Matti Joukamaa

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Papers by Matti Joukamaa

Negative features of psychosis precede onset of psychosis in a prospective general population sample of adolescents

by Matti Joukamaa and Anja Taanila

Schizophrenia Research, 2008

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Five-year mortality of Finnish schizophrenia patients in the era of deinstitutionalization

Social Psychiatry and Psychiatric Epidemiology, 2009

j Abstract Background Excess mortality among people with schizophrenia due to natural and unnatur... more j Abstract Background Excess mortality among people with schizophrenia due to natural and unnatural causes, especially due to suicides, is a well-known fact. It has been suggested that deinstitutionalization increases suicide mortality but there are also contradictory results. We studied the changes in mortality and causes of death among schizophrenia sufferers during and after the years of deinstitutionalization process in Finland. Method The sample, identified from the Finnish hospital discharge register (FHDR), consisted of patients aged 15-65 and hospitalized for the first time due to schizophrenia. We focused on the 5-year follow-up from inclusion years 1980-1998 (N = 23,959). Changes in 5-year follow-up mortality during the study period were explored for both genders and for different causes of death separately using multivariate logistic regression analyses. Results During the study period 1,926 deaths occurred. Suicide was the major cause of death in both genders. A significant reduction in overall 5-year mortality was observed among persons hospitalized in 1995-1998 when compared to people hospitalized 1980-1984. In males a significant reduction was seen in all mortality (P = 0.025) due to suicides (P = 0.007) but not in the case of natural deaths. In females no significant changes in mortality were found. Conclusion Our study confirms a reduction in suicide mortality of male schizophrenia sufferers after the deinstitutionalization process. However the overall mortality is still very high and the attention needs to be focused on the general well-being of schizophrenia patients.

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Incidence of hospitalised schizophrenia in Finland since 1980: decreasing and increasing again

Social Psychiatry and Psychiatric Epidemiology, 2011

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Schizophrenia among patients treated for rheumatoid arthritis and appendicitis

by Hannu Lauerma and Matti Joukamaa

Schizophrenia Research, 1998

The widely accepted negative association between schizophrenia and rheumatoid arthritis (RA) is b... more The widely accepted negative association between schizophrenia and rheumatoid arthritis (RA) is based on the results of investigations which sought RA in large samples of schizophrenic patients. Using a discharge register, we examined the frequency of schizophrenia in a sample of 5626 RA patients. Appendicitis patients (n = 5330) were used as a comparison group. The cumulative incidence of hospital care with the diagnosis of schizophrenia during 8 years was higher in the RA group (0.64%) than in the appendicitis group (0.47%). Schizophrenia was significantly more common in the RA group than in the appendicitis group among the young. The age-adjusted prevalence of schizophrenia was 0.96% in the RA group and 0.51% in the appendicitis group. Because of this unexpected finding, we examined the incidence of RA and appendicitis among a birth cohort born in 1966. The frequencies of RA and appendicitis among schizophrenic cohort members (n =76), cohort members with psychiatric diagnosis other than schizophrenia (n=438), and members without psychiatric diagnosis (n= 10503) were similar. These findings do not support the negative association between schizophrenia and RA. Prolonged institutionalization per se may have been the protective factor against RA in the previous studies. The findings also raise the hypothesis that genes that predispose to schizophrenia provide protection from appendicitis, historically a common cause of mortality.

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Maternal separation at birth and schizophrenia—a long-term follow-up of the Finnish Christmas Seal Home Children

Schizophrenia Research, 2003

Problems in the early mother-infant relation pose a hypothetical risk factor of schizophrenia. We... more Problems in the early mother-infant relation pose a hypothetical risk factor of schizophrenia. We studied the association between very early separation and later development of schizophrenia or other psychoses in a unique data set. The index cohort consisted of 3020 subjects born in 1945-1965 in Finland who were temporarily isolated from their family immediately after birth to adequate nursing homes due to tuberculosis in the family. The average separation time was 7 months. For every index subject, two reference subjects were matched for sex, year of birth and place of birth. The Finnish Hospital Discharge Register was used to identify subjects with schizophrenia and other psychoses arising from childhood to middle age, between January 1, 1971 and December 31, 1998. The 28-year cumulative incidence of schizophrenia was 1.6% both in the index cohort and in the reference cohort (rate ratio 1.01, 95% CI 0.75-1.37). The incidences of other psychotic disorders were 1.5% and 1.3% (RR 1.11, 95% CI 0.79-1.58), respectively. Separation at birth was not found to be associated with either schizophrenia or other psychotic illness. Temporary placement to adequate nursing homes in the first year of life is unlikely to increase the risk for schizophrenia or other psychoses.

Non-participation in a field survey with respect to psychiatric disorders

Scandinavian Journal of Public Health, 2008

Higher rates of psychiatric morbidity among non-participants may lead to biased estimates of prev... more Higher rates of psychiatric morbidity among non-participants may lead to biased estimates of prevalence and incidence in epidemiological studies of psychiatric disorders. We had a unique opportunity to explore psychiatric morbidity and non-participation in a large epidemiological survey including questionnaires and a clinical examination. Members of the Northern Finland 1966 Birth Cohort were included in the study. In phase I, a postal questionnaire was mailed to all those with a known address in 1997 (N=11,540). In phase II, all subjects living in northern Finland or the Helsinki area (N=8,463) were invited to a clinical examination. In phase III, clinical examination participants were given a questionnaire with psychological subscales to be filled in at home and returned by mail. The data on hospital-treated psychiatric disorders were obtained from the Finnish Hospital Discharge Register. Educational level was obtained from Statistics Finland. The participation rates were 76%, 71% and 61% in phases I, II and III, respectively. Subjects with any psychiatric disorder participated less actively than those without any psychiatric disorder in all phases, in both genders and at all educational levels. Participation was not found to vary across specific disorders. Gender or education did not explain the association of psychiatric disorders with participation. Owing to non-participation, the true prevalence of psychiatric disorders may be higher than the prevalence estimated from epidemiological field surveys.

Are frequent attenders of primary health care distressed?

Scandinavian Journal of Primary Health Care, 1995

To measure the level of distress among frequent attenders of primary health care. A cross-section... more To measure the level of distress among frequent attenders of primary health care. A cross-sectional study. Two public primary health care stations in Turku, south-western Finland 96 frequent attenders (eleven or more visits to a physician during the previous 12 months) and 466 control patients. SCL-25, GP evaluations, self-reported symptoms and self-experienced need for care. Frequent attenders were significantly more distressed than other patients in primary care. However, their self-experienced need for psychiatric care was very low and it did not differ from other patients self-experienced need. The GPs estimated that over 1/3 of frequent attenders suffered from mixed (physical and psychiatric) illnesses and over 1/2 from subclinical or clinical psychiatric symptoms. The corresponding proportions for other patients were significantly lower.

Alexithymia and Psychological Distress among Frequent Attendance Patients in Health Care

Psychotherapy and Psychosomatics, 1996

The aim of the present study was to find out whether alexithymia is common in frequently attendin... more The aim of the present study was to find out whether alexithymia is common in frequently attending primary health care patients and whether alexithymia and psychological distress are associated in these patients. Alexithymia was measured by the TAS-26 and psychological distress by the SCL-25 in a random sample of 394 working-age primary health care patients. Frequent attendance was defined as a minimum of 11 visits during 1 year to different kinds of outpatient health care services, excluding specialized psychiatric care. Frequently attending patients with psychological distress were found to be alexithymic more commonly than other patients, but this was not the case with other frequently attending patients. In other words, frequent attendance and alexithymia had an association mediated by psychological distress. There is a subgroup of frequently attending patients, who are alexithymic and have psychological distress, too. They usually visit health-care services because of a somatic complaint. We hypothesize that their expression of psychological distress was masked and somatized just because of alexithymia.

Alexithymia and Somatization in General Population

Psychosomatic Medicine, 2008

Objective: Even though the association between alexithymia and somatization seems plausible accor... more Objective: Even though the association between alexithymia and somatization seems plausible according to several studies with selected populations, it has not been verified in carefully controlled and nationally representative population studies. We conducted such a study to find out whether alexithymia is associated with somatization at population level. Methods: This study was a part of the Finnish Health 2000 Study. The nationally representative sample comprised 5129 subjects aged 30 to 97 years. Alexithymia was measured with the 20-item Toronto Alexithymia Scale (TAS-20) and somatic symptom reporting with the 12-item somatization scale derived from the Hopkins Symptom Checklist. Sociodemographic and health-related variables, including depressive and anxiety disorders, and physician verified somatic diagnoses, were treated as confounders in multivariate analyses. Results: Alexithymia was associated with somatization independently of somatic diseases, depression and anxiety and confounding sociodemographic variables. The TAS-20 factor scale "Difficulties Identifying Feelings" was the strongest common denominator between alexithymia and somatization. Conclusions: This was the first time the independent association between alexithymia and somatization was established in a large, nationally representative nonclinical sample of both young and old adults with and without mental disorders and somatic diseases.

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Education, gender and cognitive performance in a 62-year-old normal population: results from the Turva Project

by Matti Joukamaa and Simo Saarijärvi

Psychological Medicine, 1995

Four WAIS (Wechsler Adult Intelligence Scale) subtests, and tasks of memory and cognitive control... more Four WAIS (Wechsler Adult Intelligence Scale) subtests, and tasks of memory and cognitive control were administered to a population sample of 143 men and 179 women. Subjects with a minor advantage in years of education out-performed those with only primary schooling. Gender-related effects were also remarkable. Whereas the general abilities were equal in the genders, women out-performed men on recall of word pairs and objects, on verbal cognitive control and on Digit Symbol. In contrast, men excelled on Trail Making A, and on Block Design. The findings emphasize the need for age norms by gender and education for cognitive tests.

Does perceived social support and parental attitude relate to alexithymia? A study in Finnish late adolescents

by Matti Joukamaa and Simo Saarijärvi

Psychiatry Research, 2011

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Temperament Clusters in a Normal Population: Implications for Health and Disease

by Anja Taanila and Matti Joukamaa

PLoS ONE, 2012

Background: The object of this study was to identify temperament patterns in the Finnish populati... more

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International comparison of Cloninger’s temperament dimensions

Personality and Individual Differences, 2006

Cloninger’s Tridimensional Personality Questionnaire (TPQ) and Temperament and Character Inventor... more Cloninger’s Tridimensional Personality Questionnaire (TPQ) and Temperament and Character Inventory (TCI) have been developed to measure the following temperament dimensions: novelty seeking (NS), harm avoidance (HA), reward dependence (RD) and persistence (P). We used our previous Finnish normative study of the TPQ and TCI (Miettunen et al., 2004) to estimate correction coefficients to convert TPQ scales to comparable TCI scales.

Predicting use of coercive measures in Finland

Nordic Journal of Psychiatry, 2002

The prevalence of use of seclusion and restraints in psychiatric treatment has varied dramaticall... more The prevalence of use of seclusion and restraints in psychiatric treatment has varied dramatically among institutions, according to previous studies. We investigated the factors predicting overall and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;heavy use&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; of restrictive measures and differences in the population-based rates of use of seclusion and restraints in three university psychiatric centres in Finland (Turku, Tampere and Oulu) using a retrospective chart review. The material comprised all civil admissions to the study hospitals of working-aged people during a period of 6 months in 1996. There were significant differences among the studied centres as to the population-based level of use of seclusion and restraints. Oulu used significantly less seclusion but had a significantly higher level of use of restraints than Turku and Tampere. The individual institutions best predicted the overall use of restrictive interventions, whereas previous commitments and involuntary legal status on admission were factors predicting &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;heavy use&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; of these measures. Our results suggest that the implementation and monitoring of restrictive measures could be further harmonized.

The Hopkins Symptom Checklist-25 in screening DSM-III-R axis-I disorders

Nordic Journal of Psychiatry, 2003

Simple screening questionnaires for major psychiatric disorders are needed for epidemiological re... more Simple screening questionnaires for major psychiatric disorders are needed for epidemiological research and clinical work. We describe the characteristics of the Hopkins Symptom Checklist-25 (HSCL-25) as a screening instrument in a two-phase epidemiological survey using the Structured Clinical Interview for DSM-III-R (SCID) as a diagnostic tool. The material consisted of 1609 subjects aged 31 years who were asked to participate in a health survey. The invitation included the HSCL-25 questionnaire. All &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;screen-positive&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; (HSCL-25 mean&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;/=1.55) subjects and every tenth &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;screen-negative&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; subject were invited to participate in the SCID interview. The sensitivity of the HSCL-25 for any present DSM-III-R axis-I psychiatric disorder was 48%. The specificity was 87%. The sensitivity of cases with comorbid psychiatric disorders was 100%. The HSCL-25 is a moderate instrument for screening with present axis-I DSM-III-R psychiatric disorders in a young adult population. It can be recommended for screening of psychiatric disorders.

Psychometric properties of the Finnish 20-item Toronto Alexithymia Scale

Nordic Journal of Psychiatry, 2001

The aim of this study was to examine the factor structure and the validity of the Finnish version... more The aim of this study was to examine the factor structure and the validity of the Finnish version of the 20-item Toronto Alexithymia Scale (TAS-20). As part of the Northern Finland 1966 Birth Cohort Project, the TAS-20 was presented to a sample of 5034 31-year old persons. A confirmatory factor analysis showed that the three-factor model, earlier established with the original TAS-20, was in agreement with the Finnish version of the scale. Three criteria of goodness-of-fit met the standards for adequacy of fit. For the total scale, internal reliability (Cronbach&amp;amp;amp;amp;amp;amp;#39;s alpha) was 0.83 and for the three subscales (factors 1, 2, and 3) it was 0.81, 0.77, and 0.66, respectively. Two- and one-factor models for TAS-20 were also examined, but the other models did not perform as well as the three-factor model. The factor model also worked well with a sample of 516 students with a mean age of 24.8 years. In conclusion, the TAS-20 scale is useful in the Finnish version, too.

Somatizing frequent attenders in primary health care

Journal of Psychosomatic Research, 2001

Objective: The aim of this case-control study was to investigate the association of somatization ... more Objective: The aim of this case-control study was to investigate the association of somatization with frequent attendance in primary health care. Methods: Frequent attenders in a health center (FAs) (N = 112) and age-and sex-matched controls (COs) (N = 105) constituted the study series. Data were collected from annual statistics, medical records, postal questionnaires and personal interviews. Psychological distress was assessed using Symptom Checklist-36 (SCL-36), alexithymia was measured with Toronto Alexithymia Scale-20 (TAS-20) and hypochondriasis was screened with Whiteley Index (WI). Results: About one-third of FAs were somatizers when a cut-off point of eight symptoms on the SCL-36 somatization subscale was used as a criterion. The significant association of somatization with frequent attendance disappeared in multivariate analyses when adjusted for age, sex and chronic somatic illnesses. Hypochondriacal beliefs and psychiatric comorbidity were connected with FAs' somatization. Hypochondriacal beliefs explained somatizers' frequent attendance. A significant interaction effect between somatization and hypochondriacal beliefs was found when explaining frequent attendance. Conclusions: The results emphasize the need to use a comprehensive approach of somatization, including hypochondriacal beliefs, when treating somatizing FA patients in primary health care. D

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Frequent attender profiles: Different clinical subgroups among frequent attender patients in primary care

by Ilpo Lahti and Matti Joukamaa

Journal of Psychosomatic Research, 1997

Psychiatric and physical morbidity among frequently attending patients in primary care is high. H... more Psychiatric and physical morbidity among frequently attending patients in primary care is high. However, very few efforts have been made to sort out the complex patterns of problems these patients have. We developed a clinical grouping of these patients. Our sample consisted of 67 frequent attenders. The measures included physical and psychiatric illnesses, presenting symptoms, sociodemographic data, psychosocial situation, level of distress, global functioning, experienced life satisfaction, illness attribution, and current psychiatric treatment. We identified five groups with different profiles: (1) patients with entirely physical illnesses; (2) patients with clear psychiatric illnesses; (3) crisis patients; (4) chronically somatizing patients; and (5) patients with multiple problems. The grouping was based on multidimensional operational criteria. The majority in all groups attended for solely physical illnesses or symptoms suggesting different forms of somatization. Only a few patients were undergoing any psychiatric treatment. Differences between groups were found regarding sociodemographic factors, physical illnesses, global functioning, and satisfaction.

Age is strongly associated with alexithymia in the general population

Journal of Psychosomatic Research, 2006

Objective: We studied the prevalence of alexithymia, its distribution in different age groups in ... more Objective: We studied the prevalence of alexithymia, its distribution in different age groups in a wide age range, its association with sociodemographic and health-related variables, and its co-occurrence with depression. Methods: The study forms part of the Health 2000 Study. The original sample comprised 8028 subjects representing the general adult population of Finland. Alexithymia was measured with the 20-item Toronto Alexithymia Scale (TAS-20), and depression was measured with the 21-item Beck Depression Inventory. Altogether, 5454 participants filled in TAS-20 in their mother tongue. Results: The prevalence of alexithymia was 9.9%. Men (11.9%) were more commonly alexithymic than women (8.1%). Alexithymia was associated with male gender, increasing age, low educational level, poor perceived health, and depression. Conclusions: The findings were in line with earlier population studies. For the first time, it was possible to analyze the prevalence of alexithymia in a wide age range (30-97 years). International comparative studies are needed. D

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Alexithymia and occupational burnout are strongly associated in working population

Journal of Psychosomatic Research, 2007

Objective: The relationship between alexithymia and occupational burnout has not previously been ... more Objective: The relationship between alexithymia and occupational burnout has not previously been studied. We investigated the association between alexithymia and occupational burnout in a representative nationwide population health study. Methods: This study was a part of the Finnish Health 2000 Study. The nationally representative sample comprised 3322 employees aged 30-64 years. Alexithymia was measured with the 20-item Toronto Alexithymia Scale (TAS-20) and occupational burnout with the Maslach Burnout Inventory-General Survey. Sociodemographic and health-related variables including depression were treated as confounders in the logistic regression analyses, which were performed alternately with TAS-20 total score and the scores of the three TAS-20 factor scales as alexithymia variables. Results: Alexithymia and its three facets were significantly associated with occupational burnout even when controlled for confounding factors. Conclusions: Even though both alexithymia and depression are associated with burnout, alexithymia may be an independent risk factor for occupational burnout. D

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