä. Sidottujen gradujen saatavuuden voit tarkistaa Helka-tietokannasta (http://www.helsinki.fi/helka). Digitaaliset gradut voivat olla luettavissa avoimesti verkossa tai rajoitetusti kirjaston opinnäytekioskeilla.Endast sammandrag. Inbundna avhandlingar kan sökas i Helka-databasen (http://www.helsinki.fi/helka). Elektroniska kopior av avhandlingar finns antingen öppet på nätet eller endast tillgängliga i bibliotekets avhandlingsterminaler.Tiivistelmä - ReferatTutkimuksen päätarkoituksena oli selvittää, ovatko psykososiaaliset työtekijät työn vaativuus ja hallinta sekä organisaation relationaalinen ja proseduaalinen oikeudenmukaisuus yhteydessä mielenterveyden oireiluun. Lisäksi selvitettiin sosiaalisen tuen ja vaikeiden elämäntapahtumien yhteyttä mielenterveyden oireiluun sekä sitä, vaikuttavatko nämä tekijät psykososiaalisten työtekijöiden ja mielenterveyden yhteyteen. Vakioituina taustatekijöinä olivat ikä, siviilisääty, ammattiasema, kotitalouden tulot, haittaava pitkäaikaissairaus ja vaikeat lapsuuden tapahtumat.Mielenterveyden mittarina oli Goldbergin (1972) kehittämä itseraportoidun koetun mielenterveyden mittari GHQ-12 (General Health Questionnaire). Mittari soveltuu akuutin, lievän, ahdistus- ja masennustyyppisen mielenterveyden oireilun mittaamiseen. Käytettynä teoreettisena lähtökohtana olivat Warrin (1987) kuvaamat mielenterveyteen vaikuttavat psykososiaaliset ympäristötekijät sekä Karasekin (1979) työn vaatimukset - työn hallinta -malli (job control - job demand -model). Organisaation oikeudenmukaisuuden tarkastelussa käytettiin relationaalisen ja proseduaalisen oikeudenmukaisuuden ulottuvuuksia (Elovainio ym. 2002). Käytetty aineisto oli Helsingin kaupungin työntekijöitä koskevasta tutkimusprojektista. Kyseinen tutkimus (Helsinki Health Study) selvittää kaupungin palveluksessa olevien 40 vuotta täyttäneiden työntekijöiden terveydentilaa ja hyvinvointia. Tämä tutkimus tehtiin vuoden 2001 kyselytutkimusaineistosta (N 3065). Tutkimuksessa käytettiin kvantitatiivisia tilastollisia menetelmiä. Käytetty tilasto-ohjelma oli SPSS-10.0 ohjelma. Monimuuttuja-analyysina käytettiin logistista regressioanalyysia. Tutkimuksessa mielenterveydeltään oireilevia oli naisista 25 % ja miehistä 24 %. Naisilla psykososiaalisista työtekijöistä työn vaativuus ja vähäinen proseduaalinen oikeudenmukaisuus olivat merkittävimmät tekijät yhteydessä mielenterveyteen. Vähäinen sosiaalinen tuki ja vaikeat elämäntapahtumat olivat työn ulkopuolisina tekijöinä merkittäviä riskitekijöitä. Miehillä työn vaativuus ja vähäinen relationaalinen oikeudenmukaisuus olivat tärkeimmät tekijät yhteydessä mielenterveyden oireiluun sekä vähäinen sosiaalinen tuki ja vaikeat elämäntapahtumat työn ulkopuolisina tekijöinä. Psykososiaaliset työtekijät olivat tässä tutkimusasetelmassa sosiaalisesta tuesta ja vaikeista elämäntapahtumista pääosin riippumattomia tekijöitä

Digital rectal examination in prostate cancer screening at PSA level 3.0-3.9 ng/ml : long-term results from a randomized trial

Objective To evaluate digital rectal examination (DRE) as a predictor of prostate cancer (PC) at serum PSA level 3.0-3.9 ng/ml. We compared the PC incidence rates of men with different screening test results in this PSA range and analyzed DRE in comparison with free/total PSA ratio as an additional screening test. Materials and methods Using data from the FinRSPC trial, PC incidence rate ratios (IRR) for groups defined by the secondary screening test results (DRE vs. free/total PSA) were calculated for 17-year follow-up, using adjustment for age, family history of PC and place of residence. Screening test performance was evaluated by calculating sensitivity, specificity, positive and negative predictive value, and likelihood ratio. Results The IRR for men with a positive DRE compared to those with a negative result was 1.40 (95% confidence interval (CI) 1.00-1.96), while the IRR for men with a positive free/total PSA result compared to those with a negative one was 1.62 (95% CI 1.08-2.43). The estimated sensitivity was 0.15 (95% CI 0.11-0.20, 40/270) for DRE and 0.32 (95% CI 0.23-0.41, 36/113) for free/total PSA, and the specificity 0.91 (95% CI 0.88-0.93, 419/461) for DRE and 0.85 (95% CI 0.78-0.90, 134/158) for free/total PSA. Conclusions Our results do not support utility of DRE as a screening test for PC at serum PSA level 3.0-3.9 ng/ml, while the results regarding free/total PSA determination were more encouraging and reconfirm the decision to switch from DRE to free/total PSA.Peer reviewe

Costs of screening for prostate cancer : Evidence from the Finnish Randomised Study of Screening for Prostate Cancer after 20-year follow-up using register data

Objectives: Few empirical analyses of the impact of organised prostate cancer (PCa) screening on healthcare costs exist, despite cost-related information often being considered as a prerequisite to informed screening decisions. Therefore, we estimate the differences in register-based costs of publicly funded healthcare in the two arms of the Finnish Randomised Study of Screening for Prostate Cancer (FinRSPC) after 20 years. Methods: We obtained individual-level register data on prescription medications, as well as inpatient and outpatient care, to estimate healthcare costs for 80,149 men during the first 20 years of the FinRSPC. We compared healthcare costs for the men in each trial arm and performed statistical analysis. Results: For all men diagnosed with PCa during the 20-year observation period, mean PCa-related costs appeared to be around 10% lower in the screening arm (SA). Mean all-cause healthcare costs for these men were also lower in the SA, but differences were smaller than for PCa-related costs alone, and no longer statistically significant. For men dying from PCa, although the difference was not statistically significant, mean all-cause healthcare costs were around 10% higher. When analysis included all observations, cumulative costs were slightly higher in the CA; however, after excluding extreme values, cumulative costs were slightly higher in the SA. Conclusions: No major cost impacts due to screening were apparent, but the FinRSPC's 20-year follow-up period is too short to provide definitive evidence at this stage. Longer term follow-up will be required to be better informed about the costs of, or savings from, introducing mass PCa screening. (C) 2018 Elsevier Ltd. All rights reserved.Peer reviewe

Prostate cancer risk prediction using a polygenic risk score

Hereditary factors have a strong influence on prostate cancer (PC) risk and poorer outcomes, thus stratification by genetic factors addresses a critical need for targeted PC screening and risk-adapted follow-up. In this Finnish population-based retrospective study 2283 clinically diagnosed and 455 screen-detected patients from the Finnish Randomised Study of Screening for Prostate Cancer (FinRSPC), 2400 healthy individuals have been involved. Individual genetic risk through establishment of a polygenic risk score based on 55 PC risk SNPs identified through the Finnish subset of the Collaborative Oncological Gene-Environment Study was assessed. Men with PC had significantly higher median polygenic risk score compared to the controls (6.59 vs. 3.83, P4 ng/mL in polygenic risk score quartile four compared to quartile one (18.7% vs 8.3%, PPeer reviewe

Inverse Association between Statin Use and Cancer Mortality Relates to Cholesterol Level

Statins have been associated with a decreased cancer mortality. However, cholesterol level as such may modify the risk of cancer death. To clarify the complex interplay between statins, cholesterol level, and cancer mortality, we conducted a comprehensive analysis to separate the effects of cholesterol level and statin medication on cancer mortality. Our study population consisted of 16,924 men participating in the Finnish Randomized Study of Screening for Prostate Cancer with at least one cholesterol measurement during follow-up (1996–2017). Cox proportional regression was used to estimate hazard ratios. In total, 1699 cancer deaths were observed during the median follow-up of 19 years. When statins’ association with the risk of cancer death was estimated without adjustment for cholesterol level, statin use was associated with a lowered cancer mortality (HR 0.87; 95% CI 0.79–0.97) compared to non-users. However, with further adjustment for total cholesterol level, statin use was no longer associated with a lower cancer mortality (HR 1.08; 95% CI 0.97–1.20). Upon stratified analysis, statin use was associated with a decreased cancer mortality only if the total cholesterol level decreased after the initiation of statin use (HR 0.66; 95% CI 0.58–0.76). The inverse association between statin use and cancer mortality is limited to men with a reduction in total cholesterol level after the commencement of statins, i.e., statin use is associated with a lowered cancer mortality only if the total cholesterol level decreases. This suggests that the effect of statin use on cancer mortality relates to the decreased total cholesterol level

Antihypertensive drug use and prostate cancer-specific mortality in Finnish men

The aim of this study was to investigate pre- and post-diagnostic use of antihypertensive drugs on prostate cancer (PCa)-specific survival and the initiation of androgen deprivation therapy (ADT). The cohort investigated 8,253 PCa patients with 837 PCa-specific deaths during the median follow-up of 7.6 years after diagnosis. Information on drug use, cancer incidence, clinical features of PCa, and causes of death was collected from Finnish registries. Hazard ratios with 95% confidence intervals were calculated using Cox regression with antihypertensive drug use as a time-dependent variable. Separate analyses were performed on PCa survival related to pre- and post-diagnostic use of drugs and on the initiation of ADT. Antihypertensive drug use overall was associated with an increased risk of PCa-specific death (Pre-PCa: 1.21 (1.04–1.4), Post-PCa: 1.2 (1.02–1.41)). With respect to the separate drug groups, angiotensin II type 1 receptor (ATr) blockers, were associated with improved survival (Post-PCa: 0.81 (0.67–0.99)) and diuretics with an increased risk (Post-PCa: 1.25 (1.05–1.49)). The risk of ADT initiation was slightly higher among antihypertensive drug users as compared to non-users. In conclusion, this study supports anti-cancer effect of ATr blockers on PCa prognosis and this should be investigated further in controlled clinical trials.Peer reviewe

Prostate cancer incidence in men with prostate-specific antigen below 3 ng/mL : The Finnish Randomized Study of Screening for Prostate Cancer

Prostate-specific antigen (PSA)-based screening for prostate cancer (PCa) can reduce PCa mortality, but also involves overdetection of low-risk disease with potential adverse effects. We evaluated PCa incidence among men with PSA below 3 ng/mL and no PCa diagnosis at the first screening round of the Finnish Randomized Study of Screening for PCa. Follow-up started at the first screening attendance and ended at PCa diagnosis, emigration, death or the common closing date (December 2016), whichever came first. Cox regression analysis was used to estimate hazard ratios and their confidence intervals (CI). Among men with PSAPeer reviewe

Inverse Association between Statin Use and Cancer Mortality Relates to Cholesterol Level

Statins have been associated with a decreased cancer mortality. However, cholesterol level as such may modify the risk of cancer death. To clarify the complex interplay between statins, cholesterol level, and cancer mortality, we conducted a comprehensive analysis to separate the effects of cholesterol level and statin medication on cancer mortality. Our study population consisted of 16,924 men participating in the Finnish Randomized Study of Screening for Prostate Cancer with at least one cholesterol measurement during follow-up (1996–2017). Cox proportional regression was used to estimate hazard ratios. In total, 1699 cancer deaths were observed during the median follow-up of 19 years. When statins’ association with the risk of cancer death was estimated without adjustment for cholesterol level, statin use was associated with a lowered cancer mortality (HR 0.87; 95% CI 0.79–0.97) compared to non-users. However, with further adjustment for total cholesterol level, statin use was no longer associated with a lower cancer mortality (HR 1.08; 95% CI 0.97–1.20). Upon stratified analysis, statin use was associated with a decreased cancer mortality only if the total cholesterol level decreased after the initiation of statin use (HR 0.66; 95% CI 0.58–0.76). The inverse association between statin use and cancer mortality is limited to men with a reduction in total cholesterol level after the commencement of statins, i.e., statin use is associated with a lowered cancer mortality only if the total cholesterol level decreases. This suggests that the effect of statin use on cancer mortality relates to the decreased total cholesterol level