Background
The prevalence of psychiatric disorders in Finland
About 20% of the Finns suffer from some psychiatric disorder. Of these about 50% are mood disorders or anxiety disorders. The majority of mood disorders are depressive disorders. Their 12-month prevalence is about 5% in men and 8% in women. The corresponding values for anxiety disorders are 4% for men and 5% for women (Pirkola et al. 2004).
Costs incurred by psychiatric disorders in Finland
In 2002, the costs arising from the treatment of psychiatric disorders amounted to about 1.5 billion euros. Transfer payments paid for psychiatric disorders were 1.2 billion euros in total. The majority of transfer payments were disability pensions (1.1 billion euros). Sickness benefits were over 0.1 billion euros (based on notifications from the Pension Security Centre and Social Insurance Institution).
Effectiveness of psychotherapies
Psychotherapies are suited to the treatment of many psychiatric disorders. Among other things the following observations have been made about the effectiveness of psychotherapies (Lipsey and Wilson 1993, Lambert and Bergin 1994, Roth and Fonagy 1996):
- About 2/3 of the patients benefit from psychotherapy.
- The benefits first become evident as a decrease in acute symptoms and an improvement of wellbeing; long-lasting symptoms and problems improve more slowly.
- Different forms of therapy generally differ only slightly in their effectiveness.
- Several factors related to the patient, the therapist and their alliance modify the effectiveness of the therapies.
The coverage of effectiveness studies is limited:
- Over 90% of the studies concern short-term therapies.
- The health of the patients has only seldom been monitored for more than one year.
- Effectiveness has often only been studied in the light of changes in symptoms.
- For many therapies there are no comparative trials for certain patient groups.
Psychotherapy in Finland
Long-term psychodynamic psychotherapy has been the most popular form of psychotherapy in Finland. During the last decade the perceived need for psychotherapy and the amount of therapists have significantly increased and the proportion of therapists giving short-term therapy has grown (Pylkkänen et al. 1995, Social Insurance Institution 2003, Ministry of Education 2003).
Forms of therapy at the beginning of the project in 1994
- 80% psychodynamic
- 14% cognitive and 6% other therapies
- The majority of psychodynamic psychotherapies were long-term
Forms of therapy in 2002
- 50% psychodynamic
- 17% cognitive and 31% other, especially short-term therapies
- Individuals referred to long-term therapies were at first advised to try other treatments
Start of the Helsinki Psychotherapy Study
Little information was available concerning trials on the forms of therapy commonly used in Finland. Differences in the effectiveness between long-term and short-term therapy had not been studied in trials at all. The effectiveness of psychoanalysis and psychodynamic psychotherapy had usually been studied without comparative design and without control of possible selection.
The Helsinki Psychotherapy Study aims to give a comprehensive picture of how solution-focused therapy, short-term psychodynamic psychotherapy and long-term psychodynamic psychotherapy are suited for the treatment of outpatients with the most common psychiatric disorders, simultaneously taking into account the reduction of symptoms, remission and maintenance of working ability and functional capacity as well as costs arising from treatment.