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To identify associations between chronic conditions and eight key health risks (stress, loneliness, sleep, obesity/body mass index, smoking, exercise, alcohol consumption, and fruit intake) and provide a practical descriptive profile of the distribution of health risks within chronic conditions. The sample involved 56,988 Danish residents aged over 16 years from three national health surveys (2010/2013), one sociodemographic register, and seven national health registers. Linear and logistic regression models adjusting for socioeconomic variables were used to analyse associations with 14 disease groups and 30 common conditions. The regression analyses revealed that stress, obesity, and physical inactivity were the most consistently associated health risk factors across disease groups. We identified three groups of health risks with similar strengths of associations. Firstly, one group comprising obesity, stress, and sleep troubles, was significantly linked to 27, 23, and 22 chronic conditions, respectively. Secondly, a group of physical inactivity/loneliness showed moderate associations, linked to 19 and five chronic conditions, particularly mental health conditions; and thirdly, a group of smoking, drinking, and low fruit intake showed the weakest and fewest associations. A descriptive profile showed that anxiety, schizophrenia, attention deficit hyperactivity disorder, headaches and chronic obstructive pulmonary disease were conditions with high proportions of patients experiencing more than four health risks. The current study provides comparable, hierarchical information on the strength of associations between eight health risks and chronic conditions adjusted for socioeconomic factors. The findings suggest that healthcare professionals, policymakers and public health strategies should place less emphasis on classic behavioural health risks such as smoking and more attention on psychological factors such as stress, sleep problems, and loneliness.
The aim of this study was to assess how early-life and adult lifestyle factors influence the education gradient in health, measured by health-related quality of life, and to estimate their relative contributions to the social gradient in health. In this cohort study, we used data on an adult sample (N=8903, aged ⩾32 years at baseline) who participated in two waves of the Tromsø Study (2007/08 and 2015/16). Educational attainment was measured along four levels of completed education. Early-life factors included childhood financial circumstances, height, parental somatic and mental health, and parental substance abuse. Lifestyle factors were measured by smoking, physical activity and body mass index in the two waves. We used two measures of health-related quality of life: EQ-5D-5L and EQ VAS. Ordinary least squares regression analyses were used to estimate the education-health gradient. Shapley-Owen value decomposition estimated the relative contribution of education, early-life factors and lifestyle factors. The education-health gradient remained nearly unaffected by the inclusion of early-life factors. However, the inclusion of longitudinal data on lifestyle factors substantially attenuated the education-health gradient. Lifestyle factors accounted for 45% and 57% of the share of explained variation in EQ-5D-5L and EQ VAS, respectively, whereas early-life factors explained 43% and 19%, respectively. Beyond educational attainment, early-life factors represent an important complementary set of determinants to explain health inequalities, while lifestyle factors likely mediate the association between education and health. This highlights the need for public health measures addressing childhood circumstances.
Social disparities in healthcare access and utilisation are well-documented. However, the underlying mechanisms driving these disparities are not fully uncovered. This study presents a systematic review of qualitative research exploring organisational and relational factors that contribute to social disparities in healthcare encounters. The review was conducted in three scientific databases (PubMed, Embase and PsycInfo). Studies were independently screened by two researchers, and the quality was assessed using the Critical Appraisal Skills Programme assessment tool. A thematic analysis was used to identify patterns across included studies. In total, 15 qualitative studies were included, from which 10 themes were identified, including: (1) complexity of the healthcare system, (2) resource constraints in the healthcare system, (3) deficiencies in healthcare professionals' education, (4) patients' perceptions of health and illness, (5) roles and expectations in patient decision-making and communication, (6) prejudices and labelling of patients with lower socioeconomic status, (7) equality and power balance in healthcare interactions, (8) patients' financial and social living circumstances, (9) patients' understanding of health information, and (10) trust and respect in healthcare interactionsConclusions:The study identified key mechanisms that contribute to social disparities in healthcare encounters between patients and the healthcare system. These findings may inform future health interventions and policy actions aimed at reducing social disparities in patient-healthcare interactions. However, further research within the Scandinavian context is warranted to validate and expand upon these results.
Background:Throughout human history, socioeconomic inequalities in health are shaped by interlinked structural changes, like emerging agriculture and industrialism, demographic and economic transitions, as well as epidemics of infectious diseases, catastrophes, and climate changes. Key questions include when health inequalities emerged, and how they evolved from early communities until modern societies. Method: Based on original sources, research literature, reviews, and their critical analysis, this historical review focuses on the evolution of health inequalities, their appearance and advancement. Availability of sources limits the scope to Europe and the western world. Findings: Early hunter-gatherer communities were socioeconomically relatively equal, likely lacking major health inequalities. As agriculture emerged in the neolithic time since 10000 BCE, societies became more prosperous and unequal. In medieval societies, with deep socioeconomic inequalities, health inequalities were presumably constrained by infectious diseases and catastrophes hitting populations "democratically". John Graunt and William Petty showed in Britain novel socioeconomic and health inequalities emerging with early industrialist capitalism. By the "Revolutions of 1848" health inequalities encompassed industrial countries as shown by Rudolf Virchow and Edwin Chadwick. In the Black Report (1980) and present-day research health inequalities appear ubiquitous and often widening. Conclusions: The evolution of health inequalities follows both the constancy hypothesis, suggesting omnipresent health inequalities where social inequalities prevail, and the convergence-divergence hypothesis, suggesting variations in health inequalities from prehistory to modern time. A conundrum is, to what extent health inequalities were constrained by epidemics and catastrophes. Currently, health inequalities are a world-wide public issue to be tackled with egalitarian policies.
To investigate differences between respondents' self-reported registration with public and private primary healthcare (PHC) providers according to self-reported illness burden in the early phase of the free choice reform. The Public Health Survey undertaken in Scania, southernmost Sweden, in 2012 was a population-based study of a stratified random sample of 18-80-year olds that elicited a 51.7% participation rate. The survey included data on PHC provider type, age, sex, marital status, socioeconomic status, country of birth, and self-reported illness burden measured as poor psychological health (via the 12-item General Health Questionnaire; GHQ12), poor self-rated health, and self-reported chronic illness. Poor psychological health (GHQ12), poor self-rated health, and self-reported chronic illness were analyzed together in logistic regression models with public versus private PHC provider as the dichotomous outcome. In 2012, 55.2% reported being listed with a public PHC provider, 26.1% a private PHC provider, and 18.6% did not know what type their provider was. In the final multi-adjusted logistic regression model, the odds ratios of reporting private PHC provider were 1.01 (0.91-1.13) among respondents with poor psychological health, 0.98 (0.89-1.07) among respondents with poor self-rated health, and a non-significant 1.09 (1.00-1.20) among respondents with self-reported chronic illness. After adjusting for relevant confounders, no statistically significant differences were found between private and public PHC providers, according to self-reported illness burden in Scania in 2012.
This study provides an off-the-shelf catalogue of prevalence rates of eight health-related risk factors (self-perceived stress, loneliness, sleep quality, obesity/body mass index, smoking, physical exercise, alcohol consumption, and fruit intake) for 199 chronic conditions, disease groups and socioeconomic covariates in Denmark. The study population comprised a randomised sample of Danish residents aged 16 years and older (n=56,988). Data were derived from a linkage of three national health surveys (2010, 2013) and seven national health and sociodemographic registers. Means and prevalence rates, including sex and age-standardised estimates, were presented. The most prevalent health risks were insufficient fruit intake (93.8%), most stressed quartile (20.5%), smoking daily (17.2%), physical inactivity (16.6%), obesity (15.0%), very bothered by sleep (9.7%), drinking more than recommended (8.7%), and 'often feels lonely' (5.5%). Chronic conditions with the highest mean numbers of health risks were mental disorders (disease group F; mean = 2.6), diseases of the digestive system (K; mean = 2.2), neurological diseases (G; mean = 2.1), musculoskeletal-related diseases (M; mean = 2.0), and respiratory-related diseases (J; mean = 1.9). In comparison, people without a chronic condition had a mean of 1.6 health risks. Marked socioeconomic disparities were also observed, with more risks among groups with lower education and income. The nationally representative off-the-shelf catalogue provides essential information on eight common health risks across 199 chronic conditions and socioeconomic groups. The findings offer a resource for differentiated healthcare planning, prevention, and research.
The Scandinavian Neurotrauma Committees (SNC) guideline is a validated and well established decision tool for pediatric minor to moderate head trauma in Sweden, categorizing patients into low, moderate and high risk for intracranial injury. It recommends observation over imaging with computer tomography in low and moderate risk stratified patients. However the effect on guideline implementation on emergency department length of stay and imaging rates with computer tomography is unknown. Investigate the effects of the implementation of the SNC guidelines for pediatric minor head injury on utilization of computer tomography, emergency department length of stay and inhospital admission. A retrospective observation study between January 2011 and December 2022 in a health care system in south east Sweden where SNCs guideline was implemented at the beginning of 2017. Computer tomography imaging rates, emergency department length of stay and hospital admission was compared for pediatric visits with a chief complaint of head injury made before the implementation of the SNCs guidelines in January 2017 was compared with visits made after the implementation using segmented time series analysis. A total of 16,244 visits pre-implementation were compared with 16,164 post-implementation. Death, neurosurgical intervention and intracranial hemorrhage was rare (< 0.1% for each outcome) and did not differ between the pre-implementation and post-implementation group. Computer tomography rates were 3.3% before and 2.7% after implementation.The time-series analysis showed that the majority of the reduction happened pre-implementation (14% yearly decrease) compared to post-implementation (1.6% yearly decrease). Emergency department length of stay did not differ at 89 (interquartile range 50-150) vs 91 (interquartile range 45-159) (p = 0.11) minutes respectively. Hospital admissions showed a continual decrease during the whole study period with little effect of the guideline implementation (13% vs 12% yearly decrease, p = 0.6). There were lower rates of computer tomography in pediatric patients with minor to moderate head trauma after the implementation of the SNCs guidelines but the majority of the reduction in imaging happened before the guideline implementation.
Psychological intimate partner violence (IPV) is more prevalent than physical IPV and often has more severe consequences for both physical and mental health. This study aimed to examine the specific impact of psychological IPV on perceived general health and depression among pregnant and non-pregnant women in Stockholm, Sweden. Data were collected from 5714 women (2342 non-pregnant and 3372 pregnant) through a survey distributed at women's health clinics. The questionnaire included items on sociodemographic characteristics, self-rated health, and exposure to IPV. For non-pregnant women, IPV exposure referred to the previous year; for pregnant women, it referred to the year before pregnancy. A total of 167 (2.9%) women reported exposure to psychological IPV only. Among them, 60 experienced frequent and 91 occasional psychological IPV. Logistic regression analyses showed that psychological IPV was significantly associated with poor general health and severe depression. While no consistent dose-response pattern was observed across all health outcomes, frequent psychological IPV was linked to a higher risk of sick leave among non-pregnant women, suggesting more severe health consequences compared with occasional exposure. Women exposed solely to psychological IPV face health risks comparable to those exposed to combined forms of IPV. Psychological violence should be recognised as a serious public health issue, contributing not only to depression and poor general health but also to impaired work capacity and economic vulnerability.
This article examines how the Diderichsen model has been used and adapted in research on health inequalities during COVID-19, and explores how the pandemic has prompted further theoretical development. This review therefore addresses the question of how a well-established theoretical framework has helped researchers understand pandemic-related health inequalities and what opportunities exist for its continued refinement. A narrative literature review was conducted using Google Scholar, Web of Science, PubMed and Scopus. Included studies cited a key publication presenting the Diderichsen model and addressed COVID-19 as a central topic. After screening 298 articles, 24 were included for full analysis. The studies were categorised by how they engaged with the model - conceptually, empirically or through further development. The Diderichsen model was commonly used to frame discussions of health inequality or to interpret pandemic-related disparities in exposure, vulnerability and outcomes. Several studies emphasised occupational and housing-related exposure, class-based comorbidities and the unequal social consequences of COVID-19. A smaller number of studies proposed expanded frameworks, incorporating multilevel and temporal dimensions and introducing new mechanisms related to pandemic responses. These adaptations often focused on migrants, ethnic minorities and other particularly affected groups. The review confirms the ongoing relevance of the Diderichsen model in pandemic health inequality research. It argues that the model can be further strengthened by explicitly incorporating concepts of political decision-making, symbolic recognition and social justice. This would improve its capacity to capture the full complexity of health inequalities in times of crisis.
The existing literature lacks sufficient evidence concerning the role of personality traits in oral behaviour and their effects on oral health status (dental plaque, and dental caries) and dental visits. The aim of this study was to investigate the association between personality traits and oral health behaviour (OHB) in the adult Finnish population. This study utilised data collected from the Northern Finland Birth Cohort 1986 individuals who participated in all the follow-ups (n = 1807). Data were collected during pregnancy and later during follow-ups conducted at 1 year, 7-8 years, 15-16 years and 33-35 years using questionnaires and clinical examinations. Oral health status and number of dental visits collected in the last follow-up were considered as dependent variables. The explanatory variables included personality traits, educational background, employment, annual income, and lifestyle choices. A recursive bivariate probit model was used to model oral health status (dental plaque, and dental caries) while considering dental care utilisation. Personality traits were associated with OHB (accumulation of dental plaque and regular dental visits). Individuals with a high degree of openness had a 13% lower probability of having teeth with dental caries. Similarly, highly neurotic individuals had a 5% lower probability of having teeth with visible dental plaque and also had a higher probability of dental visiting. Personality traits are associated with OHB among young adults Finns. Policies aimed at improving dental health education and mitigating common risk factors are essential to promote oral health.
This study examined the prevalence of outdoor and in-store food and health-related advertisements, and whether their distribution differed by neighbourhood socioeconomic status (SES) in Stockholm, Sweden. A cross-sectional observational design was employed using EPOCH-an adapted tool with pre-defined categories to collect data on outdoor and in-store advertising in 10 lower-SES and 12 middle-SES neighbourhoods in Stockholm. Outdoor advertisement distributions were compared between SES categories using the Mann-Whitney U test, while in-store advertisement counts were analysed using regression models tailored to outcome distributions. Most advertisements featured energy-dense, nutrient-poor (EDNP) foods and sugar-sweetened beverages (SSBs)-59 percent of outdoor advertisements and 65 percent of in-store advertisements. Although differences in the prevalence of outdoor and in-store advertisements were noted between low- and middle-SES neighbourhoods, these associations were not statistically significant following correction for multiple testing. Across all neighbourhoods, advertisements were dominated by unhealthy products, particularly EDNP foods and SSBs. Similar levels of exposure in low- and middle-SES neighbourhoods suggest that neighbourhood SES is not a key predictor of advertising patterns in Stockholm. These findings highlight a widespread exposure to unhealthy food advertising, underscoring the need for public health strategies to address environmental drivers of diet-related outcomes.
A significant proportion of young people in Sweden do not graduate from upper secondary school with a complete diploma, which may be crucial for their mental health. A diploma influences both perceived and actual future prospects, including access to tertiary education and employment opportunities. Additionally, education fosters personal control and problem-solving skills relevant to stress management and self-esteem. Therefore, this study explores the association between obtaining an upper secondary diploma and the severity and co-occurrence of depression and anxiety symptoms among emerging adults in Sweden. Data from a population-based cohort of Swedish 21-year-olds (n=3255) were analysed. Depression and anxiety symptoms were measured using the Patient Health Questionnaire-4 (PHQ-4). Registry data provided information on upper secondary education, sex, immigrant background, and parental education. Multinomial logistic regression was used. Participants without an upper secondary diploma were at a higher risk of experiencing the most severe outcomes; that is, severe symptoms (vs. normal/mild) and co-occurring depression and anxiety symptoms (vs. no symptoms) compared with those with an academic diploma. They also had a higher risk of depression only, but not anxiety only. Additionally, compared with participants with an academic diploma, those with a vocational upper secondary diploma exhibited an elevated risk of depression only. This study highlights the link between an upper secondary diploma and mental health in emerging adulthood. It also suggests that depression, anxiety, and their co-occurrence may have distinct determinants. The findings indicate that initiatives to support school completion and re-engagement could have significant public health benefits.
Healthcare professionals often face tension between caregiving values and systemic demands for efficiency and economic stability. While caregivers focus on patient well-being, hospital leaders must ensure resource and staff management-roles that can appear contradictory. This study explores how both caregivers and leaders in a large Norwegian hospital experience meaning in their work, aiming to identify shared ground for healthcare engagement. Drawing on Hartmut Rosa's resonance theory and Tatjana Schnell's research on meaning in life, we examine how professional experiences foster or hinder resonance-a mode of being characterized by mutual responsiveness and transformation. Twelve semi-structured interviews were conducted with nurses, doctors, and leaders using a guide informed by resonance theory. Data were analyzed thematically in a multidisciplinary team. Four themes emerged: (1) healthcare as a demanding yet meaningful profession, (2) organizational challenges, (3) patient relationships, and (4) teamwork and collegial support. Across roles, participants described systemic pressures that threaten meaningful engagement, but also highlighted moments of deep resonance-particularly in patient care, collaboration, and learning. Resonance and meaning are sustained when work aligns with moral purpose and supports relational and reflective engagement. Both caregivers and leaders seek meaning in their roles, often through shared values and relationships. These findings underscore the need for organizational structures that allow space for resonance, rather than accelerating alienation through excessive control and restructuring. Caring for meaning represents common ground for caregivers and leaders. A resonance-informed healthcare leadership might strengthen both staff well-being and quality of care.
To explore perceived work ability after sickness absences of varying durations. Questionnaire data from the Healthy Finland survey in 2022-2023, which included self-rated work ability (SRWA), were linked with registry data of the Social Insurance Institution of Finland on sickness allowance for the period 2021-2022. The association between the number of disability days on sickness allowance over a period of 2 years and SRWA were analysed among sickness allowance recipients (N = 2398) by cross-tabulation and multinomial logistic regression taking potential confounding factors into account. The number of days on sickness allowance (p < .001) was associated with subsequent perceived work inability: the probability of perceived work inability increased with more sickness allowance days. Among individuals who received sickness allowance for more than 300 days over 2 years, the relative risk ratio was 174.5 for perceived work inability and 13.6 for perceived partial work inability, compared with those who received sickness allowance for 1-30 days. Nonetheless, only 44% of those with over 300 sickness allowance days perceived themselves to be completely unable to work. Individuals who did not believe they could work until normal retirement age were more likely to perceive themselves as completely or partially unable to work. Perceived partial work inability is common after receiving sickness allowance, but only a minority of recipients perceive themselves to be completely unable to work even after a high number of sickness allowance days. Utilising the remaining work capacity is key to enabling a successful return to the labour market and supporting longer working careers.
Several studies suggest that ethnic minorities are at higher risk of experiencing long COVID compared to majority populations. This study aimed to qualitatively explore the experiences of accessing care, diagnosis and rehabilitation among patients with long COVID in a multiethnic population in Denmark. We carried out 18 semi-structured interviews with individuals of Danish, Turkish and Moroccan background who were diagnosed with long COVID. Informants were sampled purposively to secure variation in sex, age, country of origin and immigration status. Our interview guide was developed using the theoretical framework of candidacy. Interviews were transcribed verbatim, member checked and subsequently analyzed using thematic framework analysis and NVivo software. Our findings show that accessing care and rehabilitation for long COVID was difficult regardless of ethnic background. Following the novelty of COVID-19 and thus uncertainty of long COVID, informants had to self-advocate and navigate established and alternative healthcare services by themselves. Additionally, patients with Moroccan and Turkish minority background had to contend with experiences of differential treatment and of having their motives for seeking help questioned, while also finding it harder to benefit from the rehabilitation measures offered. Our study demonstrates how the emergence of a new viral disease with unknown long-term sequelae resulted in a group of patients who largely carried the burden of getting better by themselves. Yet patients with an ethnic minority background experienced additional, worrying barriers. More research into relevant diagnosis, care and support for all long COVID patients is needed, especially among ethnic minorities.
Mental health literacy (MHL) is increasingly recognised as a key component of public mental health promotion. While widely cited definitions focus on recognising and managing mental disorders, recent perspectives call for broader, more holistic frameworks that also address positive mental health. However, conceptual and measurement inconsistencies persist, highlighting the need for a clearer understanding of how MHL is defined and applied across disciplines. This umbrella review synthesised 40 systematic and scoping reviews (2000-2024) to explore how MHL is conceptualised and operationalised across disciplines. Following a registered PROSPERO protocol, the review applied rigorous methods across five databases and assessed quality using the JBI Checklist. Most studies relied on a common definition by Jorm and colleagues, focusing on knowledge and beliefs about mental disorders. More recent frameworks, such as that proposed by Kutcher and colleagues, adopt a broader, salutogenic view, emphasising positive mental health, stigma reduction and help-seeking efficacy. Thirty-three MHL measures were identified, with most tools prioritising disorder-related literacy over wellbeing-focused components. The most common way the reviews operationalised MHL was by exploring it as an outcome variable in intervention studies. The review highlights the need for more comprehensive and context-sensitive MHL frameworks and tools that align with contemporary mental health promotion strategies. It underscores the importance of integrating both pathogenic and salutogenic perspectives to support mental wellbeing across diverse populations and settings. Future research should prioritise refining theoretical models, improving measurement tools and exploring implementation strategies that reflect the multifaceted nature of MHL.
The outbreak of the COVID-19 pandemic and the following lockdown enforced substantial lifestyle changes in people's everyday lives. This study aimed to assess the impacts of the COVID-19 restrictions on the ageing women's mental, social and physical well-being. Data were collected through two postal questionnaires. Baseline data were obtained in May-June 2019, prior to the pandemic. A follow-up survey was mailed to 760 eligible participants in August-September 2020; 571 women (75.1%) responded, forming the final cohort. The cohort comprised community-dwelling women born between 1932 and 1941 (mean age 82.5 years). Both surveys assessed health, lifestyle, mood, sleep, and technology use, with the follow-up including pandemic-related items. Dietary habits improved with increased consumption of fruits, vegetables and fish, and decreased intake of sweets, pastries, alcohol and meat. Sleep quality and perceived sufficiency remained stable, although nighttime awakenings declined (p=0.023). Social interactions decreased for 43.6% of respondents, yet 20.2% reported receiving more support. Functional capacity deteriorated significantly, with reduced ability to climb several floors, run 100 m and cycle (all p<0.001). Early lockdown was associated with both positive and negative outcomes. Favourable changes included healthier diets and stable sleep quality. Despite reduced face-to-face contact, perceived social support improved for some participants. However, physical functioning declined, underscoring the need to maintain mobility during prolonged restrictions.
People in Sweden have internationally good health, work environment and quality of life, a picture that has lately been questioned because of the sharp increase in stress-related diagnoses, especially among young women. This study aims to better understand how stress and psychosocial work stressors vary across age and birth cohorts using data collected between 2008 and 2018. Using hierarchical age-period-cohort-growth curve models and data from the Swedish Longitudinal Occupational Survey of Health, we estimated the age trajectories of job demands, job control, perceived long-lasting stress, sustained emotional stress and self-rated health by birth cohort. Separate analyses by sex and occupational status were also conducted. Job demands, perceived long-lasting stress and sustained emotional stress decreased with age, while self-rated health deteriorated. Statistically significant cohort and age × cohort interactions suggest that more recent birth cohorts have both a) higher job demands, lower job control, more sustained emotional stress and worse self-rated health, and b) a less favourable development with age for all outcomes. However, these cohort differences are primarily driven by younger cohorts, and they are less pronounced or inconsistent among older cohorts. Occupational status and gender seem to modify some of these developments. This study provides some support for inter-cohort changes in the work environment and health, predominantly among younger cohorts. More recent cohorts generally report poorer health and work environment along with less favourable development with age. Nevertheless, these patterns are not consistent across all age group comparisons and robust cohort comparisons are primarily possible among adjacent cohorts. It is, however, unlikely that these changes can be attributed solely to a general deterioration in working life affecting all workers equally, as the phenomenon appears largely confined to younger workers. Future studies should explore how the combined demands from several spheres of life may better explain these age and cohort differences.
To examine trends in the treatment and rehabilitation of depression prior to disability pension application due to depression. This retrospective register-based study included 30,105 applicants for disability pension due to depression, and it is based on data from the Social Insurance Institution of Finland (Kela). The trends in antidepressant purchases and rehabilitation measures during the year preceding the application were analysed for 2010-2019 using linear regression analysis, with analysis of covariance to assess the interactions of age- and sex-based population groups with these trends. A stable proportion of approximately 1 in 10 (9.2%-12.2%) applicants had had neither antidepressant purchases nor psychotherapy in the preceding year, with no statistically significant trend (p < 0.05). The proportion of applicants with a history of antidepressant use decreased slightly from 90.3% to 87.5%. However, the proportion of applicants with a history of psychotherapy or both psychotherapy and antidepressants doubled over the same period (from 6.1% to 13.5% and from 5.6% to 11.7%, respectively). Annually, estimated average antidepressant use declined by 0.25 percentage points, psychotherapy increased by 0.90 percentage points, and combined treatment increased by 0.75 percentage points, all statistically significant. A statistically significant interaction in psychotherapy trends was observed in population groups based on sex and age. The highest proportion of applicants receiving psychotherapy was among females under the age of 40. The proportion of applicants for disability pension due to depression receiving psychotherapy has increased over time. However, most applicants, particularly older males, continue to receive only antidepressants and no rehabilitation.