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  • Nguyen, Lien (Helsingin yliopisto, 2008)
    This thesis is grounded on four articles. Article I generally examines the factors affecting dental service utilization. Article II studies the factors associated with sector-specific utilization among young adults entitled to age-based subsidized dental care. Article III explores the determinants of dental ill-health as measured by the occurrence of caries and the relationship between dental ill-health and dental care use. Article IV measures and explains income-related inequality in utilization. Data employed were from the 1996 Finnish Health Care Survey (I, II, IV) and the 1997 follow-up study included in the longitudinal study of the Northern Finland 1966 Birth Cohort (III). Utilization is considered as a multi-stage decision-making process and measured as the number of visits to the dentist. Modified count data models and concentration and horizontal equity indices were applied. Dentist s recall appeared very efficient at stimulating individuals to seek care. Dental pain, recall, and the low number of missing teeth positively affected utilization. Public subvention for dental care did not seem to statistically increase utilization. Among young adults, a perception of insufficient public service availability and recall were positively associated with the choice of a private dentist, whereas income and dentist density were positively associated with the number of visits to private dentists. Among cohort females, factors increasing caries were body mass index and intake of alcohol, sugar, and soft drinks and those reducing caries were birth weight and adolescent school achievement. Among cohort males, caries was positively related to the metropolitan residence and negatively related to healthy diet and education. Smoking increased caries, whereas regular teeth brushing, regular dental attendance and dental care use decreased caries. We found equity in young adults utilization but pro-rich inequity in the total number of visits to all dentists and in the probability of visiting a dentist for the whole sample. We observed inequity in the total number of visits to the dentist and in the probability of visiting a dentist, being pro-poor for public care but pro-rich for private care. The findings suggest that to enhance equal access to and use of dental care across population and income groups, attention should focus on supply factors and incentives to encourage people to contact dentists more often. Lowering co-payments and service fees and improving public availability would likely increase service use in both sectors. To attain favorable oral health, appropriate policies aimed at improving dental health education and reducing the detrimental effects of common risk factors on dental health should be strengthened. Providing equal access with respect to need for all people ought to take account of the segmentation of the service system, with its two parallel delivery systems and different supplier incentives to patients and dentists.
  • Byskata, Stig-Göran (1980)
  • Lindholm, Erika (2014)
    Erikas abstrakt-2-2.pdf
  • Tervanotko, Hanna (Bookwell, 2013)
    The task of this study is twofold. First, it aims to analyze the treatment and the development of the figure of Miriam as a literary character in ancient Jewish texts by taking into account all the references to this figure preserved in the ancient Jewish literature from the exilic period to the early second century C.E.: Exodus 15:20-21, Numbers 12:1-15; 20:1; 26:59, Deuteronomy 24:8-9, 1 Chronicles 5:29, Micah 6:4, the Septuagint, the Dead Sea Scrolls (4Q365 6 II, 1-7; 4Q377 2 I, 9; 4Q543 1 I, 6 = 4Q545 1 I, 5; 4Q546 12, 4; 4Q547 4 I, 10; 4Q549 2, 8), Jubilees 47:4, Ezekiel the Tragedian 18, Demetrius Chronographer frag. 3, texts by Philo of Alexandria: De vita contemplativa 87; Legum allegoriae 1.76; 2.66-67; 3.103; De agricultura 80-81; Liber antiquitatum biblicarum 9:10; 20:8, and finally texts by Josephus: Antiquitates judaicae 2.221; 3.54; 3.105; 4.78. The passages referring to Miriam demonstrate that the picture of Miriam preserved in the ancient Jewish texts is richer than the Hebrew Bible suggests. Her function extends beyond the household-responsibility role that is often assigned to women in antiquity. The peak of Miriam traditions falls to the 3rd and 2nd centuries B.C.E. when this figure was used to promote the family of Levi. After this period, the figure of Miriam lost, at least partly, her prominence, and she became the target of different interpretations. She did not fit into the ideal of a woman in the Roman era, and she became more marginalized in a number of texts. Second, in light of poststructuralist literary studies that treat texts as reflections of specific social situations, I argue that the treatment of Miriam in ancient Jewish literature mostly reflects a reality in which women had little space as active agents. In particular, the interpretation of Miriam in the Greco-Roman era shows that when the political goals in the texts are emphasized, the room for women gets narrower. Despite this general tendency, prominent women may have enjoyed occasional freedom. Miriam continues to be given the title prophetess during the Greco-Roman era. That demonstrates that female prophecy was a known phenomenon even in a context that generally downplayed women.
  • Stevanovic, Melisa (Helsingin yliopisto, 2013)
    This dissertation describes people s orientations to "deontic rights" -that is, their rights to determine actions. Through analyses of video-recorded church workplace meetings between pastors and cantors as data, and conversation analysis as a theoretical and methodological framework, the study examines how participants in interaction may establish their own and each other s deontic rights in the turn-by-turn sequential unfolding of interaction. The dissertation consists of six original articles and an introduction, which introduces the central concepts of the study, provides an overview of its results, and discusses the ways in which the study contributes to the existing knowledge of social interaction. The study considers deontic rights from two different angles. First, it describes how participants in interaction may claim or mitigate their claims of deontic rights by virtue of their overt interactional conduct: Article 1 discusses the participants ways of dealing with those claims of deontic rights that arise from their participation in an encounter, and Articles 2 4 consider how participants in joint decision making may establish and maintain the symmetrical distribution of deontic rights at different sequential loci. Second, the study describes the ways in which participants may deploy their deontic rights as interactional resources, as they design their communicative actions so as to be recognizable as such. The central argument presented in Articles 5 and 6 is that, instead of always needing to claim their deontic rights (deontic stance), participants may also trust in their co-participants being aware of, and taking into account, these rights (deontic status). It is thus the complementarity and relative weight of deontic stances and deontic statuses that constitutes a fundamental mechanism by which people may engage in tough power negotiations without yet causing any overt face threats to their mutual solidarity. The study highlights the significance of face-to-face interaction as a locus of social order and seeks to enhance our understanding of the linkages between the local and wider aspects of social organization that pertain to people s interactional conduct.
  • Kangasniemi, Heikki (1986)
  • Koskinen, Arja (1992)
  • Nurmi, Ville (Helsingin yliopisto, 2009)
    This thesis is a study of a rather new logic called dependence logic and its closure under classical negation, team logic. In this thesis, dependence logic is investigated from several aspects. Some rules are presented for quantifier swapping in dependence logic and team logic. Such rules are among the basic tools one must be familiar with in order to gain the required intuition for using the logic for practical purposes. The thesis compares Ehrenfeucht-Fraïssé (EF) games of first order logic and dependence logic and defines a third EF game that characterises a mixed case where first order formulas are measured in the formula rank of dependence logic. The thesis contains detailed proofs of several translations between dependence logic, team logic, second order logic and its existential fragment. Translations are useful for showing relationships between the expressive powers of logics. Also, by inspecting the form of the translated formulas, one can see how an aspect of one logic can be expressed in the other logic. The thesis makes preliminary investigations into proof theory of dependence logic. Attempts focus on finding a complete proof system for a modest yet nontrivial fragment of dependence logic. A key problem is identified and addressed in adapting a known proof system of classical propositional logic to become a proof system for the fragment, namely that the rule of contraction is needed but is unsound in its unrestricted form. A proof system is suggested for the fragment and its completeness conjectured. Finally, the thesis investigates the very foundation of dependence logic. An alternative semantics called 1-semantics is suggested for the syntax of dependence logic. There are several key differences between 1-semantics and other semantics of dependence logic. 1-semantics is derived from first order semantics by a natural type shift. Therefore 1-semantics reflects an established semantics in a coherent manner. Negation in 1-semantics is a semantic operation and satisfies the law of excluded middle. A translation is provided from unrestricted formulas of existential second order logic into 1-semantics. Also game theoretic semantics are considerd in the light of 1-semantics.
  • Hassinen, Katriina (Helsingin yliopisto, 2016)
    Depersonalization refers to the experience of alienation from oneself. It is a common symptom, although not so widely studied in adolescents suffering from mental health problems. Depersonalization is a dissociative symptom, of which a main characteristic is loss of coherence on mental functions. However, compared to more severe forms of dissociation, depersonalization is relatively common also in nonclinical populations. The present study takes a closer look at the comorbid symptoms of adolescents experiencing depersonalization. Is there a connection between depersonalization and psychiatric diagnosis categories, severity of depression or anxiety symptoms, or symptoms associated with risk for psychosis? Based on previous studies, it is expected that mood and anxiety disorders and the severity of depressive symptoms as well as suspiciousness and perceptual abnormalities of the psychosis risk symptoms will be positively correlated with depersonalization. This study is part of the Helsinki Prodromal Study by the National Institute for Health and Welfare. The subjects (N=152) were new patients aged 15-18 in psychiatric treatment with various kinds of mental health problems. They were selected for further assessment after initial screening. Depersonalization was assessed with the Prodromal Questionnaire (PQ) depersonalization factor (Therman et al. 2014). The Structured Clinical Interview for the DSM-IV, Clinical Version (SCID-CV) and medical records were used for the diagnostic assessment. Depressive symptom severity was measured with the Beck Depression Inventory and the Beck Hopelessness Scale and severity of anxiety with the Beck Anxiety Inventory. The severity of psychosis risk symptoms was assessed with the Structured Interview of Prodromal Symptoms (SIPS). Mood disorders were associated with depersonalization as hypothesized. A similar association was not detected for anxiety disorders, though depersonalization was modestly positively correlated with the severity of depressive and anxiety symptoms. All of the positive SIPS-symptoms, especially delusional ideas were correlated with the severity of depersonalization. This was the case also with bizarre thinking, focus and attention problems, decreased experience of emotions and self, dysphoric mood and impaired tolerance to stress. These findings indicate that there are differences in the severity of depersonalization depending on the type of comorbid symptoms. For clinical applicability of the results, further study using more detailed definitions of depersonalization is needed.
  • Khan, Md. Anichul Hoque (2000)
    This paper consists both theoretical and empirical views of various features of the deposit insurance scheme/system (DIS) and its impact on likelihood of banking crises. There are hypothetical views of different kinds of features of the DIS that can have impact on banking sector fragility. On the basis of available and reliable observations the study has empirically tested four features effect on probability of banking crises. These are, 1) the presence of explicit DIS instead of implicit one, 2) the presence of voluntary membership system for the banks in the explicit DIS instead of compulsory membership system, 3) the presence of governmental administration in the explicit DIS instead of private or joint administration, and 4) the presence of ex ante funding in the explicit DIS instead of funding under ex post assessment when a bankruptcy takes place. The panel data includes both the industrial and developing countries for the period of 1980-1995 and the econometric model is a multivariate logit model (and in some case the probit model). The results suggest that the presence of an explicit DIS in a country has positive association with the likelihood of banking crises. When the study is limited only in explicit DIS countries, the presence of a voluntary membership system, instead of compulsory membership, tends to increase the banking crisis probability at 10% significance level. The presence of a governmental administration in a country using the explicit DIS, instead of a private or joint administration, is also positively associated with the banking sector fragility (at 5% significance level). The funding feature (ex ante or ex post) in explicit DIS countries is found insignificant when the standard errors are calculated in the traditional way without country and yearly fixed effects. It is significant at 10% level when the logit model is estimated with only fixed yearly effects. The similar model separating the panel data between industrial and developing countries is also estimated. None of the above features are significant for industrial countries. In the case of developing countries the presence of explicit DIS is significant at 1% level having positive association with the likelihood of banking crises, but other feature variables are not significant.
  • Grönholm, Tiia (Helsingin yliopisto, 2012)
    Dry and wet deposition are removal mechanisms of atmospheric aerosol particles. Historically, there are very scarce scientic publications reporting experimentally determined dry deposition values for the ultra-fine size range. The physics of deposition is studied both using micrometeorological field measurements conducted at SMEAR II site in Hyytiälä, Southern Finland and by modeling approaches. Dry deposition velocity depends mainly on particle size and magnitude of the atmospheric surface layer turbulence. We present experimentally determined dry deposition velocity (vd) as a function of particle size for the ultra- fine aerosol size range (10 - 150 nm) using relaxed eddy accumulation and eddy-covariance (EC) methods accompanied by particle number size distribution measurements. The highest vd was found for 10 nm particles and in all size classes vd increased with increasing friction velocity. By combining two-layer (above and sub-canopy) EC measurements and a new multi-layer canopy deposition model, we addressed how dry deposition is distributed within the forest canopy and between the canopy and the underlying ground. According to the measurements, about 20 - 30 % of particles penetrated the canopy and deposited on the forest floor. The model results showed that turbophoresis, when accounted for at the leaf scale in vertically resolved models, could increase vd for 0.1 - 2 nm particles and explain why the observations over forests generally do not support the pronounced minimum of deposition velocity for particles of that size. The developed multi-layer model was further used to study the effect of canopy structure (leaf-area shape and density) on vd. Scavenging coefficients for rain and snow deposition were calculated based on measurements of particle size distribution and precipitation. Parameterizations for both rain and snow wet deposition were derived for example to be applied in air quality and global models. Also a model including both in-cloud and below cloud wet deposition was developed and compared to the field measurements. Both snow and rain scavenging efficiency increased with increasing precipitation intensity. We also found, that the effectiveness of snow scavenging depends on the crystal or snow flake structure and the air relative humidity. Wet deposition was found to be an order of magnitude more effective "air cleaner" compared to dry deposition.
  • Heimola, Mikko (Helsingin yliopisto, 2014)
    Aims: In earlier research it has been found that music can elicit strong emotional responses, and that mood affects the way they are processed. The brain basis of musical emotions has however been studied less than that of facial emotions. Also, there have been no studies on how depressed mood affects musical emotions in the brain. In the present study, both the effect of depressed mood state and that of depressive disorder on neural processing of musical emotions is studied. The aim is to identify brain regions affected, and to model the effective connectivity between these regions and the impact of depressed mood state and depressive disorder on this system. Methods: A functional magnetic resonance imaging (fMRI) experiment was conducted, in which 56 adult subjects listened to emotional (happy, sad, and fearful) music. The experiment consisted of two conditions: in the implicit condition the subjects were asked how many instruments were playing, and in the explicit which of the three emotions best characterised the musical excerpt. The subjects also completed the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Profile of Mood States (POMS). The behavioural and imaging data were analysed both within the general linear model (GLM) to identify affected brain regions and the dynamic causal modelling (DCM) framework to model how sensory inputs enter the brain system and how experimental conditions modulate connections between specified brain regions. Results and conclusions: The subjects were mostly not clinically depressed (76%) and the MADRS scores were not correlated with neural activity in the brain. The POMS Depression scale was however associated with attenuated activity in the right posterior cingulate cortex (PCC) while listening to happy and fearful music under the implicit condition. As PCC has been associated with internally directed cognition and the management of brain's attention networks, this attenuation is likely to reflect the incongruence between stimuli and mood state, which would result in increased attention and/or a decrease in explorative cognitive activity. Comparisons of DCM models consisting of PCC, superior temporal gyrus (STG) and the amygdala indicated that auditory stimuli enter into this system via the auditory cortex in STG. The analyses could not determine whether the emotional content of the stimuli modulates connectivity between these regions, but MADRS and POMS scores were associated with amygdala connectivity. This is in line with the view that depressive disorder disrupts the amygdala's role in orienting to affective information.
  • Paile-Hyvärinen, Maria (Helsingin yliopisto, 2011)
    Background: Type 2 diabetes is linked to several complications which add to both physical and mental distress. Depression is a common co-morbidity of diabetes which can occur both as a cause and a consequence of type 2 diabetes. Depression has been shown to correlate with glucose regulation and treating depression might prove beneficial for glucose regulation as well as for mental well being. Another complication which might affect diabetes management is cognitive decline. Several risk factors and complications of diabetes might modify the risk for developing cognitive impairment, which is increased 1.5 times among subjects with type 2 diabetes. Type 2 diabetes, depression and impaired cognitive performance have all been linked to low birth weight. This thesis aimed to explore the effects and interactions of birth weight, depression and cognitive ability in relation to type 2 diabetes from a life course perspective. Subjects and methods: Studies I, II and V were part of the Helsinki Birth Cohort Study. 2003 subjects participated in an extensive clinical examination at an average age of 61 years. A standard glucose tolerance test (OGTT) was performed and depressive symptoms were assessed using the Beck Depression Inventory (BDI). In addition data was obtained from child welfare clinics and national registers. A subset of the cohort (n=1247) also performed a test on cognitive performance (CogState ®) at the average age of 64. Studies III and IV were randomised clinical trials where mildly depressed diabetic subjects were treated with paroxetine or placebo and the effect on metabolic parameters and quality of life was assessed. The first trial included 14 women and lasted 10 weeks, while the second trial included 43 subjects, both men and women, and lasted 6 months. Results: Type 2 diabetes was positively associated with the occurrence of depressive symptoms. Among diabetic subjects 23.6% had depressive symptoms, compared to 16.7% of subjects with normal glucose tolerance (OR = 1.77, p<0.001). Formal mediation analysis revealed that cardiovascular disease (CVD) is likely to act as a mediator in the association. Furthermore, low birth weight was found to modify the association between type 2 diabetes, CVD and depression. The association between BDI score and having type 2 diabetes or CVD was twice as strong in the subgroup with low birth weight (≤ 2500g) compared with the group with birth weight > 2500g (p for interaction 0.058). In the six months long randomised clinical trial (study IV) paroxetine had a transient beneficial effect on glycosylated haemoglobin A1c (GHbA1c) and quality of life when compared to placebo after three months of treatment. In study V we found that subjects with known diabetes had a consistently poorer level of cognitive performance than subjects with normal glucose tolerance in most of the tested cognitive domains. This effect was further amplified among those born with a small birth weight (p for interaction 0.002). Conclusions: Type 2 diabetes is associated with a higher occurrence of depressive symptoms compared to subjects with normal glucose tolerance. This association is especially strong among subjects with CVD and those born with a low birth weight. Treating depressed diabetic subjects with paroxetine has no long term effect on glucose regulation. Physicians should be aware of depression as an important co-morbidity of type 2 diabetes. Both depression and the cognitive decline often seen among diabetic subjects are increased if the subject is born with a low birth weight. Physicians should recognise low birth weight as an additional risk factor and modifier of diabetic complications.
  • Vataja, Risto (Helsingin yliopisto, 2005)
  • Berg, Anu (Helsingin yliopisto, 2010)
    Approximately one-third of stroke patients experience depression. Stroke also has a profound effect on the lives of caregivers of stroke survivors. However, depression in this latter population has received little attention. In this study the objectives were to determine which factors are associated with and can be used to predict depression at different points in time after stroke; to compare different depression assessment methods among stroke patients; and to determine the prevalence, course and associated factors of depression among the caregivers of stroke patients. A total of 100 consecutive hospital-admitted patients no older than 70 years of age were followed for 18 months after having their first ischaemic stroke. Depression was assessed according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R), Beck Depression Inventory (BDI), Hamilton Rating Scale (HRSD), Visual Analogue Mood Scale (VAMS), Clinical Global Impression (CGI) and caregiver ratings. Neurological assessments and a comprehensive neuropsychological test battery were performed. Depression in caregivers was assessed by BDI. Depressive symptoms had early onsets in most cases. Mild depressive symptoms were often persistent with little change during the 18-month follow-up, although there was an increase in major depression over the same time interval. Stroke severity was associated with depression especially from 6 to 12 months post-stroke. At the acute phase, older patients were at higher risk of depression, and a higher proportion of men were depressed at 18 months post-stroke. Of the various depression assessment methods, none stood clearly apart from the others. The feasibility of each did not differ greatly, but prevalence rates differed widely according to the different criteria. When compared against DSM-III-R criteria, sensitivity and specificity were acceptable for the CGI, BDI, and HRSD. The CGI and BDI had better sensitivity than the more specific HRSD. The VAMS seemed not to be a reliable method for assessing depression among stroke patients. The caregivers often rated patients depression as more severe than did the patients themselves. Moreover, their ratings seemed to be influenced by their own depression. Of the caregivers, 30-33% were depressed. At the acute phase, caregiver depression was associated with the severity of the stroke and the older age of the patient. The best predictor of caregiver depression at later follow-up was caregiver depression at the acute phase. The results suggest that depression should be assessed during the early post-stroke period and that the follow-up of those at risk of poor emotional outcome should be extended beyond the first year post-stroke. Further, the assessment of well-being of the caregivers of stroke patients should be included as a part of a rehabilitation plan for stroke patients.
  • Jylhä, Pekka (Kansanterveyslaitos, 2008)
    This study is part of the Mood Disorders Project conducted by the Department of Mental Health and Alcohol Research, National Public Health Institute, and consists of a general population survey sample and a major depressive disorder (MDD) patient cohort from Vantaa Depression Study (VDS). The general population survey study was conducted in 2003 in the cities of Espoo and Vantaa. The VDS is a collaborative depression research project between the Department of Mental Health and Alcohol Research of the National Public Health Institute and the Department of Psychiatry of the Peijas Medical Care District (PMCD) beginning in 1997. It is a prospective, naturalistic cohort study of 269 secondary-level care psychiatric out- and inpatients with a new episode of Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) MDD. In the general population survey study, a total of 900 participants (300 from Espoo, 600 from Vantaa) aged 20 70 years were randomly drawn from the Population Register Centre in Finland. A self-report booklet, including the Eysenck Personality Inventory (EPI), the Temperament and Character Inventory Revised (TCI-R), the Beck Depression Inventory and the Beck Anxiety Inventory was mailed to all subjects. Altogether 441 participants responded (94 returned only the shortened version without TCI-R) and gave their informed consent. VDS involved screening all patients aged 20-60 years (n=806) in the PMCD for a possible new episode of DSM-IV MDD. 542 consenting patients were interviewed with a semi-structured interview (the WHO Schedules for Clinical Assessment in Neuropsychiatry, version 2.0). 269 patients with a current DSM-IV MDD were included in the study and further interviewed with semi-structured interviews to assess all other axis I and II psychiatric diagnoses. Exclusion criteria were DSM-IV bipolar I and II, schizoaffective disorder, schizophrenia or another psychosis, organic and substance-induced mood disorders. In the present study are included those 193 (139 females, 54 males) individuals who could be followed up at both 6 and 18 months, and their depression had remained unipolar. Personality was investigated with the EPI. Personality dimensions associated not only to the symptoms of depression, but also to the symptoms of anxiety among general population and in depressive patients, as well as to comorbid disorders in MDD patients, supporting the dimensional view of depression and anxiety. Among the general population High Harm Avoidance and low Self-Directedness associated moderately, whereas low extraversion and high neuroticism strongly with the depressive and anxiety symptoms. The personality dimensions, especially high Harm Avoidance, low Self-Directedness and high neuroticism were also somewhat predictive of self-reported use of health care services for psychiatric reasons, and lifetime mental disorder. Moreover, high Harm Avoidance associated with a family history of mental disorder. In depressive patients, neuroticism scores were found to decline markedly and extraversion scores to increase somewhat with recovery. The predictive value of the changes in symptoms of depression and anxiety in explaining follow-up neuroticism was about 1/3 of that of baseline neuroticism. In contrast to neuroticism, the scores of extraversion showed no dependence on the symptoms of anxiety, and the change in the symptoms of depression explained only 1/20 of the follow-up extraversion compared with baseline extraversion. No evidence was found of the scar effect during a one-year follow-up period. Finally, even after controlling for symptoms of both depression and anxiety, depressive patients had a somewhat higher level of neuroticism (odds ratio 1.11, p=0.001) and a slightly lower level of extraversion (odds ratio 0.92, p=0.003) than subjects in the general population. Among MDD patients, a positive dose-exposure relationship appeared to exist between neuroticism and prevalence and number of comorbid axis I and II disorders. A negative relationship existed between level of extraversion and prevalence of comorbid social phobia and cluster C personality disorders. Personality dimensions are associated with the symptoms of depression and anxiety. Futhermore these findings support the hypothesis that high neuroticism and somewhat low extraversion might be vulnerability factors for MDD, and that high neuroticism and low extraversion predispose to comorbid axis I and II disorders among patients with MDD.
  • Ussher, Sara (2007)
    Mot bakgrunden av att depressionen blivit alltmer aktuell och mediasynlig i det finländska samhället sedan 1990-talet fokuserar denna studie på en jämförelse av lekmanna- och professionella uppfattningar om depressionens orsaker. Den teoretiska utgångspunkten är den medicinska antropologins syn på hälsa/sjukdom som ett kontextuellt fenomen påverkat inte bara av biologiska, utan också väsentligen av sociokulturella faktorer. Ett centralt syfte är att se på depressionens orsaksproblematik inom ramen för biomedicinen som ett kulturellt system med egna värderingar och att på så sätt anknyta till diskussioner om medikalisering samt till förhållandet mellan lekmän och professionella. Viktiga källor för en förståelse av depressionens kulturella förankring är de medicinska antropologerna Arthur Kleinman, Byron Good och Catherine Lutz’ produktion. Min studie har också influerats av medikaliseringskritiska verk och av den sociologiska traditionens granskning av fenomen som psykologisering och senmodern individualism. Forskningsmaterialet består av 266 texter i två finländska damtidningar (Kauneus ja Terveys, Eeva) och två finländska läkartidskrifter (Duodecim, Suomen Lääkärilehti) åren 1985, 1990, 1995 och 2000. I materialanalysen tillämpas ett diskursanalytiskt angreppssätt. Den ledande socialkonstruktionistiska tanken är här att depressionen konstrueras på olika sätt i texterna. Denna metodologiska approach kombineras med ett etnografiskt förhållningssätt till texterna som utgår från att depression är ett fenomen som ingår olika kontext. Det viktigaste forskningsresultatet är att depressionen är mångfasetterad i ett komplext samspel mellan lekmän och professionella. Depressionen har sitt ursprung i biopsykosociala krafter. Denna mångfaktoriella helhet splittras emellertid beroende på vilken del av helheten, vilken orsaksdiskurs, respektive grupp betonar och på vilket sätt. Jag tematiserade materialet i en medikalisering, i psykosociala förhållanden och i en samhällsberoende utbrändhet. Utgående från dessa kategorier framträdde sex orsaksdiskurser: biologiska, psykologiska, interpersonella, yttre förhållande, livsskede och depression som livsstil. Den biologiska diskursen framställer depressionen som ett inre organisk fel, ett slags oberoende skeende färdigt för medicinering. Också i den psykologiska diskursen blir depressionen en inre angelägenhet men på ett annat sätt; som en del av en viljestyrd personlighet som aktivt kan bearbetas. Den interpersonella diskursen utvidgar individinriktningen mot uppfattningen om en depression såsom förankrad i det sociala behovet av andra människor. I diskursen yttre förhållanden gör en vidare samhällelig anknytning depressionen till ett utpräglat externt skeende. Diskurserna som gestaltar ursprunget till depression i ett visst livsskede eller i en livsstil nedtonar i sin tur depressionens sjukdomsaspekt inom ramen för ett normalt sätt att leva. Dessa sex olika sätt att närma sig depressionens orsaker individualiserar, socialiserar och normaliserar depressionen och avspeglar djupgående synsätt på människan, världen och verkligheten.
  • Laitinen, Irmeli (Helsingfors universitet, 2008)
    Traditionally feminist scholars envisaged that feminist research should be ‘on, by and for women’. The Women and Depression Project’s focus is ‘on’ depressed women but includes implicitly the part men and the patriarchal welfare state play in their depression; ‘written’ ‘by’ depressed women who are the subjects and active participants and whose depressed voices need to be heard and ‘for’ depressed women who have the potential to use their work in groups to deal effectively with their personal feelings and social situations. The study was designed to engage depressed women in feminist therapeutic action research and to develop professionally guided self-help groups in a 10 session programme in the statutory and non-statutory sectors in Finland. I had a dual role as a psychotherapist and feminist researcher. This dual role provided two foci: to present (as a feminist researcher) the authentic voices of depressed women in these groups and to demonstrate (as a psychotherapist) how the group process had an effect on these women’s lives. Two questions guided the research process: Is it possible for depressed women who have been dealt with as objects of treatment to become active subjects in their own healing? How do Finnish women experience depression? Embedded in the WDP were multiple ways of gathering research from members of the group as well as therapeutic tools with elements of self-help, consciousness raising and group psychotherapy. While the project had a dual focus, the findings reveal that women became empowered to understand themselves and believe in their potential as social individuals through their participation in the WDP groups. In the long term, they altered their feelings and relationships to themselves and their environment as well as key embodied activities. Additionally, the findings also suggest that depression may be a consequence of invisible gendered tensions in a women friendly welfare state and reveal a type of ‘welfare depression’. According to Allardt's welfare typology, these women were somewhat secure in their "welfare having" (i.e. physical health), but lacked in their "being" (i.e. need for emotional well-being) and "loving" (i.e. wanting better personal relationships). If a new understanding of women and depression is to develop, it must explicitly include ideas on how depression is shaped at the public and private interface as well as how distress and well-being may have cultural as well as gendered variations. For depressed women, voicing long-silenced experiences can play a crucial part in their empowerment and healing. The type of women friendly care practices generated by professionally led self-help groups enabled this process to begin at least for depressed women in Finland.
  • Pyykkönen, Antti-Jussi (Helsingin yliopisto, 2012)
    The number of people suffering from type 2 diabetes (T2D) and related diseases is expected to rise to epidemic levels by the year 2030. Estimates indicate that 366 million individuals worldwide and more than 500 000 in Finland - roughly 10-16% of adult men and 7-11% of women - have T2D. Furthermore, an undefined, yet vast, number of individuals are at increased risk for T2D and pre-diabetes. Insulin resistance (IR) and deficiency in insulin secretion are the two main features of T2D. This thesis focuses on these two components. In addition, this thesis focuses on the metabolic syndrome (MetS) which refers to a cluster of aberrations of metabolic origin that increases one s risk for T2D. Along with the estimated world-wide increase in the prevalence of T2D, there exists a strong need to identify factors that may render an individual susceptible to the disease. T2D is multifactorial in origin and is thought to arise from a combination of genetic and environmental factors. This thesis focuses on depression, poor sleep quality and stressful life events as plausible environmental factors that may increase one s risk for T2D. The thesis aims to contribute to the surprisingly scanty and elusive literature on the role of these environmental psychosocial risk factors by testing (a) their associations with IR, insulin secretion and/or the MetS; and (b) whether antidepressant medication contributes to associations of depressive symptoms with IR and the MetS; and c) whether these associations depict individuals without manifest or latent T2D. These study questions were addressed in the Prevalence, Prediction and Prevention of Diabetes, the PPP-Botnia Study, comprising 5208 participants (2443 men and 2765 women). These study participants underwent a detailed clinical examination, including an oral glucose tolerance test in conjunction with which, they self-reported their depressive symptoms, sleep quality and exposure to stressful life events. The results showed that depressive symptoms (Study I); poor sleep quality, as reflected in subjective sleep complaints of sleep apnea, insomnia and daytime sleepiness (Study II); and stressful life events particularly events related to finance and work and the accumulation of stressful life events in any domain of stress (Study IV) were associated with a higher likelihood of IR. In addition, depressive symptoms and stressful life events were associated with the MetS (Studies III JA IV). No evidence was found to support the association of psychosocial factors with deficient insulin secretion (Studies I, II JA IV) or that the use of antidepressant medication drove associations of depressive symptoms with IR and the MetS (Studies I III). These associations depicted men and women without manifest or latent T2D (Studies I-IV) as well as men and women whose glucose tolerance was within a normoglycemic range (Study II). The findings of this thesis thus suggest that depressive symptoms, poor sleep quality and stressful life events are associated with a higher likelihood of IR and having the MetS, but are not associated with indices of deficient insulin secretion. In addition, these associations characterise individuals without manifest or latent T2D. Overall, the findings, though cross-sectional, seem to suggest that psychosocial factors increase one s risk for T2D by way of increasing one s risk for IR. The findings of this thesis implicate that strategies aiming to reduce depression, improve poor sleep quality and alleviate stress in individuals without T2D may offer an additional tool in diabetes prevention.
  • Aalto-Setälä, Terhi (Helsingin yliopisto, 2002)