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Paludan-Müller C, Vad OB, Stampe NK, Diederichsen SZ, Andreasen L, Monfort LM, Fosbøl EL, Køber L, Torp-Pedersen C, Svendsen JH, Olesen MS. Atrial fibrillation: age at diagnosis, incident cardiovascular events, and mortality. Eur Heart J 2024; 45:2119-2129. [PMID: 38592444 PMCID: PMC11212824 DOI: 10.1093/eurheartj/ehae216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/19/2024] [Accepted: 03/20/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND AND AIMS Patients with atrial fibrillation (AF) are at increased risks of cardiovascular diseases and mortality, but risks according to age at diagnosis have not been reported. This study investigated age-specific risks of outcomes among patients with AF and the background population. METHODS This nationwide population-based cohort study included patients with AF and controls without outcomes by the application of exposure density matching on the basis of sex, year of birth, and index date. The absolute risks and hazard rates were stratified by age groups and assessed using competing risk survival analyses and Cox regression models, respectively. The expected differences in residual life years among participants were estimated. RESULTS The study included 216 579 AF patients from year 2000 to 2020 and 866 316 controls. The mean follow-up time was 7.9 years. Comparing AF patients with matched controls, the hazard ratios among individuals ≤50 years was 8.90 [95% confidence interval (CI), 7.17-11.0] for cardiomyopathy, 8.64 (95% CI, 7.74-9.64) for heart failure, 2.18 (95% CI, 1.89-2.52) for ischaemic stroke, and 2.74 (95% CI, 2.53-2.96) for mortality. The expected average loss of life years among individuals ≤50 years was 9.2 years (95% CI, 9.0-9.3) years. The estimates decreased with older age. CONCLUSIONS The findings show that earlier diagnosis of AF is associated with a higher hazard ratio of subsequent myocardial disease and shorter life expectancy. Further studies are needed to determine causality and whether AF could be used as a risk marker among particularly younger patients.
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Affiliation(s)
- Christian Paludan-Müller
- Department of Cardiology, The Heart Center, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen O, Denmark
| | - Oliver B Vad
- Department of Cardiology, The Heart Center, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen O, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Niels K Stampe
- Department of Cardiology, The Heart Center, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen O, Denmark
| | - Søren Z Diederichsen
- Department of Cardiology, The Heart Center, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen O, Denmark
| | - Laura Andreasen
- Department of Cardiology, The Heart Center, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen O, Denmark
| | - Laia M Monfort
- Department of Cardiology, The Heart Center, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen O, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Emil L Fosbøl
- Department of Cardiology, The Heart Center, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen O, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, The Heart Center, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen O, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Copenhagen University Hospital—North Zealand Hospital, Hillerød, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jesper H Svendsen
- Department of Cardiology, The Heart Center, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen O, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Morten S Olesen
- Department of Cardiology, The Heart Center, Copenhagen University Hospital—Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen O, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Lieber SR, Jones AR, Jiang Y, Gowda P, Patel M, Lippe B, Shenoy A, Evon DM, Gurley T, Ngo V, Olumesi M, Trudeau RE, Noriega Ramirez A, Jordan-Genco L, Mufti A, Lee SC, Singal AG, VanWagner LB. Psychiatric diagnoses are common after liver transplantation and are associated with increased health care utilization and patient financial burden. Liver Transpl 2024:01445473-990000000-00373. [PMID: 38713020 DOI: 10.1097/lvt.0000000000000390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/09/2024] [Indexed: 05/08/2024]
Abstract
Psychiatric disorders after liver transplantation (LT) are associated with worse patient and graft outcomes, which may be amplified by inadequate treatment. We aimed to characterize the burden of psychiatric disorders, treatment patterns, and associated financial burden among liver transplantation recipients (LTRs). IQVIA PharMetrics (R) Plus for Academics-a large health plan claims database representative of the commercially insured US population-was used to identify psychiatric diagnoses among adult LTRs and assess treatment. Multivariable logistic regression analysis identified factors associated with post-LT psychiatric diagnoses and receipt of pharmacotherapy. Patient financial liability was estimated using adjudicated medical/pharmacy claims for LTRs with and without psychiatric diagnoses. Post-LT psychiatric diagnoses were identified in 395 (29.5%) of 1338 LTRs, of which 106 (26.8%) were incident cases. Treatment varied, with 67.3% receiving pharmacotherapy, 32.1% psychotherapy, 21.0% combination therapy, and 21.5% no treatment. Among 340 LTRs on psychotropic medications before transplant, 24% did not continue them post-LT. Post-LT psychiatric diagnoses were independently associated with female sex, alcohol-associated liver disease (ALD), prolonged LT hospitalization (>2 wk), and pre-LT psychiatric diagnosis. Incident psychiatric diagnoses were associated with female sex, ALD, and prolonged LT hospitalization. Patients with a post-LT psychiatric diagnosis had higher rates of hospitalization (89.6% vs. 81.5%, p <0.001) and financial liability (median $5.5K vs. $4.6K USD, p =0.006). Having a psychiatric diagnosis post-LT was independently associated with experiencing high financial liability >$5K. Over 1 in 4 LTRs had a psychiatric diagnosis in a large national cohort, yet nearly a quarter received no treatment. LTRs with psychiatric diagnoses experienced increased health care utilization and higher financial liability. Sociodemographic and clinical risk factors could inform high-risk subgroups who may benefit from screening and mitigation strategies.
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Affiliation(s)
- Sarah R Lieber
- Department of Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Alex R Jones
- Department of Medicine, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Yue Jiang
- Department of Statistical Science, Duke University, Durham, North Carolina, USA
| | - Prajwal Gowda
- Department of Medicine, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Madhukar Patel
- Department of Surgery, Division of Surgical Transplantation, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Ben Lippe
- Department of Psychiatry, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Akhil Shenoy
- Department of Psychiatry, Columbia University Medical Center, New York, New York, USA
| | - Donna M Evon
- Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Tami Gurley
- Department of Public Health, Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Van Ngo
- Department of Pharmacy, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Mary Olumesi
- Department of Pharmacy, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Raelene E Trudeau
- Department of Pharmacy, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Alvaro Noriega Ramirez
- Department of Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Layne Jordan-Genco
- Department of Medicine, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
- Department of Psychiatry, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Arjmand Mufti
- Department of Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Simon C Lee
- Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Amit G Singal
- Department of Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Lisa B VanWagner
- Department of Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
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Meijsen J, Hu K, Krebs MD, Athanasiadis G, Washbrook S, Zetterberg R, Avelar E Silva RN, Shorter JR, Gådin JR, Bergstedt J, Howard DM, Ye W, Lu Y, Valdimarsdóttir UA, Ingason A, Helenius D, Plana-Ripoll O, McGrath JJ, Micali N, Andreassen OA, Werge TM, Fang F, Buil A. Quantifying the relative importance of genetics and environment on the comorbidity between mental and cardiometabolic disorders using 17 million Scandinavians. Nat Commun 2024; 15:5064. [PMID: 38871766 PMCID: PMC11176385 DOI: 10.1038/s41467-024-49507-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 06/07/2024] [Indexed: 06/15/2024] Open
Abstract
Mental disorders are leading causes of disability and premature death worldwide, partly due to high comorbidity with cardiometabolic disorders. Reasons for this comorbidity are still poorly understood. We leverage nation-wide health records and near-complete genealogies of Denmark and Sweden (n = 17 million) to reveal the genetic and environmental contributions underlying the observed comorbidity between six mental disorders and 15 cardiometabolic disorders. Genetic factors contributed about 50% to the comorbidity of schizophrenia, affective disorders, and autism spectrum disorder with cardiometabolic disorders, whereas the comorbidity of attention-deficit/hyperactivity disorder and anorexia with cardiometabolic disorders was mainly or fully driven by environmental factors. In this work we provide causal insight to guide clinical and scientific initiatives directed at achieving mechanistic understanding as well as preventing and alleviating the consequences of these disorders.
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Affiliation(s)
- Joeri Meijsen
- Institute of Biological Psychiatry, Mental Health Center Sct. Hans, Mental Health Services Copenhagen University Hospital, Roskilde, Denmark.
| | - Kejia Hu
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Morten D Krebs
- Institute of Biological Psychiatry, Mental Health Center Sct. Hans, Mental Health Services Copenhagen University Hospital, Roskilde, Denmark
| | - Georgios Athanasiadis
- Institute of Biological Psychiatry, Mental Health Center Sct. Hans, Mental Health Services Copenhagen University Hospital, Roskilde, Denmark
- Department of Evolutionary Biology, Ecology and Environmental Sciences, University of Barcelona, Barcelona, Spain
| | - Sarah Washbrook
- Center for Eating and feeding Disorders research, Psychiatric Centre Ballerup, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
| | - Richard Zetterberg
- Institute of Biological Psychiatry, Mental Health Center Sct. Hans, Mental Health Services Copenhagen University Hospital, Roskilde, Denmark
| | - Raquel Nogueira Avelar E Silva
- Institute of Biological Psychiatry, Mental Health Center Sct. Hans, Mental Health Services Copenhagen University Hospital, Roskilde, Denmark
| | - John R Shorter
- Institute of Biological Psychiatry, Mental Health Center Sct. Hans, Mental Health Services Copenhagen University Hospital, Roskilde, Denmark
- Department of Science and Environment, Roskilde University, Roskilde, Denmark
| | - Jesper R Gådin
- Institute of Biological Psychiatry, Mental Health Center Sct. Hans, Mental Health Services Copenhagen University Hospital, Roskilde, Denmark
| | - Jacob Bergstedt
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - David M Howard
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Weimin Ye
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Yi Lu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Unnur A Valdimarsdóttir
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Andrés Ingason
- Institute of Biological Psychiatry, Mental Health Center Sct. Hans, Mental Health Services Copenhagen University Hospital, Roskilde, Denmark
| | - Dorte Helenius
- Institute of Biological Psychiatry, Mental Health Center Sct. Hans, Mental Health Services Copenhagen University Hospital, Roskilde, Denmark
| | - Oleguer Plana-Ripoll
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - John J McGrath
- Queensland Centre for Mental Health Research, Brisbane, Australia
- Queensland Brain Institute, The University of Queensland, Brisbane, Australia
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
| | - Nadia Micali
- Institute of Biological Psychiatry, Mental Health Center Sct. Hans, Mental Health Services Copenhagen University Hospital, Roskilde, Denmark
- Center for Eating and feeding Disorders research, Psychiatric Centre Ballerup, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Ole A Andreassen
- NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- KG Jebsen Centre for Neurodevelopmental disorders, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Thomas M Werge
- Institute of Biological Psychiatry, Mental Health Center Sct. Hans, Mental Health Services Copenhagen University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Fang Fang
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Alfonso Buil
- Institute of Biological Psychiatry, Mental Health Center Sct. Hans, Mental Health Services Copenhagen University Hospital, Roskilde, Denmark.
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Gowin K, Muminovic M, Zick SM, Lee RT, Lacchetti C, Mehta A. Integrative Therapies in Cancer Care: An Update on the Guidelines. Am Soc Clin Oncol Educ Book 2024; 44:e431554. [PMID: 38820485 DOI: 10.1200/edbk_431554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
INTRODUCTION ASCO and the Society for Integrative Oncology have collaborated to develop guidelines for the application of integrative approaches in the management of anxiety, depression, fatigue and use of cannabinoids and cannabis in patients with cancer. These guidelines provide evidence-based recommendations to improve outcomes and quality of life by enhancing conventional cancer treatment with integrative modalities. METHODS All studies that informed the guideline recommendations were reviewed by an Expert Panel which was made up of a patient advocate, an ASCO methodologist, oncology providers, and integrative medicine experts. Panel members reviewed each trial for quality of evidence, determined a grade quality assessment label, and concluded strength of recommendations. RESULTS Strong recommendations for management of cancer fatigue during treatment were given to both in-person or web-based mindfulness-based stress reduction, mindfulness-based cognitive therapy, and tai chi or qigong. Strong recommendations for management of cancer fatigue after cancer treatment were given to mindfulness-based programs. Clinicians should recommend against using cannabis or cannabinoids as a cancer-directed treatment unless within the context of a clinical trial. The recommended modalities for managing anxiety included Mindfulness-Based Interventions (MBIs), yoga, hypnosis, relaxation therapies, music therapy, reflexology, acupuncture, tai chi, and lavender essential oils. The strongest recommendation in the guideline is that MBIs should be offered to people with cancer, both during active treatment and post-treatment, to address depression. CONCLUSION The evidence for integrative interventions in cancer care is growing, with research now supporting benefits of integrative interventions across the cancer care continuum.
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Affiliation(s)
- Krisstina Gowin
- Division of Hematology Oncology, Department of Medicine, University of Arizona, Tucson, AZ
| | - Meri Muminovic
- Department of Hematology-Oncology, Memorial Cancer Institute, Memorial Healthcare System, Miami, FL
| | - Suzanna M Zick
- Family Medicine and Nutritional Sciences, University of Michigan, Ann Arbor, MI
| | - Richard T Lee
- Departments of Supportive Care Medicine and Medical Oncology, City of Hope Comprehensive Cancer Center, Irvine, CA
| | - Christina Lacchetti
- Senior Clinical Practice Guidelines Methodologist, American Society of Clinical Oncology, Alexandria, VA
| | - Ashwin Mehta
- Memorial Division of Integrative Medicine, Memorial Healthcare System, Hollywood, FL
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de Mattos Russo Rafael R, da Silva KP, de Souza Santos HG, Depret DG, Caravaca-Morera JA, Breda KML. Accuracy, potential, and limitations of probabilistic record linkage in identifying deaths by gender identity and sexual orientation in the state of Rio De Janeiro, Brazil. BMC Public Health 2024; 24:1475. [PMID: 38824562 PMCID: PMC11144332 DOI: 10.1186/s12889-024-19002-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 05/29/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Globally, the counting of deaths based on gender identity and sexual orientation has been a challenge for health systems. In most cases, non-governmental organizations have dedicated themselves to this work. Despite these efforts in generating information, the scarcity of official data presents significant limitations in policy formulation and actions guided by population needs. Therefore, this manuscript aims to evaluate the accuracy, potential, and limits of probabilistic data relationships to yield information on deaths according to gender identity and sexual orientation in the State of Rio de Janeiro. METHODS This study evaluated the accuracy of the probabilistic record linkage to obtain information on deaths according to gender and sexual orientation. Data from two information systems were used from June 15, 2015 to December 31, 2020. We constructed nine probabilistic data relationship strategies and identified the performance and cutoff points of the best strategy. RESULTS The best data blocking strategy was established through logical blocks with the first and last names, birthdate, and mother's name in the pairing strategy. With a population base of 80,178 records, 1556 deaths were retrieved. With an area under the curve of 0.979, this strategy presented 93.26% accuracy, 98.46% sensitivity, and 90.04% specificity for the cutoff point ≥ 17.9 of the data relationship score. The adoption of the cutoff point optimized the manual review phase, identifying 2259 (90.04%) of the 2509 false pairs and identifying 1532 (98.46%) of the 1556 true pairs. CONCLUSION With the identification of possible strategies for determining probabilistic data relationships, the retrieval of information on mortality according to sexual and gender markers has become feasible. Based on information from the daily routine of health services, the formulation of public policies that consider the LGBTQ + population more closely reflects the reality experienced by these population groups.
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Affiliation(s)
| | - Kleison Pereira da Silva
- School of Nursing, Public Health Nursing Department, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Davi Gomes Depret
- School of Nursing, Public Health Nursing Department, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Karen Marie Lucas Breda
- Department of Nursing, College of Education, University of Hartford, Nursing & Health Professions. West Hartford, Connecticut, United States of America
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Plana-Ripoll O, Chen D, Laustsen LM, Momen NC. The challenges at the core of multimorbidity research. Lancet Psychiatry 2024; 11:399-400. [PMID: 38642561 DOI: 10.1016/s2215-0366(24)00129-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 04/08/2024] [Indexed: 04/22/2024]
Affiliation(s)
- Oleguer Plana-Ripoll
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus University, 8200 Aarhus, Denmark; National Centre for Register-based Research, Aarhus University, 8200 Aarhus, Denmark
| | - Danni Chen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus University, 8200 Aarhus, Denmark
| | - Lisbeth Mølgaard Laustsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus University, 8200 Aarhus, Denmark
| | - Natalie C Momen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus University, 8200 Aarhus, Denmark.
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Coello K, Holstad Pedersen H, Munkholm K, Lie Kjærstad H, Stanislaus S, Rye Ostrowski S, Faurholt-Jepsen M, Miskowiak KW, Frikke-Schmidt R, Vinberg M, Thorn Ekstrøm C, Lyng Forman J, Vedel Kessing L. A composite immune and vascular stress marker in patients newly diagnosed with bipolar disorder and their unaffected first-degree relatives. Brain Behav Immun 2024; 118:449-458. [PMID: 38508346 DOI: 10.1016/j.bbi.2024.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 02/15/2024] [Accepted: 03/17/2024] [Indexed: 03/22/2024] Open
Abstract
AIMS Substantial evidence emphasizes immune dysregulation in patients with bipolar disorder (BD). However, whether immune dysregulation is present already in the early illness stages of BD or even precedes development of BD is largely unknown. In this study we compared immune and vascular stress markers in patients newly diagnosed with BD, their unaffected first-degree relatives (UR) and healthy control individuals (HC) and investigated the ability a composite immune and vascular stress marker to discriminate between the three groups of participants. METHODS In a unique sample including 373 patients newly diagnosed with BD, 95 UR and 190 HC, we compared 47 immune and vascular stress markers at the baseline visit in the ongoing longitudinal Bipolar Illness Onset study. For comparison of individual immune and vascular stress markers between groups, we applied linear mixed models, whereas the composite immune and vascular stress marker was investigated using the SuperLearner ensemble-method. RESULTS Compared with HC, patients newly diagnosed with BD had higher levels of the anti-inflammatory interleukin-1 receptor antagonist (IL-1RA) and IL-10, and of the pro-inflammatory IL-6, eotaxin, monocyte chemoattractant protein-1 (MCP-1), MCP-4, Macrophage Derived Chemokine (MDC), and Thymus and Activation-Regulated Chemokine (TARC) in analyses adjusted for sex and age ranging from 26 % higher levels of IL-6 (1.26, 95 %CI: [1.12-1.43], p < 0.001, adjusted p = 0.009) and IL-10 (1.26, 95 %CI: [1.09-1.46], p = 0.002, adjusted p = 0.049), respectively, to 9 % higher eotaxin levels (1.09, 95 %CI: [1.04-1.15], p = 0.001, adjusted p = 0.024). Of these, MDC levels were 12 % higher in BD compared with UR (1.12, 95 %CI: [1.02-1.22], p = 0.001, adjusted p = 0.024). For all other markers, UR showed no difference from patients with BD or HC. Based on a data-driven model, a composite marker including all 47 immune and vascular stress markers, sex, age, BMI, smoking status, and alcohol intake, discriminated patients with BD from HC with a with an area under the receiver operating curve (AUC) of 0.76 (95 % CI: 0.75-0.77) CONCLUSIONS: Higher levels of pro-inflammatory and anti-inflammatory immune markers are present in patients newly diagnosed with BD but not in UR compared with HC, supporting immune dysregulation playing a role in the pathophysiology of BD.
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Affiliation(s)
- Klara Coello
- Copenhagen University Hospital Frederiksberg, Frederiksberg, Denmark.
| | - Helle Holstad Pedersen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark
| | - Klaus Munkholm
- Copenhagen University Hospital Frederiksberg, Frederiksberg, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | | | | | - Sisse Rye Ostrowski
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Maria Faurholt-Jepsen
- Copenhagen University Hospital Frederiksberg, Frederiksberg, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Kamilla Woznica Miskowiak
- Copenhagen University Hospital Frederiksberg, Frederiksberg, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Ruth Frikke-Schmidt
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Clinical Biochemistry, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Maj Vinberg
- Copenhagen University Hospital Frederiksberg, Frederiksberg, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; The Early Multimodular Prevention and Intervention Research Institution (EMPIRI), Mental Health Centre, Northern Zealand, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Claus Thorn Ekstrøm
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark
| | - Julie Lyng Forman
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark
| | - Lars Vedel Kessing
- Copenhagen University Hospital Frederiksberg, Frederiksberg, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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8
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Momen NC, Petersen JD, Yilmaz Z, Semark BD, Petersen LV. Inpatient admissions and mortality of anorexia nervosa patients according to their preceding psychiatric and somatic diagnoses. Acta Psychiatr Scand 2024; 149:404-414. [PMID: 38408593 DOI: 10.1111/acps.13676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/01/2024] [Accepted: 02/14/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVE Anorexia nervosa (AN) is associated with increased risk of mortality, but little is known about the risk of inpatient admissions and mortality outcomes in individuals with diagnoses of both AN and other psychiatric and somatic conditions. We aimed to investigate the inpatient admissions and mortality among people with AN and other diagnosed conditions using Danish national registers. METHOD This retrospective cohort study included individuals diagnosed with AN in Denmark, born 1977-2010. We identified other mental and somatic conditions in this population. We used Cox proportional hazards regression to estimate the risk of inpatient admission and mortality, focusing on (i) the number of other diagnosed conditions, and (ii) specific combinations of conditions diagnosed prior to the AN diagnosis. Categories of inpatient admissions considered were due to: (i) AN, (ii) any psychiatric disorder, and (iii) any somatic disorder. Additionally, competing risks survival analysis was used to calculate the cumulative incidence of inpatient admission and all-cause mortality over the follow-up period. RESULTS The study population included 11,489 individuals. The most common conditions individuals had prior to their AN diagnosis were other eating disorders (34.5%) and anxiety disorders (32.7%). During the follow-up, 3184 (27.7%), 4604 (40.1%), and 6636 (57.8%) individuals were admitted for AN, any psychiatric disorder, and any somatic disorder, respectively; and in total 106 (0.9%) died. The risk of all outcomes was highest among those who had received a higher number of other diagnoses. For most combinations, the risks of admission and mortality were increased. DISCUSSION Our study presents the prevalence of other conditions in patients with AN in Denmark and elucidates their association with higher rates of inpatient admission and mortality. Our findings highlight the need for comprehensive, multidisciplinary care of patients with AN considering the spectrum of other diagnosed conditions to improve health outcomes.
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Affiliation(s)
- Natalie C Momen
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
| | - Jindong Ding Petersen
- International School of Public Health and One Health, Hainan Medical University, Haikou, Hainan, China
- Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Zeynep Yilmaz
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Birgitte D Semark
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
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Vessels T, Strayer N, Lee H, Choi KW, Zhang S, Han L, Morley TJ, Smoller JW, Xu Y, Ruderfer DM. Integrating Electronic Health Records and Polygenic Risk to Identify Genetically Unrelated Comorbidities of Schizophrenia That May Be Modifiable. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2024; 4:100297. [PMID: 38645405 PMCID: PMC11033077 DOI: 10.1016/j.bpsgos.2024.100297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/07/2024] [Accepted: 02/11/2024] [Indexed: 04/23/2024] Open
Abstract
Background Patients with schizophrenia have substantial comorbidity that contributes to reduced life expectancy of 10 to 20 years. Identifying modifiable comorbidities could improve rates of premature mortality. Conditions that frequently co-occur but lack shared genetic risk with schizophrenia are more likely to be products of treatment, behavior, or environmental factors and therefore are enriched for potentially modifiable associations. Methods Phenome-wide comorbidity was calculated from electronic health records of 250,000 patients across 2 independent health care institutions (Vanderbilt University Medical Center and Mass General Brigham); associations with schizophrenia polygenic risk scores were calculated across the same phenotypes in linked biobanks. Results Schizophrenia comorbidity was significantly correlated across institutions (r = 0.85), and the 77 identified comorbidities were consistent with prior literature. Overall, comorbidity and polygenic risk score associations were significantly correlated (r = 0.55, p = 1.29 × 10-118). However, directly testing for the absence of genetic effects identified 36 comorbidities that had significantly equivalent schizophrenia polygenic risk score distributions between cases and controls. This set included phenotypes known to be consequences of antipsychotic medications (e.g., movement disorders) or of the disease such as reduced hygiene (e.g., diseases of the nail), thereby validating the approach. It also highlighted phenotypes with less clear causal relationships and minimal genetic effects such as tobacco use disorder and diabetes. Conclusions This work demonstrates the consistency and robustness of electronic health record-based schizophrenia comorbidities across independent institutions and with the existing literature. It identifies known and novel comorbidities with an absence of shared genetic risk, indicating other causes that may be modifiable and where further study of causal pathways could improve outcomes for patients.
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Affiliation(s)
- Tess Vessels
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Center for Digital Genomic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Nicholas Strayer
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Hyunjoon Lee
- Psychiatric & Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Karmel W. Choi
- Psychiatric & Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Siwei Zhang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lide Han
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Center for Digital Genomic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Theodore J. Morley
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Center for Digital Genomic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jordan W. Smoller
- Psychiatric & Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Yaomin Xu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Douglas M. Ruderfer
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Center for Digital Genomic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
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10
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Larsen JT, Yilmaz Z, Bulik CM, Albiñana C, Vilhjálmsson BJ, Mortensen PB, Petersen LV. Diagnosed eating disorders in Danish registers - incidence, prevalence, mortality, and polygenic risk. Psychiatry Res 2024; 337:115927. [PMID: 38696971 DOI: 10.1016/j.psychres.2024.115927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/12/2024] [Accepted: 04/26/2024] [Indexed: 05/04/2024]
Abstract
Eating disorders are a group of severe and potentially enduring psychiatric disorders associated with increased mortality. Compared to other severe mental illnesses, they have received relatively limited research attention. Epidemiological studies often only report relative measures despite these being difficult to interpret having limited practical use. The aims of this study were to evaluate the incidence and prevalence of diagnosed anorexia nervosa (AN), bulimia nervosa, and eating disorder not otherwise specified recorded in Danish hospital registers and estimate both relative and absolute measures of subsequent mortality - both all-cause and cause-specific in a general nationwide population of 1,667,374 individuals. In a smaller, genetically informed case-cohort sample, the prediction of polygenic scores for AN, body fat percentage, and body mass index on AN prevalence and severity was estimated. Despite males being less likely to be diagnosed with an eating disorder, those that do have significantly increased rates of mortality. AN prevalence was highest for individuals with high AN and low body fat percentage/body mass index polygenic scores.
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Affiliation(s)
- Janne Tidselbak Larsen
- National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus, Denmark; Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark.
| | - Zeynep Yilmaz
- National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Clara Albiñana
- National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark
| | - Bjarni Jóhann Vilhjálmsson
- National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark; Bioinformatics Research Centre, Aarhus University, Denmark; Novo Nodisk Foundation Centre for Genomics Mechanisms of Disease, Broad Institute of MIT and Harvard, Cambridge, MA, United States
| | - Preben Bo Mortensen
- National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus, Denmark; Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - Liselotte Vogdrup Petersen
- National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus, Denmark
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11
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Sperling JD, Frikke-Schmidt R, Scheike T, Kessing LV, Miskowiak K, Vinberg M. APOE Genotype, ApoE Plasma Levels, Lipid Metabolism, and Cognition in Monozygotic Twins with, at Risk of, and without Affective Disorders. J Clin Med 2024; 13:2361. [PMID: 38673634 PMCID: PMC11051543 DOI: 10.3390/jcm13082361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/01/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Lipids influence brain function and mental health. Understanding the role of apolipoproteins in affective disorders could provide valuable insights and potentially pave the way for novel therapeutic approaches. Methods: We examined the apolipoprotein E genotype and ApoE-levels, lipid profiles, and the correlation with cognition in 204 monozygotic (MZ) twins with unipolar or bipolar disorder in remission or partial remission (affected, AT), their unaffected co-twins (high-risk, HR), and twins with no personal or family history of affective disorder (low-risk, LR). Results: The APOE genotype was not associated with affective disorders. No significant group differences in ApoE levels were found between the three risk groups. Post hoc analysis group-wise comparisons showed higher ApoE levels in the AT than HR twins and in the concordant AT twin pairs relative to the discordant twin pairs. Within the discordant twin pairs, higher ApoE levels were observed in the affected twins (AT = 39.4 mg/L vs. HR = 36.8 mg/L, p = 0.037). Limitations: The present study could benefit from a larger sample size. We did not assess dietary habits. Conclusions: The results did not support our main hypothesis. However, exploratory post hoc analysis suggests a role for plasma ApoE and triglycerides in affective disorders. Future research is needed.
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Affiliation(s)
- Jon Dyg Sperling
- The Early Multimodular Prevention and Intervention Research Institution (EMPIRI), Mental Health Centre, Northern Zealand, Copenhagen University Hospital—Mental Health Services CPH, 3400 North Zealand, Denmark;
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark (L.V.K.)
| | - Ruth Frikke-Schmidt
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark (L.V.K.)
- Department of Clinical Biochemistry Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Thomas Scheike
- Department of Biostatistics, University of Copenhagen, 1353 Copenhagen, Denmark
| | - Lars Vedel Kessing
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark (L.V.K.)
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, 2000 Frederiksberg, Denmark
| | - Kamilla Miskowiak
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark (L.V.K.)
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, 2000 Frederiksberg, Denmark
- Neurocognition and Emotion in Affective Disorders (NEAD) Centre, Department of Psychology, University of Copenhagen, and Mental Health Services, Capital Region of Denmark, 2000 Frederiksberg, Denmark
| | - Maj Vinberg
- The Early Multimodular Prevention and Intervention Research Institution (EMPIRI), Mental Health Centre, Northern Zealand, Copenhagen University Hospital—Mental Health Services CPH, 3400 North Zealand, Denmark;
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark (L.V.K.)
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12
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Hendricks-Sturrup RM, Yankah SE, Lu CY. Social determinants of health Z-code documentation practices in mental health settings: a scoping review. HEALTH AFFAIRS SCHOLAR 2024; 2:qxae046. [PMID: 38756172 PMCID: PMC11050653 DOI: 10.1093/haschl/qxae046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/29/2024] [Accepted: 04/09/2024] [Indexed: 05/18/2024]
Abstract
Mental health remains an urgent global priority, alongside efforts to address underlying social determinants of health (SDoH) that contribute to the onset or exacerbate mental illness. SDoH factors can be captured in the form of International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM), SDoH Z codes. In this scoping review, we describe current SDoH Z-code documentation practices, with a focus on mental health care contexts. Among 2 743 061 374 health care encounters noted across 12 studies in the United States, SDoH Z-code documentation rates ranged from 0.5% to 2.4%. Documentation often involved patients under 64 years of age who are publicly insured and experience comorbidities, including depression, bipolar disorder and schizophrenia, chronic pulmonary disease, and substance abuse disorders. Documentation varied across hospital types, number of beds per facility, patient race/ethnicity, and geographic region. Variation was observed regarding patient sex/gender, although SDoH Z codes were more frequently documented for males. Documentation was most observed in government, nonfederal, and private not-for-profit hospitals. From these insights, we offer policy and practice recommendations, as well as considerations for patient data privacy, security, and confidentiality, to incentivize more routine documentation of Z codes to better assist patients with complex mental health care needs.
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Affiliation(s)
| | - Sandra E Yankah
- Duke-Robert J. Margolis, MD, Institute for Health Policy, Washington, DC 20004, United States
| | - Christine Y Lu
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA 02215, United States
- Faculty of Medicine and Health, Kolling Institute, The University of Sydney and the Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, NSW 2050, Australia
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13
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Christiansen E, Reilev M, Larsen CP, Bilenberg N, Agerbo E. The joint effect of mental illness and parental suicide attempt on offspring suicide attempt and death: A Danish nationwide, registry-based study using multistate modeling. Psychiatry Res 2024; 334:115824. [PMID: 38447460 DOI: 10.1016/j.psychres.2024.115824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 02/18/2024] [Accepted: 02/24/2024] [Indexed: 03/08/2024]
Abstract
AIM The aim of this study was to analyse the joint impact of moderate-to-severe mental illness and parental suicidal attempts on suicidal attempt and premature death. METHODS Using the Danish, nationwide health registries, a cohort study was conducted including the birth cohorts 1983-1989. Cox regression and multistate models were used to estimate relative and absolute risks of suicide attempt and premature death. OUTCOME We included 384,569 individuals and 7,218 individuals experienced their first suicide attempt during follow-up, while 2,762 individuals died of all causes. Joined exposure to parental suicide attempt and own mental illness increased the relative risk of suicide attempt (HR 22.57) and premature death all causes (HR 3.17). The absolute risk of suicide attempt before the age of 35 years was 20 % for offspring exposed to both parental suicide attempts and own mental illness (23 % for women vs. 15 % for men), while the risk of death was 4 % (0.6 % for women vs. 7 % for men). CONCLUSION Exposure to both parental suicide attempt and own mental illness increases the relative and absolute risks of suicide attempt and premature death with considerable differences across sex. These findings are important in the clinical assessment of individuals with suicidal behavior.
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Affiliation(s)
- Erik Christiansen
- Centre for Suicide Research, Odense, Denmark; The Research Unit in Psychiatry - child and adults, Psychiatry in the Region of Southern Denmark, Aabenraa, Denmark; Department of Regional Health Research, Odense, University of Southern Denmark, Denmark.
| | - Mette Reilev
- Centre for Suicide Research, Odense, Denmark; Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Denmark; The Research Unit in Psychiatry - child and adults, Psychiatry in the Region of Southern Denmark, Aabenraa, Denmark
| | - Christina Petrea Larsen
- Centre for Suicide Research, Odense, Denmark; Department of Regional Health Research, Odense, University of Southern Denmark, Denmark
| | - Niels Bilenberg
- Child and Adolescent Psychiatry Odense, Mental Health Services in the Region of Southern Denmark, Denmark
| | - Esben Agerbo
- CIRRAU - Centre for Integrated Register-based Research, BSS - School of Business and Social Sciences, Aarhus University, Denmark; NCRR - National Centre for Register-based Research, BSS - School of Business and Social Sciences, Aarhus University, Denmark
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14
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Virgilsen LF, Jensen H, Falborg AZ, Prior A, Pedersen AF, Vedsted P. Psychiatric disorders and the cancer diagnostic process in general practice: a combined questionnaire and register study exploring the patients' experiences in Denmark. Scand J Prim Health Care 2024; 42:156-169. [PMID: 38149909 PMCID: PMC10851816 DOI: 10.1080/02813432.2023.2296944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 12/14/2023] [Indexed: 12/28/2023] Open
Abstract
OBJECTIVE Patients with psychiatric disorders are at risk of experiencing suboptimal cancer diagnostics and treatment. This study investigates how this patient group perceives the cancer diagnostic process in general practice. DESIGN Cross-sectional study using questionnaire and register data. SETTING General practice in Denmark. SUBJECTS Patients diagnosed with cancer in late 2016 completed a questionnaire about their experiences with their general practitioner (GP) in the cancer diagnostic process (n = 3411). Information on pre-existing psychiatric disorders was obtained from register data on psychiatric hospital contacts and primary care treated psychiatric disorders through psychotropic medications. Logistic regression was used to analyse the association between psychiatric disorders and the patients' experiences. MAIN OUTCOME MEASURES Patients' experiences, including cancer worry, feeling being taken seriously, and the perceived time between booking an appointment and the first GP consultation.[Box: see text]. RESULTS A total of 13% of patients had an indication of a psychiatric disorder. This group more often perceived the time interval as too short between the first booking of a consultation and the first GP consultation. Patients with primary care treated psychiatric disorders were more likely to worry about cancer at the first presentation and to share this concern with their GP compared with patients without psychiatric disorders. We observed no statistically significant association between patients with psychiatric disorders and perceiving the waiting time to referral from general practice, being taken seriously, trust in the GP's abilities, and the patients' knowledge of the process following the GP referral. CONCLUSION The patients' experiences with the cancer diagnostic process in general practice did not vary largely between patients with and without psychiatric disorders. Worrying about cancer may be a particular concern for patients with primary care treated psychiatric disorders.
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Affiliation(s)
| | - Henry Jensen
- Research Unit for General Practice, Aarhus C, Denmark
| | | | - Anders Prior
- Research Unit for General Practice, Aarhus C, Denmark
| | - Anette Fischer Pedersen
- Research Unit for General Practice, Aarhus C, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus C, Denmark
| | - Peter Vedsted
- Research Unit for General Practice, Aarhus C, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus C, Denmark
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15
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Shalev D, Brenner K, Carlson RL, Chammas D, Levitt S, Noufi PE, Robbins-Welty G, Webb JA. Palliative Care Psychiatry: Building Synergy Across the Spectrum. Curr Psychiatry Rep 2024; 26:60-72. [PMID: 38329570 DOI: 10.1007/s11920-024-01485-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 02/09/2024]
Abstract
PURPOSE OF REVIEW Palliative care (PC) psychiatry is a growing subspecialty focusing on improving the mental health of those with serious medical conditions and their caregivers. This review elucidates the current practice and ongoing evolution of PC psychiatry. RECENT FINDINGS PC psychiatry leverages training and clinical practices from both PC and psychiatry, addressing a wide range of needs, including enhanced psychiatric care for patients with serious medical illness, PC access for patients with medical needs in psychiatric settings, and PC-informed psychiatric approaches for individuals with treatment-refractory serious mental illness. PC psychiatry is practiced by a diverse workforce comprising hospice and palliative medicine-trained psychiatrists, psycho-oncologists, geriatric psychiatrists, other mental health professionals, and non-psychiatrist PC clinicians. As a result, PC psychiatry faces challenges in defining its operational scope. The manuscript outlines the growth, current state, and prospects of PC psychiatry. It examines its roles across various healthcare settings, including medical, integrated care, and psychiatric environments, highlighting the unique challenges and opportunities in each. PC psychiatry is a vibrant and growing subspecialty of psychiatry that must be operationalized to continue its developmental trajectory. There is a need for a distinct professional identity for PC psychiatry, strategies to navigate administrative and regulatory hurdles, and greater support for novel clinical, educational, and research initiatives.
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Affiliation(s)
- Daniel Shalev
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, 525 East 68thStreet, Box 39, New York, NY, 10065, USA.
| | - Keri Brenner
- Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Rose L Carlson
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, 525 East 68thStreet, Box 39, New York, NY, 10065, USA
| | - Danielle Chammas
- Department of Medicine, University of California: San Francisco, San Francisco, CA, USA
| | - Sarah Levitt
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Paul E Noufi
- Department of Medicine, Georgetown University, Baltimore, MD, USA
| | | | - Jason A Webb
- Department of Medicine, Oregon Health and Sciences University, Portland, OR, USA
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16
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Meijsen J, Hu K, Krebs MD, Athanasiadis G, Washbrook S, Zetterberg R, e Silva RNA, Shorter JR, Gådin JR, Bergstedt J, Howard DM, Ye W, Lu Y, Valdimarsdóttir UA, Ingason A, Mikkelsen DH, Plana-Ripoll O, McGrath JJ, Micali N, Andreassen OA, Werge TM, Fang F, Buil A. Quantifying the Relative Importance of Genetics and Environment on the Comorbidity between Mental- and Cardiometabolic Disorders: A Comprehensive Analysis of National Register Data from 17 million Scandinavians. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.29.24303530. [PMID: 38464139 PMCID: PMC10925466 DOI: 10.1101/2024.02.29.24303530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Mental disorders (MDs) are leading causes of disability and premature death worldwide, partly due to high comorbidity with cardiometabolic disorders (CMDs). Reasons for this comorbidity are still poorly understood. We leverage nation-wide health records and complete genealogies of Denmark and Sweden (n=17 million) to reveal the genetic and environmental contributions underlying the observed comorbidity between six MDs and 14 CMDs. Genetic factors contributed about 50% to the comorbidity of schizophrenia, affective disorders, and autism spectrum disorder with CMDs, whereas the comorbidity of attention-deficit/hyperactivity disorder and anorexia with CMDs was mainly or fully driven by environmental factors. These findings provide causal insight to guide clinical and scientific initiatives directed at achieving mechanistic understanding as well as preventing and alleviating the consequences of these disorders.
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Affiliation(s)
- Joeri Meijsen
- Institute of Biological Psychiatry, Mental Health Center Sct. Hans, Mental Health Services Copenhagen, Roskilde, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Copenhagen, Denmark
| | - Kejia Hu
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Morten Dybdahl Krebs
- Institute of Biological Psychiatry, Mental Health Center Sct. Hans, Mental Health Services Copenhagen, Roskilde, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Copenhagen, Denmark
| | - Georgios Athanasiadis
- Institute of Biological Psychiatry, Mental Health Center Sct. Hans, Mental Health Services Copenhagen, Roskilde, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Copenhagen, Denmark
- Department of Evolutionary Biology, Ecology and Environmental Sciences, University of Barcelona, Barcelona, Spain
| | - Sarah Washbrook
- Institute of Biological Psychiatry, Mental Health Center Sct. Hans, Mental Health Services Copenhagen, Roskilde, Denmark
| | - Richard Zetterberg
- Institute of Biological Psychiatry, Mental Health Center Sct. Hans, Mental Health Services Copenhagen, Roskilde, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Copenhagen, Denmark
| | - Raquel Nogueira Avelar e Silva
- Institute of Biological Psychiatry, Mental Health Center Sct. Hans, Mental Health Services Copenhagen, Roskilde, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Copenhagen, Denmark
| | - John R. Shorter
- Institute of Biological Psychiatry, Mental Health Center Sct. Hans, Mental Health Services Copenhagen, Roskilde, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Copenhagen, Denmark
- Department of Science and Environment, Roskilde University, Denmark
| | - Jesper R. Gådin
- Institute of Biological Psychiatry, Mental Health Center Sct. Hans, Mental Health Services Copenhagen, Roskilde, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Copenhagen, Denmark
| | - Jacob Bergstedt
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - David M. Howard
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Weimin Ye
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Yi Lu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Unnur A. Valdimarsdóttir
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Andrés Ingason
- Institute of Biological Psychiatry, Mental Health Center Sct. Hans, Mental Health Services Copenhagen, Roskilde, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Copenhagen, Denmark
- Lundbeck Foundation GeoGenetics Centre, GLOBE Institute, University of Copenhagen, Copenhagen, Denmark
| | - Dorte Helenius Mikkelsen
- Institute of Biological Psychiatry, Mental Health Center Sct. Hans, Mental Health Services Copenhagen, Roskilde, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Copenhagen, Denmark
| | - Oleguer Plana-Ripoll
- Institute of Biological Psychiatry, Mental Health Center Sct. Hans, Mental Health Services Copenhagen, Roskilde, Denmark
| | - John J. McGrath
- Queensland Centre for Mental Health Research, Brisbane, Australia
- Queensland Brain Institute, The University of Queensland, Brisbane, Australia
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
| | - Nadia Micali
- Institute of Biological Psychiatry, Mental Health Center Sct. Hans, Mental Health Services Copenhagen, Roskilde, Denmark
- Center for Eating and feeding Disorders research, Psychiatric Centre Ballerup, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Ole A. Andreassen
- NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- KG Jebsen Centre for Neurodevelopmental disorders, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Thomas M. Werge
- Institute of Biological Psychiatry, Mental Health Center Sct. Hans, Mental Health Services Copenhagen, Roskilde, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Copenhagen, Denmark
- Lundbeck Foundation GeoGenetics Centre, GLOBE Institute, University of Copenhagen, Copenhagen, Denmark
| | - Fang Fang
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Alfonso Buil
- Institute of Biological Psychiatry, Mental Health Center Sct. Hans, Mental Health Services Copenhagen, Roskilde, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Copenhagen, Denmark
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17
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Sen P, Prandovszky E, Honkanen JK, Chen O, Yolken R, Suvisaari J. Dysregulation of Microbiota in Patients With First-Episode Psychosis Is Associated With Symptom Severity and Treatment Response. Biol Psychiatry 2024; 95:370-379. [PMID: 38061464 DOI: 10.1016/j.biopsych.2023.10.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/21/2023] [Accepted: 10/23/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND The gut microbiome has been implicated in the pathogenesis of mental disorders where the gut-brain axis acts as a bidirectional communication network. METHODS Herein, we investigated the compositional and functional differences of gut microbiome between patients with first-episode psychosis (FEP) (n = 26) and healthy control participants (n = 22) using whole-genome shotgun sequencing. In addition, we assessed the oral microbiome in patients with FEP (n = 13) and listed their taxonomic diversity. RESULTS Our findings suggest that there is a dysbiosis of gut microbiota in patients with FEP. Relative abundance of Bifidobacterium adolescentis, Prevotella copri, and Turicibacter sanguinis was markedly increased (linear discriminant analysis scores [log10] > 1, and Mann-Whitney U test; false discovery rate-adjusted p values < .05) in the FEP group compared with the healthy control participants. Pathway analysis indicated that several metabolic pathways, particularly deoxyribonucleotide biosynthesis, branched-chain amino acid biosynthesis, tricarboxylic acid cycle, and fatty acid elongation and biosynthesis, were dysregulated in the FEP group compared with the healthy control group. In addition, this preliminary study was able to identify specific gut microbes (at baseline) that were predictive of weight gain in the FEP group at a 1-year follow-up. Bacteroides dorei, Bifidobacterium adolescentis, Turicibacter sanguinis, Roseburia spp., and Ruminococcus lactaris were positively associated (eXtreme gradient boosting, XGBoost regression model, Shapley additive explanations, R2 = 0.82) with weight gain. CONCLUSIONS Our findings may suggest the involvement of gut microbiota in the pathogenesis of psychosis. The benefit of modulation of the gut microbiome in the treatment of psychotic disorders should be explored further.
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Affiliation(s)
- Partho Sen
- Turku Bioscience Centre, University of Turku and Åbo Akademi University, Turku, Finland
| | - Emese Prandovszky
- Stanley Division of Developmental Neurovirology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jarno K Honkanen
- Translational Immunology Program, Research Programs Unit, University of Helsinki, Helsinki, Finland
| | - Ou Chen
- Stanley Division of Developmental Neurovirology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Robert Yolken
- Stanley Division of Developmental Neurovirology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jaana Suvisaari
- Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland; Finnish Institute for Health and Welfare, Helsinki, Finland.
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Tolentino DA, Ajuwon AM. A cross-sectional study on social determinants of mental health during COVID-19 among adults in California. J Adv Nurs 2024; 80:683-691. [PMID: 37550826 DOI: 10.1111/jan.15803] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 06/19/2023] [Accepted: 07/12/2023] [Indexed: 08/09/2023]
Abstract
AIM To explore the impact of structural and intermediary social determinants of health (SDoH) on Californian adults' mental health during the early phase of the COVID-19 pandemic. DESIGN This cross-sectional study used data from the 2020 cycle of the California Health Interview Survey, the largest US state-level population health survey. METHODS Descriptive statistics and logistic regression were used to analyse the data. Using a general social determinant of health framework, we operationalized different survey questions to measure structural and intermediary determinants of mental health. RESULTS Mental health during the early phase of COVID-19 among adults in California was associated with age, gender, health conditions, delayed care, employment status (loss of job or reduced income) and discrimination. People in higher social strata were more likely to have better mental health for many of these factors. CONCLUSION This study supports the assertion that material circumstances (such as employment status) and discrimination are associated with experiencing mental health issues among adults in California during COVID-19. Racism is a public health issue, and as nurses, addressing racism is critical. In addition, much work is needed to address SDoH to improve health outcomes, especially among marginalized populations. IMPACT This study addressed the knowledge gap concerning the social determinants of mental health among Californian adults during the early phase of the COVID-19 pandemic. Those who had reduced income and those who lost their jobs during the COVID-19 pandemic were 46% and 56%, respectively, more likely to report mental health problems. Those who experienced discrimination in healthcare were 304% more likely to report mental health issues. This research will increase the understanding of the social determinants of health, particularly for those with chronic illnesses and mental health issues during the COVID-19 pandemic. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution, as we used an existing US state dataset. However, California Health Interview Survey is the largest state health survey in the United States and interviews more than 20,000 households each year representing the health care needs of Californians.
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Hartwell EE, Jinwala Z, Milone J, Ramirez S, Gelernter J, Kranzler HR, Kember RL. Application of polygenic scores to a deeply phenotyped sample enriched for substance use disorders reveals extensive pleiotropy with psychiatric and medical traits. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.22.24301615. [PMID: 38343859 PMCID: PMC10854354 DOI: 10.1101/2024.01.22.24301615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
Co-occurring psychiatric, medical, and substance use disorders (SUDs) are common, but the complex pathways leading to such comorbidities are poorly understood. A greater understanding of genetic influences on this phenomenon could inform precision medicine efforts. We used the Yale-Penn dataset, a cross-sectional sample enriched for individuals with SUDs, to examine pleiotropic effects of genetic liability for psychiatric and medical traits. Participants completed an in-depth interview that provides information on demographics, environment, medical illnesses, and psychiatric and SUDs. Polygenic scores (PGS) for psychiatric disorders and medical traits were calculated in European-ancestry (EUR; n=5,691) participants and, when discovery datasets were available, for African-ancestry (AFR; n=4,918) participants. Phenome-wide association studies (PheWAS) were then conducted. In AFR participants, the only PGS with significant associations was bipolar disorder (BD), all of which were with substance use phenotypes. In EUR participants, PGS for major depressive disorder (MDD), generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), schizophrenia (SCZ), body mass index (BMI), coronary artery disease (CAD), and type 2 diabetes (T2D) all showed significant associations, the majority of which were with phenotypes in the substance use categories. For instance, PGS MDD was associated with over 200 phenotypes, 15 of which were depression-related (e.g., depression criterion count), 55 of which were other psychiatric phenotypes, and 126 of which were substance use phenotypes; and PGS BMI was associated with 138 phenotypes, 105 of which were substance related. Genetic liability for psychiatric and medical traits is associated with numerous phenotypes across multiple categories, indicative of the broad genetic liability of these traits.
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20
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Flanagan EH, Wyatt JP, Pavlo AJ, Kang S, Blackman KD, Ocasio L, Guy K, O'Connell MJ, Bellamy CD. Care integration goes Beyond Co-Location: Creating a Medical Home. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:123-133. [PMID: 38015324 DOI: 10.1007/s10488-023-01317-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2023] [Indexed: 11/29/2023]
Abstract
How to successfully integrate mental health and primary care remains a critically important question given the continued morbidity and early mortality of people with serious mental illness. This study investigated integration in a community mental health center (MHC) primarily treating people with SMI in a large, urban northeastern city where an on-site primary care center (PCC) was opened resulting in co-located mental health and primary care services being provided. Using focus groups and online surveys this study asked participants about their thoughts and interactions with the on-site PCC. Participants included staff from clinical, non-clinical, and leadership roles in the mental health center (MHC; PCC staff; and MHC clients who did not use the on-site PCC). MHC staff also offered their thoughts about and experiences with the on-site PCC one year and two years after the on-site PCC opened through an on-line survey. In both methods, staff reported limited awareness and expectations of the PCC in the first year. Staff indicated that successful care integration goes beyond co-location and peer health navigation can enhance integration. Finally, staff discussed desires for enhancing care integration and co-located services into a medical home that included communicating across medical records and providers at different agencies. Our results suggest that, in addition to the previously researched three C's of care integration (consultation, coordination, and collaboration), two more C's were essential to successful care integration: co-location and communication. Communication across medical records and providers at different agencies was an essential component of care integration, and co-location added increased ability to communicate across providers.
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Affiliation(s)
- Elizabeth H Flanagan
- Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA
| | - Janan P Wyatt
- Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA.
- Yale University School of Medicine, 319 Peck Street Building 1, New Haven, CT, 06513, USA.
| | - Anthony J Pavlo
- Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA
| | - Sylvia Kang
- New York University Grossman School of Medicine, One Park Ave, New York, NY, 10016, USA
| | - Kimberly D Blackman
- Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA
| | - Luz Ocasio
- Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA
| | - Kimberly Guy
- Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA
| | - Maria J O'Connell
- Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA
| | - Chyrell D Bellamy
- Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA
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21
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von Below A, Hällström T, Sundh V, Björkelund C, Hange D. Association between anxiety and depression and all-cause mortality: a 50-year follow-up of the Population Study of Women in Gothenburg, Sweden. BMJ Open 2023; 13:e075471. [PMID: 37989363 PMCID: PMC10668159 DOI: 10.1136/bmjopen-2023-075471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 11/06/2023] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVES This study aimed to examine the association between anxiety disorders and/or major depression disorder (ADs/MDD) and all-cause mortality in a 50-year perspective and to examine specific risk and health factors that may influence such an association. DESIGN Observational population study, 1968-2019. SETTING The Population Study of Women in Gothenburg, Sweden (PSWG). PARTICIPANTS In 1968-1969, 899 (out of 1462) women from PSWG were selected according to date of birth for a psychiatric investigation, including diagnostic evaluation. Eight hundred (89%) were accepted. Twenty-two women were excluded. Of the 778 included, 135 participants (17.4 %) had solely ADs, 32 (4.1%) had solely MDD and 25 (3.2%) had comorbid AD/MDD. PRIMARY AND SECONDARY OUTCOME MEASURES Associations between ADs, MDD, comorbid AD/MDD and all-cause mortality with adjustments for potential confounding factors. Differences between the groups concerning health and risk factors and their association with mortality. RESULTS In a fully adjusted model, ADs were non-significantly associated with all-cause mortality (HR 1.17, 95% CI 0.98 to 1.41). When examining age during risk time as separate intervals, a significant association between mortality and AD was seen in the group of participants who died at the age of 65-80 years (HR 1.70, 95% CI 1.26 to 2.29). In the younger or older age interval, the association did not reach significance at the 95% level of confidence. Among confounding factors, smoking and physical activity were the strongest contributors. The association between smoking and mortality tended to be further increased in the group with ADs versus the group without such disorders (HR 2.10, 95% CI 1.60 to 2.75 and HR 1.82, 95% CI 1.56 to 2.12, respectively). CONCLUSIONS This study suggests potential links between ADs, age and mortality among women with 50 years of follow-up, but does not provide definitive conclusions due to the borderline significance of the results.
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Affiliation(s)
- Amanda von Below
- Primary Health Care/School of Public Health and Community Medicine, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
| | - Tore Hällström
- Department of Psychiatry and Neurochemistry, Gothenburg University, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden
| | - Valter Sundh
- Primary Health Care/School of Public Health and Community Medicine, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
| | - Cecilia Björkelund
- Primary Health Care/School of Public Health and Community Medicine, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
| | - Dominique Hange
- Primary Health Care/School of Public Health and Community Medicine, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
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22
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Chan JKN, Correll CU, Wong CSM, Chu RST, Fung VSC, Wong GHS, Lei JHC, Chang WC. Life expectancy and years of potential life lost in people with mental disorders: a systematic review and meta-analysis. EClinicalMedicine 2023; 65:102294. [PMID: 37965432 PMCID: PMC10641487 DOI: 10.1016/j.eclinm.2023.102294] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 11/16/2023] Open
Abstract
Background Mental disorders are associated with premature mortality. There is increasing research examining life expectancy and years-of-potential-life-lost (YPLL) to quantify the disease impact on survival in people with mental disorders. We aimed to systematically synthesize studies to estimate life expectancy and YPLL in people with any and specific mental disorders across a broad spectrum of diagnoses. Methods In this systematic review and meta-analysis, we searched Embase, MEDLINE, PsychINFO, WOS from inception to July 31, 2023, for published studies reporting life expectancy and/or YPLL for mental disorders. Criteria for study inclusion were: patients of all ages with any mental disorders; reported data on life expectancy and/or YPLL of a mental-disorder cohort relative to the general population or a comparison group without mental disorders; and cohort studies. We excluded non-cohort studies, publications containing non-peer-reviewed data or those restricted to population subgroups. Survival estimates, i.e., life expectancy and YPLL, were pooled (based on summary data extracted from the included studies) using random-effects models. Subgroup analyses and random-effects meta-regression analyses were performed to explore sources of heterogeneity. Risk-of-bias assessment was evaluated using the Newcastle-Ottawa Scale. This study is registered with PROSPERO (CRD42022321190). Findings Of 35,865 studies identified in our research, 109 studies from 24 countries or regions including 12,171,909 patients with mental disorders were eligible for analysis (54 for life expectancy and 109 for YPLL). Pooled life expectancy for mental disorders was 63.85 years (95% CI 62.63-65.06; I2 = 100.0%), and pooled YPLL was 14.66 years (95% CI 13.88-15.98; I2 = 100.0%). Disorder-stratified analyses revealed that substance-use disorders had the shortest life expectancy (57.07 years [95% CI 54.47-59.67]), while neurotic disorders had the longest lifespan (69.51 years [95% CI 67.26-71.76]). Substance-use disorders exhibited the greatest YPLL (20.38 years [95% CI 18.65-22.11]), followed by eating disorders (16.64 years [95% CI 7.45-25.82]), schizophrenia-spectrum disorders (15.37 years [95% CI 14.18-16.55]), and personality disorders (15.35 years [95% CI 12.80-17.89]). YPLLs attributable to natural and unnatural deaths in mental disorders were 4.38 years (95% CI 3.15-5.61) and 8.11 years (95% CI 6.10-10.13; suicide: 8.31 years [95% CI 6.43-10.19]), respectively. Stratified analyses by study period suggested that the longevity gap persisted over time. Significant cross-study heterogeneity was observed. Interpretation Mental disorders are associated with substantially reduced life expectancy, which is transdiagnostic in nature, encompassing a wide range of diagnoses. Implementation of comprehensive and multilevel intervention approaches is urgently needed to rectify lifespan inequalities for people with mental disorders. Funding None.
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Affiliation(s)
- Joe Kwun Nam Chan
- LKS Faculty of Medicine, Department of Psychiatry, The University of Hong Kong, Hong Kong, China
| | - Christoph U. Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Child and Adolescent Psychiatry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Corine Sau Man Wong
- LKS Faculty of Medicine, School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Ryan Sai Ting Chu
- LKS Faculty of Medicine, Department of Psychiatry, The University of Hong Kong, Hong Kong, China
| | - Vivian Shi Cheng Fung
- LKS Faculty of Medicine, Department of Psychiatry, The University of Hong Kong, Hong Kong, China
| | - Gabbie Hou Sem Wong
- LKS Faculty of Medicine, Department of Psychiatry, The University of Hong Kong, Hong Kong, China
| | - Janet Hiu Ching Lei
- LKS Faculty of Medicine, Department of Psychiatry, The University of Hong Kong, Hong Kong, China
| | - Wing Chung Chang
- LKS Faculty of Medicine, Department of Psychiatry, The University of Hong Kong, Hong Kong, China
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China
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23
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Carlson LE, Ismaila N, Addington EL, Asher GN, Bradt J, Mehta A, Rowland JH. Integrative Oncology Care of Symptoms of Anxiety and Depression in Adults With Cancer: SIO-ASCO Guideline Summary and Q&A. JCO Oncol Pract 2023; 19:847-851. [PMID: 37582242 DOI: 10.1200/op.23.00358] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 06/18/2023] [Indexed: 08/17/2023] Open
Abstract
This SIO-ASCO guideline Q&A provides guidance on integrative oncology care of symptoms of anxiety and depression in adult patients with cancer
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Affiliation(s)
- Linda E Carlson
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nofisat Ismaila
- American Society of Clinical Oncology (ASCO), Alexandria, VA
| | | | - Gary N Asher
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Joke Bradt
- Department of Creative Arts Therapies, Drexel University, Philadelphia, PA
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Carlson LE, Ismaila N, Addington EL, Asher GN, Atreya C, Balneaves LG, Bradt J, Fuller-Shavel N, Goodman J, Hoffman CJ, Huston A, Mehta A, Paller CJ, Richardson K, Seely D, Siwik CJ, Temel JS, Rowland JH. Integrative Oncology Care of Symptoms of Anxiety and Depression in Adults With Cancer: Society for Integrative Oncology-ASCO Guideline. J Clin Oncol 2023; 41:4562-4591. [PMID: 37582238 DOI: 10.1200/jco.23.00857] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/13/2023] [Indexed: 08/17/2023] Open
Abstract
PURPOSE To provide evidence-based recommendations to health care providers on integrative approaches to managing anxiety and depression symptoms in adults living with cancer. METHODS The Society for Integrative Oncology and ASCO convened an expert panel of integrative oncology, medical oncology, radiation oncology, surgical oncology, palliative oncology, social sciences, mind-body medicine, nursing, methodology, and patient advocacy representatives. The literature search included systematic reviews, meta-analyses, and randomized controlled trials published from 1990 through 2023. Outcomes of interest included anxiety or depression symptoms as measured by validated psychometric tools, and adverse events. Expert panel members used this evidence and informal consensus with the Guidelines into Decision Support methodology to develop evidence-based guideline recommendations. RESULTS The literature search identified 110 relevant studies (30 systematic reviews and 80 randomized controlled trials) to inform the evidence base for this guideline. RECOMMENDATIONS Recommendations were made for mindfulness-based interventions (MBIs), yoga, relaxation, music therapy, reflexology, and aromatherapy (using inhalation) for treating symptoms of anxiety during active treatment; and MBIs, yoga, acupuncture, tai chi and/or qigong, and reflexology for treating anxiety symptoms after cancer treatment. For depression symptoms, MBIs, yoga, music therapy, relaxation, and reflexology were recommended during treatment, and MBIs, yoga, and tai chi and/or qigong were recommended post-treatment. DISCUSSION Issues of patient-health care provider communication, health disparities, comorbid medical conditions, cost implications, guideline implementation, provider training and credentialing, and quality assurance of natural health products are discussed. While several approaches such as MBIs and yoga appear effective, limitations of the evidence base including assessment of risk of bias, nonstandardization of therapies, lack of diversity in study samples, and lack of active control conditions as well as future research directions are discussed.Additional information is available at www.asco.org/survivorship-guidelines.
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Affiliation(s)
- Linda E Carlson
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | | | - Gary N Asher
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Chloe Atreya
- University of California San Francisco, San Francisco, CA
| | | | - Joke Bradt
- Department of Creative Arts Therapies, Drexel University, Philadelphia, PA
| | | | | | | | - Alissa Huston
- University of Rochester Medical Center, Rochester, NY
| | | | - Channing J Paller
- Sidney Kimmel Comprehensive Cancer Center, John Hopkins University, Baltimore, MD
| | | | - Dugald Seely
- University of Ottawa, Ottawa, ON, Canada
- Canadian College of Naturopathic Medicine, Toronto, ON, Canada
| | - Chelsea J Siwik
- Osher Center for Integrative Health, University of California, San Francisco, San Francisco, CA
| | - Jennifer S Temel
- Massachusetts General Hospital and Harvard Medical School, Boston, MA
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25
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Konings SRA, Mierau JO, Visser E, Bruggeman R, Feenstra TL. Life years lost for users of specialized mental healthcare. Acta Psychiatr Scand 2023; 148:338-346. [PMID: 37697672 DOI: 10.1111/acps.13608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/05/2023] [Accepted: 08/09/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Mental disorders are burdensome and are associated with increased mortality. Mortality has been researched for various mental disorders, especially in countries with national registries, including the Nordic countries. Yet, knowledge gaps exist around national differences, while also relatively less studies compare mortality of those seeking help for mental disorders in specialized mental healthcare (SMH) by diagnosis. Additional insight into such mortality distributions for SMH users would be beneficial for both policy and research purposes. We aim to describe and compare the mortality in a population of SMH users with the mortality of the general population. Additionally, we aim to investigate mortality differences between sexes and major diagnosis categories: anxiety, depression, schizophrenia spectrum and other psychotic disorders, and bipolar disorder. METHODS Mortality and basic demographics were available for a population of N = 10,914 SMH users in the north of The Netherlands from 2010 until 2017. To estimate mortality over the adult lifespan, parametric Gompertz distributions were fitted on observed mortality using interval regression. Life years lost were computed by calculating the difference between integrals of the survival functions for the general population and the study sample, thus correcting for age. Survival for the general population was obtained from Statistics Netherlands (CBS). RESULTS SMH users were estimated to lose 9.5 life years (95% CI: 9.4-9.6). Every major diagnosis category was associated with a significant loss of life years, ranging from 7.2 (95% CI: 6.4-7.9) years for anxiety patients to 11.7 (95% CI: 11.0-12.5) years for bipolar disorder patients. Significant differences in mortality were observed between male SMH users and female SMH users, with men losing relatively more life years: 11.0 (95% CI: 10.9-11.2) versus 8.3 (95% CI: 8.2-8.4) respectively. This difference was also observed between sexes within every diagnosis, although the difference was insignificant for bipolar disorder. CONCLUSION There were significant differences in mortality between SMH users and the general population. Substantial differences were observed between sexes and between diagnoses. Additional attention is required, and possibly specific interventions are needed to reduce the amount of life years lost by SMH users.
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Affiliation(s)
- Stefan R A Konings
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
- Rob Giel Research center, University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Groningen, The Netherlands
| | - Jochen O Mierau
- Faculty of Economics and Business, Department of Economics, Econometrics & Finance, University of Groningen, Groningen, The Netherlands
- Team Strategy & External Relations, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Lifelines, Groningen, The Netherlands
| | - Ellen Visser
- Rob Giel Research center, University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Groningen, The Netherlands
| | - Richard Bruggeman
- Rob Giel Research center, University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Groningen, The Netherlands
| | - Talitha L Feenstra
- Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
- Center for Nutrition, Prevention and Health Services Research, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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Mustonen A, Rodriguez A, Scott JG, Vuori M, Hurtig T, Halt A, Miettunen J, Alakokkare A, Niemelä S. Attention deficit hyperactivity and oppositional defiant disorder symptoms in adolescence and risk of substance use disorders-A general population-based birth cohort study. Acta Psychiatr Scand 2023; 148:277-287. [PMID: 37431766 PMCID: PMC10953420 DOI: 10.1111/acps.13588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 05/29/2023] [Accepted: 06/12/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Externalizing symptoms are associated with risk of future substance use disorder (SUD). Few longitudinal studies exist using general population-based samples which assess the spectrum of attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) symptoms. AIMS/OBJECTIVES We aimed to study the associations between adolescent ADHD symptoms and subsequent SUD and additionally examine whether the risk of SUD is influenced by comorbid oppositional defiant disorder (ODD) symptoms. METHODS The Northern Finland Birth Cohort 1986 was linked to nationwide health care register data for incident SUD diagnoses until age 33 years (n = 6278, 49.5% male). ADHD/ODD-case status at age 16 years was defined using parent-rated ADHD indicated by Strengths and Weaknesses of ADHD symptoms and Normal Behaviors (SWAN) questionnaire with 95% percentile cut-off. To assess the impact of ODD comorbidity on SUD risk, participants were categorized into four groups based on their ADHD/ODD case status. Cox-regression analysis with hazard ratios (HRs) and 95% confidence intervals (CIs) were used to study associations between adolescent ADHD/ODD case statuses and subsequent SUD. RESULTS In all, 552 participants (8.8%) presented with ADHD case status at the age of 16 years, and 154/6278 (2.5%) were diagnosed with SUD during the follow-up. ADHD case status was associated with SUD during the follow-up (HR = 3.84, 95% CI 2.69-5.50). After adjustments for sex, family structure, and parental psychiatric disorder and early substance use the association with ADHD case status and SUD remained statistically significant (HR = 2.60, 95% CI 1.70-3.98). The risk of SUD remained elevated in individuals with ADHD case status irrespective of ODD symptoms. CONCLUSIONS ADHD in adolescence was associated with incident SUD in those with and without symptoms of ODD. The association of ADHD and SUD persisted even after adjustment for a wide range of potential confounds. This emphasizes the need to identify preventative strategies for adolescents with ADHD so as to improve health outcomes.
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Affiliation(s)
- Antti Mustonen
- Faculty of Medicine and Health TechnologyTampere UniversityTampereFinland
- Department of PsychiatrySeinäjoki Central HospitalSeinäjokiFinland
- Research Unit of Population HealthUniversity of OuluOuluFinland
| | - Alina Rodriguez
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial CollegeLondonUK
- Centre for Psychiatry and Mental HealthQueen Mary UniversityLondonUK
| | - James G. Scott
- Child Health Research CentreThe University of QueenslandSouth BrisbaneQueenslandAustralia
- Child and Youth Mental HealthChildren's Health QueenslandSouth BrisbaneQueenslandAustralia
| | - Miika Vuori
- Research Center for Child Psychiatry, INVEST Research FlagshipUniversity of TurkuTurkuFinland
- The Finnish Institute for Health and WelfareHelsinkiFinland
| | - Tuula Hurtig
- Research Unit of Clinical Medicine, PsychiatryUniversity of OuluOuluFinland
- Clinic of Child PsychiatryOulu University HospitalOuluFinland
- Medical Research Center OuluOulu University Hospital and University of OuluOuluFinland
| | - Anu‐Helmi Halt
- Research Unit of Clinical Medicine, PsychiatryUniversity of OuluOuluFinland
- Medical Research Center OuluOulu University Hospital and University of OuluOuluFinland
- Department of PsychiatryOulu University HospitalOuluFinland
| | - Jouko Miettunen
- Research Unit of Population HealthUniversity of OuluOuluFinland
- Medical Research Center OuluOulu University Hospital and University of OuluOuluFinland
| | | | - Solja Niemelä
- Department of PsychiatryUniversity of TurkuTurkuFinland
- Addiction Psychiatry Unit, Department of PsychiatryTurku University HospitalTurkuFinland
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Thomsen MK, Jørgensen MD, Pedersen L, Erichsen R, Sørensen HT, Mikkelsen EM. Mental disorders, participation, and trajectories in the Danish colorectal cancer programme: a population-based cohort study. Lancet Psychiatry 2023; 10:518-527. [PMID: 37353263 DOI: 10.1016/s2215-0366(23)00179-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/20/2023] [Accepted: 04/25/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND People with mental disorders exhibit increased mortality due to colorectal cancer, despite having a similar incidence to the general population. We aimed to evaluate the extent to which people with mental disorders participate in organised colorectal cancer screening. METHODS We conducted a population-based cohort study of all Danish residents aged 50-74 years who were invited to undergo biennial faecal immunochemical testing between March 1, 2014, and Sept 30, 2018. We used national registry data from all first-time invitees. The primary endpoint was participation within 90 days of invitation. We calculated the proportion who participated and assessed their screening results and adherence to and completeness of follow-up colonoscopy according to their history of mental disorders, classified as none, mild or moderate, or severe. We computed crude and adjusted participation differences in percentage points and participation ratios using the pseudo-observations method. FINDINGS Of 2 036 704 people who were invited, we included 2 036 352 in the final cohort, of whom 1 008 045 (49·5%) were men and 1 028 307 (50·5%) were women, with a mean age of 60·7 years (SD 8·3, range 49-78). Data on ethnicity were not collected. Compared with people with no mental disorders, the adjusted analysis showed lower participation among people with mild or moderate mental disorders (men: participation difference -4·4 percentage points [95% CI -4·7 to -4·1]; women: -3·8 percentage points [-4·1 to -3·6]) and severe mental disorders (men: participation difference -13·8 percentage points [-14·3 to -13·3]; women: -15·4 percentage points [-15·8 to -14·9]). People with mental disorders had a higher proportion of positive faecal immunochemical test results, lower adherence to colonoscopy, and more incomplete colonoscopies than people without mental disorders. INTERPRETATION People with mental disorders were less likely to participate in colorectal cancer screening than those without these disorders. Patients with mental disorders could benefit from support or encouragement from their general practitioner or mental health-care facility to participate in cancer screening. Potential interventions should consider type of mental disorder, as needs might differ. FUNDING Danish Cancer Society, Danish Health Foundation.
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Affiliation(s)
- Mette Kielsholm Thomsen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark; CASTLE - Cancer Survivorship and Treatment Late Effects, Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Marie Dahl Jørgensen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Rune Erichsen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark; Department of Surgery, Randers Regional Hospital, Randers, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Ellen M Mikkelsen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
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Vessels T, Strayer N, Choi KW, Lee H, Zhang S, Han L, Morley TJ, Smoller JW, Xu Y, Ruderfer DM. Identifying modifiable comorbidities of schizophrenia by integrating electronic health records and polygenic risk. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.06.01.23290057. [PMID: 37333378 PMCID: PMC10274978 DOI: 10.1101/2023.06.01.23290057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Patients with schizophrenia have substantial comorbidity contributing to reduced life expectancy of 10-20 years. Identifying which comorbidities might be modifiable could improve rates of premature mortality in this population. We hypothesize that conditions that frequently co-occur but lack shared genetic risk with schizophrenia are more likely to be products of treatment, behavior, or environmental factors and therefore potentially modifiable. To test this hypothesis, we calculated phenome-wide comorbidity from electronic health records (EHR) in 250,000 patients in each of two independent health care institutions (Vanderbilt University Medical Center and Mass General Brigham) and association with schizophrenia polygenic risk scores (PRS) across the same phenotypes (phecodes) in linked biobanks. Comorbidity with schizophrenia was significantly correlated across institutions (r = 0.85) and consistent with prior literature. After multiple test correction, there were 77 significant phecodes comorbid with schizophrenia. Overall, comorbidity and PRS association were highly correlated (r = 0.55, p = 1.29×10-118), however, 36 of the EHR identified comorbidities had significantly equivalent schizophrenia PRS distributions between cases and controls. Fifteen of these lacked any PRS association and were enriched for phenotypes known to be side effects of antipsychotic medications (e.g., "movement disorders", "convulsions", "tachycardia") or other schizophrenia related factors such as from smoking ("bronchitis") or reduced hygiene (e.g., "diseases of the nail") highlighting the validity of this approach. Other phenotypes implicated by this approach where the contribution from shared common genetic risk with schizophrenia was minimal included tobacco use disorder, diabetes, and dementia. This work demonstrates the consistency and robustness of EHR-based schizophrenia comorbidities across independent institutions and with the existing literature. It identifies comorbidities with an absence of shared genetic risk indicating other causes that might be more modifiable and where further study of causal pathways could improve outcomes for patients.
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Affiliation(s)
- Tess Vessels
- Division of Genetic Medicine, Department of Medicine, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville TN
| | - Nicholas Strayer
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville TN
| | - Karmel W. Choi
- Psychiatric & Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston MA
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston MA
| | - Hyunjoon Lee
- Psychiatric & Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston MA
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston MA
| | - Siwei Zhang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville TN
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville TN
| | - Lide Han
- Division of Genetic Medicine, Department of Medicine, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville TN
| | - Theodore J. Morley
- Division of Genetic Medicine, Department of Medicine, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville TN
| | - Jordan W. Smoller
- Psychiatric & Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston MA
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston MA
- Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA
| | - Yaomin Xu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville TN
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville TN
| | - Douglas M. Ruderfer
- Division of Genetic Medicine, Department of Medicine, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville TN
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville TN
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN
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Bateson D, Woo YL, Kulkarni J. Elimination of cervical cancer: ensuring equity. Lancet Public Health 2023; 8:e248-e249. [PMID: 36965976 DOI: 10.1016/s2468-2667(23)00055-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 02/23/2023] [Indexed: 03/27/2023]
Affiliation(s)
- Deborah Bateson
- The Daffodil Centre, The University of Sydney, a joint venture between Cancer Council NSW, Sydney, NSW 2011, Australia.
| | - Yin Ling Woo
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Jayashri Kulkarni
- HER Centre Australia, Monash Alfred Psychiatry research centre, Central Clinical School Department of Psychiatry, Melbourne, VIC, Australia
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Schou Pedersen H, Sparle Christensen K, Prior A. Variation in Psychometric Testing in General Practice - A Nationwide Cohort Study. Clin Epidemiol 2023; 15:391-405. [PMID: 36994319 PMCID: PMC10040341 DOI: 10.2147/clep.s396819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/03/2023] [Indexed: 03/31/2023] Open
Abstract
Objective Most mental disorders are diagnosed and treated in general practice. Psychometric tests may help the general practitioner diagnose and treat mental disorders like dementia, anxiety, and depression. However, little is known about the use of psychometric tests in general practice and their impact on further treatment. We aimed to assess the use of psychometric tests in Danish general practice and to estimate whether variation in use is associated with the provided treatment and death by suicide in patients. Methods This nationwide cohort study included registry data on all psychometric tests performed in Danish general practice in 2007-2018. We used Poisson regression models adjusted for sex, age, and calendar time to assess predictors of use. We used fully adjusted models to estimate the standardized utilization rates for all general practices. Results A total of 2,768,893 psychometric tests were used in the study period. Considerable variations were observed among general practices. A positive association was seen between a general practitioner's propensity to use psychometric testing and talk therapy. Patients listed with a general practitioner with low use had an increased rate of redeemed prescriptions for anxiolytics [incidence rate ratio (95% confidence interval):1.39 (1.23;1.57)]. General practitioners with high use had an increased rate of prescriptions for antidementia drugs [1.25 (1.05;1.49)] and first-time antidepressants [1.09 (1.01;1.19)]. High test use was seen for females [1.58 (1.55; 1.62)] and patients with comorbid diseases. Low use was seen for populations with high income [0.49 (0.47; 0.51)] and high educational level [0.78 (0.75; 0.81)]. Conclusion Psychometric tests were used mostly for women, individuals with a low socioeconomic status, and individuals with comorbid conditions. The use of psychometric tests depends on general practice and is associated with talk therapy, redemptions for anxiolytics, antidementia drugs, and antidepressants. No association was found between general practice rates and other treatment outcomes.
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Affiliation(s)
- Henrik Schou Pedersen
- Research Unit for General Practice, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Kaj Sparle Christensen
- Research Unit for General Practice, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Anders Prior
- Research Unit for General Practice, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
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Association between excess mortality in depressive status and frailty among older adults: A population-based Kyoto-Kameoka prospective cohort study. Arch Gerontol Geriatr 2023; 110:104990. [PMID: 36905806 DOI: 10.1016/j.archger.2023.104990] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 02/17/2023] [Accepted: 03/03/2023] [Indexed: 03/08/2023]
Abstract
OBJECTIVES Frailty has been shown to be a mediator of the risk of excess death due to depression in older adults, although this relationship has not been sufficiently investigated. Our objective was to evaluate this relationship. METHODS We used data from 7,913 Japanese people aged≥65 years who participated in the Kyoto-Kameoka prospective cohort study and who provided valid responses to the Geriatric Depression Scale-15 (GDS-15) and the World Health Organization-Five Well-Being Index (WHO-5) in mail-in surveys. Depressive status was assessed using the GDS-15 and WHO-5. Frailty was evaluated using the Kihon Checklist. Data on mortality were collected from February 15, 2012, to November 30, 2016. We evaluated the relationship between depression and all-cause mortality risk using a Cox proportional-hazards model. RESULTS The prevalence of depressive status assessed by GDS-15 and WHO-5 was 25.4% and 40.1%, respectively. In total, 665 deaths were recorded during a median follow-up period of 4.75 years (35,878 person-years). After adjusting for confounders, we found that depressive status assessed by the GDS-15 had a higher risk of mortality than those without it (hazard ratio [HR] 1.62, 95% confidence interval [CI] 1.38-1.91). This association was moderately weaker when adjusted for frailty (HR 1.46, 95% CI 1.23-1.73). Similar results were observed when depression was assessed with the WHO-5. CONCLUSION Our findings suggest that the risk of excess death due to depressive status in older adults may be partially explained by frailty. This indicates a need to focus on improving frailty besides conventional depression treatments.
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Plana-Ripoll O, Weye N, Knudsen AK, Hakulinen C, Madsen KB, Christensen MK, Agerbo E, Laursen TM, Nordentoft M, Timmermann A, Whiteford H, Øverland S, Iburg KM, McGrath JJ. The association between mental disorders and subsequent years of working life: a Danish population-based cohort study. Lancet Psychiatry 2023; 10:30-39. [PMID: 36480953 DOI: 10.1016/s2215-0366(22)00376-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/23/2022] [Accepted: 10/27/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Mental disorders can affect workforce participation via a range of mechanisms. In this study, we aimed to estimate the association between different types of mental disorders and working years lost, defined as the number of years not actively working or enrolled in an educational programme. METHODS In this population-based cohort study, we included all people aged 18-65 years (mean 38·0 [SD 13·9]) in the Danish Civil Registration System from Jan 1, 1995 to Dec 31, 2016. Information on mental disorders was obtained from the Danish Psychiatric Central Research Register and information on labour market characteristics was obtained from administrative registers. Follow-up started at age 18 years, immigration to Denmark, or on Jan 1, 1995, whichever came later; and it ended at age 65 years, death, emigration from Denmark, disability pension, voluntary early retirement, or Dec 31, 2016 (whichever came earlier). As the main outcome, we estimated working years lost for those diagnosed with any mental disorder and 24 types of mental disorders, as well as for the general population of same age and sex. We decomposed total working years lost into periods of unemployment or sick leave, disability pension, voluntary early retirement, or death. Data on ethnicity were not available through administrative registers. FINDINGS A total of 5 163 321 individuals, 2 642 383 men and 2 520 938 women, were followed up for 65·4 million person-years. Overall, 488 775 (9·47%) individuals were diagnosed with a mental disorder. On average, individuals with mental disorders lost an additional 10·52 (95% CI 10·48-10·57) years of working life compared with the general Danish population. Receiving a disability pension (7·54 [7·49-7·59] years) and longer periods of unemployment (2·24 [2·21-2·27] years) accounted for most of this difference. INTERPRETATION Our findings foreground the substantial impact of mental disorders on workforce participation. There is a need to invest in programmes that reduce the burden of working years lost and assist people with mental disorders in returning to the workforce. FUNDING Lundbeck Foundation and Danish National Research Foundation.
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Affiliation(s)
- Oleguer Plana-Ripoll
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark; National Centre for Register-based Research, Aarhus University, Aarhus, Denmark.
| | - Nanna Weye
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Ann Kristin Knudsen
- Department of Disease Burden, Norwegian Institute of Public Health, Bergen, Norway
| | - Christian Hakulinen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland; Welfare State Research and Reform, Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Maria Klitgaard Christensen
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Esben Agerbo
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
| | - Thomas Munk Laursen
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
| | - Merete Nordentoft
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark; Copenhagen Research Centre for Mental Health, Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Allan Timmermann
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
| | - Harvey Whiteford
- Queensland Centre for Mental Health Research, Park Centre for Mental Health, Wacol, QLD, Australia; School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Simon Øverland
- Section for Health Care Collaboration, Haukeland University Hospital, Bergen, Norway
| | | | - John J McGrath
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; Queensland Centre for Mental Health Research, Park Centre for Mental Health, Wacol, QLD, Australia; Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia
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Lozupone M, Castellana F, Sardone R, Berardino G, Mollica A, Zupo R, De Pergola G, Griseta C, Stallone R, La Montagna M, Dibello V, Seripa D, Daniele A, Altamura M, Solfrizzi V, Bellomo A, Panza F. Late-Onset Depression but not Early-Onset Depression may Increase the Risk of All-Cause Mortality in Older Age: 8-Year Follow-Up of the Salus in Apulia Study. J Am Med Dir Assoc 2022; 24:679-687. [PMID: 36596468 DOI: 10.1016/j.jamda.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/21/2022] [Accepted: 12/01/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Individuals with late-life depression (LLD) may have shorter survival, but there is a lack of findings in population-based settings about health-related outcomes of LLD and its subtypes: early-onset depression (EOD) and late-onset depression (LOD). We aimed to evaluate the risk of all-cause mortality of individuals with LLD and its subtypes in an older population-based cohort. Moreover, we investigated whether inflammatory, cognitive, genetic features and multimorbidity could modify the effect of this association. DESIGN Longitudinal population-based study with 8-year follow-up. SETTING AND PARTICIPANTS We analyzed data on a sample of 1479 participants, all aged >65 years, in the Salus in Apulia Study. METHODS LLD was diagnosed through DSM-IV-TR criteria and LOD and EOD according to the age of onset. Multimorbidity status was defined as the copresence of 2 or more chronic diseases. RESULTS The overall prevalence of LLD in this older sample from Southern Italy was 10.2%, subdivided into 3.4% EOD and 6.8% LOD. In multivariable Cox models adjusted for age, gender, education, global cognition, apolipoprotein E ε4 allele, physical frailty, interleukin-6, and multimorbidity, LLD showed a greater risk of all-cause mortality. LOD differed from EOD regarding gender, education, cognitive dysfunctions, and diabetes mellitus. There was a significantly increased risk of all-cause mortality for participants with LOD (hazard ratio:1.99; 95% CI 1.33-2.97) in the time of observation between enrollment date and death date (7.31 ± 2.17 months). CONCLUSIONS AND IMPLICATION In older age, individuals with LOD but not with EOD had a significantly decreased survival, probably related to increased inflammation, multimorbidity, and cognitive impairments.
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Affiliation(s)
- Madia Lozupone
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy.
| | - Fabio Castellana
- Healthy Aging Phenotypes Research Unit-"Salus in Apulia Study"-National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy
| | - Rodolfo Sardone
- Healthy Aging Phenotypes Research Unit-"Salus in Apulia Study"-National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy
| | - Giuseppe Berardino
- Psychiatric Unit, Department of Clinical & Experimental Medicine, University of Foggia, Foggia, Italy
| | - Anita Mollica
- Psychiatric Unit, Department of Clinical & Experimental Medicine, University of Foggia, Foggia, Italy
| | - Roberta Zupo
- Healthy Aging Phenotypes Research Unit-"Salus in Apulia Study"-National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy
| | - Giovanni De Pergola
- Healthy Aging Phenotypes Research Unit-"Salus in Apulia Study"-National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy
| | - Chiara Griseta
- Healthy Aging Phenotypes Research Unit-"Salus in Apulia Study"-National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy
| | - Roberta Stallone
- Neuroscience and Education, Human Resources Excellence in Research, University of Foggia, Foggia, Italy
| | - Maddalena La Montagna
- Psychiatric Unit, Department of Clinical & Experimental Medicine, University of Foggia, Foggia, Italy
| | - Vittorio Dibello
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Davide Seripa
- Hematology and Stem Cell Transplant Unit, "Vito Fazzi" Hospital, Lecce, Italy
| | - Antonio Daniele
- Department of Neuroscience, Catholic University of Sacred Heart, Rome, Italy; Neurology Unit, IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Mario Altamura
- Psychiatric Unit, Department of Clinical & Experimental Medicine, University of Foggia, Foggia, Italy
| | - Vincenzo Solfrizzi
- Dipartimento Interdisciplinare di Medicina, Clinica Medica e Geriatria "Cesare Frugoni", University of Bari Aldo Moro, Bari, Italy
| | - Antonello Bellomo
- Psychiatric Unit, Department of Clinical & Experimental Medicine, University of Foggia, Foggia, Italy
| | - Francesco Panza
- Healthy Aging Phenotypes Research Unit-"Salus in Apulia Study"-National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy.
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Davis WA, Bruce DG, Starkstein SE, Davis TME. Temporal Trends in Mortality Associated with Comorbid Type 2 Diabetes and Schizophrenia: The Fremantle Diabetes Study. J Clin Med 2022; 12:jcm12010300. [PMID: 36615099 PMCID: PMC9820984 DOI: 10.3390/jcm12010300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/28/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND In Phase I of the community-based Fremantle Diabetes Study (FDS1), there was evidence of a deleterious interactive effect of schizophrenia and type 2 diabetes on mortality. Our aim was to investigate whether the mortality gap had improved in FDS Phase II (FDS2) conducted 15 years later. METHODS Participants with type 2 diabetes from FDS1 (n = 1291 recruited 1993-1996) and FDS2 (n = 1509 recruited 2008-2011) were age-, sex- and postcode-matched 1:4 to people without diabetes. Schizophrenia at entry and incident deaths were ascertained from validated administrative data. RESULTS Schizophrenia affected 50/11,195 (0.45%) of participants without diabetes and 17/2800 (0.61%) of those with type 2 diabetes (p = 0.284). During 142,304 person-years of follow-up, the mortality rate (95% CI) was lowest for the FDS2 subgroup without diabetes/schizophrenia (18.2 (16.9, 19.6)/1000 person-years) and highest in FDS2 and FDS1 subgroups with type 2 diabetes/schizophrenia (53.3 (14.5, 136.6) and 98.0 (31.8, 228.8)/1000 person-years, respectively). Compared to the respective FDS subgroup without diabetes/schizophrenia, the mortality rate ratio was approximately 50% higher in the type 2 diabetes subgroup, and three times higher in those with type 2 diabetes/schizophrenia. In Cox regression, unadjusted hazard ratios were highest in those with type 2 diabetes/schizophrenia in FDS1 (HR (95% CI): 3.71 (1.54, 8.93) and FDS2 (2.96 (1.11, 7.91)), increasing to 5.61 (2.33, 13.5) and 26.9 (9.94, 72.6), respectively, after adjustment for age. CONCLUSIONS Although limited by small numbers of schizophrenia cases, these data suggest that comorbid type 2 diabetes and schizophrenia remains associated with a substantial and possibly increasing mortality gap.
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Formánek T, Krupchanka D, Mladá K, Winkler P, Jones PB. Mortality and life-years lost following subsequent physical comorbidity in people with pre-existing substance use disorders: a national registry-based retrospective cohort study of hospitalised individuals in Czechia. Lancet Psychiatry 2022; 9:957-968. [PMID: 36335974 DOI: 10.1016/s2215-0366(22)00335-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/26/2022] [Accepted: 09/02/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Substance use disorders constitute a major global public health problem, attributable largely to their subsequent comorbidity with other health conditions. This study aimed to investigate the risk of all-cause death and life-years lost following hospitalisation for 28 subsequent physical comorbid conditions in people with a previous hospitalisation for substance use disorder, compared with matched counterparts without substance use disorder. METHODS We did a retrospective cohort study on data from Czech nationwide registers of all-cause hospitalisations and deaths during the period from Jan 1, 1994, to Dec 31, 2017. The cohorts consisted of individuals who had initially been hospitalised between 15 and 70 years of age (index hospitalisation) and who were subsequently hospitalised with one or more of 28 comorbid physical health conditions. We included individuals with an index hospitalisation for substance use disorders and up to three counterparts without substance use disorders with a subsequent hospitalisation for the same physical health condition, with matching on sex, age (±3 years), work status, and discharge year at first hospitalisation for the subsequent condition. Data on ethnicity were not available. Risk of death due to any cause following the first hospitalisation for each physical health condition until Dec 31, 2017, and life-years lost after disease onset at ages 30, 45, and 60 years, and before 81 years of age, were examined. FINDINGS From a total 56 229 563 records of hospitalisations identified, we included 121 153 people with hospitalisation for substance use disorders and 6 742 134 people without hospitalisation for substance use disorders in the study. The 28 condition-specific cohorts comprised a median of 6444 individuals (IQR 2033-12 358), ranging from 444 for multiple sclerosis to 36 356 for diseases of the circulatory system. Across the cohorts, the proportion of males ranged from 31·4% for thyroid disorder to 100·0% for prostate disorders. The mean baseline age ranged from 30·0 years (SD 9·1) for chronic viral hepatitis in people with pre-existing substance use disorders to 62·2 years (9·7) for Parkinson's disease in people without pre-existing substance use disorders. After adjusting for potential confounders using stratified Cox proportional hazards models, individuals with a pre-existing substance use disorder had an increased risk of death due to any cause after the onset of 26 out of 28 physical health conditions, relative to their counterparts without substance use disorders, with adjusted hazard ratios ranging from 1·15 (1·09-1·21) for chronic liver disease to 3·86 (2·62-5·67) for thyroid disorder. For seven subsequent health conditions, the risk of death was more than doubled in the group with pre-existing substance use disorders. When compared with the general population via mortality tables, people with pre-existing substance use disorders had substantial losses in life-years after the onset of most of the subsequent physical health conditions regardless of age of onset, and, for the majority of comorbidities, lost considerably more life-years than their counterparts without substance use disorders. INTERPRETATION A history of hospitalisation for substance use disorders appears to have a significant negative effect on prognosis following the development of various subsequent physical health conditions. These findings strongly suggest that clinical vigilance and high-quality integrated treatment for people with substance use disorders could be life-saving and should be given higher priority on the public health agenda. FUNDING National Institute for Health and Care Research Applied Research Collaboration East of England at Cambridge and Peterborough National Health Service Foundation Trust.
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Affiliation(s)
- Tomáš Formánek
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czechia; Department of Psychiatry, University of Cambridge, Cambridge, UK.
| | - Dzmitry Krupchanka
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Karolína Mladá
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czechia; Department of Psychiatry, Faculty of Medicine, University Hospital in Pilsen, Charles University Prague, Pilsen, Czechia
| | - Petr Winkler
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czechia; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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Segura ÀG, Prohens L, Mezquida G, Amoretti S, Bioque M, Ribeiro M, Gurriarán-Bas X, Rementería L, Berge D, Rodriguez-Jimenez R, Roldán A, Pomarol-Clotet E, Ibáñez A, Usall J, García-Portilla MP, Cuesta MJ, Parellada M, González-Pinto A, Berrocoso E, Bernardo M, Mas S, González-Díaz JM, Arbelo N, González-Peñas J, Pina-Camacho L, Diestre A, Selma J, Zorrilla I, López P, Trabsa A, Monserrat C, Sanchez-Pastor L, Nuñez-Doyle A, Fatjó-Vilas M, Sarró S, Butjosa A, Pardo M, López-Ilundain JM, Sánchez Torres AM, Saiz-Ruiz J, Ochoa-Mangado E, RIevero O, De-la-Cámara C, Echevarría RS, González-Blanco L. Epigenetic clocks in relapse after a first episode of schizophrenia. SCHIZOPHRENIA 2022; 8:61. [PMID: 35869075 PMCID: PMC9307769 DOI: 10.1038/s41537-022-00268-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/04/2022] [Indexed: 11/17/2022]
Abstract
The main objective of the present study was to investigate the association between several epigenetic clocks, covering different aspects of aging, with schizophrenia relapse evaluated over a 3-year follow-up period in a cohort of ninety-one first-episode schizophrenia patients. Genome-wide DNA methylation was profiled and four epigenetic clocks, including epigenetic clocks of chronological age, mortality and telomere length were calculated. Patients that relapsed during the follow-up showed epigenetic acceleration of the telomere length clock (p = 0.030). Shorter telomere length was associated with cognitive performance (working memory, r = 0.31 p = 0.015; verbal fluency, r = 0.28 p = 0.028), but no direct effect of cognitive function or symptom severity on relapse was detected. The results of the present study suggest that epigenetic age acceleration could be involved in the clinical course of schizophrenia and could be a useful marker of relapse when measured in remission stages.
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De Giorgi R, Cowen PJ, Harmer CJ. Statins in depression: a repurposed medical treatment can provide novel insights in mental health. Int Rev Psychiatry 2022; 34:699-714. [PMID: 36786109 DOI: 10.1080/09540261.2022.2113369] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Depression has a large burden, but the development of new drugs for its treatment has proved difficult. Progresses in neuroscience have highlighted several physiopathological pathways, notably inflammatory and metabolic ones, likely involved in the genesis of depressive symptoms. A novel strategy proposes to repurpose established medical treatments of known safety and to investigate their potential antidepressant activity. Among numerous candidates, growing evidence suggests that statins may have a positive role in the treatment of depressive disorders, although some have raised concerns about possible depressogenic effects of these widely prescribed medications. This narrative review summarises relevant findings from translational studies implicating many interconnected neurobiological and neuropsychological, cardiovascular, endocrine-metabolic, and immunological mechanisms by which statins could influence mood. Also, the most recent clinical investigations on the effects of statins in depression are presented. Overall, the use of statins for the treatment of depressive symptoms cannot be recommended based on the available literature, though this might change as several larger, methodologically robust studies are being conducted. Nevertheless, statins can already be acknowledged as a driver of innovation in mental health, as they provide a novel perspective to the physical health of people with depression and for the development of more precise antidepressant treatments.
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Affiliation(s)
- Riccardo De Giorgi
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
| | - Philip J Cowen
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
| | - Catherine J Harmer
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
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Mutz J, Choudhury U, Zhao J, Dregan A. Frailty in individuals with depression, bipolar disorder and anxiety disorders: longitudinal analyses of all-cause mortality. BMC Med 2022; 20:274. [PMID: 36038880 PMCID: PMC9425946 DOI: 10.1186/s12916-022-02474-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/11/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Frailty is a medical syndrome that is strongly associated with mortality risk and an emerging global health burden. Mental disorders are associated with reduced life expectancy and elevated levels of frailty. In this study, we examined the mortality risk associated with frailty in individuals with a lifetime history of mental disorders compared to individuals without a history of mental disorders. METHODS The UK Biobank study recruited > 500,000 adults, aged 37-73, between 2006 and 2010. We derived the two most common albeit distinctive measures of frailty, the frailty phenotype and the frailty index. Individuals with lifetime depression, bipolar disorder or anxiety disorders were identified from multiple data sources. The primary outcome was all-cause mortality. We have also examined differences in frailty, separately by sex and age. RESULTS Analyses included up to 297,380 middle-aged and older adults with a median follow-up of 12.19 (interquartile range = 1.31) years, yielding 3,516,706 person-years of follow-up. We observed higher levels of frailty in individuals with mental disorders for both frailty measures. Standardised mean differences in the frailty index ranged from 0.66 (95% confidence interval [CI] 0.65-0.67) in individuals with anxiety disorders to 0.94 (95% CI 0.90-0.97) in individuals with bipolar disorder, compared to people without mental disorders. For key comparisons, individuals with a mental disorder had greater all-cause mortality hazards than the comparison group without mental disorders. The highest hazard ratio (3.65, 95% CI 2.40-5.54) was observed among individuals with bipolar disorder and frailty, relative to non-frail individuals without mental disorders. CONCLUSIONS Our findings highlight elevated levels of frailty across three common mental disorders. Frailty and mental disorders represent potentially modifiable targets for prevention and treatment to improve population health and life expectancy, especially where both conditions coexist.
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Affiliation(s)
- Julian Mutz
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Memory Lane, London, SE5 8AF, UK.
| | - Umamah Choudhury
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Memory Lane, London, SE5 8AF, UK
| | - Jinlong Zhao
- Department of Basic & Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Alexandru Dregan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Yamada Y, Fujiwara M, Etoh T, Wada R, Inoue S, Kodama M, Yoshimura Y, Horii S, Matsushita T, Fujimori M, Shimazu T, Nakaya N, Hinotsu S, Tabata M, Tamura K, Uchitomi Y, Yamada N, Inagaki M. Issues of cancer care in people with mental disorders as perceived by cancer care providers: A quantitative questionnaire survey. Psychooncology 2022; 31:1572-1580. [PMID: 35770322 DOI: 10.1002/pon.5992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/20/2022] [Accepted: 06/27/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To reduce cancer care disparities, this study aimed to clarify the difficulties in cancer care for people with mental disorders as perceived by cancer care providers. METHODS Cancer care providers at 17 designated cancer hospitals in Japan were surveyed using mail questionnaires. Respondents were asked to rate 29 items related to difficulties or insufficiencies in cancer care for patients with mental disorders on a five-point Likert scale. We analyzed the proportion of respondents who answered "difficult/insufficient" in each item. We also calculated the proportions of responders stratified according to the presence of psychiatric support systems within their hospitals. RESULTS A total of 388 (58.4%) cancer care providers responded. Among the issues related to "difficulties in diagnosing and treating cancer," support for decision-making, assessment of treatment adherence, and assessment of physical symptoms were perceived as most difficult (73.5%-81.5% of respondents). Among the issues related to 'difficulties or insufficiencies in collaboration among multidisciplinary health care providers,' the issue of advance consultation and sharing information with the patient's primary psychiatric care provider was perceived as most difficult (52.2%). Among the issues related to "insufficiencies of in-hospital and community medical systems," education to provide reasonable accommodation was perceived as most insufficient (47.4%). The perceived difficulties of over half of the issues varied significantly between hospitals depending on the level of psychiatric support systems. CONCLUSIONS This study clarified the difficulties of cancer care in patients with mental disorders as perceived by cancer care providers. Some issues may be resolved by psychiatric liaison teams.
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Affiliation(s)
- Yuto Yamada
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Masaki Fujiwara
- Department of Neuropsychiatry, Okayama University Hospital, Okayama, Japan
| | - Tsuyoshi Etoh
- Department of Nursing, Shimane University Hospital, Izumo, Japan
| | - Riho Wada
- Department of Social Work, Faculty of Health and Welfare, Kawasaki University of Medical Welfare, Okayama, Japan
| | - Shinichiro Inoue
- Department of Neuropsychiatry, Okayama University Hospital, Okayama, Japan
| | | | | | | | | | - Maiko Fujimori
- Division of Supportive Care, Survivorship and Translational Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Taichi Shimazu
- Division of Behavioral Sciences, Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Naoki Nakaya
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Shiro Hinotsu
- Department of Biostatistics and Data Management, Sapporo Medical University, Sapporo, Japan
| | - Masahiro Tabata
- Departments of Allergy and Respiratory Medicine, Okayama University Hospital, Okayama, Japan
| | - Kenji Tamura
- Department of Medical Oncology, Shimane University Hospital, Izumo, Japan
| | - Yosuke Uchitomi
- National Cancer Center Institute for Cancer Control, Group for Supportive Care and Survivorship Research, Tokyo, Japan
| | - Norihito Yamada
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Masatoshi Inagaki
- Department of Psychiatry, Faculty of Medicine, Shimane University, Izumo, Japan
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