Biomedical subjects
Jyrki Korkeila
Publications and source records attributed to Jyrki Korkeila.
Childhood adversities, adult risk factors and depressiveness: a population study.
OBJECTIVE: Childhood adversities have been associated with adulthood depressiveness, but the contribution of adult risk factors is seldom described. We examined whether adult risk factors lie on the pathway from childhood adversity to adult depressiveness (pathway hypothesis) or whether the association depends on life events (vulnerability hypothesis). METHOD: Among 21,101 randomly sampled working-aged respondents [the Health and Social Support in Finland (HeSSup) Study], the hypotheses were tested with logistic regression analysis models studying the associations between Beck Depression Inventory (BDI)-assessed depressiveness and self-reported childhood adversities alone and in combination with recent adverse events. RESULTS: Childhood adversities were consistently associated with depressiveness (women, age-adjusted odds ratio 3.1, 95% confidence intervals 2.6-3.7; men, 2.6, 2.1-3.3), although the risks were decreased by more than 30% after adjustments for adult risk factors such as living alone, education, alcohol consumption, social support and negative affectivity. Childhood adversities combined with recent life events were associated with depressiveness in an additive manner. Women with childhood adversities and recent person-independent events especially had increased vulnerability for depressiveness. CONCLUSIONS: The childhood adversity-depressiveness associations were partly mediated by adult risk factors, supporting a pathway from childhood adversities to depressiveness through adult risk factors. Increased vulnerability for depressiveness was found among respondents with childhood adversities in combination with recent death/illness events. The findings emphasize the importance of early risk factors when identifying persons at risk of depression.
Structure of needs among persons with schizophrenia.
BACKGROUND: The importance of needs assessment for service development has been widely recognised. Several studies have focused on the associations between ratings of needs by patients and staff and have found clear differences, especially concerning the unmet needs. METHODS: The present study is part of a Nordic Multicentre study that investigates the life and care of outpatients with a schizophrenia group illness in all the Nordic countries. The aim of this paper is to study the patterns of needs as identified by patients and staff according to the Camberwell Assessment of Needs (CAN). Quality of life, level of functioning, and psychiatric symptoms were assessed. RESULTS: The sample includes 300 patients, 194 (65%) men and 106 (35%) women. The factor analysis identified five factors for patients and four factors for staff in the questionnaire on ratings of needs. In four of the five patient-related factors a meaningful interpretation was possible, and the factors were named skills, illness, coping, and substance abuse. The staff-related factors were named skills, impairment, symptom, and substance abuse. There were significant associations between the sum scores constructed from the factors and measures of functioning level and symptoms. CONCLUSIONS: It seems that the sum factor reflecting secondary needs was the most important of the identified factors among both patient and staff ratings. The item-by-item comparisons in previous studies have emphasised differences between patient and staff ratings, but our analysis of the structure of needs also found similarities in the structures and in the associations between the identified sum scores and measures of symptoms, functioning level, and quality of life.
Subjective versus interviewer assessment of global quality of life among persons with schizophrenia living in the community: a Nordic multicentre study.
BACKGROUND: Few studies have investigated differences between subjective and externally assessed quality of life in individuals with a severe mental illness. In a sample of 387 patients with schizophrenia living in the community the present study investigated the association between subjective and interviewer-rated quality of life, clinical and sociodemographic factors related to the two assessments, and if discrepancies in the assessments were related to any clinical or social features of the patients. METHOD: The study was a Nordic multicentre study with a cross-sectional design. Instruments used were the Lancashire Quality of Life Profile, the Brief Psychiatric Rating Scale, the Interview Schedule for Social Interaction, Camberwell Assessment of Needs and General Assessment of Functioning. RESULTS: The correlation between subjective and interviewer-rated quality of life was moderate (ICC = 0.33). More severe affective symptoms, fewer emotional relations and a lower monthly income were related to poorer subjectively rated quality of life but in a stepwise multiple regression analysis accounted for only 14.1% of the variance. Poorer interviewer-rated quality of life was mainly related to a more severe psychopathology but also to a lower monthly income, fewer emotional relations and not being employed. Together these factors accounted for 45.5% of the variance. A greater discrepancy between the subjective and the interviewer rating was found in patients with less affective symptoms, unemployment, and a better social network. CONCLUSION: Only a moderate correlation between subjective and interviewer-assessed global quality of life was found, implying that the sources of assessment differed, as was also shown in subsequent regression models. It is concluded that both perspectives on the patient's quality of life may be valuable for treatment planning, especially in cases where differences in quality of life assessment related to the patient's psychopathology may be expected.
Psychiatric trainees in Finland 2001.
This study examined Finnish psychiatric trainees' views on their education. This was a survey study of nationwide data on Finnish psychiatric trainees in 2001. The quality of training was considered at least moderate by 84% of the respondents. Training on epidemiology, on taking history and status, and on psychopharmacology was considered the best. Quality was rated bad for training in leadership and administration, and educating the community. Research was done by 20%, and a personal clinical supervisor was appointed to 52% of the respondents. Offensive treatment had been experienced by 49% of the trainees in this study. Generally, studies of training also reflect strengths and weaknesses of the profession. Based on our results, it seems especially that training in leadership and in educating the community need to be improved; both of these are quintessential skills to survive in the struggle for economic and human resources. Furthermore, treatment of the trainees could still be better; attention should be paid to supervision of all trainees. Moreover, research must become more attractive. Psychiatry can be developed by the development of psychiatric training.
[Attention deficit hyperactivity disorder in adults].
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Axis-I disorders and vulnerability to psychosis.
BACKGROUND: The psychopathology that manifests during the prodromal phase of first-episode psychosis is varied. Little is known about the clinical diagnoses of subjects with so-called prodromal or psychotic-like symptoms. METHOD: Samples of psychotic patients, first-degree relatives (FDRs) of psychotic, or severely ill patients, treatment-seeking patients, and a random community sample (in all 157 subjects) were assessed by the Structured Interview for Prodromal Symptoms (SIPS) and the SCID-I. Vulnerability to psychosis (VTP) was defined by severity of positive symptoms reported in the SIPS interview and associated with lifetime SCID-I diagnoses. RESULTS: The number of lifetime diagnoses received increased linearly as the SIPS symptoms approached more psychotic-like phenomena. All VTP subjects received on average 2.5, and currently prodromal subjects 2.9 lifetime SCID-I diagnoses, while the corresponding figure for non-VTP subjects was 0.7 (p<0.0001). Mood disorders and comorbid anxiety disorders were particularly common. CONCLUSION: Vulnerability to psychosis seems to be associated with a high number of lifetime Axis-I diagnoses. Occurrence of anxiety disorders is remarkable, and most VTP subjects can be diagnosed with a lifetime mood disorder. VTP subjects require careful assessment of mood and anxiety symptoms and adequate treatment for their multiple disorders.
Dissociative disorders among psychiatric patients.
The aim was to determine the rate of dissociative disorders among psychiatric in- (n = 34) and out-patients (n = 37) and to compare the rate to that of nonclinical subjects (n = 297). Dissociative disorders (17% of patients) could be grouped according to the severity of the symptoms and their relation to affective disorders.
Establishing a set of mental health indicators for Europe.
AIMS: This review presents the background work for developing a set of mental health indicators as part of a comprehensive health monitoring system in the European Union. The review focuses on the appraisal of mental health at population level with special emphasis on assessments that could be useful for mental health promotion. METHODS: A functional model of mental health is used to delineate variables important for a set of mental health indicators. Variables that are not possible to monitor at population level are not discussed here. Literature searches were conducted through the MEDLINE, PSYCHLIT, and SOCIOLOGICAL ABSTRACTS databases and available textbooks. RESULTS: The review presents findings from research seeking associations between mental health and ill health and different individual, social, economic, ecological, and service-related characteristics. Specific domains as key starting points in establishing a set of mental health indicators are outlined according to the research findings. CONCLUSION: A set of mental health indicators can enhance the visibility of mental health issues in the European context. Ultimately the indicators could be used in estimating how the targets set for health policies are met, and whether there has been a measurable decrease in disability, suffering, and disease.
Micropsia and dissociative disorders.
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[Meeting a patient with hypochondria].
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