Naisten mielenterveys ja lisääntymisterveys

This research aims at studying the relationship between mental health and reproductive features in women. The epidemiology and phenomenology of many psychiatric disorders differ between genders, with depressive and anxiety disorders, as well as attempted suicide, being more common in women, and completed suicide, personality disorders and substance use disorders, in men. It is plausible that (endogenous and exogenous gonadal hormones and reproductive events contribute to this pattern. Data on women who participated in two Finnish opulation-based studies (Health 2000 and FINRISK 1997, 2002 and 2007) were analyzed. Data were collected through face-to-face interviews, self-administered questionnaires and health examinations. Different structured (BDI-21, BDI-13, GHQ-12, CIDI) and non-structured tools were used to assess mental health and psychological well-being. Study I focused on the association between mental health and miscarriage, by history and number; Studies II and III focused on the relationship with use of hormonal contraception (either oral or intrauterine) and its duration; Study IV concentrated on the associations between mental health and hormone therapy in perimenopausal and postmenopausal women. Study I showed that a miscarriage as a pregnancy outcome was related to a high prevalence of depressive disorders, and to more severe depressive or anxiety symptoms compared with other pregnancy outcomes. Moreover, the higher the number of miscarriages was, the worse the current state of mood was and the higher the frequency of a psychiatric diagnosis. Studies II and III revealed that the use of hormonal contraception was not associated with adverse psychological status or depressive symptoms/disorders. Additionally, no effect of different hormonal compounds was detected. The main finding in Study IV was the high prevalence of depressive and anxiety disorders among women in connection with the menopausal transition. Moreover, in this group, an association between current use of hormone therapy and worse psychological well-being or mental health was detected. The results of this study support the hypothesis of an association between psychological well-being and reproductive features in women. The importance of considering reproductive health and events when assessing psychological status and mental health in women is discussed.Tässä tutkimuksessa tarkastellaan naisten mielenterveyden ja lisääntymisterveyden välistä suhdetta. Monet psykiatriset sairaudet ja oireet ilmenevät eri lailla sukupuolten välillä, esimerkiksi masennustila ja ahdistusoireet ovat yleisempiä naisilla, kun sitä vastoin itsemurhat sekä persoonallisuus- ja päihdehäiriöt ovat yleisempiä miehillä. On todennäköistä, että sukurauhashormonit ja lisääntymistapahtumat vaikuttavat mielenterveydessä ilmeneviin eroihin. Naisten tutkimusaineistona käytettiin kahta suomalaista väestötutkimusta (Terveys 2000 ja FINRISK 1997, 2002, 2007). Tämä aineisto koostui henkilökohtaisista haastatteluista, kyselylomaketiedoista ja terveystarkastusmittauksista. Mielenterveyden ja hyvinvoinnin arvioinnissa käytettiin sekä strukturoituja (BDI-21, BDI-13, GHQ-12, CIDI) että ei-strukturoituja menetelmiä. Ensimmäinen tutkimus koski mielenterveyden ja keskenmenojen sekä niiden määrän välistä suhdetta. Toisessa ja kolmannessa tutkimuksessa tarkasteltiin mielenterveyden ja hormonaalisten (suun kautta nautittavien tai kohdunsisäisten) ehkäisykeinojen käytön sekä ehkäisyn keston välistä suhdetta. Neljäs tutkimus keskittyi mielenterveyden ja hormonikorvaushoidon välisiin yhteyksiin vaihdevuosi-ikäisillä ja vanhemmilla naisilla. Ensimmäinen tutkimus osoitti että keskenmenon kokeneilla masennus oireet ja häiriöt olivat yleisiä. Tämän lisäksi keskenmeno yhdistyi vakavampiin mielenterveyden häiriöihin verrattuna muihin raskauden lopputuloksiin. Mitä enemmän keskenmenoja oli, sitä todennäköisempiä olivat psyykkiset oireet tai mielenterveyden häiriöt. Toinen ja kolmas tutkimus osoittivat, että hormonaalisen ehkäisyn käyttö ei ollut yhteydessä psyykkiseen pahoinvointiin tai masennusoireisiin. Eri hormoniyhdisteet eivät tässä suhteessa eronneet toisistaan. Neljännen tutkimuksen päälöydös oli se, että masennus- ja ahdistuneisuushäiriöt olivat yleisiä vaihdevuosi-ikäisillä naisilla. Lisäksi tässä ryhmässä hormonikorvaushoidon käyttö oli yhteydessä psyykkiseen pahoinvointiin. Tämän tutkimuksen tulokset tukevat hypoteesia, että naisten lisääntymisterveys vaikuttaa psyykkiseen hyvinvointiin. Lisääntymisterveyttä edistämällä voidaan mahdollisesti edistää myös mielenterveyttä

Psychothérapie interpersonnelle de groupe : une revue de littérature

La psychothérapie interpersonnelle (PTI) a d’abord été conçue en tant qu’approche psychothérapeutique pour traiter la dépression, mais on l’a depuis largement utilisée pour traiter plusieurs autres pathologies. Récemment, on a aussi adapté la PTI à un format de groupe, qui comporte à la fois les avantages et les désavantages des autres psychothérapies de groupe. Utilisée pour la première fois par Wilfley et ses collègues, cette adaptation garde les principales caractéristiques de la PTI, c’est-à-dire le rôle central de l’axe interpersonnel et l’identification d’un (ou de deux) des quatre domaines interpersonnels problématiques (le deuil pathologique, la transition de rôle, les conflits de rôles et les déficits interpersonnels). L’adaptation conserve aussi le rôle actif du thérapeute et du patient individuel au sein du groupe. À ce jour, la psychothérapie interpersonnelle adaptée aux groupes (PTI-G) a servi à traiter plusieurs pathologies (les Troubles des conduites alimentaires non spécifiques, la boulimie, les troubles dépressifs et les troubles de stress post-traumatique [TSPT]) et ce, auprès de plusieurs populations (adolescents, aînés, femmes enceintes ou « nouvelles mères », femmes toxicomanes incarcérées). Bien que la qualité générale des études sur les résultats soit à ce jour plutôt pauvre, l’examen de l’état actuel des connaissances indique que la PTI-G peut s’avérer utile et qu’elle peut présenter un certain nombre d’avantages dans le traitement de divers troubles psychiatriques auprès de plusieurs populations de patients.Interpersonal Psychotherapy was conceived as a psychotherapeutic approach to treating Depression, but has since now been broadly used to treat many other disorders. It has also recently been adapted to delivery in the group setting, with both advantages and disadvantages as other group psychotherapies. This adaptation, first used by Wilfley and colleagues, maintained the main features of IPT, i.e. the central role of the interpersonal focus and identification of one (or two) out of four problem interpersonal areas (Grief; Role Transition; Role Disputes; Interpersonal Deficits). It also kept the active role of the therapist and individual patient within the group. To date, G-IPT has been used for several diseases (Eating Disorders not Otherwise Specified, Bulimia Nervosa, Depressive Disorder, Posttraumatic Stress Disorder) and several populations (Adolescents, Older People, Pregnant Women or “New-Mothers,” Substance-abusing Female Prisoners). Although the overall quality of most of outcome studies is to date quite poor, the review of the current state of knowledge shows the G-IPT may be helpful and present a number of advantages to treat different psychiatric disorders in several populations of patients.La psicoterapia interpersonal (PTI) fue inicialmente concebida como enfoque psicoterapéutico para tratar la depresión, pero desde entonces ha sido utilizada ampliamente para tratar varias otras patologías. Recientemente también ha sido adaptada a un formato de grupo que comprende a la vez las ventajas y desventajas de las otras psicoterapias de grupo. Utilizada la primera vez por Wilfley y sus colegas, esta adaptación conserva las principales características de la PTI, es decir, el rol central del eje interpersonal y la identificación de uno (o dos) de los cuatro aspectos interpersonales problemáticos (el duelo patológico, la transición del rol, los conflictos de roles y los déficits interpersonales). La adaptación conserva también el rol activo del terapeuta y del paciente individual en el seno del grupo. A la fecha, la psicoterapia interpersonal adaptada a los grupos (PTI-G) ha servido para tratar varias patologías (los trastornos de conductas alimenticias no específicos, la bulimia, los trastornos depresivos y los trastornos de estrés postraumático [TSPT], en pacientes de diversas poblaciones (adolescentes, ancianos, mujeres embarazadas o “madres primerizas”, mujeres toxicómanas encarceladas). Aunque la calidad general de los estudios acerca de los resultados a la fecha es más bien pobre, el examen del estado actual de los conocimientos indica que la PTI-G puede ser útil y puede presentar un cierto número de ventajas en el tratamiento de diversos trastornos psiquiátricos en varias poblaciones de pacientes.A Psicoterapia Interpessoal (PTI) foi concebida primeiramente como abordagem psicoterapêutica para tratar a depressão, mas desde então, ela é vastamente utilizada para tratar várias outras patologias. Recentemente, ela foi adaptada ao formato de grupo, que comporta ao mesmo tempo as vantagens e as desvantagens das outras psicoterapias de grupo. Utilizada pela primeira vez por Wilfley e seus colegas, esta adaptação mantém as principais características da PTI, ou seja, o papel central do eixo interpessoal e a identificação de uma (ou de duas) das quatro áreas interpessoais problemáticas (luto patológico, transição de papéis, conflitos de papéis e déficits interpessoais). A adaptação conserva também o papel ativo do terapeuta e do paciente individual dentro do grupo. Até hoje, a psicoterapia interpessoal adaptada aos grupos (PTI-G) serviu para tratar várias patologias (Transtornos de condutas alimentares não específicas, bulimia, transtornos depressivos e transtornos de estresse pós-traumático [TSPT]) junto a várias populações (adolescentes, idosos, mulheres grávidas, ou “novas mães”, mulheres toxicômanas detidas). Apesar da qualidade geral dos estudos sobre os resultados ser até hoje relativamente pobre, o exame do estado atual dos conhecimentos indica que a PTI-G pode tornar-se útil e que ela pode apresentar um certo número de vantagens no tratamento de vários transtornos psiquiátricos junto a várias populações de pacientes

High hs-CRP levels after an attempted suicide : A matched case-control study

Publisher Copyright: © 2022 The AuthorsWe found significantly higher levels of hs-CRP in 27 subjects who had recently attempted suicide compared to 27 age- and sex-matched healthy subjects. Moreover, the levels of hs-CRP in suicide attempters were not related to background or psychopathological characteristics, nor to the methods of suicide attempt. Our matched case-control study confirms previous observations of high levels of the inflammation marker hs-CRP in patients who have attempted suicide, irrespective of their underlying type and levels of psychopathology.Peer reviewe

Empathy profiles differ by gender in people who have and have not attempted suicide

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Population-level indicators associated with hormonal contraception use : a register-based matched case-control study

Background Monitoring factors related to hormonal contraception (HC) use is essential to evaluating public health strategies and promoting access to contraception. We aimed to examine municipal social and health indicators of HC use at the population level, and to identify patterns of inequality across Finnish municipalities. Methods We identified all women (15-49 years) with a redeemed HC prescription in Finland in 2017 (n = 294,445), and a control group of non-users. Municipal social and health indicators at the population level were retrieved from the nationwide Statistics and Indicator Bank. Differences between the groups across 309 municipalities were calculated, and associations of municipal-specific proportions of HC users with municipal-specific indicators were studied using LASSO (Least Absolute Shrinkage and Selection Operator) models. Results Sociodemographic differences between HC users and non-users were non-homogenous across municipalities. Indicators positively associated with HC use included: larger population and higher proportions of population aged 16-24 years, of household-dwelling units with one person, of persons with higher education, and of divorces among those aged 25-64. Lower HC use was associated with higher proportions of Swedish-speaking population, of those aged 7-15 years, of young people not in education/training, and of household-dwelling units in overcrowded conditions. Lower HC use was also associated with indicators of outpatient and inpatient healthcare, and of municipal finances in welfare and healthcare. Conclusions Sociodemographic differences in relation to HC use exist across Finnish municipalities. Municipal indicators of social structure, health and welfare, and investment in and use of healthcare services are related to HC use.Peer reviewe

Associations between hormonal contraception use, sociodemographic factors and mental health: a nationwide, register-based, matched case–control study

Objectives Sociodemographic and mental health characteristics are associated with contraceptive choices. We aimed to describe the sociodemographic, reproductive and mental health characteristics of all fertile-aged women in Finland who used hormonal contraception (HC) in 2017. Design A nationwide, register-based study. Setting All women living in Finland in 2017; data from the Care Register of Health Care, Medical Birth Register, Population Register Centre, Prescription Centre, Register of Induced Abortions. Participants All women aged 15-49 with one redeemed HC prescription in 2017 (n=294 356), and a same-sized, age-matched and residence-matched, control group of non-users. Outcomes Rates of HC use; associations between HC use and mental disorders, sociodemographic and reproductive characteristics. Results 25.8% of women aged 15-49 years used HC. Women with the lowest socioeconomic levels had lower odds of using HC than women with upper-level statuses (OR, 95% CI students: 0.97, 0.94 to 0.99; entitled to pension: 0.66, 0.63 to 0.69; other: 0.87, 0.85 to 0.89; unknown: 0.90, 0.85 to 0.90). Women with the highest education (secondary: 1.46, 1.43 to 1.48; tertiary: 1.64, 1.58 to 1.70; academic: 1.60, 1.56 to 1.63) and income (second quarter: 1.57, 1.54 to 1.60; third quarter: 1.85, 1.82 to 1.89; fourth quarter: 2.01, 1.97 to 2.06), and unmarried women had higher odds of using HC than women with the lowest education and income levels, and married (0.61, 0.60 to 0.62), divorced (0.86, 0.84 to 0.88), widowed (0.73, 0.65 to 0.83) or other marital status women (0.26, 0.22 to 0.30). Parous women (0.70, 0.69 to 0.71), those with previous induced abortion(s) (0.91, 0.89 to 0.92) or recent eating (0.68, 0.62 to 0.75) or personality (0.89, 0.79 to 0.97) disorders had lower odds of HC use. Absolute risk differences between women with and without mental disorders ranged from 3.1% (anxiety disorders) to 10.1% (eating disorders). Conclusions A quarter of the fertile-aged women use HC in Finland. Sociodemographic disparities persist in relation to HC use, although of small effect size. HC use is less common among women suffering from severe to moderate psychiatric disorders, especially eating disorders.Peer reviewe

Associations between use of psychotropic medications and use of hormonal contraception among girls and women aged 15-49 years in Finland : a nationwide, register-based, matched case-control study

Objectives The relationship between the use of contraception and of psychiatric medications is understudied. We examined whether the current and past use of psychotropic medications is associated with the use and type of hormonal contraception (HC). Design Nationwide register-based matched case-control study. Settings All fertile-aged (15-49 years) girls and women living in Finland in 2017; data from several national registers. Participants 294 356 girls and women with a redeemed prescription of HC in 2017, and their same-sized control group of non-users (n=294 356) identified through the Prescription Centre. Main outcome measures Associations between the use of psychotropic medications and the use of HC, and the type of HC tested in logistic regression models. Results Altogether 19.5% of the HC users, and 18% of the HC non-users received at least one prescription for a psychotropic medication in 2017. Among HC users, the proportions of occasional and regular users of psychotropic medications in 2013-2016 were 4.5% and 14.8%, while among HC non-users the respective figures were 4.3% and 14.6%, respectively. In multivariable logistic regression models both the use of psychotropic medications in 2017, and their occasional or regular use between 2013-2016 were associated with higher odds of HC use, although with small to very small effect sizes (ORs between 1.37 and 1.06 and 95% CIs 1.22 to 1.53, and 1.03 to 1.09, respectively). After adjustment for covariates, when fixed combinations of progestogens and oestrogens for systemic use was the reference category, women using almost any class of psychotropic medications had higher odds of using other types of HC. Conclusions Fertile-aged girls and women with current and past use of psychotropic medications have higher odds of using HC, with a specific pattern in the type of contraceptives used. Further research is warranted to examine whether our observations indicate a reduction of unwanted pregnancies in women with psychiatric disorders.Peer reviewe

Systemic hormonal contraception and risk of venous thromboembolism

Introduction The increased risk of venous thromboembolism associated with the use of hormonal contraception is well recognized, but evidence regarding hormonal contraception containing natural estradiol is limited. This study aimed to assess the associations between the patterns of use of different systemic hormonal contraceptives and the risk of venous thromboembolism during 2017-2019. Material and Methods All fertile-aged women (15-49 years) living in Finland in 2017 and using hormonal contraception in 2017 and their 1:1 age- and residence-matched controls not using hormonal contraception in 2017 (altogether 587 559 women) were selected from the Prescription Centre. All incident venous thromboembolism cases during 2018-2019 and their 4:1 age-matched controls were further analyzed in a prospective nested case-control design to assess the associations between the use (starting, stopping, continuous vs no use) of different hormonal contraception types and venous thromboembolism. Results Altogether, 1334 venous thromboembolism cases occurred during the follow-up period (incidence rate 1.14 per 1000 person-years, 95% confidence interval [CI] 1.08-1.20), with an incidence rate ratio of hormonal contraception vs no hormonal contraception use of 1.42 (95% CI 1.27-1.58). Compared with non-use, starting the use of gestodene and ethinylestradiol (adjusted odds ratio [aOR] 2.85; 95% CI 1.62-5.03), drospirenone and ethinylestradiol (aOR 1.55; 95% CI 0.98-2.44), desogestrel and ethinylestradiol (aOR 1.97; 95% CI 0.99-3.92), and transdermal patch releasing norelgestromin and ethinylestradiol (aOR 5.10; 95% CI 1.12-23.16), as well as continuing the use of gestodene and ethinylestradiol (aOR 2.60; 95% CI 1.61-4.21), drospirenone and ethinylestradiol (aOR 1.55; 95% CI 1.02-2.37), cyproterone-acetate and estrogen/ethinylestradiol (aOR 1.66; 95% CI 1.06-2.61), and vaginal ring releasing etonogestrel and ethinylestradiol (aOR 3.27; 95% CI 1.95-5.48) were associated with venous thromboembolism risk. Regarding the type of estrogen, the highest risk was associated with current use (vs non use in the previous 180 days) of ethinylestradiol-containing preparations (aOR 2.20; 95% CI 1.82-2.65), followed by estradiol-containing preparations (aOR 1.39; 95% CI 1.04-1.87) with no risk for progestin-only hormonal contraception. Current use of estradiol-containing preparations was not associated with venous thromboembolism risk after exclusion of cyproterone-acetate and estrogen/ethinylestradiol (aOR 1.05; 95% CI 0.66-1.66). Conclusions An increased risk of venous thromboembolism is associated with ethinylestradiol-containing combined preparations. The use of estradiol-containing combined preparations confers only a slightly increased risk, possibly driven by cyproterone-containing combined oral contraceptives, whereas the use of progestin-only contraception is not associated with venous thromboembolism.Peer reviewe

The effect of hormone therapy on serum melatonin concentrations in premenopausal and postmenopausal women: A randomized, double-blind, placebo-controlled study

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Melatonin in perimenopausal and postmenopausal women : associations with mood, sleep, climacteric symptoms, and quality of life

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