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Since 1980s, several reports, based mainly in hospital registers, have suggested that the incidence of schizophrenia is decreasing. However, changes in capacity of mental hospitals, in admission policy and in diagnostic practice have not always been taken into account.
Our aim was to study 1) how annual first admission rate for schizophrenia varied during a quick deinstitutiolisation period in Finland and 2) how it was associated with changes in admission policy and diagnostic practice.
From the National Hospital Discharge Register, we identified 30 041, 15 to 64 year old patients admitted for the first time for schizophrenia to mental hospital in Finland between 1980 and 2003, as well as numbers of annual inpatient days in and all patients admitted to mental hospitals. Rates for all admitted patients and first-admitted schizophrenia patients (RFASpo) were calculated and analysed with Poisson regression analysis.
RFASpo decreased from 56.4 in 1980 to 29.5 in 1991, stayed stable until 1998 and slightly increased thereafter (30.8 in 1998 and 37.8 in 2003). Changes in RFASpo, coincided with changes in all admissions and periods of official diagnostic classifications. RFASpo varied also between gender and age groups.
In 1980s, decrease of first-admission rate for schizophrenia seemed to be dependent on change in admission policy, in number of mental beds available and in diagnostic practice. In 1990s, increase of first-admission rate for schizophrenia may be associated with economic recession and increased number of beds for adolescents.
In the general population the 12-month prevalence of GAD is estimated to be about 2%. Higher prevalences have been found in primary care settings, with estimates of well over 6%. The role of sleep problems and pain in GAD remains understudied.
To evaluate the frequency of sleep problems and pain in newly diagnosed GAD patients in 5 European countries.
Non-interventional, cross-sectional survey of 1650 adult patients newly diagnosed with GAD in primary care settings. Assessment included clinical interview rating and self report data.
Mean age of the sample was 49.2 years (SD; 14.5). Mean GAD-7 score was 14.8 (SD; 3.1) and the median duration of symptoms was 12.0 months. The proportion with sleep disturbance and pain were 85.9% and 75.9%, respectively. Disturbed sleep had persisted for a median of 9.0 months and was mainly classified as “difficulty in falling asleep” (76.1%) or “nocturnal awakening” (58.8%). The median duration of pain was 6.0 months, and located mainly in the cervical region (47.0%) and upper back/limbs (40.1%). The mean number of days that patients were unable to work because of GAD-related health problems during the preceding 3 month period was 10.8 (95%CI; 9.6-12.0). The proportion of patients that visited the primary care physician and specialist during the preceding 3 months was 93.8% and 40.3%, respectively.
Sleep problems and pain are extremely frequent characteristics of GAD, contributing to the disability and work productivity profile associated with GAD as well as the patients’ use of health care resources.
Results of adulthood mental health of those born late-preterm (34 + 0–36 + 6 weeks + days of gestation) are mixed and based on national registers. We examined if late-preterm birth was associated with a higher risk for common mental disorders in young adulthood when using a diagnostic interview, and if this risk decreased as gestational age increased.
A total of 800 young adults (mean = 25.3, s.d. = 0.62 years), born 1985–1986, participated in a follow-up of the Arvo Ylppö Longitudinal Study. Common mental disorders (mood, anxiety and substance use disorders) during the past 12 months were defined using the Composite International Diagnostic Interview (Munich version). Gestational age was extracted from hospital birth records and categorized into early-preterm (<34 + 0, n = 37), late-preterm (34 + 0–36 + 6, n = 106), term (37 + 0–41 + 6, n = 617) and post-term (⩾42 + 0, n = 40).
Those born late-preterm and at term were at a similar risk for any common mental disorder [odds ratio (OR) 1.11, 95% confidence interval (CI) 0.67–1.84], for mood (OR 1.11, 95% CI 0.54–2.25), anxiety (OR 1.00, 95% CI 0.40–2.50) and substance use (OR 1.31, 95% CI 0.74–2.32) disorders, and co-morbidity of these disorders (p = 0.38). While the mental disorder risk decreased significantly as gestational age increased, the trend was driven by a higher risk in those born early-preterm.
Using a cohort born during the advanced neonatal and early childhood care, we found that not all individuals born preterm are at risk for common mental disorders in young adulthood – those born late-preterm are not, while those born early-preterm are at a higher risk. Available resources for prevention and intervention should be targeted towards the preterm group born the earliest.