The association between overtime work and depression is still unclear. This study examined the association between overtime work and the onset of a major depressive episode (MDE).
Prospective cohort ...study with a baseline examination of working hours, psychological morbidity (an indicator of baseline depression) and depression risk factors in 1991-1993 and a follow-up of major depressive episode in 1997-1999 (mean follow-up 5.8 years) among British civil servants (the Whitehall II study; 1626 men, 497 women, mean age 47 years at baseline). Onset of 12-month MDE was assessed by the Composite International Diagnostic Interview (CIDI) at follow-up. In prospective analysis of participants with no psychological morbidity at baseline, the odds ratio for a subsequent major depressive episode was 2.43 (95% confidence interval 1.11 to 5.30) times higher for those working 11+ hours a day compared to employees working 7-8 hours a day, when adjusted for socio-demographic factors at baseline. Further adjustment for chronic physical disease, smoking, alcohol use, job strain and work-related social support had little effect on this association (odds ratio 2.52; 95% confidence interval 1.12 to 5.65).
Data from middle-aged civil servants suggest that working long hours of overtime may predispose to major depressive episodes.
Background
Early-life low socioeconomic position (SEP) increases the risk of adult major depression; however, associations vary according to the measure of SEP and adults’ life stage. Although ...maternal education often predicts offspring health better than other SEP indicators, including paternal education, it is unclear how maternal and paternal education differentially influence early-adult depression, and how early-life and adult risk factors may mediate the association.
Methods
Longitudinal data come from the Canadian National Population Health Survey from 1994/1995 to 2006/2007, restricted to a sample (
N
= 1,267) that was aged 12–24 years in 1994/1995. Past-year major depressive episode (MDE) was assessed in 2004/2005 and 2006/2007 using the Composite International Diagnostic Interview Short Form for Major Depression. Logistic regression models were used to estimate odds ratios (OR) and 95 % confidence intervals (CI) for the association between both maternal and paternal education and MDE, adjusting for respondent’s demographics, early-life adversities, adult SEP, psychosocial factors, and physical health.
Results
Offsprings of mothers with less than secondary school education had higher odds of MDE (adjusted OR 2.04, 95 % CI 1.25–3.32) relative to those whose mothers had more education. Paternal education was not associated with MDE. Although adult income, student status, psychosocial stress, and several early-life adversities remained associated with MDE in the fully adjusted model, the estimate for maternal education was not reduced.
Conclusions
Maternal education was associated with MDE in early adulthood, independent of paternal education and other early-life and early-adult risk factors.
Well-being is an important health outcome and a potential national indicator of policy success. There is a need for longitudinal epidemiological surveys to understand determinants of well-being. This ...study examines the role of personal social support and psychosocial work environment as predictors of well-being in an occupational cohort study.
Social support and work characteristics were measured by questionnaire in 5182 United Kingdom civil servants from phase 1 of the Whitehall II study and were used to predict subjective well-being assessed using the Affect Balance Scale (range -15 to 15, SD = 4.2) at phase 2. External assessments of job control and demands were provided by personnel managers.
Higher levels of well-being were predicted by high levels of confiding/emotional support (difference in mean from the reference group with low levels of confiding/emotional support = 0.63, 95%CI 0.38-0.89, p(trend)<0.001), high control at work (0.57, 95%CI 0.31-0.83, p(trend)<0.001; reference low control) and low levels of job strain (0.60, 95%CI 0.31-0.88; reference high job strain), after adjusting for a range of confounding factors and affect balance score at baseline. Higher externally assessed work pace was also associated with greater well-being.
Our results suggest that the psychosocial work environment and personal relationships have independent effects on subjective well-being. Policies designed to increase national well-being should take account of the quality of working conditions and factors that facilitate positive personal relationships. Policies designed to improve workplaces should focus not only on minimising negative aspects of work but also on increasing the positive aspects of work.
Many Canadian adolescents and young adults with mental health problems face delayed detection, long waiting lists, poorly accessible services, care of inconsistent quality and abrupt or absent ...inter-service transitions. To address these issues, ACCESS Open Minds, a multi-stakeholder network, is implementing and systematically evaluating a transformation of mental health services for youth aged 11 to 25 at 14 sites across Canada. The transformation plan has five key foci: early identification, rapid access, appropriate care, the elimination of age-based transitions between services, and the engagement of youth and families.
The ACCESS Open Minds Research Protocol has multiple components including a minimum evaluation protocol and a stepped-wedge cluster randomized trial, that are detailed in this paper. Additional components include qualitative methods and cost-effectiveness analyses. The services transformation is being evaluated at all sites via a minimum evaluation protocol. Six sites are participating in the stepped-wedge trial whereby the intervention (a service transformation along the key foci) was rolled out in three waves, each commencing six months apart. Two sites, one high-population and one low-population, were randomly assigned to each of the three waves, i.e., randomization was stratified by population size. Our primary hypotheses pertain to increased referral numbers, and reduced wait times to initial assessment and to the commencement of appropriate care. Secondary hypotheses pertain to simplified pathways to care; improved clinical, functional and subjective outcomes; and increased satisfaction among youth and families. Quantitative measures addressing these hypotheses are being used to determine the effectiveness of the intervention.
Data from our overall research strategy will help test the effectiveness of the ACCESS Open Minds transformation, refine it further, and inform its scale-up. The process by which our research strategy was developed has implications for the practice of research itself in that it highlights the need to actively engage all stakeholder groups and address unique considerations in designing evaluations of complex healthcare interventions in multiple, diverse contexts. Our approach will generate both concrete evidence and nuanced insights, including about the challenges of conducting research in real-world settings. More such innovative approaches are needed to advance youth mental health services research.
Clinicaltrials.gov, ISRCTN23349893 (Retrospectively registered: 16/02/2017).
Cumulative exposure to socioeconomic disadvantage across the life course may be inversely associated with coronary heart disease (CHD); the mechanisms are not fully clear. An objective of this study ...was to determine whether cumulative life-course socioeconomic position (SEP) is associated with CHD incidence in a well-characterized US cohort that had directly assessed childhood and adulthood measures of SEP and prospectively measured CHD incidence. Furthermore, analyses aimed to evaluate whether adjustment for CHD risk factors reduces the association between cumulative life-course SEP and CHD. The authors examined 1,835 subjects who participated in the Framingham Heart Study Offspring Cohort from 1971 through 2003 (mean age, 35.0 years; 52.4% women). Childhood SEP was measured as father's education; adulthood SEP was assessed as own education and occupation. CHD incidence included myocardial infarction, coronary insufficiency, and coronary death. Cox proportional hazards analyses indicated that cumulative SEP was associated with incident CHD after adjustment for age and sex (hazard ratio = 1.82, 95% confidence interval: 1.17, 2.85 for low vs. high cumulative SEP score). Adjustment for CHD risk factors reduced that magnitude of association (hazard ratio = 1.29, 95% confidence interval: 0.78, 2.13). These findings underscore the potential importance of CHD prevention and treatment efforts for those whose backgrounds include low SEP throughout life.
Maternal mortality ratio due to postpartum haemorrhage (PPH) is higher in France than in Canada. We explored this difference by comparing PPH features between these two countries.
Using data between ...2004 and 2006, we compared the incidence, risk factors, causes and use of second-line treatments, of PPH between France (N = 6,660 PPH) and Canada (N = 9,838 PPH). We assessed factors associated with PPH through multivariate logistic models.
PPH incidence, overall (4.8% (95% CI 4.7-4.9) in Canada and 4.5% (95% CI 4.4-4.7) in France), and after vaginal delivery (5.3% (95%CI 5.2-5.4) in Canada and 4.8 (95%CI 4.7-4.9) in France), were significantly higher in Canada than in France, but not after caesarean delivery. Women delivering without PPH were similar between the two populations, except for macrosomia (11% in Canada, 7% in France, p<0.001), caesarean delivery (27% in Canada, 18% in France, p<0.001), and episiotomy (17% in Canada, 34% in France, p<0.001). After vaginal delivery, factors strongly associated with PPH were multiple pregnancy, operative delivery and macrosomia in both populations, and episiotomy only in France (Odds Ratio 1.39 (95% CI 1.23-1.57)). The use of second-line treatments for PPH management was significantly more frequent in France than in Canada after both vaginal and caesarean delivery.
PPH incidence was not higher in France than in Canada and there was no substantial difference in PPH risk factors between the 2 countries. Greater use of second-line treatments in PPH management in France suggests a more frequent failure of first-line treatments and a higher rate of severe PPH, which may be involved in the higher maternal mortality ratio due to PPH.
OBJECTIVES: To estimate the predictive relationship between depressive symptoms and 8‐year dementia incidence in a large prospective community sample of French older adults and to compare the effect ...magnitude for men and women.
DESIGN: Prospective population‐based cohort with four interview waves and complete vital status ascertainment.
SETTING: Urban and rural communities in the Aquitaine Region (Gironde and Dordogne), southwest France.
PARTICIPANTS: Three thousand seven hundred seventy‐seven adults aged 65 and older residing in noninstitutional settings at study baseline.
MEASUREMENTS: Each participant was interviewed by a neuropsychologist and screened for dementia with the Mini‐Mental State Examination, a cognitive test battery, and a standardized questionnaire designed to ascertain the presence of the criteria for dementia according to the Diagnostic and Statistical Manual for Mental Disorders, Third Edition, Revised (DSM‐III‐R). Dementia status and subtype were confirmed using neurological examination and categorized according to DSM‐III‐R criteria for dementia and the National Institute of Neurological Disorders and Stroke/Alzheimer's and Related Disorders Association criteria. The Hachinski score was calculated to specify the etiology: possible or probable Alzheimer's disease, vascular dementia, and other types of dementia. Depressive symptomatology was evaluated using the Center for Epidemiologic Studies—Depression scale. Statistical analyses were weighted to correct for attrition not due to mortality.
RESULTS: Ninety‐seven men (incidence rate: 14.4/1,000) and 183 women (Incidence rate: 19.0/1,000) developed dementia during 8 years of follow‐up. Baseline prevalence of depressive symptomatology was 12.9% for men and 14.7% for women. Depressive symptoms increased risk of dementia at subsequent interview wave, but only for men (odds ratio (OR) (men) = 3.5, 95% confidence interval (CI) = 1.9–6.5; OR (women) = 1.2, 95% CI = 0.7–2.0, P‐value for sex difference = 0.03). The hypothesis that vascular depression might explain the observed sex difference was studied, and it was found that risk was 50% higher for men with hypertension who were depressed than for normotensive men. For women, hypertension status did not modify the absence of an association.
CONCLUSION: This study supports the hypothesis of a relationship between proximal depressive symptomatology and dementia in men, but distant depression did not increase dementia risk in this sample. The results suggest that depression in older men might reflect a form of vascular depression associated with cerebral vascular pathology or multiinfarct disease that may amplify the dementing or declining process, hence accelerating the onset of manifest symptoms of dementia.
This special issue of AJPH is a reflection of the growing need to conceptualize the assessment of diagnosis, trends, treatment, and stigma of psychiatric disorders as central foci of public health. ...We solicited an open call for manuscripts related to issues of population mental health, and the high number of quality scientific studies received bespeaks the prolific output of research within this field. Presented in this issue are a variety of articles selected for rigor, diversity of perspectives and topics, and heterogeneity in research on prevention and intervention. We also solicited commentaries and opinions from thought leaders in the field to advance our discussion through provocative and innovative thinking regarding mental health challenges around the globe.
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Population mental health refers to the distribution of mental health and wellness, as well as psychiatric disorders, within and across societies. In the first two decades of the 21st century, mental ...illness and psychiatric disorders in the United States and across the world are looming large as a cause of morbidity and mortality, and are far more often discussed in the public arena than before. Although psychiatric disorders have been recognized for generations as contributing to individual and societal burden, awareness of their impact on individuals, their families, and society, as well as the associated costs, is stronger than ever. Actions informed by best available evidence can no longer be postponed.Both by their frequency and consequences, psychiatric disorders affect societal health as measured by numerous health, social, and economic indicators. In this issue, we hope to shed light on the emerging challenges for improving population mental health. Psychiatric disorders, and their underlying mental health and wellness dimensions, remain among the most disabling health conditions worldwide, with significant burdens on individuals and societies (Vigo et al. Estimating the true global burden of mental illness. Lancet Psychiatry. 2016 ;3(2):171-178.).
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