| New articles - Uudet artikkelit 6.11.2006 - ISI Web of Knowledge & PubMed Search Alert |
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Contribution of burnout to the association between job strain
and depression: The health 2000 study
Ahola, K., Honkonen, T., Kivimaki, M., Virtanen, M., Isometsa, E., Aromaa, A. and Lonnqvist, J. Journal of Occupational and Environmental Medicine. 2006; 48(10): 1023-1030. Article. IF 1.886 Objective: The objective of this study was to investigate the contribution of burnout to the association between job strain and depression. Methods: A representative sample of 3270 Finnish employees aged 30 to 64 years responded to the Maslach Burnout Inventory-General Survey and the Beck Depression Inventory and participated in the Composite International Diagnostic Interview. Results: High strain compared with low strain was associated with 7.4 (95% confidence interval [CI] = 5.6-9.7) times higher odds of burnout, 3.8 (95% CI = 2.8-5.1) times higher odds of depressive symptoms, and 1.7 (95% CI = 1.1-2.6) times higher odds of depressive disorders. The risk for depressive symptoms and for depressive disorders of high strain was reduced by 69% or more after adjusting for burnout. Conclusion: Burnout is strongly related to job strain and may in part mediate the association between job strain and depression. Berghall, H., Siren, J., Sarkar, D., Julkunen, I., Fisher, P. B., Vainionpaa, R. and Matikainen, S. Microbes and Infection. 2006; 8(8): 2138-2144. Article. IF 3.154 Activation of host cell antiviral responses is mediated by receptors detecting the presence of viruses. Here we have studied the role of double-stranded RNA (dsRNA) binding molecules melanoma differentiation-associated gene 5 (mda-5), retinoic acid inducible gene I (RIG-I), and Toll-like receptor 3 (TLR3) in measles virus (MV)-induced expression of antiviral cytokines and chemokines in human A549 lung epithelial cells and human umbilical vein endothelial cells (HUVECs). We show that MV infection results in the activation of mda-5, RIG-I, and TLR3 gene expression that is followed by high expression of interferon (IFN)-beta, interleukin (IL)-28 and IL-29, CCL5, and CXCL10 genes. We also demonstrate that IFN-alpha and IFN-beta upregulate mda-5, RIG-I, and TLR3 gene expression in epithelial and endothelial cell lines. Forced expression of mda-5, but not that of RIG-I or TLR3, leads to enhanced IFN-beta promoter activity in MV-infected A549 cells. Our results suggest that IFN-inducible mda-5 is involved in MV-induced expression of antiviral cytokines. (c) 2006 Elsevier SAS. All rights reserved. Broms, U., Madden, P. A. F., Heath, A. C., Pergadia, M. L., Shiffman, S. and Kaprio, J. Behavior Genetics. 2006; 36(6): 958-958. Meeting Abstract. IF 3.171 Composition of brain oscillations in ongoing EEG during major depression disorder Fingelkurts, A. A., Fingelkurts, A. A., Rytsala, H., Suominen, K., Isometsa, E. and Kahkonen, S. Neuroscience Research. 2006; 56(2): 133-144. Article. IF 2.184 In the present study, we examined the composition of
electroencephalographic (EEG) brain oscillations in 12 unmedicated
major depressive outpatients and 10 healthy subjects during resting
conditions (closed eyes). The exact composition of brain
oscillations was assessed by the probability-classification
analysis of short-term EEG spectral patterns. In contrast to
previous studies of depression, the current study found that major
depression affects brain activity in nearly the whole cortex and
manifests itself in considerable reorganization of the composition
of brain oscillations in a broad frequency range: 0.5-30 Hz. At the
same time, the magnitude of the effect of depression was maximal in
the posterior cortex of the brain. Interhemisphere asymmetry during
major depression was also observed in the whole cortex with right
hyperactivity in frontal, parietal and occipital brain areas. It is
suggested that depressive brain is manifested in the superposition
of distributed multiple oscillations. Our findings provide new
insight on the relationship between major depressive disorder and
cortical oscillatory activity. Perceived financial difficulties and maladjustment outcomes in adolescence Frojd, S., Marttunen, M., Pelkonen, M., von der Pahlen, B. and Kaltiala-Heino, R. European Journal of Public Health. 2006; 16(5): 542-548. Article. IF 1.118 Background: Studies using traditional SES indicators in strictly adolescent populations have usually failed to find class differences in adolescent mental health. The present study aimed to find out whether there is an association between adolescent perceived financial difficulties of the family and adolescent maladjustment, and to explore the possible sex differences in this association. Methods: School-based survey on 3278 ninth grade students (15-16 years old) in two economically well developed Finnish cities. Results: One-fifth of the adolescents reported that their family had financial difficulties in the previous 12 months. Perceiving financial difficulties was significantly more common among girls than boys. Perceived financial difficulties were associated with known risk factors of poverty and with depression and harmful drinking patterns in both sexes. Adjusting for parental educational levels, parental unemployment and family structure did not change the significant association with maladjustment outcomes. Additional adjustment with comorbidity, however, levelled out the significance of the association of perceived financial difficulties and harmful drinking patterns in boys. Conclusion: While adolescent perception of financial difficulties is probably associated with the objective financial situation of the family it may also be an indicator of the psychological meaning attached to the situation and should thus be considered a possible risk factor for adolescent maladjustment in clinical practice. Hannula, J. A., Lahtela, K., Jarvikoski, A., Salminen, J. K. and Makela, P. Nordic Journal of Psychiatry. 2006; 60(5): 372-378. Article. IF 0.964 The aim was to present the content of the newly developed observer rating scale of work ability - The Occupational Functioning Scale (OFS) - and its basic psychometric properties. Psychiatric disorders cause functional impairment in several domains, including occupational functioning. The assessment of work-related functioning is often neglected in psychiatric research, partly due to a lack of reliable and valid instruments. The validity of OFS was evaluated by comparing it with other work ability measures (SAS-work, Work Ability Index, sickness absence) and to non-work-ability related measures [ Inventory of Interpersonal Problems (IIP), Symptom Check List - General Symptomatic Index (SCL-90-GSI)] in 150 patients with depressive or anxiety disorders. Reliability was determined by 39 videotaped interviews rated by four judges. OFS showed excellent inter-rater reliability (intraclass correlation =0.91) and good criterion validity by being more strongly related to other scales of occupational functioning (vertical bar r vertical bar = 0.39 - 0.47) than to measures of general distress (SCL-90-GSI) and interpersonal problems (IIP)(vertical bar r vertical bar = 0.26 and 0.12). OFS is a simple, reliable and clinically meaningful instrument for assessment of work ability in depressive and anxiety disorders. Helasoja, V., Lahelma, E., Prattala, R., Klumbiene, J., Pudule, I. and Tekkel, M. Public Health. 2006; 120(9): 841-853. Article. IF 0.986 Background: Socioeconomic inequalities in health in the Baltic countries are possibly increasing due to concomitant pressures. This study compared time trends from 1994 to 2004 in the pattern and magnitude of educational inequalities in health in Estonia, Latvia, Lithuania and Finland. Methods: The data were gathered from cross-sectional postal surveys of the Finbalt project, conducted every second year since 1994 on adult populations (aged 20-64 years) in Estonia (n = 9049), Latvia (n = 7685), Lithuania (n = 11634) and Finland (n = 18821). Three self-reported health indicators were used: (i) less than good perceived health, (ii) diagnosed diseases, and (iii) symptoms. Results: The existing educational inequalities in health in three Baltic countries and Finland remained generally stable over time from 1994 to 2004. Also, the overall prevalence of all three health indicators was generally stable, but in the Baltic countries improvement in perceived health was mainly found among the better-educated men and women. Diagnosed diseases increased in the Baltic countries, except Lithuania, where diseases decreased among the better-educated women. Symptoms increased among the better-educated Estonian and Finnish women. Conclusions: The period from 1994 to 2004 of relative
stabilization since the worst conditions of the social transition
has not been followed by notable changes in self-reported health,
and this appears to be the situation across all educational groups
in the Baltic countries. While health inequalities did not markedly
change, substantial inequalities do remain, and there were
indications of favourable developments mainly among the
better-educated respondents. The factors contributing towards
increasing health inequalities may only be visible in the
future. Huurre, T., Eerola, M., Rahkonen, O. and Aro, H. J Affect Disord. 2006. Journal article. IF 3.078 BACKGROUND: The aim of this prospective longitudinal study of adolescents was to investigate socioeconomic differences in adult depression and in the domain of social support from adolescence to adulthood. We also studied the modifying effect of social support on the relationship between socioeconomic status (SES) and depression. METHODS: All 16-year-old ninth-grade school pupils of one Finnish city completed questionnaires at school (n=2194). Subjects were followed up using postal questionnaires when aged 22 and 32 years. RESULTS: At 32 years of age there was a social gradient in depression, with a substantially higher prevalence among subjects with lower SES. Low parental SES during adolescence did not affect the risk of depression at 32 years of age, but the person's lower level of education at 22 years did. Lower level of support among subjects with lower SES was found particularly in females. Some evidence indicated that low level of social support had a greater impact on depression among lower SES group subjects. However, this relationship varied depending on the domain of social support, life stage and gender. On the other hand, the results did not support the hypothesis that social support would substantially account for the variation in depression across SES groups. LIMITATIONS: The assessments and classifications of social support were rather brief and crude, particularly in adolescence and early adulthood. CONCLUSIONS: It is important to pay attention to social support resources in preventive programs and also in the treatment settings, with a special focus on lower SES group persons. Official marital status, cohabiting, and self-rated health-time trends in Finland, 1978-2001 Joutsenniemi, K. E., Martelin, T. P., Koskinen, S. V., Martikainen, P. T., Harkanen, T. T., Luoto, R. M. and Aromaa, A. J. European Journal of Public Health. 2006; 16(5): 476-483. Article. IF 1.118 Background: Married persons are healthier and live longer than single, divorced, and widowed persons. Time trends in self-rated health (SRH) by marital status and cohabitation have remained largely unstudied. We aim to assess the levels and trends of SRH by official marital status and cohabitation, and to study the causes of these differences. Methods: Two nationally representative cross-sectional surveys were conducted 20 years apart in Finland. Data on self-reported marital status, SRH, education, smoking, and long-standing illness were collected from Finns aged 30 - 64 years in 1978 - 80 (Mini-Finland Health Survey, N 6102, response rate 96%) and 2000 - 01 (Health 2000 Survey, N 5871, response rate 92%). Results: SRH has improved in the last 20 years, but differences between marital status groups have not reduced. In 2000 - 01, non-married persons reported worse SRH than married persons. Among men, single [cumulative odds ratio (COR) 1.55; 95% confidence interval (95% CI) 1.22 - 1.99] and divorced (COR 1.55; 95% CI 1.17 - 2.05) persons showed the poorest SRH, while among women widows (1.53; 95% CI 1.04 - 2.26) were the most disadvantaged group. The SRH of cohabiting persons did not significantly differ from that of married persons. Differences in educational structure, smoking, and the prevalence of long-term illness explain part of the marital status differences in SRH among men, but less so among women. Among both single men and women as well as among widowed women, SRH had improved slightly less than in the other groups. Conclusion: The challenges on public health posed by growing numbers of currently not married people are likely to increase. Keski-Nisula, L., Pekkanen, J., Xu, B., Putus, T. and Koskela, P. Allergy. 2006; 61(12): 1467-72. Journal Article. IF 4.120 Background: Maternal use of oral contraceptive pills (OCPs) might increase the prevalence of allergic diseases among offspring. The aim of the study was to clarify if there are differences between OCP types in this association. Methods: Primary outcomes were asthma, allergic rhinitis and atopic eczema among 1182 children (618 asthmatic and 564 controls) aged 5-6 years. Results: Maternal previous use of desogestrel, gestodene or cyproterone acetate before pregnancy, each combined with ethinyloestradiol (EO), increased the risk of allergic rhinitis among offspring compared with those children whose mothers had not used OCPs (OR 1.67, 95% CI 1.07-2.59, P < 0.024), and this risk was increased mainly in those children with parental allergy (OR 1.78, 95% CI 1.11-2.86, P < 0.018), especially in boys (OR 2.12, 95% CI 1.17-3.84, P < 0.014). No associations were observed between maternal use of OCPs before pregnancy and asthma or atopic eczema among offspring. The association between the previous use of OCPs and allergic rhinitis was not mediated through maternal sex steroid levels during early pregnancy, but women who had used more androgenic types of progestin formulas had higher serum levels of progesterone during early pregnancy. Conclusion: Maternal previous use of desogestrel, gestodene or cyproterone acetate before pregnancy, each combined with EO, increased the risk of allergic rhinitis among offspring compared with those children whose mothers had not used OCPs and this risk was detected mainly in boys and in children with parental allergy. Kestila, L., Koskinen, S., Martelin, T., Rahkonen, O., Pensola, T., Aro, H. and Aromaa, A. Eur J Public Health. 2006; 16(3): 306-15. Journal Article. IF 1.118 BACKGROUND: Of the many studies assessing the impact of childhood living conditions on health and health inequalities in adulthood, only few have combined information on current determinants of health with detailed individual level data on different aspects of childhood living conditions and adversities. This study aims (i) to assess the role of parental education, self-reported childhood adversities and family structure as determinants of different dimensions of health in early adulthood, and (ii) to identify the role of the respondent's own education as a modifier of the association between childhood living conditions and health. METHODS: The study is based on a representative sample (n = 3669; participation rate 83%) of young adults aged 18-39 years in 2000 in Finland. The main outcome measures were poor self-rated health (SRH), psychological distress (by GHQ12) and somatic morbidity. RESULTS: Parental education, problems in childhood and the respondent's own education were independently related to SRH and psychological distress. The impact of childhood living conditions on health varied by gender and according to the measure of health. Childhood conditions were strongly associated with poor SRH and psychological distress, whereas the connection with somatic morbidity was weaker. The associations remained relatively unchanged after controlling for the respondent's own education. CONCLUSIONS: Childhood living conditions and adversities are strongly associated with poor SRH and psychological distress in early adulthood. Early recognition of childhood adversities followed by relevant support measures may play an important role in preventing health problems in adulthood. Kilkkinen, A., Heistaro, S., Laatikainen, T., Janus, E., Chapman, A., Absetz, P. and Dunbar, J. Diabetes Res Clin Pract. 2006. Journal article. IF 1.236 Although clinical trials have shown that lifestyle modifications reduce the risk of type 2 diabetes, translating lessons from trials to primary care remains a challenge. The aim of the study was to evaluate efficacy and feasibility of primary care-based diabetes prevention model with modest resource requirements in rural Australia. Three hundred and eleven subjects with at least a moderate risk of type 2 diabetes participated in a combined dietary and physical activity intervention. Clinical measurements and fasting blood samples were taken at the baseline and after intervention. After 3 months intervention, total (change -3.5%, p<0.001) and LDL cholesterol (-4.8%, p<0.001) plasma levels as well as body mass index (-2.5%, p<0.001), weight (-2.5%, p<0.001), and waist (-1.6%, p<0.001) and hip (-2.7%, p<0.001) circumferences reduced significantly. A borderline reduction was found in triglyceride levels (-4.8%, p=0.058) while no changes were observed in HDL cholesterol (+0.6%, p=0.525), glucose (+0.06%, p=0.386), or systolic (-0.98%, p=0.095) or diastolic (-1.06%, p=0.134) blood pressure levels. In conclusion, a lifestyle intervention improved health outcomes - especially obesity and blood lipids - in a population at high risk of developing type 2 diabetes. Our results suggest that the present model is effective and feasible to carry out in primary care settings. Lahti, T. A., Leppamaki, S., Lonnqvist, J. and Partonen, T. Neurosci Lett. 2006; 406(3): 174-7. Journal Article. IF 1.898 Daylight saving time (DST) is widely adopted. We explored the effects of transition to daylight saving time on sleep. With the use of wrist-worn accelerometers, we monitored the rest-activity cycles on a sample of 10 healthy adults for 10 days around the transition to summer time. Identical measurement protocols were carried out twice on the same individuals during the transitions in the years of 2003 and 2004, yielding data on 200 person-days for analysis. Both sleep duration and sleep efficiency were reduced after the transition both years. After the transition sleep time was shortened by 60.14min (P<0.01) and sleep efficiency was reduced by 10% (P<0.01) on average. Transition to daylight saving time appears to compromise the process of sleep by decreasing both sleep duration and sleep efficiency. Liukkonen, T., Silvennoinen-Kassinen, S., Jokelainen, J., Rasanen, P., Leinonen, M., Meyer-Rochow, V. B. and Timonen, M. Biological Psychiatry. 2006; 60(8): 825-830. Article. IF 6.779 Background: To investigate whether depressive episodes (previous, current single, and recurrent) are associated in both genders with highly sensitive C-reactive protein (hs-CRP) levels, earlier recommended for risk assessment of cardiovascular disease. The impact of the severity of current single and recurrent depressive episodes on this putative association was also investigated. Methods: The genetically homogeneous Northern Finland 1966 Birth Cohort was followed until age 31, when, in a cross-sectional setting (n = 5269), the highly sensitive enzyme immunoassay (bs-F-IA) method was used to measure CRP concentration. Depressive episodes were defined through mailed questionnaires, including Hopkins Symptom Checklist-25 (HSCL-25) and information oil. self-reported, doctor-diagnosed depression. Results: After adjusting for confounders, logistic regression analyses showed that in male subjects, elevated hs-CRP levels (>= 1.0 mg/L) fold, respectively. Correspondingly, an increased the probability for severe current and recurrent depressive episodes 1.7-fold and 3.1-fold level of > 3.0 mg/L increased the probability for recurrent depression up to 4.1-fold. In female subjects, no statistically significant associations were found. Conclusions: Our results support the hypothesis that an activation of systemic inflammatory Processes may contribute to the pathophysiology of severe depression in men. Further investigations are needed regarding the impact of our findings on diagnostic/treatment strategies concerning severe and, especially recurrent, depression in men. Pelkonen, M., Notkola, I. L., Nissinen, A., Tukiainen, H. and Koskela, H. Chest. 2006; 130(4): 1129-1137. Article. IF 4.008 Purpose: To describe the 30-year cumulative incidence of chronic bronchitis and COPD in relation to smoking habits. The effect of chronic bronchitis on pulmonary function and mortality was also examined. Methods: Middle-aged men belonging to two rural Finnish cohorts of the Seven Countries Study (n = 1,711 in 1959) were followed up for up to 40 years until 2000. Standard questionnaires were used to measure chronic bronchitis, and repeated spirometry was used to evaluate pulmonary function during the 30 years. Forty-year mortality data were examined. Results: The cumulative incidence of chronic bronchitis and COPD was 42% and 32%, respectively, in continuous smokers, compared to 26% and 14% in ex-smokers and 22% and 12% in never-smokers. During the follow-up, subjects with chronic bronchitis had on average 252 mL (95% confidence interval, 211 to 293 mL) lower forced expiratory volume than those without it. The decrease in forced expiratory volume attributable to chronic bronchitis was most pronounced in those with persistent symptoms and in smokers. In subjects with chronic bronchitis, all-cause mortality was increased by a hazard ratio of 1.30 (95% confidence interval, 1.02 to 1.65). Smokers with chronic bronchitis who decreased their daily cigarette consumption increased their median life span by 2.4 years. Conclusions: The lifetime risk of chronic bronchitis among smokers is approximately two in five, and almost one half of smokers who have chronic bronchitis, also acquire COPD. Chronic bronchitis is related to earlier death, also in never-smokers, probably partly through a rapid decline in pulmonary function. Siren, J., Imaizumi, T., Sarkar, D., Pietila, T., Noah, D. L., Lin, R. T., Hiscott, J., Krug, R. M., Fisher, P. B., Julkunen, I. and Matikainen, S. Microbes and Infection. 2006; 8(8): 2013-2020. Article. IF 3.154 Activation of host cell antiviral responses is mediated by
pattern recognition receptors. Cytoplasmic RNA helicases, retinoic
acid inducible gene-I (RIG-I) and melanoma
differentiation-associated gene 5 (mda-5) have been identified to
function as receptors for double-stranded RNA. Here we show that
interferon (IFN)-alpha pretreatment enhances influenza A
virus-induced expression of IFN-alpha, IFN-beta, interleukin
(IL)-28 and IL-29 genes in human dendritic cells and epithelial
cell lines. Both IFN-alpha and IFN-beta strongly enhanced RIG-I and
mda-5 mRNA and protein expression in these cell types. Expression
of RIG-I and mda-5 gene constructs, but not that of TLR3, lead to a
dramatic enhancement of IFN-beta promoter driven transcription in
influenza A virus-infected epithelial cells. Furthermore, dominant
negative RIG-I gene construct inhibited influenza A virus-induced
IFN-beta promoter activity. In conclusion, our results show that in
epithelial cells influenza A virus-induced antiviral cytokine gene
expression is triggered by RIG-I and mda-5, whose expression is
positively regulated by IFN-alpha. Stolzenberg-Solomon, R. Z., Vieth, R., Azad, A., Pietinen, P., Taylor, P. R., Virtamo, J. and Albanes, D. Cancer Research. 2006; 66(20): 10213-10219. Article. IF 7.616 Sun exposure is associated with lower death rates for pancreatic cancer in some ecological studies. Skin exposure to UVB light induces cutaneous production of precursors to 25-hydroxyvitamin D [25(OH)D]. Pancreatic islet and duct cells express 25(OH)D-3-1 alpha-hydroxylase that generates the biologically active 1,25(OH)2 vitamin D form. Thus, 25(OH)D concentrations could affect pancreatic function and possibly pancreatic cancer etiology. We conducted a prospective nested case-control study in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention cohort of male Finnish smokers, ages 50 to 69 years at baseline, to test whether more adequate vitamin D status, as determined by prediagnostic serum 25(OH)D concentrations, was associated with lower pancreatic cancer risk. Two hundred incident exocrine pancreatic cancer cases that occurred between 1985 and 2001 (up to 16.7 years of follow-up) were matched by age and date of blood draw to 400 controls who were alive and free of cancer at the time the case was diagnosed. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated using conditional logistic regression. Higher vitamin D concentrations were associated with a 3-fold increased risk for pancreatic cancer (highest versus lowest quintile, > 65.5 versus < 32.0 nmol/L: OR, 2.92; 95% CI, 1.56-5.48, P-trend = 0.001) that remained after excluding cases diagnosed early during follow-up. Contrary to expectations, subjects with higher prediagnostic vitamin D status had an increased pancreatic cancer risk compared with those with lower status. Our findings need to be replicated in other populations and caution is warranted in their interpretation and implication. Our results are intriguing and may provide clues that further the understanding of the etiology of this highly fatal cancer. Syrjanen, R. K., Herva, E. E., Makela, P. H., Puhakka, H. J., Auranen, K. J., Takala, A. K. and Kilpi, T. M. Pediatr Infect Dis J. 2006; 25(11): 1032-1036. Journal article. IF 3.047 BACKGROUND:: In selecting treatment of acute otitis media (AOM), knowledge of its etiology would be valuable. We revisited the possibility to use the nasopharyngeal culture of Streptococcus pneumoniae (Pnc) and Haemophilus influenzae (Hi) for predicting their presence in the middle ear fluid (MEF) during AOM. METHODS:: The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of bacterial culture of the nasopharyngeal aspirate (NPA) in predicting the presence of the same pathogen in the MEF were assessed during AOM events among children followed from 2 to 24 months of age. RESULTS:: The data comprised 586 AOM events. For Pnc, the sensitivity and NPV were high, 99% (95% confidence interval = 95-100%) and >99% (97-100%), respectively. The specificity and PPV were relatively low, 63% (57-68%) and 50% (43-56%). For Hi, the sensitivity and the NPV were lower (77%, 69-83% and 93%, 90-95%) than for Pnc, but the specificity and the PPV were higher (88%, 85-91% and 64%, 56-71%). The quantity of Pnc and Hi in the NPA was clearly related to their presence in the MEF. If both Pnc and Hi were found in the nasopharynx, Hi was more likely cultured from MEF. CONCLUSION:: Together with clinical and epidemiologic features of AOM, the nasopharyngeal culture can be helpful in selecting specific antimicrobial therapy. Prospective study of risk factors for attempted suicide among patients with bipolar disorder Valtonen, H. M., Suominen, K., Mantere, O., Leppamaki, S., Arvilommi, P. and Isometsa, E. T. Bipolar Disorders. 2006; 8(5): 576-585. Article. IF 4.812 Objective: There are few prospective studies on risk factors for attempted suicide among representative samples of psychiatric patients with bipolar I and II disorders. We conducted a prospective study to investigate risk for suicide attempts among a secondary-level sample of psychiatric in- and outpatients with bipolar disorder (BD). Methods: In the Jorvi Bipolar Study (JoBS), 1,630 psychiatric in- and outpatients from three Finnish cities were screened for BDs with the Mood Disorder Questionnaire (MDQ). Using the Structured Clinical Interview for DSM-IV Disorders (SCID)-I and -II, 191 patients were diagnosed with BDs (90 bipolar I and 101 bipolar II). Information on suicide attempts during the follow-up was obtained for 176 patients (92%) at the 6-month follow-up and for 160 patients (84%) at the 18-month follow-up. Results: During the 18-month follow-up 20% of patients (35/176) attempted suicide. In a Cox regression model, baseline previous suicide attempts (OR 3.8, 95% CI 1.7-8.8; p = 0.001), hopelessness (OR 1.2, 95% CI 1.1-1.3; p < 0.001), depressive phase at index episode (OR 2.4, 95% CI 1.1-5.3; p = 0.03) and younger age at intake (OR 0.94, 95% CI 0.91-0.97; p < 0.001) were independent risk factors for suicide attempts during follow-up, whereas factors such as bipolar I or II, or comorbidity did not reach statistical significance. Conclusions: During a medium-term follow-up, as many as one-fifth of random psychiatric patients with BD attempted suicide, which highlights the public health importance of suicidal behavior in BD. Previous suicide attempts, hopelessness and depressive phase were the key indicators of risk. |