| 1. |
- Einiö, Elina, et al.
(författare)
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Is impending or actual death of a spouse with dementia bad for mental health? Antidepressant use surrounding widowhood
- 2020
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Ingår i: European Journal of Public Health. - : Oxford University Press (OUP). - 1101-1262 .- 1464-360X. ; 30:5, s. 953-957
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Tidskriftsartikel (refereegranskat)abstract
- Background: Previous studies have shown that the risk of death is elevated after the death of a spouse. Limited evidence is available on changes in mental health before and after bereavement among individuals whose spouse dies of dementia. Methods: We analyzed changes in the 3-month prevalence of antidepressant use for 5 years before and 3 years after widowhood for individuals whose spouses died of either dementia or other causes. The study used data of 41 855 widowed individuals and repeated-measures logistic regression analyses. Antidepressant use was based on the prescription register of Finland in 1995-2007. Results: Five years before widowhood, the 3-month prevalence for antidepressant use was 4% among widowing men and 6-7% among widowing women, regardless of whether the spouse died of dementia or other causes. Further changes in antidepressant use depended on a spouse's cause of death. Women whose spouses died of dementia experienced large increase in antidepressant use starting from 3 to 4 years prior to widowhood, whereas other widows did not experience large increase until after widowhood. The trajectories for men were similar. Antidepressant use following the death of a spouse with dementia stayed at a new heightened level after widowhood. Conclusions: The trajectories of antidepressant use indicate that the process of losing a spouse to dementia is bad for mental health, already a few years prior to widowhood. There are no clear improvements in mental health after the death of a spouse with dementia. Support services for individuals whose spouses' dementia progresses are needed.
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| 2. |
- Hegvik, Tor-Arne, et al.
(författare)
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Labor epidural analgesia and subsequent risk of offspring autism spectrum disorder and attention-deficit/hyperactivity disorder : A cross-national cohort study of 4.5 million individuals and their siblings
- 2023
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Ingår i: American Journal of Obstetrics and Gynecology. - : Elsevier. - 0002-9378 .- 1097-6868. ; 228:2, s. 233.e1-233.e12
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: A recent study has suggested that labor epidural analgesia may be associated with increased rates of offspring autism spectrum disorder (ASD). Subsequent replication attempts have lacked sufficient power to confidently exclude the possibility of a small effect and the causal nature of this association remains unknown.OBJECTIVE: To investigate the extent to which exposure to labor epidural analgesia is associated with offspring ASD and attention-deficit/hyperactivity disorder (ADHD) following adjustments for unmeasured familial confounding.STUDY DESIGN: We identified 4,498,462 singletons and their parents using the Medical Birth Registers in Finland (cohorts born 1987-2005), Norway (1999-2015), and Sweden (1987-2011), linked with population and patient registries. These cohorts were followed from birth until they either had the outcomes of interest, emigrated, died, or reached the end of the follow-up (at mean ages 13.6-16.8 years), whichever occurred first. Cox regression models were used to estimate country-specific associations between labor epidural analgesia recorded at birth and outcomes (e.g., at least one secondary care diagnosis of ASD and ADHD or at least one dispensed prescription of medication used for the treatment of ADHD). The models were adjusted for sex, birth year, birth order, and unmeasured familial confounders via sibling-comparisons. Pooled estimates across all three countries were estimated using inverse variance weighted fixed-effects meta-analysis models.RESULTS: A total of 4,498,462 individuals (48.7% female) were included, 1,091,846 (24.3%) of which were exposed to labor epidural analgesia. Of these, 1.2% were diagnosed with ASD and 4.0% with ADHD. On the population level, pooled estimates showed that labor epidural analgesia was associated with increased risk of offspring ASD (adjusted hazard ratio, aHR=1.12; 95% CI: 1.10-1.14, absolute risks: 1.20% vs. 1.07%) and ADHD (aHR=1.20; 1.19-1.21; 3.95% vs. 3.32%). However, when comparing full-siblings who were differentially exposed to labor epidural analgesia, the associations were fully attenuated for both conditions, with narrow confidence intervals (aHRASD=0.98; 0.93-1.03; aHRADHD=0.99; 0.96-1.02).CONCLUSION: In this large cross-national study, we found no support for the hypothesis that exposure to labor epidural analgesia causes either offspring autism spectrum disorder or attention-deficit/hyperactivity disorder.
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| 3. |
- Kühn, Mine, et al.
(författare)
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Pathways into single motherhood, re-partnering, and trajectories of antidepressant medication purchases
- 2023
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Ingår i: Social Psychiatry and Psychiatric Epidemiology. - : Springer Science and Business Media LLC. - 0933-7954 .- 1433-9285. ; 58:3, s. 409-420
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Tidskriftsartikel (refereegranskat)abstract
- Single motherhood is known to be distressing, and to be associated with poor mental health. However, less is known about the pathways into and out of single motherhood, or about the mental health trajectories of single mothers. We used total population registry data on Finnish women who experienced the life events of separation (616,762), widowhood (43,355), or child birth (515,756) during the 1995–2018 period while between the ages of 15–64. Single mothers were compared with women who experienced the same life event, but without becoming a single mother. The results for women who separated showed that among single mothers, there was a substantial increase in antidepressant use at the time of separation, and only a moderate decline after separation. Among women who experienced widowhood, those who had underage children initially had lower antidepressant use than women without children, but this gap narrowed in the post-widowhood period. In addition, single women experienced more unfavorable mental health trajectories than partnered women around the time they gave birth. Re-partnering was associated with more favorable mental health among all groups of single mothers. Given the growing prevalence of single-parent households, our results underscore the need for context-specific interventions to support single mothers’ mental health.
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| 4. |
- Metsä-Simola, Niina, et al.
(författare)
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Grandparental support and maternal depression : Do grandparents’ characteristics matter more for separating mothers?
- 2024
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Ingår i: Population Studies. - : Routledge. - 0032-4728 .- 1477-4747.
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Tidskriftsartikel (refereegranskat)abstract
- Grandparental support may protect mothers from depression, particularly mothers who separate and enter single parenthood. Using longitudinal Finnish register data on 116,917 separating and 371,703 non-separating mothers with young children, we examined differences in mothers’ antidepressant purchases by grandparental characteristics related to provision of support. Grandparents’ younger age (<70 years), employment, and lack of severe health problems predicted a lower probability of maternal depression. Depression was also less common if grandparents lived close to the mother and if the maternal grandparents’ union was intact. Differences in maternal depression by grandparental characteristics were larger among separating than among non-separating mothers, particularly during the years before separation. Overall, maternal grandmothers’ characteristics appeared to matter most, while the role of paternal grandparents was smaller. The findings suggest that grandparental characteristics associated with increased potential for providing support and decreased need of receiving support predict a lower likelihood of maternal depression, particularly among separating mothers.
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| 5. |
- Metsä-Simola, Niina, et al.
(författare)
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Neurological conditions and subsequent divorce risk in the Nordic countries : the importance of gender and both spouses’ education
- 2024
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Ingår i: Journal of Epidemiology and Community Health. - 0143-005X .- 1470-2738.
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Tidskriftsartikel (refereegranskat)abstract
- Background Prior studies suggest that poor physical health, accompanied by functional disability, is associated with increased divorce risk. However, this association may depend on gender, the socioeconomic resources of the couple, as well as the social policy and social (in)equality context in which the illness is experienced. This study focuses on neurological conditions, which often have substantial functional consequences.Methods We used longitudinal population-wide register data from the years 2007–2016 (Denmark, Sweden) or 2008–2017 (Finland, Norway) to follow 2 809 209 married couples aged 30–64 for neurological conditions, identified using information on specialised healthcare for diseases of the nervous system and subsequent divorce. Cox regression models were estimated in each country, and meta-analysis used to calculate across-country estimates.Results During the 10-year follow-up period, 22.2% of couples experienced neurological conditions and 12.0% of marriages ended in divorce. In all countries, divorce risk was elevated among couples where at least one spouse had a neurological condition, and especially so if both spouses were ill. The divorce risk was either larger or similar for husband’s illness, compared with wife’s illness, in all educational categories. For the countries pooled, the weighted average HR was 1.21 (95% CI 1.20 to 1.23) for wives’ illness, 1.27 (95% CI 1.25 to 1.29) for husbands’ illness and 1.38 (95% CI 1.34 to 1.42) for couples where both spouses were ill.Conclusions Despite some variation by educational resources and country context, the results suggest that the social consequences of illness are noticeable even in Nordic welfare states, with the husband’s illness being at least as important as the wife’s.
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| 6. |
- Metsä-Simola, Niina, et al.
(författare)
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Physical health conditions and subsequent union separation : a couple-level register study on neurological conditions, heart and lung disease, and cancer
- 2021
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Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 75:7, s. 674-680
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Tidskriftsartikel (refereegranskat)abstract
- Background Studies that assess the role of physical health conditions on separation risk are scarce and mostly lack health information on both partners. It is unclear how the association between physical illness and separation risk varies by type of illness, gender of the ill spouse and age of the couple.Methods We used Finnish register data on 127 313 couples to examine how neurological conditions, heart and lung disease, and cancer are associated with separation risk. The data included information on medication, hospitalisations, separations and sociodemographic characteristics. Marital and non-marital cohabiting couples aged 40-70 years were followed from 1998 to 2003 for the onset of health conditions and subsequent separation, and Cox regression was used to examine the associations.Results Compared with healthy couples, the HR of separation was elevated by 43% for couples in which both spouses had a physical health condition, by 22% for couples in which only the male spouse had fallen ill, and by 11% for couples in which only the female had fallen ill. Among older couples, the associations between physical illness and separation risk were even clearer. The association with separation risk was strongest for neurological conditions, and after incidence of these conditions among males, separation risk increased over time. Adjustment for sociodemographic characteristics had little effect.Conclusions Our findings suggest that poor health may largely strain relationships through disability and associated burden of spousal care, and this should be taken into consideration when planning support services for couples with physical health conditions.
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| 7. |
- Metsä-Simola, Niina S., et al.
(författare)
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Changes in parents' psychotropic medication use following child's cancer diagnosis : A fixed-effects register-study in Finland
- 2022
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Ingår i: Cancer Medicine. - : Wiley. - 2045-7634. ; 11:16, s. 3145-3155
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Tidskriftsartikel (refereegranskat)abstract
- Background: Symptoms of depression and anxiety are elevated among parents of children with cancer. However, knowledge of parents' psychotropic medication use following child's cancer diagnosis is scarce.Methods: We use longitudinal Finnish register data on 3266 mothers and 2687 fathers whose child (aged 0–19) was diagnosed with cancer during 2000–2016. We record mothers' and fathers' psychotropic medication use (at least one annual purchase of anxiolytics, hypnotics, sedatives, or antidepressants) 5 years before and after the child's diagnosis and assess within-individual changes in medication use by time since diagnosis, cancer type, child's age, presence of siblings, and parent's living arrangements and education using linear probability models with the individual fixed-effects estimator. The fixed-effects models compare each parent's annual probability of psychotropic medication use after diagnosis to their annual probability of medication use during the 5-year period before the diagnosis.Results: Psychotropic medication use was more common among mothers than fathers already before the child's diagnosis, 11.2% versus 7.3%. Immediately after diagnosis, psychotropic medication use increased by 6.0 (95% CI 4.8–7.2) percentage points among mothers and by 3.2 (CI 2.1–4.2) percentage points among fathers. Among fathers, medication use returned to pre-diagnosis level by the second year, except among those whose child was diagnosed with acute lymphoblastic leukemia or lymphoblastic lymphoma. Among mothers of children with a central nervous system cancer, medication use remained persistently elevated during the 5-year follow-up. For mothers with other under-aged children or whose diagnosed child was younger than 10 years, the return to pre-diagnosis level was also slow.Conclusions: Having a child with cancer clearly increases parents' psychotropic medication use. The increase is smaller and more short-lived among fathers, but among mothers its duration depends on both cancer type and family characteristics. Our results suggest that an increased care burden poses particular strain to the long-term mental well-being of mothers.
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| 8. |
- Metsä-Simola, Niina, et al.
(författare)
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Time patterns of external and alcohol-related mortality after marital and non-marital separation : the contribution of psychiatric morbidity
- 2020
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Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 74:6, s. 510-518
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Tidskriftsartikel (refereegranskat)abstract
- Background External and alcohol-related mortality is elevated postseparation, but the role of poor mental health in explaining this excess is unclear. We assess postseparation excess mortality by union type and over time since separation and examine how psychiatric morbidity present already before separation, during the separation process and after separation attenuates this excess.Methods Using individual-level register data from 1995 to 2012, we followed 311 751 Finns in long-term unions. Psychiatric morbidity was identified from dates of prescription medication purchases and hospital admissions, separations from dates of moving out of joint households and mortality from the Death Register. Cox regression was used to analyse postseparation mortality controlling for psychiatric morbidity before, during and after separation.Results External and alcohol-related excess mortality is most pronounced immediately after separation, particularly among men, and is much larger following marital than nonmarital separation. After sociodemographic factors are adjusted for, further adjustment for psychiatric morbidity attenuates the excess by about 25%. Psychiatric morbidity poorly explains alcohol-related postseparation excess mortality, but for suicide mortality, adjustment for psychiatric morbidity reduces the excess by about 40% among men and 50% among women. Among women, this is largely due to psychiatric morbidity present already before separation, whereas amongmen the attenuation is also due to psychiatric morbidity during the separation process and after it.Conclusion Separation may exacerbate the problems of people already in poor mental health, and relationship dynamics should thus be considered during treatment. Particularly among men separation is a risk factor for suicide even without pre-existing mental health problems.
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