Life satisfaction and morbidity among postmenopausal women

OBJECTIVE: To investigate associations between morbidity and global life satisfaction in postmenopausal women taking into account type and number of diseases. MATERIALS AND METHODS: A total of 11,084 women (age range 57-66 years) from a population-based cohort of Finnish women (OSTPRE Study) responded to a postal enquiry in 1999. Life satisfaction was measured with a 4-item scale. Self-reported diseases diagnosed by a physician and categorized according to ICD-10 main classes were used as a measure of morbidity. Enquiry data on health and lifestyle were used as covariates in the multivariate logistic models. RESULTS: Morbidity was strongly associated with life dissatisfaction. Every additional disease increased the risk of life dissatisfaction by 21.1% (p < .001). The risk of dissatisfaction was strongest among women with mental disorders (OR = 5.26; 95%CI 3.84-7.20) and neurological disorders (OR = 3.62; 95%CI 2.60-5.02) compared to the healthy (each p < .001). Smoking, physical inactivity and marital status were also associated with life dissatisfaction (each p < .001) but their introduction to the multivariate model did not attenuate the pattern of associations. CONCLUSIONS: Morbidity and life dissatisfaction have a disease-specific and dose-dependent relationship. Even if women with mental and neurological disorders have the highest risk for life dissatisfaction, monitoring life satisfaction among aging women regardless of disorders should be undertaken in order to intervene the joint adverse effects of poor health and poor well-being

Associations between personality and musculoskeletal disorders in the general population: A systematic review protocol

There is growing evidence of the comorbidity between personality disorder (PD) and musculoskeletal disorders (MSDs). However, there are no systematic reviews including critical appraisal and meta-analyses that identify, evaluate, and synthesize the available evidence on these associations. Therefore, we present here a protocol of the methodology to undertake a systematic review, with the objective to evaluate associations between PD and MSDs in epidemiological population-based studies. A systematic review of observational studies will be conducted. A complete search strategy will be developed in consultation with a health librarian. To identify peer-reviewed literature, the search will be translated for, and implemented in Medline Complete, CINAHL Complete, and PsycINFO via the EBSCOhost platform from 1990 to the present. Gray literature will be identified. Studies will be eligible if they examine general population participants aged 15 years and over. Associations of interest are the presence of threshold or positive screen according to the DSM-V/5 (groupings: any, Clusters A, B, C, specific PD) or ICD-10 for PD in relation to arthritis, back/neck conditions, fibromyalgia, osteopenia/osteoporosis, and/or “any” of these MSDs. Data extraction and critical appraisal will be conducted in line with the Joanna Briggs Institute (JBI) guidance for systematic reviews of etiology and risk. The results from all studies will be presented in tables, text, and figures. A descriptive synthesis will present the characteristics of included studies, critical appraisal results, and descriptions of the main findings. Where appropriate, meta-analyses will be performed. If heterogeneity (e.g., I2 = 50%) is detected, subgroup/sensitivity analysis may be used to explore the possible sources. The systematic review does not require ethics approval. The proposed systematic review will strengthen the evidence base on what is known regarding associations between PD and MSDs by identifying, evaluating, and synthesizing the findings of existing observational studies including meta-analyses, where appropriate

A systematic review of personality and musculoskeletal disorders: evidence from general population studies

IntroductionWe conducted a systematic review to evaluate the quality and extent of evidence on associations between personality disorders (PDs) and musculoskeletal disorders (MSDs) in population-based studies, since these disorders are leading causes of disease burden worldwide.MethodsA search strategy of published, peer-reviewed and gray literature was developed in consultation with a liaison librarian and implemented for Embase, CINAHL Complete, Medline Complete, and PsycINFO via the EBSCOhost platform from 1990 to the present and CORDIS and ProQuest Dissertations & Theses Global, respectively. The inclusion criteria were as follows: I) general population participants aged ≥15 years; II) self-report, probable PD based on positive screen, or threshold PD according to the DSM-IV/5 (groupings: any, Clusters A/B/C, specific PD) or ICD-10/11; III) MSDs identified by self-report or ICD criteria (arthritis, back/neck conditions, fibromyalgia, osteopenia/osteoporosis) and III) cohort, case-control, and cross-sectional study designs. Two reviewers independently screened articles and extracted the data. Critical appraisal was undertaken using the Joanna Briggs Institute checklists for systematic reviews of etiology and risk. A descriptive synthesis presents the characteristics of included studies, critical appraisal results, and descriptions of the main findings. This review adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.ResultsThere were 11 peer-reviewed, published articles included in this review (n = 9 cross-sectional and n = 2 case-control studies); participants were ≥18 years in these studies. No published gray literature was identified. Semi-structured interviews were the most common method to ascertain PDs; all studies utilized self-reported measures to identify MSDs. Overall, we detected limited and conflicting evidence for associations between PDs and MSDs.DiscussionThe main result may be explained by lack of population-based longitudinal evidence, heterogenous groupings of PD, and few comparable cross-sectional and case-control studies. Strengths of the review include a comprehensive search strategy and a discussion of mechanisms underlying possible associations between PDs and MSDs.ConclusionsThe quality of most studies included in this review that examined associations between PD and MSDs in general population adults was high. However, the results demonstrated limited and conflicting evidence for these associations, in part, due to lack of comparable evidence, which should be addressed in future research.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42021243094

Personality Disorder and Physical Health Comorbidities: A Link With Bone Health?

We examined whether personality disorders (PDs) (any, cluster A/B/C) were associated with bone mineral density (BMD) in a population-based sample of Australian women (n = 696). Personality and mood disorders were assessed using semi-structured diagnostic interviews. BMD was measured at the spine, hip, and total body using dual-energy x-ray absorptiometry (GE-Lunar Prodigy). Anthropometrics, medication use, physical conditions, and lifestyle factors were documented. The association between PDs (any, cluster A/B/C) and BMD (spine/hip/total body) was examined with multiple linear regression models. The best models were identified by backward elimination including age, weight, physical activity, smoking status, alcohol consumption, dietary calcium intake, mood disorders, physical multimorbidity, socioeconomic status, and medications affecting bone. The variables were retained in the model if p < 0.05. All potential interactions in final models were tested. Those with cluster A PD, compared to those without, had 6.7% lower hip BMD [age, weight adjusted mean 0.853 (95% CI 0.803–0.903) vs. 0.910 (95% CI 0.901–0.919) g/cm2, p = 0.027] and 3.4% lower total body BMD [age, weight, smoking, alcohol, calcium adjusted mean 1.102 (95% CI 1.064–1.140) vs. 1.139 (95% CI 1.128–1.150) g/cm2, p = 0.056]. No associations were observed between cluster B/C PDs and hip/total body BMD or between any of the PD clusters and spine BMD. To our knowledge, this study is the first to investigate the bone health of women with PD in a population-based sample. Given the paucity of literature, replication and longitudinal research including the examination of underlying mechanisms and sex differences are warranted

Psychiatric disorders, psychotropic medication use and falls among women: an observational study

BACKGROUND: Psychotropic agents known to cause sedation are associated with an increased risk of falls, but the role of psychiatric illness as an independent risk factor for falls is not clear. Thus, this study aimed to investigate the association between psychiatric disorders, psychotropic medication use and falls risk. METHODS: This study examined data collected from 1062 women aged 20-93 yr (median 50 yr) participating in the Geelong Osteoporosis Study, a large, ongoing, population-based study. Depressive and anxiety disorders for the preceding 12-month period were ascertained by clinical interview. Current medication use and falls history were self-reported. Participants were classified as fallers if they had fallen to the ground at least twice during the same 12-month period. Anthropometry, demographic, medical and lifestyle factors were determined. Logistic regression was used to test the associations, after adjusting for potential confounders. RESULTS: Fifty-six women (5.3%) were classified as fallers. Those meeting criteria for depression within the past 12 months had a 2.4-fold increased odds of falling (unadjusted OR = 2.4, 95% CI 1.2-4.5). Adjustment for age and mobility strengthened the relationship (adjusted OR = 2.7, 95% CI 1.4-5.2) between depression and falling, with results remaining unchanged following further adjustment for psychotropic medication use (adjusted OR = 2.7, 95% CI 1.3-5.6). In contrast, past (prior to 12-month) depression were not associated with falls. No association was observed between anxiety and falls risk. Falling was associated with psychotropic medication use (unadjusted OR = 2.8, 95% CI 1.5-5.2), as well as antidepressant (unadjusted OR = 2.4, 95% CI 1.2-4.8) and benzodiazepine use (unadjusted OR = 3.4, 95% CI 1.6-7.3); associations remained unchanged following adjustment for potential confounders. CONCLUSION: The likelihood of falls was increased among those with depression within the past 12 months, independent of psychotropic medication use and other recognised confounders, suggesting an independent effect of depression on falls risk. Psychotropic drug use was also confirmed as an independent risk factor for falls, but anxiety disorders were not. Further research into the underlying mechanisms is warranted

The stability of life satisfaction in a 15-year follow-up of adult Finns healthy at baseline

BACKGROUND: While physical health has improved considerably over recent decades in Finland, the disease burden of mental health, especially that of depression, has become increasingly demanding. However, we lack long-term data on the natural course of subjective well-being in the general population. The aim of this study was to investigate the long-term course of self-reported life satisfaction. METHODS: This was a 15-year prospective cohort study on a nationwide sample of adult Finnish twins (N = 9679), aged 18–45 and healthy at baseline, who responded to postal questionnaires in 1975, 1981 and 1990 including a 4-item life satisfaction scale (happiness/easiness/interest in life and feelings of loneliness). Life satisfaction score (range: 4–20) was classified into three categories: satisfied (4–6), intermediate (7–11) and dissatisfied group (12–20). The associations between life satisfaction scores during the follow-up were studied with linear/logistic regression. RESULTS: Moderate stability and only a slight effect of age or birth-cohort on mean life satisfaction score (LS) were detected. In 1990, 56% of all and 31% of the dissatisfied remained in the same LS category as at baseline. Only 5.9% of the study subjects changed from being satisfied to dissatisfied or vice versa. Correlations between continuous scores (1975, 1981 and 1990) were 0.3–0.4. Baseline dissatisfaction (compared to satisfaction) predicted dissatisfaction in 1981 (OR = 10.4; 95%CI 8.3–13.1) and 1990 (5.6; 4.6–6.8). Multiple adjustments decreased the risk only slightly. CONCLUSIONS: Life satisfaction in adult Finns was moderately stable during 15 years. Among an identifiable group (i.e. the dissatisfied) life dissatisfaction may become persistent, which places them at a greater risk of adverse health outcomes

Effects of antidepressants on postmenopausal bone loss - a 5-year longitudinal study from the OSTPRE cohort

BACKGROUND: Osteoporosis and depression are major health problems worldwide. The association between antidepressants, a treatment for depression, and bone health needs more detailed exploration. OBJECTIVE: The present study investigates antidepressant medication use and postmenopausal bone loss over time. METHODS: A total of 1988 women (aged 57-67) participating in the Kuopio Osteoporosis Risk Factor and Prevention Study (OSTPRE) cohort responded to a postal enquiry and had their femoral neck bone mineral density (BMD) measured in 1999 and again in 2004. Data on antidepressant use was obtained from the National Prescription Register. Multiple regression techniques were used to test the associations, before and after adjustment for anthropometric, medical, physical and lifestyle factors. RESULTS: Over the five years of follow-up, 319 (16.0%) women purchased antidepressants. Mean baseline femoral neck BMD for the entire study group was 881mg/cm(2) (SD 123) and mean 5-year bone loss was 6.0mg/cm(2) (SD 4.7). After adjustments, users of tricyclic antidepressants (TCA) had greater annual BMD loss than non-users (-3.6mg/cm(2) vs. -1.1mg/cm(2); P=0.031). Accelerated bone loss was also associated with selective serotonin reuptake inhibitor\u27s (SSRI) use (P=0.001) and use of other antidepressants in a dose-response way, with the latter only among women of low-weight and normal-weight women who had lost weight over the study period. CONCLUSIONS: In conclusion, the use of SSRIs seems to accelerate postmenopausal bone loss in a dose-response manner. Associations between TCA and other antidepressant use and bone loss may also exist. Thus, the possibility of increased risk of osteoporosis should be considered when prescribing antidepressants for postmenopausal women

Multimorbidity predicts falls differentially according to the type of fall in postmenopausal women

OBJECTIVE: To ascertain whether the risk of falls of different types is related to morbidity (number of chronic medical conditions) among postmenopausal women. STUDY DESIGN: This cohort study uses data from a population-based prospective cohort study (OSTPRE). The study population consisted of 10,594 women aged 47-56 years living in Kuopio Province, Eastern Finland, in 1989, who responded to postal enquiries at both baseline and 5-year follow-up, in 1994. Morbidity (i.e. number of diagnosed chronic medical conditions) was reported in 1989 and falls in 1994. Falls were categorized as slip or nonslip, and \u27frequent falls\u27 was defined as two or more in a 12-month period. RESULTS: The risk (odds ratio (OR) with 95% CI) of a fall increased with the number of chronic medical conditions. The OR was 1.28 (1.17-1.40) for those with 1-2 conditions and 1.41 (1.24-1.60) for those with multimorbidity (≥3 conditions) compared with healthy respondents. Multimorbidity was associated with a greater risk of the woman experiencing frequent nonslip falls (OR=2.57; 2.01-3.29) than frequent slip falls (OR=1.46; 1.17-1.80). Adjusting with logistic regression for age, number of medications and smoking did not affect the risk estimates. CONCLUSION: Multimorbidity has a much smaller effect on slip than on nonslip falls in postmenopausal women. This should be taken into account when investigating the effects of multimorbidity on fall risk in varying weather conditions

Densidade Mineral Óssea em Mulheres Asmáticas, na Fase Perimenopausa

RESUMO: Os corticóides inalados, constituem a terapêutica anti-inflamatória de eleição, utilizada nos asmáticos, por longos penodos.Para além dos corticóides inalados utilizados como terapêutica preventiva, a corticoterapia oral e endovenosa é por vezes necessária nos períodos de exacerbação da doença.É bem conhecido o risco de osteoporose em doentes com asma grave medicados com corticoterapta oral a longo prazo O efeito dos corticóides inalados a nivel da densidade óssea, não é bem conhecido, pelo que tem sido alvo de estudos recentes.A menopausa é considerada o principal factor de risco da osteoporose. Ainda não é bem conhecido qual o papel da asma como factor de risco de ostcoporose equal o impacto dos corticóides inalados na densitometria óssea.Os autores procederam a urn estudo inicialmente dingido a uma população de 14220 mulheres dos 47 aos 56 anos de idade (período perimenopausa), residentes na Província de Kuopio, no Leste da Finlândia.Foi enviado urn inquérito incluindo a história ginecológica, uso de terapêutica hormonal de substituição, paridade, peso, altura, actividade fisica, consumo de produtos lácteos, hábitos tabágicos, morbilidade e teraêuticas habituais. Houve resposta em 84 4% dos inquiridos.Foi realizada osteodensitometria óssea (BMD) do colo do fémur esquerdo e coluna em 3222 mulheres, de acordo com um estudo randomizado simples, estratificado.Após exclusão de alguns registos considerados inválidos, a população estudada consistia em 2941 mulheres, das quais 119 eram asmáticas. A estas foi feito um inquérito adicional acerca do uso de cortticóides, dose diária, duração e regularidade.Os autores verificaram que 72 doentes (60.5%) estavam medicadas com corticóides inalados. Dez asmáticas faziam regularmente corticoterapia oral. Em 61 doentes havia referência a pelo menos um curso de corticóide oral nos últimos 6 meses. Vinte e oito asmáticas nunca tinham feito terapêutica corticóide.A análise preliminar dos resultados permitiu verificar que não havia diferenças estatísticamente significativas entre as asmáticas e não asmatícas, excepto no indice de massa corporal (BMI), com um valor médio de 27 0 Kg/m2 versus 26.1Kg/m2.Nas asmáticas, a idade e o tempo de menopausa correlacionouse negativamente com a BMD da coluna, enquanto que o peso eo BMI se correlacionaram positivamente com a BMD da coluna e fémur.As asmáticas que não estavam medicadas com terapêutica hormonal de substitutção (n=83) apresentavam valores médios de densitometria óssea da coluna e femural inferiores, relativamente às correspondentes, não asmáticas (BMD da coluna 1 083±0 150 [SD] versus 1.128±0 160 g/cm2, p<0.05. BMD femural, 0 894 ± 0 112 [SD] versus 1.128 g/cm2, p<0.05).Embora as BMDs realizadas nas doentes asmáticas medicadas com corticóides inalados não tenham sido significativamente inferiores, a duração do tratamento correlacionouse negativamente com a BMD da coluna.Os autores concluem que na mulher em fase perimenopáusica, a Asma Brônquica associase a uma diminuição da densidade óssea. Este facto parece ser devido mais aos corticóides do que à doença em si. Contudo, a terapêutica hormonal de substituição parece constituir um factor protector contra a perda de densidade óssea, também nas doentes asmáticas. COMENTÁRIO: A terapêutica anti-inflamatória, nomeadamente a corticóide inalada, é largamente utilizada na terapêutica preventiva da asma brônquica, sendo apenas excluida a sua indicação nos casos de asma intermitente (7).A menopausa e a corticoterapia oral são factores de risco de osteoporose bem conhecidos.Contudo, o papel da asma brônquica e da terapêutica corticóide inalada na osteoporose, não estão ainda bem definidos, tendo sido objecto do presente estudo.Os autores procederam ao estudo de uma população de mulheres em fase perimenopáusica residentes numa provincia do Leste da Finlândia, que foi subdividida em dois grupos: asmáticas (n=119) e não asmáticas (n=2941).Foi estudada a densidade mineral óssea através da BMD da coluna e fémur nos dois grupos, após resposta a um inquérito exaustivo de todos os factores conhecidos passíveis de interferir com os resultados da BMD.São escassos os estudos da BMD em doentes asmáticas e os que existem englobam na maioria ambos os sexos e diversos grupos etários (1,2,3,4,5, 6).Os autores verificaram que comparativamente com as não asmáticas, as doentes asmáticas apresentavam uma menor densidade óssea (BMD da coluna e fémur). Esta diferença foi mais marcada e estatisticamente significativa nas asmáticas não submetidas a terapêutica hormonal.Relativamente ao efeito dos mineralocorticóides, os autores concluiram que a duração, a dose e a terapêutica regular com corticóides orais se correlacionava negativamente com a BMD da coluna, correlação também encontrada com os corticóides inalados, embora menos significativa.Contudo, será de salientar que no grupo de 119 asmáticas, apenas 26 (23.5%) fizeram exclusivamente corticoterapia inalada. Sessenta e cinco doentes (54.6%), para além de corticóides inalados usados regularmente, necessitaram fazer curtos períodos de corticoides orais, facto que podera ter interferido negativamente nos resultados encontrados.Para além de o número de asmáticas estudado ser relativamente pequeno (n=119), a idade média de início da terapêutica corticóide inalada regular foi sómente aos 49 0±4.9 anos, com uma duração média de apenas 5.2±4.1 anos e uma dose média diária de 1.0±0.4 mg.Os aspectos mais relevantes do presente trabalho são a constataçãdo de um risco aumentado de osteoporose nas mulheres asmáticas, representando a corticoterapia oral o factor de risco mais importante, embora pareça que os corticóides inalados podem influenciar negativamente a BMD da coluna.Os resultados sugerem ainda o efeito profilático positivo da terapêutica hormonal de substituição nas mulheres asmáticas na fase perimenopausa. aspecto que deverá ser considerado na pránca clínica. Palavras-chave: Osteoporose, asma, corticosteróides, Key-words: Osteoporosis, asthma, corticosteroid

Personality disorder is an excess risk factor for physical multimorbidity among women with mental state disorders

We examined whether mental state disorders (lifetime mood, anxiety, eating, substance misuse) with comorbid personality disorder are associated with physical multimorbidity in a population-based sample of women. Mental state and personality disorders were assessed using semi-structured diagnostic interviews. Clinical measures were performed and medical conditions, medication use and lifestyle factors were documented by questionnaire. Mental state disorders were associated with higher odds of physical multimorbidity; risk was especially high for those with comorbid personality disorder. These findings suggest that mental state and physical comorbidity might be worsened by the additional comorbidity of personality disorder