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Psychotic depression and the risk of death due to suicide
- T. Paljarvi, J. Tiihonen, M. Lähteenvuo, A. Tanskanen, S. Fazel, H. Taipale
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S442
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Introduction
Depression markedly increases the risk of suicide, and depression is the most common psychiatric disorder diagnosed in persons with a completed suicide, but the interplay between depression and psychotic symptoms in suicides has remained unsettled.
ObjectivesThe purpose of this study was to establish the risk of suicide associated with incident psychotic depression (PD) compared to incident non-psychotic severe depression (NPD) in a large nationwide cohort.
MethodsThis cohort study used routine data from nationwide health registers in Finland. Eligible participants were aged 18 ̶ 59 years at the index diagnosis. Causes of death were defined by the International Classification of Diseases, 10th revision codes. The follow-up time was up to five years. Adjusted Cox regression models were used to analyse risk of death by method of suicide.
ResultsWe included 17331 individuals with incident PD and 85989 individuals with incident NPD. Most of the deaths due to suicides occurred within the first two years after the index diagnosis. Compared to NPD, PD was associated with an overall two-fold increased risk of suicide (adjusted hazard ratio, (aHR) 2.19, 95% confidence interval (CI) 1.95, 2.46), after adjusting for psychiatric comorbidities. In PD, the highest relative risks were for impact-related suicides (aHR 3.03, 95%CI 2.23, 4.13) and for suffocation-related suicides (aHR 2.72, 95%CI 2.23, 3.30), whereas the lowest relative risk was for intentional poisonings (aHR 1.66, 95%CI 1.37, 2.02).
ConclusionsPsychotic symptoms increased the risk of suicide 2-fold of the risk that was associated with severe depression, after controlling for comorbid psychiatric disorders. The severity of suicidal ideation may be higher in PD than in NPD, which then leads to more lethal methods of self-harm.
Disclosure of InterestT. Paljarvi: None Declared, J. Tiihonen Grant / Research support from: Janssen-Cilag, Eli Lilly, Consultant of: HLS Therapeutics, Orion, and WebMed Global, Speakers bureau of: Eli Lilly, Evidera, Janssen-Cilag, Lundbeck, Mediuutiset, Otsuka, Sidera, and Sunovion, M. Lähteenvuo Shareolder of: Genomi Solutions ltd, Nursie Health ltd, Springflux ltd, Grant / Research support from: Finnish Medical Foundation, Emil Aaltonen Foundation, Speakers bureau of: Sunovion, Lundbeck, Otsuka Pharma, Orion Pharma, Recordati, Janssen, Janssen-Cilag, A. Tanskanen Grant / Research support from: Janssen-Cilag, Eli Lilly, S. Fazel Grant / Research support from: Wellcome Trust, H. Taipale Grant / Research support from: Janssen-Cilag, Eli Lilly, Academy of Finland, Speakers bureau of: Janssen-Cilag, Otsuka
Healthcare costs and productivity losses in treatment-resistant depression in Finland
- S. Rannanpää, H. Taipale, A. Tanskanen, M. Lähteenvuo, S. Huoponen, J. Tiihonen
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S268
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Introduction
Due to its relatively high prevalence and recurrent nature, depression causes a major burden on healthcare systems and societies.
ObjectivesTo investigate healthcare resource utilization and costs associated with treatment-resistant depression (TRD) compared with non-TRD depression in Finland.
MethodsOf all patients aged 16-65 years and diagnosed with depression in Finland during 2004-2016, persons with TRD (N=15 405) were identified from nationwide registers and matched 1:1 with comparison persons with depression but no TRD. TRD was defined as initiation of a third treatment trial after having failed two pharmacological treatment trials. Follow-up period covered five years after TRD or corresponding matching data (until end of 2018). Healthcare resource utilization was studied with negative binomial regression and average excess costs of TRD with generalized estimating equations, by adjusting for baseline costs, comorbidity and baseline severity of depression.
ResultsPersons with TRD (mean age 38.7, SD 13.1, 60.0% women) had more healthcare utilization and work disability (sick leaves and disability pensions), adjusted incidence rate ratio for work disability days was 1.72 (95% CI 1.64-1.80). This resulted in higher total costs for persons with TRD, adjusted mean difference 7572 (95% CI 7215-7929) EUR per patient per year, higher productivity losses (due to sick leaves and disability pensions, mean difference 5296, 95% CI 5042-5550) and direct healthcare costs (2002, 95% CI 1853-2151) compared with non-TRD patients. Mean difference was highest during the first year after TRD (total costs difference 11760, 95% CI 11314-12206).
ConclusionsTreatment-resistant depression is associated with a significant cost burden.
DisclosureThis study was funded by Janssen-Cilag Finland and the Finnish Ministry of Social Affairs and Health through the developmental fund for Niuvanniemi Hospital. ML was partly funded by personal grants from the Finnish Medical Foundation and Emil Aaltonen fou
Trajectories of labour market marginalisation among young adults with newly diagnosed attention-deficit/hyperactivity disorder (ADHD)
- M. Helgesson, S. Rahman, E. Björkenstam, K. Gustafsson, R. Amin, H. Taipale, A. Tanskanen, L. Ekselius, E. Mittendorfer-Rutz
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- Journal:
- Epidemiology and Psychiatric Sciences / Volume 30 / 2021
- Published online by Cambridge University Press:
- 22 October 2021, e67
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Aims
Labour market marginalisation (LMM), i.e. severe problems in finding and keeping a job, is common among young adults with attention-deficit/hyperactivity disorder (ADHD). This study aimed to disentangle the extent of LMM as well as the heterogeneity in patterns of LMM among young adults with ADHD and what characterises those belonging to these distinct trajectories of LMM.
MethodsThis population-based register study investigated all 6287 young adults, aged 22–29 years, who had their first primary or secondary diagnosis of ADHD in Sweden between 2006 and 2011. Group-based trajectory (GBT) models were used to estimate trajectories of LMM, conceptualised as both unemployment and work disability, 3 years before and 5 years after the year of an incident diagnosis of ADHD. Odds ratios (ORs) with 95% confidence intervals (CIs) for the association between individual characteristics and the trajectory groups of LMM were estimated by multinomial logistic regression.
ResultsSix distinct trajectories of LMM were found: ‘increasing high’ (21% belonged to this trajectory group) with high levels of LMM throughout the study period, ‘rapidly increasing’ (19%), ‘moderately increasing’ (21%), ‘constant low’ (12%) with low levels of LMM throughout the study period, ‘moderately decreasing’ (14%) and finally ‘fluctuating’ (13%), following a reversed u-shaped curve. Individuals with the following characteristics had an increased probability of belonging to trajectory groups of increasing LMM: low educational level (moderately increasing: OR: 1.4; CI: 1.2–1.8, rapidly increasing: OR: 1.7; CI: 1.3–2.1, increasing high: OR: 2.9; CI: 2.3–3.6), single parents (moderately increasing: OR: 1.6; CI: 1.1–2.4, rapidly increasing: OR: 2.0; CI: 1.3–3.0), those born outside the European Union/the Nordic countries (rapidly increasing: OR: 1.7; CI: 1.1–2.5, increasing high: OR: 2.1; CI: 1.4–3.1), persons living in small cities/villages (moderately increasing: OR: 2.4; CI: 1.9–3.0, rapidly increasing: OR: 2.1; CI: 1.6–2.7, increasing high: OR: 2.6; CI: 2.0–3.3) and those with comorbid mental disorders, most pronounced regarding schizophrenia/psychoses (rapidly increasing: OR: 6.7; CI: 2.9–19.5, increasing high: OR: 12.8; CI: 5.5–37.0), autism spectrum disorders (rapidly increasing: OR: 4.6; CI: 3.1–7.1, increasing high: OR: 9.6; CI: 6.5–14.6), anxiety/stress-related disorders (moderately increasing: OR: 1.3; CI: 1.1–1.7, rapidly increasing: OR: 2.0; CI: 1.6–2.5, increasing high: OR: 1.8; CI: 1.5–2.3) and depression/bipolar disorder (moderately increasing: OR: 1.3; CI: 1.0–1.6, rapidly increasing: OR: 1.7; CI: 1.4–2.2, increasing high: OR: 1.5; CI: 1.2–1.9).
ConclusionsAbout 61% of young adults were characterised by increasing LMM after a diagnosis of ADHD. To avoid marginalisation, attention should especially be given to young adults diagnosed with ADHD with a low educational level, that are single parents and who are living outside big cities. Also, young adults with comorbid mental disorders should be monitored for LMM early in working life.
Use of pharmacotherapies for treatment resistant depression in finland: A nationwide cohort study
- H. Taipale, M. Lähteenvuo, A. Tanskanen, S. Rannanpää, J. Tiihonen
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- Journal:
- European Psychiatry / Volume 64 / Issue S1 / April 2021
- Published online by Cambridge University Press:
- 13 August 2021, p. S108
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Introduction
There is a lack of knowledge on utilized pharmacotherapies for treatment resistant depression (TRD).
ObjectivesTo investigate the courses of treatment of TRD.
MethodsAll patients aged 16-65 years and diagnosed with depression in Finland during 2004-2016 were included (identified from nationwide registers for inpatient and specialized outpatient care, sick leaves and disability pensions). New antidepressant users were identified with six-month washout period and followed up for two years to observe the possible emergence of TRD, which was defined as initiation of a third treatment after having two failed pharmacological treatments with adequate duration. Pharmacological treatments were analyzed using PRE2DUP-method.
ResultsDuring follow-up, 177,144 persons had their first registered depression (mean age:39.5, 62.5% women). Of them, 10.9% (N=19,322) met TRD criteria. Among the TRD patients, most common first and second lines antidepressants were as follows: SSRIs (44.6%), mirtazapine (19.0%) and SNRIs (16.5%). As the third line of treatment, 44.2% of TRD patients had antidepressant monotherapy, 32.1% a combination of ≥2 antidepressants, 15.8% antipsychotic or mood stabilizer augmentation and an antidepressant, 4.9% both combination of antidepressants and an augmentation with a mood stabilizer or antipsychotic, 2.7% antipsychotic or mood stabilizer monotherapy and 0.3% ECT monotherapy. Of TRD patients, 36.2% (N=6985) progressed to the fourth line of treatment and most common treatments were antidepressant monotherapy (37.5%), antidepressant combinations (30.8%) and augmentation (20.3%).
ConclusionsAlthough antidepressant combination and augmentation strategies became more frequent, antidepressant monotherapies were still the most common third and fourth lines of depression treatment.
DisclosureThe study was funded by Janssen and SR is an employee of Janssen.
Associations between brain morphology and outcome in schizophrenia in a general population sample
- E. Jääskeläinen, P. Juola, J. Kurtti, M. Haapea, M. Kyllönen, J. Miettunen, P. Tanskanen, G.K. Murray, S. Huhtaniska, A. Barnes, J. Veijola, M. Isohanni
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- European Psychiatry / Volume 29 / Issue 7 / September 2014
- Published online by Cambridge University Press:
- 15 April 2020, pp. 456-462
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Objective
To analyse associations between brain morphology and longitudinal and cross-sectional measures of outcomes in schizophrenia in a general population sample.
MethodsThe sample was the Northern Finland 1966 Birth Cohort. In 1999–2001, structural brain MRI and measures of clinical and functional outcomes were analysed for 54 individuals with schizophrenia around the age of 34. Sex, total grey matter, duration of illness and the use of antipsychotic medication were used as covariates.
ResultsAfter controlling for multiple covariates, increased density of the left limbic area was associated with less hospitalisations and increased total white matter volume with being in remission. Higher density of left frontal grey matter was associated with not being on a disability pension and higher density of the left frontal lobe and left limbic area were related to better functioning. Higher density of the left limbic area was associated with better longitudinal course of illness.
ConclusionsThis study, based on unselected general population data, long follow-up and an extensive database, confirms findings of previous studies, that morphological abnormalities in several brain structures are associated with outcome. The difference in brain morphology in patients with good and poor outcomes may reflect separable aetiologies and developmental trajectories in schizophrenia.
The nature and correlates of paid and unpaid work among service users of London Community Mental Health Teams
- B. Lloyd-Evans, S. Marwaha, T. Burns, J. Secker, E. Latimer, R. Blizard, H. Killaspy, J. Totman, S. Tanskanen, S. Johnson
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- Epidemiology and Psychiatric Sciences / Volume 22 / Issue 2 / June 2013
- Published online by Cambridge University Press:
- 18 October 2012, pp. 169-180
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Aims.
Little is known about how the rates and characteristics of mental health service users in unpaid work, training and study compare with those in paid employment.
Methods.From staff report and patient records, 1353 mental health service users of seven Community Mental Health Teams in two London boroughs were categorized as in paid work, unpaid vocational activity or no vocational activity. Types of work were described using Standard Occupational Classifications. The characteristics of each group were reported and associations with vocational status were explored.
Results.Of the sample, 5.5% were in paid work and 12.7% were in unpaid vocational activity, (including 5.3% in voluntary work and 8.1% in study or training). People in paid work were engaged in a broader range of occupations than those in voluntary work and most in paid work (58.5%) worked part-time. Younger age and high educational attainment characterized both groups. Having sustained previous employment was most strongly associated with being in paid work.
Conclusions.Rates of vocational activity were very low. Results did not suggest a clear clinical distinction between those in paid and unpaid activity. The motivations for and functions of unpaid work need further research.