Room
1er étage - E130
Theme
Findings on mental health
Chair
Wim Nieuwenboom
Title
“Even when you are 18 it’s difficult because you are only 18 too”: transitions at adolescence and young adulthood when living with a motor disability
Name
Christina Akre
Affiliation
Centre universitaire de médecine générale et santé publique - Unisanté et Université de Lausanne
Abstract
Introduction:Research on adolescents and young adults (AYAs) with chronic conditions (CC) focuses on transfer from pediatric to adult care, with rare consideration for the multiple transitions they undergo to adulthood. Our aim was to listen to AYAs with motor disability (MD), gaining insights of their transitions and of how health professionals (HP) can support them.
Methods:
As part of a larger qualitative study on diagnosis literacy, we used individual interviews with 10 AYAs (M:F 1:1; mean age 18.7y[15-24]) with MD. Interviews were recorded online (N=8) or in a clinic (N=2), lasted 45-150 minutes, and transcribed verbatim. An inductive approach revealed spontaneous preoccupations with transition, when no questions were asked regarding the topic; transcripts were coded for those aspects and analyzed thematically.
Results:
AYAs described 3 types of transitions:
Healthcare:
AYAs underlined strong differences between pediatric and adult care, “different worlds”. Pediatric care was qualified as joyful; being part of a community; horizontal trustful relations with HPs; feeling safe; considering patients’ experience and expertise. Adult care was associated with top-down relations with HPs; feeling insecure and lonely with one’s condition; lack of account for patients’ expertise; poor coordination and follow-up by HPs with “transition failures”; HPs lack of knowledge on childhood onset CCs and caring for AYAs.
Psychosocial:
Participants described adolescence as a difficult period, struggling to break free from parents while being physically dependent; longing for normality; challenging to accept oneself with MD; refusal to talk about their MD. Some reported seeking help from a psychologist. Some considered it a necessary phase that helped them accept their MD. They stressed difficulties in romantic relationships, peer judgement, and self-image.
School:
These implied having to explain their disability repeatedly, during a period of refusal to talk about it. School also meant integration difficulties, feeling different, bullying and mocking. They questioned ordinary vs. specialized schooling to access further education or work.
Conclusion:
The different transitions AYAs with MD go through are of great importance to them, often more than any other aspect of care. Given the high use of healthcare in this population, HPs should accompany them through these transitions by focusing on these issues and maintaining a trustworthy relationship beyond entering adulthood.
Title
Long-term antidepressant prescriptions in the elderly and risk of severe adverse outcomes
Name
Melanie Alexandra Amrein
Affiliation
Helsana Group
Abstract
Antidepressants are massively prescribed worldwide. Prolonged consumption is becoming increasingly common, especially among the older population. However, the long-term use of antidepressant has come under increasing criticism in recent years due to the controversial studies on their effectiveness compared to placebo, the unnecessary medication costs associated with it, and due to its potentially adverse events. Adverse events of antidepressants are more common in scientific studies of long-term antidepressant users such as claims based studies, compared to short-term clinical trials. The aim of this study is to investigate whether the risk of adverse events (cardiovascular disease, diabetes, dementia), as well as the risk of hospitalization and all-cause mortality increases with increasing duration of antidepressant use.
This retrospective cohort study analyzes Helsana claims data between 2013 and 2022 using propensity score matching. People aged 65 and older with a first-time prescription for an antidepressant were included in the study. People were differentiated into long-term users (>= 2 years of use), medium-term user (1-2 years), short-term users (< 1 year of use) and no-use controls.
Between 2013 and 2022, 49’057 people had at least one prescription of an antidepressant and were older than 65 years. 16’405 were long-term, 7’487 medium-term and 25’165 short-term users. Each long-term user was assigned a group of non-user control person using propensity score matching (based on the descriptives variables such as age or region of residence in Switzerland, comorbidities using Pharmaceutical Cost Groups and Charlson Comorbidity Index, number of hospitalizations, psychological diagnoses, and nursing home stays). After propensity score matching, the final control sample consisted of 49’654 cases. Relationships between different antidepressant users and outcomes (dementia, cardiovascular diseases, diabetes, number of hospitalizations and mortality) are exam-ined using binomial logistic regressions. As a secondary analysis, regressions are calculated separately for the different antidepressant groups.
Using propensity score matching, this study highlights the risk for several adverse outcomes associated to longer duration of antidepressant use.
Title
Free Is Not Enough: The Long-Run Impact of Free Education on Late-Life Cognitive Function - Evidence from Ireland
Name
Kieny Clémence
Affiliation
Unisanté
Abstract
This study explores the enduring impacts of Ireland's 1967 Free Education reform, a pivotal policy that expanded access to secondary education, on cognitive function in later life. It specifically examines how these effects vary among different socio-economic groups. We use data from the Irish Longitudinal Study on Ageing (TILDA), a nationally representative survey of 8,504 Irish adults aged 50 years and older. Specifically, we use the comprehensive array of objective cognitive metrics captured in the most recent wave of health assessments (Wave 3, 2014-2015). We conduct a reduced-form analysis, comparing individuals born just around 1953 - the first cohort affected by the reform - while controlling for age trends and predetermined variables. Furthermore, we disaggregate results between individuals who grew up in low vs. high socio-economic status (SES) families, based on their father’s occupation when they were 14. Our findings show that despite the reform significantly increasing years of schooling, specifically among individuals from low parental SES, it had a negligible impact on old-age cognitive performance. Subgroup analysis reveals that the reform even appeared to have a negative impact on some measures of global cognition among the high SES group. Investigating potential causal channels, we explore the reform's impact on employment outcomes, income levels, health behaviors, and physical activity. Results show no impact among the low SES group and some detrimental effects among the high SES group, including a decrease in the likelihood of current employment and an increased likelihood of smoking. These findings suggest that while the reform succeeded in increasing access to education, it did not translate into long-term benefits. This could be due to several factors, such as the insufficient increase in schooling duration, the lack of impact on educational certificates, and documented declines in educational quality due to rapid implementation. Moreover, it appears to have had harmful effects for high SES students who were more likely to have already been enrolled in secondary school before the reform. Our study highlights the need for caution in educational expansion reforms, emphasizing the importance of a simultaneous investment in educational quality. This research contributes to the broader debate on the impact of education policies, underscoring the complexity of such reforms and their implications.
Title
Do trends in education explain declines in dementia? Causal evidence from compulsory schooling reforms in the UK
Name
Nathalie Monnet
Affiliation
Unisanté
Abstract
An extensive literature suggests that higher educational attainment is associated with better cognitive functioning in older age, but the extent to which education is causally linked to dementia has not been well established. A related literature suggests that the incidence of dementia has been declining: Data for the UK suggests that dementia incidence declined by 2.7% annually from 2002 to 2013 in England (Ahmadi-Abhari et al., 2017). Education trends are often offered as an explanation, but there is no causal evidence that education influences dementia risk and trends.We investigate the causal impact of education on late-life cognitive impairment and dementia by exploiting two significant educational reforms in the UK. The 1947 reform elevated the minimum school-leaving age from 14 to 15, affecting children born after April 1st, 1933, while the subsequent 1972 reform raised the mandatory leaving age to 16 for those born after September 1st, 1957. Leveraging data from the English Longitudinal Study on Ageing (ELSA) and the Harmonized Cognitive Assessment Project (HCAP) subsample, we estimate dementia probability using a novel algorithm that incorporates information from respondents and proxy informants.
Our analysis employs a Fuzzy Regression Discontinuity (FRD) approach to explore the impact of education on dementia risk, exploiting the exogenous variation in schooling years induced by these pivotal reforms. Initial findings confirm the significant impact of both reforms on years of schooling, thereby establishing a robust foundation for our FRD analysis.
Our study aims to fill critical gaps in the current understanding of the role of education as a protective factor to prevent cognitive decline and dementia. The development of a novel algorithm for dementia based on the HCAP assessments allows us to assess dementia probabilities, an approach not previously used in studies on the causal impact of education. Causal estimates enable us to estimate the contribution of education trends to declines in dementia incidence. Our findings will provide important insights on the potential of education-based interventions as a means to mitigate dementia prevalence in aging populations.
Title
Advancing Suicide Prevention in Switzerland: the Role of Reliable Suicide Data
Name
Werdin Sophia
Affiliation
Swiss Tropical and Public Health Institute
Abstract
Background: Suicide is a major public health problem, impacting individuals, families and communities worldwide. Its prevention requires a comprehensive approach with diverse integrated interventions that are guided by current research findings and suicide data. In a qualitative study, we investigated suicide prevention measures and strategies in Germany, Austria and Switzerland to address critical gaps, highlight success factors and enhance suicide prevention in these countries. As part of this, we analyzed expert opinions on the relevance and quality of national suicide data.
Methods: We conducted online, semi-structured interviews with 36 suicide prevention experts from Germany, Austria and Switzerland, incorporating perspectives from policy, science and practice. The interviews, carried out from September 2022 to February 2023, were audio-recorded, transcribed verbatim and analyzed using the Framework method.
Results: Although national suicide statistics are of comparatively high quality in all three countries, they are not sufficient for a thorough investigation of suicidal behavior. Therefore, some federal states and cantons have implemented their own suicide monitoring systems, providing more detailed and timely data. None of the three countries has national routine data on suicide attempts, mainly due to challenges in defining and recording them. Regional efforts to record suicide attempts exist, but are often limited in scope and sample size. Many experts advocated for establishing a centralized suicide (attempt) registry, recognizing its potential for enhancing suicide prevention measures.
Discussion: High-quality suicide data are important for identifying patterns and trends in suicidal behavior, enabling timely responses and supporting suicidality research. The refinement of national statistics should be guided by established best practices in specific regions or other countries. With regard to suicide attempts, a standardized approach for consistent recording across key settings, such as psychiatric hospitals, police departments, and emergency services, is necessary. A suicide attempt monitoring system requires a standardized definition of suicide attempts, comprehensive training for professionals involved, and cross-sector agreement on leadership and funding. Reliable suicide data not only provide a more accurate representation of this major public health issue but also facilitate the development of targeted suicide prevention measures.