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Depression: HELP
Articles by Tuula Oksanen
Based on 20 articles published since 2008
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Between 2008 and 2019, T. Oksanen wrote the following 20 articles about Depression.
 
+ Citations + Abstracts
1 Review Prognostic factors for return to work after depression-related work disability: A systematic review and meta-analysis. 2017

Ervasti, Jenni / Joensuu, Matti / Pentti, Jaana / Oksanen, Tuula / Ahola, Kirsi / Vahtera, Jussi / Kivimäki, Mika / Virtanen, Marianna. ·Finnish Institute of Occupational Health, Helsinki, Finland. Electronic address: jenni.ervasti@ttl.fi. · Finnish Institute of Occupational Health, Helsinki, Finland. · Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland. · Finnish Institute of Occupational Health, Helsinki, Finland; Clinicum, Faculty of Medicine, University of Helsinki, Finland; Department of Epidemiology and Public Health, University College London, UK. ·J Psychiatr Res · Pubmed #28772111.

ABSTRACT: Knowledge about factors influencing return to work (RTW) after depression-related absence is highly relevant, but the evidence is scattered. We performed a systematic search of PubMed and Embase databases up to February 1, 2016 to retrieve cohort studies on the association between various predictive factors and return to work among employees with depression for review and meta-analysis. We also analyzed unpublished data from the Finnish Public Sector study. Most-adjusted estimates were pooled using fixed effects meta-analysis. Eleven published studies fulfilled the eligibility criteria, representing 22 358 person-observations from five different countries. With the additional unpublished data from the 14 101 person-observations from the Finnish Public Sector study, the total number of person-observations was 36 459. The pooled estimates were derived from 2 to 5 studies, with the number of observations ranging from 260 to 26 348. Older age (pooled relative risk [RR] 0.95; 95% confidence interval [CI] 0.84-0.87), somatic comorbidity (RR = 0.80, 95% CI 0.77-0.83), psychiatric comorbidity (RR = 0.86, 95% CI 0.83-0.88) and more severe depression (RR = 0.96, 95% CI 0.94-0.98) were associated with a lower rate of return to work, and personality trait conscientiousness with higher (RR = 1.06, 95% CI 1.02-1.10) return to work. While older age and clinical factors predicted slower return, significant heterogeneity was observed between the studies. There is a dearth of observational studies on the predictors of RTW after depression. Future research should pay attention to quality aspects and particularly focus on the role of workplace and labor market factors as well as individual and clinical characteristics on RTW.

2 Review Job strain as a risk factor for clinical depression: systematic review and meta-analysis with additional individual participant data. 2017

Madsen, I E H / Nyberg, S T / Magnusson Hanson, L L / Ferrie, J E / Ahola, K / Alfredsson, L / Batty, G D / Bjorner, J B / Borritz, M / Burr, H / Chastang, J-F / de Graaf, R / Dragano, N / Hamer, M / Jokela, M / Knutsson, A / Koskenvuo, M / Koskinen, A / Leineweber, C / Niedhammer, I / Nielsen, M L / Nordin, M / Oksanen, T / Pejtersen, J H / Pentti, J / Plaisier, I / Salo, P / Singh-Manoux, A / Suominen, S / Ten Have, M / Theorell, T / Toppinen-Tanner, S / Vahtera, J / Väänänen, A / Westerholm, P J M / Westerlund, H / Fransson, E I / Heikkilä, K / Virtanen, M / Rugulies, R / Kivimäki, M / Anonymous6130894. ·National Research Centre for the Working Environment,DK-2100 Copenhagen Ø,Denmark. · Finnish Institute of Occupational Health,FI-00250 Helsinki,Finland. · Stress Research Institute, Stockholm University,SE-106 91 Stockholm,Sweden. · Department of Epidemiology and Public Health,University College London,London WC1E 6BT,UK. · Institute of Environmental Medicine,Karolinska Institutet,SE-171 77 Stockholm,Sweden. · Department of Occupational and Environmental Medicine,Bispebjerg University Hospital,DK-2400 Copenhagen,Denmark. · Federal Institute for Occupational Safety and Health (BAuA),D-10317 Berlin,Germany. · INSERM, U1085, Research Institute for Environmental and Occupational Health (IRSET), Epidemiology in Occupational Health and Ergonomics (ESTER) Team, F-49000, Angers,France. · Netherlands Institute of Mental Health and Addiction,3521 VS Utrecht,The Netherlands. · Department of Medical Sociology,University of Düsseldorf,40225 Düsseldorf,Germany. · Institute of Behavioral Sciences,University of Helsinki,FI-00014 Helsinki,Finland. · Department of Health Sciences,Mid Sweden University,SE-851 70 Sundsvall,Sweden. · Department of Public Health,University of Helsinki,FI-00014 Helsinki,Finland. · Unit of Social Medicine,Frederiksberg University Hospital,DK-2000 Copenhagen,Denmark. · The Danish National Centre for Social Research,DK-1052 Copenhagen,Denmark. · The Netherlands Institute for Social Research,2515 XP The Hague,The Netherlands. · Folkhälsan Research Center,FI-00290 Helsinki,Finland. · Occupational and Environmental Medicine,Uppsala University,SE-751 85 Uppsala,Sweden. ·Psychol Med · Pubmed #28122650.

ABSTRACT: BACKGROUND: Adverse psychosocial working environments characterized by job strain (the combination of high demands and low control at work) are associated with an increased risk of depressive symptoms among employees, but evidence on clinically diagnosed depression is scarce. We examined job strain as a risk factor for clinical depression. METHOD: We identified published cohort studies from a systematic literature search in PubMed and PsycNET and obtained 14 cohort studies with unpublished individual-level data from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium. Summary estimates of the association were obtained using random-effects models. Individual-level data analyses were based on a pre-published study protocol. RESULTS: We included six published studies with a total of 27 461 individuals and 914 incident cases of clinical depression. From unpublished datasets we included 120 221 individuals and 982 first episodes of hospital-treated clinical depression. Job strain was associated with an increased risk of clinical depression in both published [relative risk (RR) = 1.77, 95% confidence interval (CI) 1.47-2.13] and unpublished datasets (RR = 1.27, 95% CI 1.04-1.55). Further individual participant analyses showed a similar association across sociodemographic subgroups and after excluding individuals with baseline somatic disease. The association was unchanged when excluding individuals with baseline depressive symptoms (RR = 1.25, 95% CI 0.94-1.65), but attenuated on adjustment for a continuous depressive symptoms score (RR = 1.03, 95% CI 0.81-1.32). CONCLUSIONS: Job strain may precipitate clinical depression among employees. Future intervention studies should test whether job strain is a modifiable risk factor for depression.

3 Article Long working hours and depressive symptoms: systematic review and meta-analysis of published studies and unpublished individual participant data. 2018

Virtanen, Marianna / Jokela, Markus / Madsen, Ida Eh / Magnusson Hanson, Linda L / Lallukka, Tea / Nyberg, Solja T / Alfredsson, Lars / Batty, G David / Bjorner, Jakob B / Borritz, Marianne / Burr, Hermann / Dragano, Nico / Erbel, Raimund / Ferrie, Jane E / Heikkilä, Katriina / Knutsson, Anders / Koskenvuo, Markku / Lahelma, Eero / Nielsen, Martin L / Oksanen, Tuula / Pejtersen, Jan H / Pentti, Jaana / Rahkonen, Ossi / Rugulies, Reiner / Salo, Paula / Schupp, Jürgen / Shipley, Martin J / Siegrist, Johannes / Singh-Manoux, Archana / Suominen, Sakari B / Theorell, Töres / Vahtera, Jussi / Wagner, Gert G / Wang, Jian Li / Yiengprugsawan, Vasoontara / Westerlund, Hugo / Kivimäki, Mika. ·Finnish Institute of Occupational Health, PO Box 40, 00032 Työterveyslaitos, Finland. marianna.virtanen@ttl.fi. ·Scand J Work Environ Health · Pubmed #29423526.

ABSTRACT: Objectives This systematic review and meta-analysis combined published study-level data and unpublished individual-participant data with the aim of quantifying the relation between long working hours and the onset of depressive symptoms. Methods We searched PubMed and Embase for published prospective cohort studies and included available cohorts with unpublished individual-participant data. We used a random-effects meta-analysis to calculate summary estimates across studies. Results We identified ten published cohort studies and included unpublished individual-participant data from 18 studies. In the majority of cohorts, long working hours was defined as working ≥55 hours per week. In multivariable-adjusted meta-analyses of 189 729 participants from 35 countries [96 275 men, 93 454 women, follow-up ranging from 1-5 years, 21 747 new-onset cases), there was an overall association of 1.14 (95% confidence interval (CI) 1.03-1.25] between long working hours and the onset of depressive symptoms, with significant evidence of heterogeneity (I

4 Article Organizational justice and disability pension from all-causes, depression and musculoskeletal diseases: A Finnish cohort study of public sector employees. 2016

Juvani, Anne / Oksanen, Tuula / Virtanen, Marianna / Elovainio, Marko / Salo, Paula / Pentti, Jaana / Kivimäki, Mika / Vahtera, Jussi. ·Federation of Municipalities for Social and Health Services, Occupational Health Care Unit of Vihti, Nummenselkä 2, 03100 Nummela, Finland. anne.juvani@fimnet.fi. ·Scand J Work Environ Health · Pubmed #27501162.

ABSTRACT: OBJECTIVES: Work-related stress has been linked to increased risk of disability pensioning, but the association between perceived justice of managerial behavior and decision-making processes at the workplace (ie, organizational justice) and risk of disability pensioning remains unknown. We examined the associations of organizational justice and its relational and procedural components with all-cause and diagnosis-specific disability pensions with repeated measures of justice. METHODS: Data from 24 895 employees responding to repeated surveys on organizational justice in 2000-2002 and 2004 were linked to the records of a national register for disability pensions from 2005-2011. Associations of long-term organizational justice (average score from two surveys) with disability pensions were studied with Cox proportional hazard regression adjusted for demographics, socioeconomic status, baseline health and health risk behavior, stratified by sex. RESULTS: During a mean follow-up of 6.4 years, 1658 (7%) employees were granted disability pension (282 due to depression; 816 due to musculoskeletal diseases). Higher organizational justice was associated with a lower risk of disability pensioning [hazard ratio (HR) per one-unit increase in 5-point justice scale 0.87 (95% CI 0.81-0.94)]. For disability pension due to depression and musculoskeletal diseases, the corresponding HR were 0.77 (95% CI 0.65-0.91) and 0.87 (95% CI 0.79-0.97), respectively. Adjustment for job strain and effort-reward imbalance attenuated the HR by 20-80%. CONCLUSIONS: Supervisors` fair treatment of employees and fair decision-making in the organizations are associated with a decreased risk of disability pensioning from all-causes, depression and musculoskeletal diseases. These associations may be attributable to a wider range of favorable work characteristics.

5 Article Return to work after depression-related absence by employees with and without other health conditions: a cohort study. 2015

Ervasti, Jenni / Vahtera, Jussi / Pentti, Jaana / Oksanen, Tuula / Ahola, Kirsi / Kivekäs, Teija / Kivimäki, Mika / Virtanen, Marianna. ·From the Development of Work and Organizations (Ervasti, Vahtera, Pentti, Oksanen, Ahola, Kivekäs, Kivimäki, Virtanen). Finnish Institute of Occupational Health, Helsinki, Finland · Department of Public Health (Vahtera), University of Turku and Turku University Hospital, Turku, Finland · Department of Epidemiology and Public Health (Kivimäki), University College London, London, UK · and Department of Behavioral Sciences (Kivimäki), University of Helsinki, Helsinki, Finland. ·Psychosom Med · Pubmed #25675157.

ABSTRACT: OBJECTIVE: Among employees with depression, diagnoses of other psychiatric and somatic conditions are common. However, few studies have examined whether the combined presence of depression and other psychiatric or somatic disorders adversely affects return to work after depression-related absence from work. METHODS: We examined the association of present and recent psychiatric and somatic conditions and return to work after depression-related absence in a cohort of 9908 Finnish public sector employees with at least one such episode. The data included a total of 14,101 episodes during the period January 2005 to December 2011. RESULTS: A total of 89% (n = 12,486) of depression-related absence episodes ended in return to work during the follow-up. For those episodes, the median length of absence was 34 days (interquartile range, 20-69 days). After adjustment for sex, age, socioeconomic status, and type of employment contract, present or recent psychiatric disorders other than depression (hazard ratio [HR] = 0.78, 95% confidence interval [CI] = 0.74-0.83), cancer (HR = 0.66, 95% CI = 0.47-0.92), diabetes (HR = 0.73, 95% CI = 0.62-0.86), cardiovascular disease (HR = 0.78, 95% CI = 0.62-0.99), hypertension (HR = 0.76, 95% CI = 0.67-0.85), musculoskeletal disorders (HR = 0.82, 95% CI = 0.77-0.87), and asthma (HR = 0.84, 95% CI = 0.75-0.94) were all associated with a lower likelihood of returning to work compared with depression episodes without other conditions. CONCLUSIONS: Among employees with depression-related absence, return to work is delayed in the presence of other psychiatric and somatic conditions. These findings suggest that other diseases should be taken into account when evaluating the outcome of depression-related absence. Randomized controlled trials are needed to examine whether integrated treatment of mental and physical disorders improves successful return to work after depression.

6 Article The role of psychiatric, cardiometabolic, and musculoskeletal comorbidity in the recurrence of depression-related work disability. 2014

Ervasti, Jenni / Vahtera, Jussi / Pentti, Jaana / Oksanen, Tuula / Ahola, Kirsi / Kivekäs, Teija / Kivimäki, Mika / Virtanen, Marianna. ·Development of Work and Organizations, Finnish Institute of Occupational Health, Helsinki, Finland. ·Depress Anxiety · Pubmed #24996130.

ABSTRACT: BACKGROUND: Comorbid psychiatric disorders, cardiovascular disease, chronic hypertension, diabetes, and musculoskeletal disorders are highly prevalent in depression. However, the extent to which these conditions affect the recurrence of depression-related work disability is unknown. The specific aims of the study were to investigate the extent to which comorbid other psychiatric disorders, cardiometabolic, and musculoskeletal conditions were associated with the recurrence of depression-related work disability among employees who had returned to work after a depression-related disability episode. METHODS: A cohort study of Finnish public sector employees with at least one depression-related disability episode during 2005-2011 after which the employee had returned to work (14,172 depression-related work disability episodes derived from national health and disability registers for 9,946 individuals). We used Cox proportional hazard models for recurrent events. RESULTS: Depression-related work disability recurred in 35% of the episodes that had ended in return to work from a previous episode, totaling 4,927 recurrent episodes among 3,095 (31%) employees. After adjustment for sex, age, socioeconomic status, and type of employment contract, comorbid psychiatric disorder (hazard ratio = 1.82, 95% CI 1.68-1.97), cardiovascular disease (1.39, 95% CI 1.04-1.87), diabetes (1.43, 95% CI 1.11-1.85), chronic hypertension (1.33, 95% CI 1.11-1.58), and musculoskeletal disorder (1.17, 95% CI 1.06-1.28) were associated with an increased risk of a recurrent episode compared to those without these comorbid conditions. CONCLUSIONS: Recurrence of depression-related work disability is common. Employees with comorbid psychiatric, cardiometabolic, or musculoskeletal conditions are at an increased risk of recurrent depression-related work disability episodes.

7 Article Is temporary employment a risk factor for work disability due to depressive disorders and delayed return to work? The Finnish Public Sector Study. 2014

Ervasti, Jenni / Vahtera, Jussi / Virtanen, Pekka / Pentti, Jaana / Oksanen, Tuula / Ahola, Kirsi / Kivimäki, Mika / Virtanen, Marianna. ·Finnish Institute of Occupational Health, Topeliuksenkatu 41 a A, FI-00250, Helsinki, Finland. jenni.ervasti@ttl.fi. ·Scand J Work Environ Health · Pubmed #24664298.

ABSTRACT: OBJECTIVES: Research on temporary employment as a risk factor for work disability due to depression is mixed, and few studies have measured work disability outcome in detail. We separately examined the associations of temporary employment with (i) the onset of work disability due to depression, (ii) the length of disability episodes, and (iii) the recurrence of work disability, taking into account the possible effect modification of sociodemographic factors. METHODS: We linked the prospective cohort study data of 107 828 Finnish public sector employees to national registers on work disability (>9 days) due to depression from January 2005 to December 2011. RESULTS: Disability episodes were longer among temporary than permanent employees after adjustment for age, sex, level of education, chronic somatic disease, and history of mental/behavioral disorders [cumulative odds ratio (COR) 1.37, 95% confidence interval (95% CI) 1.25-51). The association between temporary employment and the length of depression-related disability episodes was more pronounced among participants with a low educational level (COR 1.95, 95% CI 1.54-2.48) and older employees (>52 years; COR 3.67, 95% CI 2.83-4.76). The association was weaker in a subgroup of employees employed for ≥ 50% of the follow-up period (95% of the original sample). Temporary employment was not associated with the onset or recurrence of depression-related work disability. CONCLUSIONS: Temporary employment is associated with slower return to work, indicated by longer depression-related disability episodes, especially among older workers and those with a low level of education. Continuous employment might protect temporary employees from prolonged work disability.

8 Article Optimism and pessimism as predictors of initiating and ending an antidepressant medication treatment. 2014

Kronström, Kim / Karlsson, Hasse / Nabi, Hermann / Oksanen, Tuula / Salo, Paula / Sjösten, Noora / Virtanen, Marianna / Pentti, Jaana / Kivimäki, Mika / Vahtera, Jussi. ·Researcher, Department of Psychiatry, University of Turku , Turku , Finland. ·Nord J Psychiatry · Pubmed #23286692.

ABSTRACT: BACKGROUND: The personality variables optimism and pessimism are potential risk factors for disorders commonly treated with antidepressants. AIMS: To evaluate optimism and pessimism as predictors of initiating and ending an antidepressant treatment. METHODS: Data consisted of 29,930 public sector employees with no record of diagnosed depression. Optimism and pessimism were measured using the Revised Life Orientation Test (LOT-R) at baseline. The data of purchases of antidepressants were from the national Drug Prescription Register. RESULTS: During the mean follow-up of 4.4 years, 1681 participants initiated and of them 1288 ended an antidepressant treatment lasting at least 100 days. In the adjusted model, high optimism was associated with a lower likelihood of starting antidepressant medication treatment (hazard ratios, HR, 0.67, 95% CI 0.62-0.73) and a higher likelihood of stopping the treatment (HR = 1.18, 95% CI 1.08-1.30). High pessimism was associated with a higher likelihood of starting antidepressant medication treatment (HR = 1.27, 95% CI 1.16-1.38) and a lower likelihood of stopping it (HR = 0.89, 95% CI 0.80-0.98). These associations remained after optimism score was adjusted for pessimism and vice versa or those with symptoms of mental health problems at baseline were removed from the analyses. CONCLUSIONS: Low optimism and high pessimism are independently associated with an increased likelihood of initiating antidepressant medication treatment, but with a decreased likelihood of ending it during the follow-up.

9 Article Depression-related work disability: socioeconomic inequalities in onset, duration and recurrence. 2013

Ervasti, Jenni / Vahtera, Jussi / Pentti, Jaana / Oksanen, Tuula / Ahola, Kirsi / Kivimäki, Mika / Virtanen, Marianna. ·Development of Work and Organizations, Finnish Institute of Occupational Health, Helsinki, Finland. ·PLoS One · Pubmed #24278194.

ABSTRACT: OBJECTIVE: Depression is a major cause of disability in working populations and the reduction of socioeconomic inequalities in disability is an important public health challenge. We examined work disability due to depression with four indicators of socioeconomic status. METHODS: A prospective cohort study of 125 355 Finnish public sector employees was linked to national register data on work disability (>9 days) due to depressive disorders (International Classification of Diseases, codes F32-F34) from January 2005 to December 2011. Primary outcomes were the onset of work disability due to depressive disorders and, among those with such disability, return to work after and recurrent episodes of work disability due to depression. RESULTS: We found a consistent inverse socioeconomic gradient in work disability due to depression. Lower occupational position, lower educational level, smaller residence size, and rented (vs. owner-occupied) residence were all associated with an increased risk of work disability. Return to work was slower for employees with basic education (cumulative odds ratio = 1.21, 95% CI: 1.05-1.39) compared to those with higher education. Recurrent work disability episodes due to depression were less common among upper-grade non-manual workers (the highest occupational group) than among lower-grade non-manual (hazard ratio = 1.16, 95% CI: 1.07-1.25) and manual (hazard ratio = 1.14, 95% CI: 1.02-1.26) workers. CONCLUSIONS: These data from Finnish public sector employees show persistent socioeconomic inequalities in work disability due to depression from 2005 to 2011 in terms of onset, recovery and recurrence.

10 Article Perceived organizational justice as a predictor of long-term sickness absence due to diagnosed mental disorders: results from the prospective longitudinal Finnish Public Sector Study. 2013

Elovainio, Marko / Linna, Anne / Virtanen, Marianna / Oksanen, Tuula / Kivimäki, Mika / Pentti, Jaana / Vahtera, Jussi. ·National Institute for Health and Welfare, PO Box 30, 00271 Helsinki, Finland. marko.elovainio@thl.fi ·Soc Sci Med · Pubmed #23849237.

ABSTRACT: Organizational justice perceptions have been suggested to be associated with symptoms of mental health but the nature of the association is unknown due to reporting bias (measurement error related to response style and reversed causality). In this study, we used prospective design and long-term (>9 days) sickness absence with psychiatric diagnosis as the outcome measure. Participants were 21,221 Finnish public sector employees (the participation rate at baseline in 2000-2002 68%), who responded to repeated surveys of procedural and interactional justice in 2000-2004 along with register data on sickness absence with a diagnosis of depression or anxiety disorders (822 cases). Results from logistic regression analyses showed that a one-unit increase in self-reported and work-unit level co-worker assessed interactional justice was associated with a 25-32% lower odds of sickness absence due to anxiety disorders. These associations were robust to adjustments for a variety of potential individual-level confounders including chronic disease (adjusted OR for self-reported interactional justice 0.77, 95% CI 0.65-0.91) and were replicated using co-worker assessed justice. Only weak evidence of reversed causality was found. The results suggest that low organizational justice is a risk factor for sickness absence due to anxiety disorders.

11 Article Effect of depression onset on adherence to medication among hypertensive patients: a longitudinal modelling study. 2013

Sjösten, Noora / Nabi, Hermann / Westerlund, Hugo / Salo, Paula / Oksanen, Tuula / Pentti, Jaana / Virtanen, Marianna / Kivimäki, Mika / Vahtera, Jussi. ·Finnish Institute of Occupational Health, Turku, Finland. noora.sjosten@utu.fi ·J Hypertens · Pubmed #23666419.

ABSTRACT: OBJECTIVES: Although a link between depression and poor adherence to antihypertensive medication (AHM) has been found, it is not known whether depression actually leads to poorer adherence or whether poor adherence only is a marker of depression. In this study we aimed to determine the time order between hypertension, depression and changes in adherence to AHM. METHODS: The analyses were based on data gathered from a longitudinal cohort of Finnish employees (The Finnish Public Sector Study). A total of 852 chronically hypertensive men and women at baseline with a recorded onset of depression during the 9-year observation window and 2359 hypertensive control participants matched for age, sex, socio-economic status, time of study entry, employer and geographic area were included in the study. Individuals with any sign of depression during 4 years before the beginning of the study were excluded. To describe long-term trajectories (4 years before and 4 years after the recorded depression) of AHM adherence in relation to the onset of depression, annual data on reimbursed AHM prescriptions were gathered from the national Drug Prescription Register. Annual nonadherence rates (i.e. number of 'days-not-treated') were based on filled prescriptions. RESULTS: Among male cases, the rate of 'days-not-treated' was 1.52 times higher (95% confidence interval 1.08-2.14) in the years after the onset of depression compared to preonset levels. In women and in male controls, no change in adherence to AHM was observed between these time periods. CONCLUSION: In hypertensive men, the onset of recorded depression increases the risk of nonadherence to AHM.

12 Article Job strain and the risk of disability pension due to musculoskeletal disorders, depression or coronary heart disease: a prospective cohort study of 69,842 employees. 2012

Mäntyniemi, Anne / Oksanen, Tuula / Salo, Paula / Virtanen, Marianna / Sjösten, Noora / Pentti, Jaana / Kivimäki, Mika / Vahtera, Jussi. ·Occupational Health Care Unit of Vihti, Federation of Municipalities for Social and Health Services, Ritalantie 4 E 6, 03100 Nummela, Finland. anne.mantyniemi@fimnet.fi ·Occup Environ Med · Pubmed #22573793.

ABSTRACT: OBJECTIVES: Observational studies suggest that high job strain is a risk factor for retirement on health grounds, but few studies have analysed specific diagnoses. We examined job strain's association with all-cause and cause-specific disability pensions. METHODS: Survey responses to questions about job strain from 48,598 (response rate, 68%) public sector employees in Finland from 2000 to 2002 were used to determine work unit- and occupation-based scores. These job strain scores were assigned to all the 69,842 employees in the same work units or occupations. All participants were linked to the disability pension register of the Finnish Centre of Pensions with no loss to follow-up. Cox proportional hazard models were used to calculate HRs and their 95% CIs for disability pensions adjusted by demographic, work unit characteristics and baseline health in analyses stratified by sex and socioeconomic position. RESULTS: During a mean follow-up of 4.6 years, 2572 participants (4%) were granted a disability pension. A one-unit increase in job strain was associated with a 1.3- to 2.4-fold risk of requiring a disability pension due to musculoskeletal diseases in men, women and manual workers, depending on the measure of job strain (work unit or occupation based). The risk of disability pension due to cardiovascular diseases was increased in men with high job strain but not in women nor in any socioeconomic group. No consistent pattern was found for disability pension due to depression. CONCLUSION: High job strain is a risk factor for disability pension due to musculoskeletal diseases.

13 Article Insomnia symptoms as a predictor of incident treatment for depression: prospective cohort study of 40,791 men and women. 2012

Salo, Paula / Sivertsen, Børge / Oksanen, Tuula / Sjösten, Noora / Pentti, Jaana / Virtanen, Marianna / Kivimäki, Mika / Vahtera, Jussi. ·Centre of Expertise for Work Organizations, Finnish Institute of Occupational Health, Lemminkäisenkatu 14-18 B, FI-20520 Turku, Finland. ·Sleep Med · Pubmed #22177343.

ABSTRACT: OBJECTIVE: To examine the quantity and quality of insomnia symptoms as predictors of treatment for depression in the largest cohort study to date. METHODS: Forty thousand seven hundred and ninety-one Finnish public sector employees (mean age 43.9 years, 81% female), free of depression at baseline, participated in this prospective observational cohort study. Participants responded to the survey in 2000-2002 or 2004 and the mean follow-up was 3.3 years. Self-reported sleep was linked to comprehensive individual-level health registers to assess treatment for depression (antidepressant medication, commencements of psychotherapy or hospitalization due to depression). RESULTS: One thousand seven hundred and three participants fulfilled any of our set criteria for depression-related treatment. After adjustments for baseline characteristics, insomnia symptoms five to seven nights/week were associated with an increased risk of incident treatment for depression, hazard ratio 1.64 (95% confidence interval 1.44-1.86). Hazard ratio for symptoms two to four nights/week was 1.46 (1.29-1.64). Difficulties initiating or maintaining sleep and non-refreshing sleep increased the risk when analyzed separately. Those reporting all four symptoms at least twice a week had 2.09-fold (1.75-2.49) risk. The findings did not materially change after excluding depression cases within the first two years of the follow-up. CONCLUSIONS: These data suggest an association between insomnia symptoms and moderately increased risk of clinically significant depression outcomes. Insomnia should be considered as a component in prediction models for new-onset depression.

14 Article Low level of optimism predicts initiation of psychotherapy for depression: results from the Finnish Public Sector Study. 2011

Karlsson, Hasse / Kronström, Kim / Nabi, Hermann / Oksanen, Tuula / Salo, Paula / Virtanen, Marianna / Suominen, Sakari / Kivimäki, Mika / Vahtera, Jussi. ·Department of Psychiatry, University of Helsinki, Helsinki, Finland. hasse.karlsson @ utu.fi ·Psychother Psychosom · Pubmed #21502771.

ABSTRACT: BACKGROUND: The patient's personality may be one of the many factors that contribute to the decision to initiate a certain treatment for depression. The aim of this study was to examine whether dispositional optimism and pessimism play a role in the initiation of psychotherapy as the treatment for new-onset depression in previously nondepressed public sector employees. METHODS: This prospective observational cohort study included 38,717 (mean age: 45 years; 76% female) public sector employees who responded to a survey in 1997, 2000-2001 and/or 2004 and had no history of depression at cohort entry. Dispositional optimism and pessimism were assessed via the revised Life Orientation Test and linked to individual records of indicators of depression onset in comprehensive national health registers, and of long-term psychotherapy for depression in particular. RESULTS: During a mean follow-up of 4.0 years, 1,616 (4%) incident cases of depression were observed. Of them, 79 started long-term, state-subsidized psychotherapy for depression. A 1-unit increase in mean optimism score was associated with a 38% lower likelihood of initiating psychotherapy as a treatment for depression and a 32% lower likelihood of depressive disorder in general during follow-up. Pessimism score was not associated with initiation of psychotherapy for depression, but a 1-unit increase in pessimism score was associated with a 28% increase in the likelihood of depressive disorder. These findings were robust to adjustments for demographics, health risk behaviors and somatic diseases at baseline. CONCLUSION: This study suggests that although both low optimism and high pessimism increase the risk for depression, only low optimism influences the initiation of psychotherapy as a treatment modality for depression. This could imply that depressed patients with low optimism should receive more attention in the beginning of the depressive episode than patients with high optimism.

15 Article Optimism and pessimism as predictors of work disability with a diagnosis of depression: a prospective cohort study of onset and recovery. 2011

Kronström, Kim / Karlsson, Hasse / Nabi, Hermann / Oksanen, Tuula / Salo, Paula / Sjösten, Noora / Virtanen, Marianna / Pentti, Jaana / Kivimäki, Mika / Vahtera, Jussi. ·Department of Psychiatry, University of Turku, 20500 Turku, Finland. kim.kronstrom@fimnet.fi ·J Affect Disord · Pubmed #21055822.

ABSTRACT: BACKGROUND: Personality characteristics are assumed to affect to the vulnerability to depression and its outcomes. The aim of this study was to examine optimism and pessimism as predictors of depression-related work disability and subsequent return to work. METHODS: We conducted a prospective cohort study of 38,214 public sector employees with no record of diagnosed depression. Optimism and pessimism were measured using the Revised Life Orientation Test (LOT-R). Records of long-term (>90 days) work disability with a diagnosis of depression and subsequent return to work until the end of 2005 were obtained from the national health registers. RESULTS: During the mean follow-up of 4.0 (SD=2.3) years, 287 employees encountered work disability with a diagnosis of depression. Of them, 164 (57%) returned to work during the follow-up. One unit increase in the optimism mean score (range 1-4) was associated with a 25% lower risk of work disability due to depression and a 37% higher probability of returning to work after a work disability period when adjusted for age and sex. In the fully-adjusted model hazard ratios per one unit increase in optimism were 0.79 (95% CI 0.66-0.96) for work disability and 1.30 (95% CI 1.01-1.66) for return to work. The pessimism mean score (range 1-4) was only associated with a lower probability of returning to work (fully-adjusted HR per one unit increase 0.66, 95% Cl 0.49-0.88). CONCLUSION: The level of optimism was a stronger predictor of work disability with a diagnosis of depression than the level of pessimism, while both optimism and pessimism predicted returning to work.

16 Article Early retirement from work among employees with a diagnosis of personality disorder compared to anxiety and depressive disorders. 2011

Korkeila, J / Oksanen, T / Virtanen, M / Salo, P / Nabi, H / Pentti, J / Vahtera, J / Kivimäki, M. ·Department of psychiatry, University of Turku, Kunnallissairaalantie 20, 20700 Turku, Finland. jyrkor@utu.fi ·Eur Psychiatry · Pubmed #20541917.

ABSTRACT: OBJECTIVE: Risk of retirement from work before statutory retirement age among employees with personality disorders is unknown. METHOD: We used diagnoses of awarded medical rehabilitations and hospitalisations to select two clinical cohorts from a population of 151,618 employees: participants in rehabilitation (total N=1942, 233 personality disorder, 419 anxiety disorder and 1290 depression cases) and hospitalised patients (N=1333, 354, 126 and 853, respectively). Early retirement from work was tracked through national registers during a period of 5 years. Cox proportional hazard models were used to examine the association of diagnostic groups with risk of early retirement. RESULTS: In models adjusted for age, sex and socioeconomic position, the relative risk of early retirement for patients with personality disorders was 3.5-fold (95% CI 2.1 to 5.8) in the rehabilitation cohort and 2.3-fold (95% CI 1.6 to 3.5) in the hospital cohort compared with anxiety disorders. The corresponding hazard ratios of early retirement for personality disorders compared with depressive disorders were 1.1 (95% CI 0.8-1.5) and 1.7 (95% CI 1.4-2.1), respectively. CONCLUSIONS: Personality disorders increase the risk of early retirement at least to an equal extent as depression and more than twice that of anxiety disorders.

17 Article Antidepressant use before and after the diagnosis of type 2 diabetes: a longitudinal modeling study. 2010

Kivimäki, Mika / Tabák, Adam G / Lawlor, Debbie A / Batty, G David / Singh-Manoux, Archana / Jokela, Markus / Virtanen, Marianna / Salo, Paula / Oksanen, Tuula / Pentti, Jaana / Witte, Daniel R / Vahtera, Jussi. ·Department of Epidemiology and Public Health, University College London, London, UK. m.kivimaki@ucl.ac.uk ·Diabetes Care · Pubmed #20368411.

ABSTRACT: OBJECTIVE: To examine antidepressant use before and after the diagnosis of diabetes. RESEARCH DESIGN AND METHODS: This study was a longitudinal analysis of diabetic and nondiabetic groups selected from a prospective cohort study of 151,618 men and women in Finland (the Finnish Public Sector Study, 1995-2005). We analyzed the use of antidepressants in those 493 individuals who developed type 2 diabetes and their 2,450 matched nondiabetic control subjects for each year during a period covering 4 years before and 4 years after the diagnosis. For comparison, we undertook a corresponding analysis on 748 individuals who developed cancer and their 3,730 matched control subjects. RESULTS: In multilevel longitudinal models, the odds ratio for antidepressant use in those who developed diabetes was 2.00 (95% CI 1.57-2.55) times greater than that in nondiabetic subjects. The relative difference in antidepressant use between these groups was similar before and after the diabetes diagnosis except for a temporary peak in antidepressant use at the year of the diagnosis (OR 2.66 [95% CI 1.94-3.65]). In incident cancer case subjects, antidepressant use substantially increased after the cancer diagnosis, demonstrating that our analysis was sensitive for detecting long-term changes in antidepressant trajectories when they existed. CONCLUSIONS: Awareness of the diagnosis of type 2 diabetes may temporarily increase the risk of depressive symptoms. Further research is needed to determine whether more prevalent use of antidepressants noted before the diagnosis of diabetes relates to effects of depression, side effects of antidepressant use, or a common causal pathway for depression and diabetes.

18 Article Prospective study of workplace social capital and depression: are vertical and horizontal components equally important? 2010

Oksanen, Tuula / Kouvonen, Anne / Vahtera, Jussi / Virtanen, Marianna / Kivimäki, Mika. ·Finnish Institute of Occupational Health, Lemminkäisenkatu, Turku, Finland. tuula.oksanen@ttl.fi ·J Epidemiol Community Health · Pubmed #19692720.

ABSTRACT: BACKGROUND: Recent studies have emphasised the multidimensional nature of the social capital concept, but it is not known whether the health effects of social capital vary by dimension. The objective of this study was to examine the vertical component (ie, respectful and trusting relationships across power differentials at work) and the horizontal component of workplace social capital (trust and reciprocity between employees at the same hierarchical level) as risk factors for subsequent depression. METHODS: A cohort of 25 763 Finnish public sector employees who were initially free from depression was followed up on average 3.5 years for new self-reported physician-diagnosed depression and recorded antidepressant prescriptions derived from national registers. RESULTS: Factor analysis confirmed the existence of vertical and horizontal components of workplace social capital. The odds for new physician-diagnosed depression and antidepressant treatment were 30-50% higher for employees with low vertical or horizontal workplace social capital than for their counterparts with high social capital at work. In mutually adjusted models, vertical and horizontal social capital remained independent predictors of physician-diagnosed depression and antidepressant treatment. CONCLUSION: These results highlight the importance of both vertical and horizontal components of workplace social capital as predictors of employee mental health.

19 Article Overcrowding in hospital wards as a predictor of antidepressant treatment among hospital staff. 2008

Virtanen, Marianna / Pentti, Jaana / Vahtera, Jussi / Ferrie, Jane E / Stansfeld, Stephen A / Helenius, Hans / Elovainio, Marko / Honkonen, Teija / Terho, Kirsi / Oksanen, Tuula / Kivimäki, Mika. ·Finnish Institute of Occupational Health, Helsinki, Finland. marianna.virtanen@ttl.fi ·Am J Psychiatry · Pubmed #18676590.

ABSTRACT: OBJECTIVE: This report assessed whether hospital ward overcrowding predicts antidepressant use among hospital staff. METHOD: The extent of hospital ward overcrowding was determined using administrative records of monthly bed occupancy rates between 2000 and 2004 in 203 somatic illness wards in 16 Finnish hospitals providing specialized health care. Information on job contracts for personnel was obtained from the employers' registers. Comprehensive daily data on purchased antidepressant prescriptions (World Health Organization's Anatomical Therapeutic Chemical classification code N06A) for nurses (N=6,699) and physicians (N=641) was derived from national registers. Cox proportional hazards models were used to examine the association between bed occupancy rate and subsequent antidepressant treatment. Monthly bed occupancy rates were used as a time-dependent exposure that could change in value over the course of observation. Hazard ratios were adjusted for sex, age, occupation, type and length of employment contract, hospital district, specialty, and calendar year. RESULTS: Exposure over 6 months to an average bed occupancy rate over 10% in excess of the recommended limit was associated with new antidepressant treatment. This association followed a dose-response pattern, with increasing bed occupancy associated with an increasing likelihood of antidepressant use. There was no evidence of reverse causality; antidepressant treatment among employees did not predict subsequent excess bed occupancy. CONCLUSIONS: The increased risk of antidepressant use observed in this study suggests that overcrowding in hospital wards may have an adverse effect on the mental health of staff.

20 Article Low workplace social capital as a predictor of depression: the Finnish Public Sector Study. 2008

Kouvonen, Anne / Oksanen, Tuula / Vahtera, Jussi / Stafford, Mai / Wilkinson, Richard / Schneider, Justine / Väänänen, Ari / Virtanen, Marianna / Cox, Sara J / Pentti, Jaana / Elovainio, Marko / Kivimäki, Mika. ·Institute of Work, Health, and Organisations, University of Nottingham, Nottingham, United Kingdom. anne.kouvonen@nottingham.ac.uk ·Am J Epidemiol · Pubmed #18413361.

ABSTRACT: In a prospective cohort study of Finnish public sector employees, the authors examined the association between workplace social capital and depression. Data were obtained from 33,577 employees, who had no recent history of antidepressant treatment and who reported no history of physician-diagnosed depression at baseline in 2000-2002. Their risk of depression was measured with two indicators: recorded purchases of antidepressants until December 31, 2005, and self-reports of new-onset depression diagnosed by a physician in the follow-up survey in 2004-2005. Multilevel logistic regression analysis was used to explore whether self-reported and aggregate-level workplace social capital predicted indicators of depression at follow-up. The odds for antidepressant treatment and physician-diagnosed depression were 20-50% higher for employees with low self-reported social capital than for those reporting high social capital. These associations were not accounted for by sex, age, marital status, socioeconomic position, place of work, smoking, alcohol use, physical activity, and body mass index. The association between social capital and self-reported depression attenuated but remained significant after further adjustment for baseline psychological distress (a proxy for undiagnosed mental health problems). Aggregate-level social capital was not associated with subsequent depression.