The number of people seeking gender reassignment (GR) has increased everywhere and these increases particularly concern adolescents and emerging adults with female sex. It is not known whether the ...psychiatric needs of this population have changed alongside the demographic changes.
A register-based follow-up study of individuals who contacted the nationally centralized gender identity services (GIS) in Finland in 1996-2019 (gender dysphoria GD group,
= 3665), and 8:1 age and sex-matched population controls (
= 29,292). The year of contacting the GIS was categorized to 5-year intervals (index periods). Psychiatric needs were assessed by specialist-level psychiatric treatment contacts in the Finnish Care Register for Hospital Care in 1994-2019.
The GD group had received many times more specialist-level psychiatric treatment both before and after contacting specialized GIS than had their matched controls. A marked increase over time in psychiatric needs was observed. Among the GD group, relative risk for psychiatric needs after contacting GIS increased from 3.3 among those with the first appointment in GIS during 1996-2000 to 4.6 when the first appointment in GIS was in 2016-2019. When index period and psychiatric treatment before contacting GIS were accounted for, GR patients who had and who had not proceeded to medical GR had an equal risk compared to controls of needing subsequent psychiatric treatment.
Contacting specialized GIS is on the increase and occurs at ever younger ages and with more psychiatric needs. Manifold psychiatric needs persist regardless of medical GR.
The COVID-19 pandemic has caused an unequally distributed extra workload to hospital personnel and first reports have indicated that especially front-line health care personnel are psychologically ...challenged. A majority of the Finnish COVID-19 patients are cared for in the Helsinki University Hospital district. The psychological distress of the Helsinki University Hospital personnel has been followed via an electronic survey monthly since June 2020. We report six-month follow-up results of a prospective 18-month cohort study. Individual variation explained much more of the total variance in psychological distress (68.5%, 95% CI 65.2-71.9%) and negative changes in sleep (75.6%, 95% CI 72.2-79.2%) than the study survey wave (1.6%, CI 0.5-5.5%; and 0.3%, CI 0.1-1.2%). Regional COVID-19 incidence rates correlated with the personnel's psychological distress. In adjusted multilevel generalized linear multiple regression models, potentially traumatic COVID-19 pandemic-related events (OR 6.54, 95% CI 5.00-8.56) and front-line COVID-19 work (OR 1.81, 95% CI 1.37-2.39) was associated with personnel psychological distress but age and gender was not. While vaccinations have been initiated, creating hope, continuous follow-up and psychosocial support is still needed for all hospital personnel.
BackgroundAll-cause and suicide mortalities of gender-referred adolescents compared with matched controls have not been studied, and particularly the role of psychiatric morbidity in mortality is ...unknown.ObjectiveTo examine all-cause and suicide mortalities in gender-referred adolescents and the impact of psychiatric morbidity on mortality.MethodsFinnish nationwide cohort of all <23 year-old gender-referred adolescents in 1996–2019 (n=2083) and 16 643 matched controls. Cox regression models with HRs and 95% CIs were used to analyse all-cause and suicide mortalities.FindingsOf the 55 deaths in the study population, 20 (36%) were suicides. In bivariate analyses, all-cause mortality did not statistically significantly differ between gender-referred adolescents and controls (0.5% vs 0.3%); however, the proportion of suicides was higher in the gender-referred group (0.3% vs 0.1%). The all-cause mortality rate among gender-referred adolescents (controls) was 0.81 per 1000 person-years (0.40 per 1000 person-years), and the suicide mortality rate was 0.51 per 1000 person-years (0.12 per 1000 person-years). However, when specialist-level psychiatric treatment was controlled for, neither all-cause nor suicide mortality differed between the two groups: HR for all-cause mortality among gender-referred adolescents was 1.0 (95% CI 0.5 to 2.0) and for suicide mortality was 1.8 (95% CI 0.6 to 4.8).ConclusionsClinical gender dysphoria does not appear to be predictive of all-cause nor suicide mortality when psychiatric treatment history is accounted for.Clinical implicationsIt is of utmost importance to identify and appropriately treat mental disorders in adolescents experiencing gender dysphoria to prevent suicide.
This study explored the relationship between cultural leisure activities, recovery experiences and two outcomes among hospital workers. The differences in recovery experiences (detachment, ...relaxation, mastery and control) and outcomes (work engagement and subjective recovery state) among hospital personnel (N=769) were analysed by the type (receptive or creative) and frequency of cultural activities. The cross-sectional data were collected by a digital questionnaire. Employees who reported both receptive and creative cultural leisure activities on a weekly basis had the highest relaxation, mastery and control experiences during off-job time. In addition, those with weekly creative activities had beneficial mastery experiences. There were no differences in recovery outcomes after adjustment for age, except in work engagement. Cultural leisure activities, and creative activities in particular, play an important role in certain aspects of recovery.
Abstract
Background
The COVID-19 pandemic strained healthcare workers but the individual challenges varied in relation to actual work and changes in work. We investigated changes in healthcare ...workers’ mental health under prolonging COVID-19 pandemic conditions, and heterogeneity in the mental-health trajectories.
Methods
A monthly survey over a full year was conducted for employees of the HUS Helsinki University Hospital (
n
= 4804) between 4th June 2020 to 28th May 2021. Pandemic-related potentially traumatic events (PTEs), work characteristics (e.g., contact to COVID-19 patients), local COVID-19 incidence, and demographic covariates were used to predict Mental Health Index-5 (MHI-5) and Insomnia Severity Index (ISI) in generalized multilevel and latent-class mixed model regressions.
Results
Local COVID-19 log-incidence (odds ratio, OR = 1.21, with 95% CI = 1.10–1.60), directly caring for COVID-19 patients (OR = 1.33, CI = 1.10–1.60) and PTEs (OR = 4.57, CI = 3.85–5.43) were all independently associated with psychological distress, when (additionally) adjusting for age, sex, profession, and calendar time. Effects of COVID-19 incidence on mental health were dissociable from calendar time (i.e., evolved in time) whereas those on sleep were not. Latent mental-health trajectories were characterized by a large class of “stable mental health” (62% of employees) and minority classes for “early shock, improving” (14%) and “early resilience, deteriorating” mental health (24%). The minority classes, especially “early shock, improving”, were more likely to live alone and be exposed to PTEs than the others.
Conclusions
Healthcare workers faced changing and heterogeneous mental-health challenges as the COVID-19 pandemic prolonged. Adversity and mental ill-being may have accumulated in some employees, and factors like living arrangements may have played a role. Knowledge on employees’ demographic and socioeconomic background, as well as further research on the factors affecting employees’ resilience, may help in maintaining healthy and efficient workforce in the face of a prolonging pandemic.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
IntroductionInsomnia is a common symptom among patients with schizophrenia and schizoaffective disorder, negatively impacting symptom severity, functioning and well-being; however, it is rarely the ...direct focus of treatment. The main recommended treatment for insomnia is cognitive behavioural therapy (CBT-I). There is some evidence that CBT-I can also be used to treat insomnia in patients with schizophrenia, but only a few randomised controlled trials (RCTs) have been published. The aim of this ongoing RCT is to determine whether we can alleviate symptoms of insomnia and improve the quality of life in patients with schizophrenia and schizoaffective disorder through CBT-I delivered via the internet or in a group mode.Methods and analysesThe aim of this study is to recruit 84–120 outpatients from the Psychosis Clinics of Helsinki University Hospital and the City of Helsinki Health Services. The main inclusion criteria are a diagnosis of schizophrenia or schizoaffective disorder and self-reported sleep problems. The study will be performed on a cyclic basis, with a target of 12–24 patients per cycle. Participants are randomly assigned into three groups: (1) a group receiving only treatment as usual (TAU), (2) internet-based individual therapy for insomnia (iCBT-I)+TAU or (3) group therapy for insomnia (GCBT-I) conducted via a virtual platform+TAU. The primary outcome measures are quantitative changes in the Insomnia Severity Index score and/or changes in health-related quality of life using the 15D quality of life measure. Secondary outcomes include self-reported variables for sleep, health, stress and the severity of psychotic and depressive symptoms; objective outcomes include actigraphy and bed sensor data to evaluate circadian rhythms and motor activity. Outcome measures are assessed at baseline and after the treatment period at weeks 12, 24 and 36.Ethics and disseminationThe Coordinating Ethics Committee of the Hospital District of Helsinki and Uusimaa, Finland, approved the study protocol. The results will be published in peer-reviewed journals.Trial registration number NCT04144231.
Chronic nonspecific symptoms attributed to indoor nonindustrial work environments are common and may cause disability, but the medical nature of this disability is unclear. The aim was to medically ...characterize the disability manifested by chronic, recurrent symptoms and restrictions to work participation attributed to low-level indoor pollutants at workplace and whether the condition shares features with idiopathic environmental intolerance.
We investigated 12 patients with indoor air–related work disability. The examinations included somatic, psychological, and psychiatric evaluations as well as investigations of the autonomic nervous system, cortisol measurements, lung function, and allergy tests. We evaluated well-being, health, disability, insomnia, pain, anxiety, depression, and burnout via questionnaires.
The mean symptom history was 10.5 years; for disabling symptoms, 2.7 years. Eleven patients reported reactions triggered mainly by indoor molds, one by fragrances only. Ten reported sensitivity to odorous chemicals, and three, electric devices. Nearly all had co-occurrent somatic and psychiatric diagnoses and signs of pain, insomnia, burnout, and/or elevated sympathetic responses. Avoiding certain environments had led to restrictions in several life areas. On self-assessment scales, disability showed higher severity and anxiety showed lower severity than in physician assessments.
No medical cause was found to explain the disability. Findings support that the condition is a form of idiopathic environmental intolerance and belongs to functional somatic syndromes. Instead of endless avoidance, rehabilitation approaches of functional somatic syndromes are applicable.
The increasing mental demands of healthcare work call for developing complementary health promotion strategies. Cultural leisure activities have long been recognized as a source of wellbeing and ...coping for employees. Yet, little is known about implementation of employer-provided cultural activities—how they are encountered and experienced. In this study, a public sector hospital department offered monthly cultural events for personnel: Theater, concerts, musicals, dance-performances, museum visits and sight-seeing. A digital questionnaire was sent to hospital staff (N = 769) to ask about their participation in employer-provided cultural activities during the past 6 months. The motives and obstacles for participation, and the quality of experience of the cultural events, were explored quantitatively and qualitatively. The main motives for participation were related to well-being, content of cultural events and invitations from employer or colleagues. For some, the participation was hampered by work-shifts and missing information. The participants experienced recreation, relaxation and psychological detachment from strain, which is essential for recovery. Community participation was more common than individual participation. Shared cultural experiences among employees may increase the social capital at workplace, but equal access for all employees should be guaranteed.
Simpson-Angus Scale (SAS) is an established instrument for neuroleptic-induced parkinsonism (NIP), but its statistical properties have been studied insufficiently. Some shortcomings concerning its ...content have been suggested as well. According to a recent report, the widely used SAS mean score cut-off value 0.3 of for NIP detection may be too low. Our aim was to evaluate SAS against DSM-IV diagnostic criteria for NIP and objective motor assessment (actometry).
Ninety-nine chronic institutionalised schizophrenia patients were evaluated during the same interview by standardised actometric recording and SAS. The diagnosis of NIP was based on DSM-IV criteria. Internal consistency measured by Cronbach's alpha, convergence to actometry and the capacity for NIP case detection were assessed.
Cronbach's alpha for the scale was 0.79. SAS discriminated between DSM-IV NIP and non-NIP patients. The actometric findings did not correlate with SAS. ROC-analysis yielded a good case detection power for SAS mean score. The optimal threshold value of SAS mean score was between 0.65 and 0.95, i.e. clearly higher than previously suggested threshold value.
We conclude that SAS seems a reliable and valid instrument. The previously commonly used cut-off mean score of 0.3 has been too low resulting in low specificity, and we suggest a new cut-off value of 0.65, whereby specificity could be doubled without loosing sensitivity.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Objective This study examined whether indicators of poor health and health risk behaviors among hospital staff differ between the ward specialties. Methods Across 21 hospitals in Finland, 8003 ...employees (mean age 42 years, 87% women, 86% nurses) working in internal medicine, surgery, obstetrics and gynecology, pediatrics, intensive care, and psychiatry responded to a baseline survey on health and health risk behaviors (response rate 70%). Responses were linked to records of sickness absence and medication over the following 12 months. Results Psychiatric staff had higher odds of smoking odds ratio (OR) 2.58,95% confidence interval (95% CI) 2.14-3.12, high alcohol use (OR 1.55, 95% CI 1.21-1.99), physical inactivity (OR 1.30, 95% CI 1.11-1.53), chronic physical disease (OR 1.19, 95% CI 1.04-1.36), current or past mental disorders (OR 1.81, 95% CI 1.50-2.17), and co-occurring poor health indicators (OR 2.65,95% CI 2.08-3.37) as compared to those working in other specialties. They also had higher odds of sickness absence due to mental disorders (OR 1.40, 95% CI 1.02-1.92) and depression (OR 1.61, 95% CI 1.02-2.55) at follow-up after adjustment for baseline health and covariates. Personnel in surgery had the lowest probability of morbidity. No major differences between specialties were found in the use of psychotropic medication. Conclusion The prevalence of hospital employees with an adverse health risk profile is higher in psychiatric wards than other specialties.
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