Time patterns of external and alcohol-related mortality after marital and non-marital separation : the contribution of psychiatric morbidity

Background External and alcohol-related mortality is elevated postseparation, but the role of poor mental health in explaining this excess is unclear. We assess postseparation excess mortality by union type and over time since separation and examine how psychiatric morbidity present already before separation, during the separation process and after separation attenuates this excess. Methods Using individual-level register data from 1995 to 2012, we followed 311 751 Finns in long-term unions. Psychiatric morbidity was identified from dates of prescription medication purchases and hospital admissions, separations from dates of moving out of joint households and mortality from the Death Register. Cox regression was used to analyse postseparation mortality controlling for psychiatric morbidity before, during and after separation. Results External and alcohol-related excess mortality is most pronounced immediately after separation, particularly among men, and is much larger following marital than non-marital separation. After sociodemographic factors are adjusted for, further adjustment for psychiatric morbidity attenuates the excess by about 25%. Psychiatric morbidity poorly explains alcohol-related postseparation excess mortality, but for suicide mortality, adjustment for psychiatric morbidity reduces the excess by about 40% among men and 50% among women. Among women, this is largely due to psychiatric morbidity present already before separation, whereas among men the attenuation is also due to psychiatric morbidity during the separation process and after it. Conclusion Separation may exacerbate the problems of people already in poor mental health, and relationship dynamics should thus be considered during treatment. Particularly among men separation is a risk factor for suicide even without pre-existing mental health problems.Peer reviewe

Pathways into single motherhood, re-partnering, and trajectories of antidepressant medication purchases

Single motherhood is known to be distressing, and to be associated with poor mental health. However, less is known about the pathways into and out of single motherhood, or about the mental health trajectories of single mothers. We used total population registry data on Finnish women who experienced the life events of separation (616,762), widowhood (43,355), or child birth (515,756) during the 1995–2018 period while between the ages of 15–64. Single mothers were compared with women who experienced the same life event, but without becoming a single mother. The results for women who separated showed that among single mothers, there was a substantial increase in antidepressant use at the time of separation, and only a moderate decline after separation. Among women who experienced widowhood, those who had underage children initially had lower antidepressant use than women without children, but this gap narrowed in the post-widowhood period. In addition, single women experienced more unfavorable mental health trajectories than partnered women around the time they gave birth. Re-partnering was associated with more favorable mental health among all groups of single mothers. Given the growing prevalence of single-parent households, our results underscore the need for context-specific interventions to support single mothers’ mental health.Single motherhood is known to be distressing, and to be associated with poor mental health. However, less is known about the pathways into and out of single motherhood, or about the mental health trajectories of single mothers. We used total population registry data on Finnish women who experienced the life events of separation (616,762), widowhood (43,355), or child birth (515,756) during the 1995–2018 period while between the ages of 15–64. Single mothers were compared with women who experienced the same life event, but without becoming a single mother. The results for women who separated showed that among single mothers, there was a substantial increase in antidepressant use at the time of separation, and only a moderate decline after separation. Among women who experienced widowhood, those who had underage children initially had lower antidepressant use than women without children, but this gap narrowed in the post-widowhood period. In addition, single women experienced more unfavorable mental health trajectories than partnered women around the time they gave birth. Re-partnering was associated with more favorable mental health among all groups of single mothers. Given the growing prevalence of single-parent households, our results underscore the need for context-specific interventions to support single mothers’ mental health.Peer reviewe

Does the suddenness matter? Antidepressant use before and after a spouse dies suddenly or expectedly of stroke

Aims: Changes in mental health at the time of widowhood may depend on the expectedness of spousal death, but scant evidence is available for spousal deaths attributable to stroke. Methods: Using register-linkage data for Finland, we assessed changes in antidepressant use before and after spousal death for those whose spouses died suddenly of stroke between 1998 and 2003 (N=1820) and for those whose spouses died expectedly of stroke, with prior hospitalisation for cerebrovascular disease (N=1636). We used both population-averaged logit models and individual fixed-effects linear probability models. The latter models control for unobserved time-invariant heterogeneity between the individuals. Results: Our study indicates that the suddenness of a spouse's death from stroke plays a role in the well-being of the surviving spouse. Increases in antidepressant use appeared larger following widowhood for those whose spouses died suddenly of stroke relative to those whose spouses had a medical history of cerebrovascular disease. Conclusions: The suddenness of a spouse's death from stroke plays a role for the surviving spouse. The results suggest multifaceted timings of distress surrounding spousal death, depending on the suddenness of a spouse's death from stroke.Peer reviewe

Psychiatric morbidity and subsequent divorce : a couple-level register-based study in Finland

Purpose Studies that assess the role of mental health for the risk of divorce are scarce and mostly rely on individual-level data, although divorce is a couple-level phenomenon. Using data on couples, we examine the effects of both spouses’ psychiatric morbidity on the risk of divorce, and whether socio-demographic factors affect these associations. Methods We followed 96,222 Finnish married couples for 6 years using register-based data on both spouses and their household. New incidence of psychiatric morbidity and subsequent divorce was identified from dates of prescription medication purchases and hospital admissions, and dates of registered divorce. Socio-demographic factors were measured annually for both spouses and their household. The effect of incident psychiatric morbidity on divorce risk was analyzed using Cox regression. Results Psychiatric morbidity in men increased the age-adjusted risk of divorce more than twofold and in women nearly twofold. The risk of divorce was particularly pronounced immediately after new incidence of psychiatric morbidity, before settling to a persistently high level. Psychiatric morbidity in both spouses increased the risk of divorce almost threefold. Adjustment for socio-economic factors had little effect on these associations. Conclusions Psychiatric morbidity is a persistent risk factor of divorce. The risk is larger when both spouses experience psychiatric morbidity compared to only one spouse. The findings are consistent with the idea that poor relationship quality and dissatisfaction in couples suffering from mental health problems have long-term consequences for marital stability. Treatment of psychiatric morbidity should not focus only on the individual but on couple-level dynamics.Peer reviewe

The effects of unemployment among single mothers on adolescent children’s mental health

The effects of parental unemployment on the health and well-being of children have been receiving increased attention in recent years. However, the previous research on this topic focused on children living in two-parent families. This paper studies the effects of maternal unemployment in single- mother families – a particularly vulnerable family setting for coping with the effects of unemployment – on the mental health of adolescent children. We use data from a large, register-based panel of Finnish adolescents aged 15-21 years in 1995-2018 (n=150,073) that includes information on maternal unemployment and adolescent psychotropic medication purchases in six-month periods. We employ panel data models with individual fixed effects to explore how maternal unemployment was associated with adolescents’ psychotropic medication use, net of measured time-varying confounders and all stable unobserved confounders. We estimate separate models for adolescent boys and girls, and also examine whether the effects were mediated through maternal income, or were compensated for by the absent father’s income or the mother’s re-partnering. Our findings show that exposure to maternal unemployment was associated with a moderate increase in psychotropic medication use among boys and girls, although the effect was statistically significant only for boys. This effect was not mediated by the mother’s income, and it did not differ depending on the biological father’s income or the mother’s re-partnering. Our results suggest that boys are more vulnerable to the stressful event of maternal unemployment than girls, and do not support the assumption that the financial consequences and income losses associated with unemployment mediate these effects. Further research is needed to investigate the vulnerability of adolescent boys, and the factors that contribute to the potentially greater resilience of adolescent girls to the effects of maternal unemployment

Trajectories of mental health before and after old-age and disability retirement : a register-based study on purchases of psychotropic drugs

WOS:000308570400003OBJECTIVES: Retirement from paid work is a major life event facing increasingly large numbers of people in the coming years. We examined trajectories of mental health five years before and five years after old-age and disability retirement using data on purchases of psychotropic drugs. METHODS: The study included all employees from the City of Helsinki, Finland, retiring between 2000-2008 due to old age (N=4456) or disability (N=2549). Purchases of psychotropic drugs were analyzed in 20 3-month intervals before and after retirement using graphical methods and growth curve models. RESULTS: Old-age retirement was unrelated to purchases of psychotropic drugs. Among disability retirees, psychotropic medication tripled before retirement. The average increase was 0.95 [95% confidence interval (95% CI) 0.73-1.16] daily defined doses (DDD) 5-1.5 years before retirement; from 1.5 years until retirement it was 5.68 DDD (95% CI 5.33-6.03) for each 3-month interval. After disability retirement, purchases of antidepressants decreased on average by 0.40 DDD (95% CI 0.57-0.23) for each 3-month interval, those of hypnotics and sedatives increased by 0.30 DDD (95% CI 0.12-0.47), and no changes were seen for other psychotropic drugs. The changes before and after retirement were largest among those who retired due to mental disorders and those whose retirement had been granted as temporary. CONCLUSIONS: While no overall decrease in psychotropic medication after retirement was observed, purchases of antidepressants decreased after disability retirement. Long-term trajectories suggest that disability retirement might be prevented if mental health problems were tackled more efficiently earlier in the pre-retirement period.Peer reviewe

Labor epidural analgesia and subsequent risk of offspring autism spectrum disorder and attention-deficit/hyperactivity disorder : A cross-national cohort study of 4.5 million individuals and their siblings

Background A recent study has suggested that labor epidural analgesia may be associated with increased rates of offspring autism spectrum disorder (ASD). Subsequent replication attempts have lacked sufficient power to confidently exclude the possibility of a small effect and the causal nature of this association remains unknown. Objective To investigate the extent to which exposure to labor epidural analgesia is associated with offspring ASD and attention-deficit/hyperactivity disorder (ADHD) following adjustments for unmeasured familial confounding. Study design We identified 4,498,462 singletons and their parents using the Medical Birth Registers in Finland (cohorts born 1987-2005), Norway (1999-2015), and Sweden (1987-2011), linked with population and patient registries. These cohorts were followed from birth until they either had the outcomes of interest, emigrated, died, or reached the end of the follow-up (at mean ages 13.6-16.8 years), whichever occurred first. Cox regression models were used to estimate country-specific associations between labor epidural analgesia recorded at birth and outcomes (e.g., at least one secondary care diagnosis of ASD and ADHD or at least one dispensed prescription of medication used for the treatment of ADHD). The models were adjusted for sex, birth year, birth order, and unmeasured familial confounders via sibling-comparisons. Pooled estimates across all three countries were estimated using inverse variance weighted fixed-effects meta-analysis models. Results A total of 4,498,462 individuals (48.7% female) were included, 1,091,846 (24.3%) of which were exposed to labor epidural analgesia. Of these, 1.2% were diagnosed with ASD and 4.0% with ADHD. On the population level, pooled estimates showed that labor epidural analgesia was associated with increased risk of offspring ASD (adjusted hazard ratio, aHR=1.12; 95% CI: 1.10-1.14, absolute risks: 1.20% vs. 1.07%) and ADHD (aHR=1.20; 1.19-1.21; 3.95% vs. 3.32%). However, when comparing full-siblings who were differentially exposed to labor epidural analgesia, the associations were fully attenuated for both conditions, with narrow confidence intervals (aHRASD=0.98; 0.93-1.03; aHRADHD=0.99; 0.96-1.02). Conclusion In this large cross-national study, we found no support for the hypothesis that exposure to labor epidural analgesia causes either offspring ASD or ADHD.Peer reviewe

Avioeron jälkeinen kuolleisuus : rekisteripohjainen seurantatutkimus vuosina 1998 2003 purkautuneista avioliitoista

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.Eronneiden naimisissa olevia suurempi kuolleisuusriski on havaittu laajalti aiemmassa tutkimuksessa. Sen sijaan eronneiden ylikuolleisuuden vaihtelua avioeron jälkeisenä aikana tunnetaan selvästi vähemmän. Koska avioerot ovat viime aikoina yleistyneet, koskettavat niiden seuraukset yhä useampia. Niillä on siksi myös merkittävää kansanterveydellistä vaikutusta. Tehdyn tutkimuksen tavoitteena oli tarkastella avioeron jälkeistä kuolleisuutta sekä siihen vaikuttavia tekijöitä. Tutkimuksessa käytettiin Tilastokeskuksen muodostamaa yksilötasoista, pitkittäistä rekisteriaineistoa. Aineistossa oli avioero- ja kuolintietojen lisäksi useita sosiodemografisia muuttujia. Tutkimusväestö koostui vuonna 1997 avioliitossa olleista 30 64-vuotiaista, joita seurattiin vuoden 2003 loppuun asti. Yhteensä otoksessa oli 182 787 henkeä, joista 11 882 erosi ja 23 410 kuoli seurannan aikana. Eronneiden ja naimisissa olevien välistä kuolleisuuseroa analysoitiin käyttäen Coxin regressiota, joka kuuluu niin sanottuihin elinaikamalleihin. Tutkimuksessa eronneiden ja naimisissa olevien välillä havaittiin selvä kuolleisuusero sekä miehillä että naisilla. Lähtötilannetta kuvaavien sosiodemografisten muuttujien vakiointi ei kaventanut kuolleisuuseroa. Eronneiden miesten vakioitu ylikuolleisuus oli 131 ja naisten 70 prosenttia. Heti avioeron jälkeen eronneiden miesten suhteellinen kuolleisuusriski oli lähes kolminkertainen naimisissa oleviin verrattuna, mutta ylikuolleisuus aleni selvästi avioerosta kuluneen ajan mukana. Naisilla vastaavaa aikavaihtelua ei havaittu. Silti eronneiden miesten ylikuolleisuus oli vielä neljän vuoden kuluttua avioerosta hieman suurempaa kuin ylikuolleisuus eronneilla naisilla. Korostuneimpia siviilisäätyjen väliset kuolleisuuserot olivat tapaturmaisissa, väkivaltaisissa sekä alkoholiperäisissä syissä. Näissä syissä eronneiden ylikuolleisuus myös väheni selvästi avioerosta kuluneen ajan mukana sekä miehillä että naisilla. Miehillä eronneiden ja naimisissa olevien välinen kuolleisuusero oli suurempi kuin naisilla riippumatta avioerosta kuluneesta ajasta. Tutkimuksessa nousi esiin myös sellaisia ryhmiä, jotka olivat avioeron jälkeen erityisen haavoittuvia. Tällaisia ryhmiä olivat esimerkiksi nuoret miehet, alaikäisten lasten isät, työttömät, eläkeläisnaiset sekä ne naiset, joilla omien tulojen osuus asuntokunnan tuloista oli ennen avioeroa pieni. Miehillä ikäryhmän sekä nuorimman lapsen iän havaittiin myös vaikuttavan siihen, miten nopeasti eronneiden ylikuolleisuus aleni avioeron jälkeen. Saatujen tulosten perusteella siviilisäätyjen väliset kuolleisuuserot eivät näyttäisi johtuvan avioeroon päätyvien lähtökohtaisesti huonommasta yhteiskunnallisesta asemasta. Sen sijaan avioeroon vaikuttaa liittyvän sekä pidempiaikaista rasitusta että lyhytaikaisempaa stressiä. Lisäksi stressin määrässä ja siihen sopeutumisessa on selviä sosiodemografisia eroja. Taloudelliset tekijät vaikuttavat naisilla hieman enemmän avioeron ja kuolleisuuden yhteyteen sosiaalisten tekijöiden korostuessa miehillä. Vaikutukset välittyvät ainakin osittain terveyskäyttäytymisen muutoksina