EDUCATIONAL ATTAINMENT AS A PROTECTIVE FACTOR FOR PSYCHIATRIC DISORDERS: FINDINGS FROM A NATIONALLY REPRESENTATIVE LONGITUDINAL STUDY

Educational attainment and mental health conditions: a within-sibship Mendelian randomization study

Importance

Observational studies have demonstrated consistent protective effects of higher educational attainment (EA) on the risk of suffering mental health conditions (MHC). Determining whether these beneficial effects are causal is challenging given the potential role of dynastic effects and demographic factors (assortative mating and population structure) in this association.

Objective

To evaluate to what extent the relationship between EA and various MHC is independent from dynastic effects and demographic factors.

Design

Within-sibship Mendelian randomization (MR) study.

Setting

One-sample MR analyses included participants' data from the Trøndelag Health Study (HUNT, Norway) and UK Biobank (United Kingdom). For two-sample MR analyses we used summary statistics from publicly available genome-wide-association-studies.

Participants

61 880 siblings (27 507 sibships).

Exposure

Years of education.

Main outcomes

Scores for symptoms of anxiety, depression and neuroticism using the Hospital Anxiety Depression Scale (HADS), the 7-item Generalized Anxiety Disorder Scale (GAD-7), the 9-item Patient Health Questionnaire (PHQ-9), and the Eysenck Personality Questionnaire, as well as self-reported consumption of psychotropic medication.

Results

One standard deviation (SD) unit increase in years of education was associated with a lower symptom score of anxiety (-0.20 SD [95%CI: -0.26, -0.14]), depression (-0.11 SD [-0.43, 0.22]), neuroticism (-0.30 SD [-0.53, -0.06]), and lower odds of psychotropic medication consumption (OR: 0.60 [0.52, 0.69]). Estimates from the within-sibship MR analyses showed some attenuation, which however were suggestive of a causal association (anxiety: -0.17 SD [-0.33, -0.00]; depression: -0.18 SD [-1.26, 0.89]; neuroticism: -0.29 SD [-0.43, -0.15]); psychotropic medication consumption: OR, 0.52 [0.34, 0.82]).

Conclusions and Relevance

Associations between EA and MHC in adulthood, although to some extend explained by dynastic effects and demographic factors, overall remain robust, indicative of a causal effect. However, larger studies are warranted to improve statistical power and further validate our conclusions.

The Path from Personality to Anxiety and Depression Is Mediated by Cognition in Multiple Sclerosis

BACKGROUND

Multiple sclerosis (MS) is a neurodegenerative immunological disease causing significant impairment in all life areas. Therefore, personality changes are observed and associated with higher prevalence of depression and anxiety disorders. Considering this relationship, we hypothesized that clinical symptoms and personality disorders are more prevalent in MS and that dysfunctional psychological mechanisms mediate the path from personality disorders to clinical symptoms.

METHODS

The study sample consisted of 43 patients with MS (age M = 41.9, SD = 11.5) and 31 controls (age M = 39.8, SD = 10.3). Measures of personality, anxiety, depression, fatigue, health status, and dysfunctional psychological mechanisms were conducted.

RESULTS

The prevalence of clinical symptoms was increased in MS patients as compared to controls. Also, dependent and schizoid personality traits (PTs) were observed in the patient sample. Negative automatic thoughts (NATs) were found to mediate the association between dependent PT and clinical symptoms. Along with schizoid PT, all dysfunctional psychological mechanisms impacted clinical symptoms.

DISCUSSION

The results of our research are in line with previous studies showing that anxiety, depression, and dysfunctional personality traits are more prevalent in MS as compared to controls.

CONCLUSIONS

PTs and dysfunctional psychological mechanisms predicted depression, anxiety, fatigue, and health status in MS patients. Cognition acts as a strong mediator between PTs and psychopathology in MS. Hence, integrative personalized psychological treatment is recommended to improve the quality of care in MS.

Community Reinforcement and Family Training versus counselling for parents of treatment-refusing young adults with hazardous substance use: A randomized controlled trial

BACKGROUND AND AIMS

Despite the high prevalence and negative effects of hazardous substance use, few young adults enter treatment. Community Reinforcement and Family Training (CRAFT), a support programme for concerned significant others of people with substance use disorders, has proved efficacious in promoting treatment entry. The aim of the current trial was to compare the efficacy of CRAFT with an active control for parents of young adults (aged 18-24 years) with hazardous substance use.

DESIGN

This was a randomized controlled superiority trial comparing CRAFT (n = 58) with an active control group receiving manualized counselling (n = 55), with outcome assessments at 6, 12 and 24 weeks (primary end-point). A sequential design with a stopping rule was added post recruitment commencement.

SETTING

The study took place in two outpatient clinics for young adults in Stockholm, Sweden, and subsequently via video-conference due to COVID-19.

PARTICIPANTS

Between October 2018 and May 2021, 113 participants (92% female) who were parents of young adults (87% male) were recruited. Recruitment was discontinued when 70% of the planned sample had been recruited, following an interim analysis of the primary outcome showing no difference between conditions.

INTERVENTION AND COMPARATOR

Participants were randomized (ratio 1 : 1) to eight manual-based individual CRAFT sessions or five individual manual-based counselling sessions + one voluntary psychoeducative group session, delivered over maximum 14 weeks.

MEASUREMENTS

The primary outcome measure was the rate of young adult entry in substance use treatment during the trial period (24 weeks).

FINDINGS

At the 24 weeks follow-up, 19 (33%) of CRAFT participants and 17 (31%) of counselling participants had reported young adult treatment entry, with no difference between conditions (odds ratio CRAFT versus counselling 0.84, 95% confidence interval = 0.35; 1.99, P = 0.700). Both conditions reported clinically relevant reductions in young adult substance use, but no change in participants' levels of depression, anxiety or stress.

CONCLUSIONS

This trial showed no statistically significant evidence that Community Reinforcement and Family Training (CRAFT), a support programme for concerned significant others of people with substance use disorders, is more efficacious than manual-based counselling regarding treatment entry for young adults.

Construction of a depression risk prediction model for type 2 diabetes mellitus patients based on NHANES 2007-2014

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a prevalent global health issue that has been linked to an increased risk of depression. The objective of this study was to construct a nomogram model for predicting depression in T2DM patients.

METHODS

A total of 4280 patients with T2DM were included in this study from the 2007-2014 NHANES. The entire dataset was split randomly into training set comprising 70 % of the data and a validation set comprising 30 % of the data. LASSO and multivariate logistic regression analyses identified predictors significantly associated with depression, and the nomogram was constructed with these predictors. The model was assessed by C-index, calibration curve, the hosmer-lemeshow test and decision curve analysis (DCA).

RESULTS

The nomogram model comprised of 9 predictors, namely age, gender, PIR, BMI, education attainment, smoking status, LDL-C, sleep duration and sleep disorder. The C-index of the training set was 0.780, while that of the validation set was 0.752, indicating favorable discrimination for the model. The model exhibited excellent clinical applicability and calibration in both the training and validation datasets. Moreover, the cut-off value of the nomogram is 223.

LIMITATIONS

This study has shortcomings in data collection, lack of external validation, and results non-extrapolation.

CONCLUSIONS

Our nomogram exhibits high clinical predictability, enabling clinicians to utilize this tool in identifying high-risk depressed patients with T2DM. It has the potential to decrease the incidence of depression and significantly improve the prognosis of patients with T2DM.

Algorithmic fairness in precision psychiatry: analysis of prediction models in individuals at clinical high risk for psychosis

BACKGROUND

Computational models offer promising potential for personalised treatment of psychiatric diseases. For their clinical deployment, fairness must be evaluated alongside accuracy. Fairness requires predictive models to not unfairly disadvantage specific demographic groups. Failure to assess model fairness prior to use risks perpetuating healthcare inequalities. Despite its importance, empirical investigation of fairness in predictive models for psychiatry remains scarce.

AIMS

To evaluate fairness in prediction models for development of psychosis and functional outcome.

METHOD

Using data from the PRONIA study, we examined fairness in 13 published models for prediction of transition to psychosis (n = 11) and functional outcome (n = 2) in people at clinical high risk for psychosis or with recent-onset depression. Using accuracy equality, predictive parity, false-positive error rate balance and false-negative error rate balance, we evaluated relevant fairness aspects for the demographic attributes 'gender' and 'educational attainment' and compared them with the fairness of clinicians' judgements.

RESULTS

Our findings indicate systematic bias towards assigning less favourable outcomes to individuals with lower educational attainment in both prediction models and clinicians' judgements, resulting in higher false-positive rates in 7 of 11 models for transition to psychosis. Interestingly, the bias patterns observed in algorithmic predictions were not significantly more pronounced than those in clinicians' predictions.

CONCLUSIONS

Educational bias was present in algorithmic and clinicians' predictions, assuming more favourable outcomes for individuals with higher educational level (years of education). This bias might lead to increased stigma and psychosocial burden in patients with lower educational attainment and suboptimal psychosis prevention in those with higher educational attainment.

Unraveling shared susceptibility loci and Mendelian genetic associations linking educational attainment with multiple neuropsychiatric disorders

Background

Empirical studies have demonstrated that educational attainment (EA) is associated with neuropsychiatric disorders (NPDs), suggesting a shared etiological basis between them. However, little is known about the shared genetic mechanisms and causality behind such associations.

Methods

This study explored the shared genetic basis and causal relationships between EA and NPDs using the high-definition likelihood (HDL) method, cross phenotype association study (CPASSOC), transcriptome-wide association study (TWAS), and bidirectional Mendelian randomization (MR) with summary-level data for EA (N = 293,723) and NPDs (N range = 9,725 to 455,258).

Results

Significant genetic correlations between EA and 12 NPDs (rg range - 0.49 to 0.35; all p < 3.85 × 10-3) were observed. CPASSOC identified 37 independent loci shared between EA and NPDs, one of which was novel (rs71351952, mapped gene: ARFGEF2). Functional analyses and TWAS found shared genes were enriched in brain tissue, especially in the cerebellum and highlighted the regulatory role of neuronal signaling, purine nucleotide metabolic process, and cAMP-mediated signaling pathways. CPASSOC and TWAS supported the role of three regions of 6q16.1, 3p21.31, and 17q21.31 might account for the shared causes between EA and NPDs. MR confirmed higher genetically predicted EA lower the risk of ADHD (ORIVW: 0.50; 95% CI: 0.39 to 0.63) and genetically predicted ADHD decreased the risk of EA (Causal effect: -2.8 months; 95% CI: -3.9 to -1.8).

Conclusion

These findings provided evidence of shared genetics and causation between EA and NPDs, advanced our understanding of EA, and implicated potential biological pathways that might underlie both EA and NPDs.

The Association of Untreated Mental Health Problems with Alcohol and Tobacco use Among New York City Taxi Drivers

OBJECTIVES

Mental disorders and substance use disorders are highly comorbid. The "self-medication hypothesis" posits that individuals may use substances such as tobacco and alcohol to cope with symptoms associated with untreated mental health problems. The present study examined the association between having a currently untreated mental health condition and tobacco and alcohol use among male taxi drivers in NYC, a population at risk for poor mental and physical health outcomes.

METHODS

The sample included 1105 male, ethnoracially diverse, primarily foreign-born NYC taxi drivers participating in a health fair program. This secondary cross-sectional analysis utilized logistic regression modeling to examine whether endorsement of a currently untreated mental health problem (i.e., depression, anxiety, or posttraumatic stress disorder) was associated with alcohol and/or tobacco use, controlling for potential confounders.

RESULTS

8.5% of drivers reported having mental health problems; among these, only 0.5% reported receiving treatment. Untreated mental health problems were associated with an increased risk of current tobacco/alcohol use after controlling for age, educational attainment, nativity, and pain history: drivers with untreated mental health problems had 1.9x the odds of reporting current tobacco use [95% CI: 1.10-3.19] and 1.6x the odds of reporting current alcohol use [95% CI: 1.01-2.46] than those without untreated mental health problems.

CONCLUSIONS

Few drivers with mental health problems receive treatment. In line with the self-medication hypothesis, drivers with untreated mental health problems demonstrated significantly increased risk of tobacco and alcohol use. Efforts to encourage timely screening and treatment of mental health problems among taxi drivers are warranted.

Childhood family environment predicting psychotic disorders over a 37-year follow-up - A general population cohort study

BACKGROUND

Childhood adverse effects and traumatic experiences increase the risk for several psychiatric disorders. We now investigated whether prospectively assessed childhood family environment per se contributes to increased risk for psychotic disorders in adulthood, and whether these family patterns are also relevant in the development of affective disorders.

METHODS

We used the Young Finns Data (n = 3502). Childhood family environment was assessed in 1980/1983 with previously constructed risk scores: (1) disadvantageous emotional family atmosphere (parenting practices, parents' life satisfaction, parents' mental disorder, parents' alcohol intoxication), (2) adverse socioeconomic environment (overcrowded apartment, home income, parent's employment, occupational status, educational level), and (3) stress-prone life events (home movement, school change, parental divorce, death, or hospitalization, and child's hospitalization). Psychiatric diagnoses (ICD-10 classification) over the lifespan were collected up to 2017 from the national registry of hospital care. Non-affective psychotic disorder and affective disorder groups were formed.

RESULTS

Frequent stress-prone life events predicted higher likelihood of non-affective psychotic disorders (OR = 2.401, p = 0.001). Adverse socioeconomic environment or emotional family atmosphere did not predict psychotic disorders. Only disadvantageous emotional family atmosphere predicted modestly higher likelihood of affective disorders (OR = 1.583, p = 0.013).

CONCLUSIONS

Our results suggest that childhood family environment and atmosphere patterns as such contribute to the risk for developing adulthood mental disorders with relative disorder specificity. The results emphasize the importance of both individual and public health preventive initiatives, including family support interventions.

The presence and severity of neuropsychiatric symptoms and their association with quality of life among patients with dementia

BACKGROUND

Neuropsychiatric symptoms are common manifestations of dementia. The presence and severity of these symptoms differ depending on different personal and contextual factors.

PURPOSE

This study aimed to investigate the presence and predictors of neuropsychiatric symptoms and the association between the severity of these symptoms and the quality of life in a sample of patients with dementia in Jordan.

METHODS

In this cross-sectional study, 112 patients with dementia residing in Jordanian nursing homes were recruited using the consecutive sampling method.

RESULTS

The mean severity of neuropsychiatric symptoms was 9.58. The most prevalent neuropsychiatric symptoms among patients were depression (61.6%), followed by irritability (55.4%), and a feeling of euphoria (54.5%). The regression analysis results indicated that gender, marital status, and dementia severity significantly predicted the neuropsychiatric symptoms severity score and explained 17.70% of the variance. A significant negative correlation between the severity of neuropsychiatric symptoms and quality of life was found.

CONCLUSION

The study's results indicate that our sample reported mild neuropsychiatric symptoms. These symptoms' high prevalence and persistence negatively impact patients' quality of life. The study's results can help mental health nurses determine the factors impacting effective treatment strategies to combat these symptoms. Future longitudinal studies are warranted to help explain the importance of early diagnosis and management of these symptoms in preventing dementia progression.

Psychological challenges and related factors of ordinary residents after "7.20" heavy rainstorm disaster in Zhengzhou: a cross-sectional survey and study

BACKGROUND

In 2021, a once-in-a-century heavy rainstorm suddenly attacked Zhengzhou, an important inland city in northern China. However, there have been no studies on the psychological health of disaster-stricken residents. This study is the first to comprehensively report on the mental health status and related factors of local ordinary residents after the heavy rainstorm.

OBJECTIVE

The purpose of this study is to investigate the mental health status and related influencing factors of local ordinary residents after the flood disaster, and to provide reference for government departments to formulate disaster psychological intervention countermeasures based on evidence-driven strategies.

METHODS

The snowball sampling technique was used in this study, and measurement tools of Rainstorm Exposure Questionnaire, Subjective Perception of Rainstorm, Post-Traumatic Stress Disorder Checklist-Civilian version (PCL-C), Depression, Anxiety and Stress Scale-21 (DAS-21) and Chinese version of Social Support Rating Scale (SSRS) were used to evaluate the rainstorm exposure, subjective perception of the rainstorm, psychological symptoms and social support of the disaster-stricken residents within a week after the rainstorm. Logistic regression analysis was used to examine the psychological status and related factors of local residents after the rainstorm disaster.

RESULTS

A total of 469 valid samples were obtained in this study. All the subjects were in the disaster area and experienced the rainstorm personally, with normal intelligence. The statistical results showed that 25.37% people had experienced at least three rainstorm-related stresses, nearly 20.26% people had post-traumatic stress disorder (PTSD) symptoms, and 39.3%, 53.92% and 65.83% people had depression, anxiety and stress symptoms, respectively. Multivariable logistic regression analyses indicated that female (all p < 0.05), the divorced, agricultural workers/farmers (all p < 0.05), students (all p < 0.05), people experiencing at least three rainstorm-related stresses (p < 0.05 or p < 0.01), people with lower satisfaction at the social flood fighting measures (p < 0.05 or p < 0.01) and people with low social support (p < 0.05 or p < 0.01) were all independent risk factors for poor psychological health, and college education or above (p < 0.05 or p < 0.01), the lower degree of worrying about themselves (all p < 0.01), family members (all p < 0.01) and family property (all p < 0.01) were all related to higher psychological health among flood survivors after the disaster.

CONCLUSIONS

Rainstorm could cause local residents to have various degrees of psychological symptoms. This study identified factors associated with the psychological health of disaster-stricken residents, which could be used to develop psychological interventions in improving psychological health of local residents.

Adolescent substance use and high school noncompletion: exploring the nature of the relationship using a discordant twin design

BACKGROUND AND AIMS

Previous studies have demonstrated associations between substance use and reduced educational attainment; however, many were unable to account for potential confounding factors like genetics and the rearing environment. In the few studies that controlled for these factors, the substances assessed were limited to alcohol, cannabis, and tobacco. To address these limitations, we examined the relationship between adolescent use of seven kinds of substances, the number of additional substances used, and high school noncompletion within a large sample of Australian twins.

DESIGN

A series of two-level generalized mixed effects logistic regressions were conducted to examine associations between adolescent substance use and high school noncompletion.

SETTING

Australia.

PARTICIPANTS

A total of 9579 adult Australian twins from two cohorts of the Australian Twin Registry.

MEASUREMENTS

Assessments of high school completion, childhood major depression, conduct disorder symptoms, substance use initiation, demographics, and parental educational attainment using the Australian version of the Semi-Structured Assessment for the Genetics of Alcoholism.

FINDINGS

There were unique within-twin-pair effects of use of sedatives (odds ratio [OR] = 22.39 [95% confidence interval (CI) = 1.18-423.48]) and inhalants/solvents (OR = 10.46 [95% CI = 1.30-84.16]) on high school noncompletion. The number of substances used in adolescence was strongly associated with high school noncompletion across all discordant twin models (ORs from 1.50-2.32, Ps < 0.03).

CONCLUSIONS

In Australia, adolescent substance use appears to be associated with early school dropout, with the effects of any given substance largely because of the confounding factors of parental education, childhood conduct disorder symptoms, and use of other substances. Sedatives and inhalants/solvents have effects on high school noncompletion that cannot be explained by polysubstance use or familial factors.

Educational Attainment Polygenic Scores: Examining Evidence for Gene-Environment Interplay with Adolescent Alcohol, Tobacco and Cannabis Use

Genes associated with educational attainment may be related to or interact with adolescent alcohol, tobacco and cannabis use. Potential gene-environment interplay between educational attainment polygenic scores (EA-PGS) and adolescent alcohol, tobacco, and cannabis use was evaluated with a series of regression models fitted to data from a sample of 1871 adult Australian twins. All models controlled for age, age², cohort, sex and genetic ancestry as fixed effects, and a genetic relatedness matrix was included as a random effect. Although there was no evidence that adolescent alcohol, tobacco or cannabis use interacted with EA-PGS to influence educational attainment, there was a significant, positive gene-environment correlation with adolescent alcohol use at all PGS thresholds (ps <.02). Higher EA-PGS were associated with an increased likelihood of using alcohol as an adolescent (ΔR² ranged from 0.5% to 1.1%). The positive gene-environment correlation suggests a complex relationship between educational attainment and alcohol use that is due to common genetic factors.

Psychosocial Distress among Family Members of COVID-19 Patients Admitted to Hospital and Isolation Facilities in the Philippines: A Prospective Cohort Study

This study determined the psychosocial impact of COVID-19 on families of adult COVID-19 patients in isolation facilities in Metro Manila, Philippines. This prospective cohort study was conducted in COVID-19 healthcare facilities. Data collection was undertaken 2 weeks and 8 weeks after discharge. Logistic regression was performed to determine the socioeconomic and clinical factors influencing anxiety, depression, and family function. Based on HADS-P, 43.2% of the participants had anxiety symptoms, and 16.2% had depression symptoms 2 weeks after the discharge of their relative with COVID-19 infection. The prevalence of anxiety and depression significantly decreased to 24.3% and 5.4%, respectively, 8 weeks after discharge. The percentage of participants with a perceived moderate family dysfunction was 9.5% in the 2nd week and 6.8% in the 8th week post discharge. Participants with perceived severe family dysfunction increased from none to 4.1%. The most inadequate family resources for the participants were economic, medical, and educational resources. Patient anxiety (p = 0.010) and perceived inadequate family resources (p = 0.032) were associated with anxiety symptoms among family members. Patient anxiety (p = 0.013) and low educational attainment (p = 0.002) were associated with anxiety symptoms among family members 8 weeks after discharge. On the other hand, patient depression (p = 0.013) was a factor related to depressive symptoms among family members 2 weeks after discharge. This study provided an in-depth understanding of the mental health status of family members caring for relatives with COVID-19 infection. This can be used to guide healthcare professionals caring for COVID-19 patients and their family members.

The effect of college degree attainment on neurodegenerative symptoms in genetically at-risk women

Using longitudinal data, the present study examined the association between college degree attainment and the manifestation of neurodegenerative symptoms among women (n = 93) at elevated genetic risk. The neurodegenerative symptoms investigated in this study are due to FXTAS (Fragile X-associated Tremor/Ataxia Syndrome), a condition with onset after age 50. Those at risk for FXTAS have a mutation of a single gene found on the X chromosome. FXTAS is characterized by intention tremor, gait ataxia, executive function deficits, memory issues, and neuropathy. College degree attainment has been shown to provide neuroprotective effects in the general population, delaying the development of neurodegenerative conditions such as Alzheimer's disease. For this reason, college degree attainment is a potentially salient resource for those at risk of FXTAS. The results of the present research indicated significantly more severe FXTAS symptoms in women who did not attain a college degree as compared with those who were college graduates, although the two groups were similar in age, genetic risk, household income, health behaviors, and general health problems. Furthermore, symptoms in those who did not attain a college degree worsened over the 9-year study period at a significantly faster rate than the college graduates. The association between college degree attainment and FXTAS symptoms was significantly mediated by depression, which was lower among the graduates than those who did not attain a college degree. Thus, the present research is an example of how a sociodemographic factor can mitigate neurodegenerative conditions in genetically at-risk adults.

Assessing the depression risk in the U.S. adults using nomogram

BACKGROUND

Depression has received a lot of attention as a common and serious illness. However, people are rarely aware of their current depression risk probabilities. We aimed to develop and validate a predictive model applicable to the risk of depression in US adults.

METHODS

This study was conducted using the database of the National Health and Nutrition Examination Survey (NHANES, 2017-2012). In particular, NHANES (2007-2010) was used as the training cohort (n = 6015) for prediction model construction and NHANES (2011-2012) was used as the validation cohort (n = 2812) to test the model. Depression was assessed (defined as a binary variable) by the Patient Health Questionnaire (PHQ-9). Socio-demographic characteristics, sleep time, illicit drug use and anxious days were assessed using a self-report questionnaire. Logistic regression analysis was used to evaluate independent risk factors for depression. The nomogram has the advantage of being able to visualize complex statistical prediction models as risk estimates of individualized disease probabilities. Then, we developed two depression risk nomograms based on the results of logistic regression. Finally, several validation methods were used to evaluate the prediction performance of nomograms.

RESULTS

The predictors of model 1 included gender, age, income, education, marital status, sleep time and illicit drug use, and model 2, furthermore, included anxious days. Both model 1 and model 2 showed good discrimination ability, with a bootstrap-corrected C index of 0.71 (95% CI, 0.69-0.73) and 0.85 (95% CI, 0.83-0.86), and an externally validated C index of 0.71 (95% CI, 0.68-0.74) and 0.83 (95% CI, 0.81-0.86), respectively, and had well-fitted calibration curves. The area under the receiver operating characteristic curve (AUC) values of the models with 1000 different weighted random sampling and depression scores of 10-17 threshold range were higher than 0.7 and 0.8, respectively. Calculated net reclassification improvement (NRI) and integrated discrimination improvement (IDI) showed the discrimination or accuracy of the prediction models. Decision curve analysis (DCA) demonstrated that the depression models were practically useful. The network calculators work for participants to make personalized predictions.

CONCLUSIONS

This study presents two prediction models of depression, which can effectively and accurately predict the probability of depression as well as helping the U.S. civilian non-institutionalized population to make optimal treatment decisions.

Risk of Developing Type 2 Diabetes in Individuals With a Psychiatric Disorder: A Nationwide Register-Based Cohort Study

OBJECTIVE

Previous studies have investigated the incidence of type 2 diabetes in individuals with psychiatric disorders, but most studies have focused on a specific psychiatric disorder or a selected sample. More population-based studies are needed to determine these associations in representative samples. We therefore aimed to determine these associations in a nationwide, register-based dynamic cohort study.

RESEARCH DESIGN AND METHODS

We analyzed data from 5,005,612 adults living in Denmark between 1995 and 2018, without prior diabetes. We investigated 10 different categories of psychiatric disorders and a composite group with any psychiatric disorder. Individuals with a psychiatric disorder were compared with individuals without using multivariable-adjusted Poisson regression to estimate incidence rate ratios (IRR) of type 2 diabetes. We modeled age-specific incidence rates (IR) for individuals with and without the specific psychiatric disorder. All models were stratified by sex.

RESULTS

In total, 334,739 individuals developed type 2 diabetes during follow-up. For all investigated categories of psychiatric disorders, we found increased IR of type 2 diabetes for individuals with versus those without a psychiatric disorder (IRR: men, 1.47 [95% CI 1.45-1.50]; women, 1.65 [95% CI 1.62-1.68]). When we examined age-specific IR, the largest differences were found in the younger population (<50 years).

CONCLUSIONS

We found that the IR of type 2 diabetes was higher in individuals with a psychiatric disorder compared with individuals without a psychiatric disorder and particularly high in the younger people with a psychiatric disorder. New studies into the prevention and early detection of type 2 diabetes in these groups are warranted.

Prevalence of depressive and anxiety symptoms and their relationship with life-threatening events, tobacco dependence and hazardous alcohol drinking: a population-based study in the Brazilian Amazon

BACKGROUND

The burden of mental health disorders is high and may be particularly alarming in developing countries. We assessed the prevalence of depressive and anxiety symptoms and their relationship with life-threatening events, tobacco dependence, and hazardous alcohol drinking in the Brazilian Amazon.

METHODS

Cross-sectional population-based study conducted in Manaus in 2019 with adults selected by probabilistic sampling. Depressive symptoms were measured by the PHQ-9 instrument (cut-off ≥9) and anxiety symptoms by the GAD-7 scale (cut-off ≥10). Prevalence ratios (PRs) of depressive and anxiety symptoms were calculated by Poisson regression with robust variance with 95% confidence intervals (CI) following a hierarchical model. Partial least squares structural equation modeling was used to investigate the relationship between the outcomes and risk behaviors.

RESULTS

Out of the 2,321 participants, 24.3% (95%CI 22.2-26.5%) had depressive and 21.6% (95%CI 19.6-23.7%) had anxiety symptoms. Depressive symptoms were more frequent in women (PR=1.32; 95%CI 1.08-1.61), lower social class (PR=1.59; 95%CI 1.11-2.27), life-threatening events (PR=2.66; 95%CI 2.00-3.54), tobacco dependence (PR=1.84; 95%CI 1.37-2.47), worse health statuses (p<0.001), and chronic diseases (PR=1.63; 95%CI 1.33-2.00), but were lower in older adults (p=0.014). Anxiety symptoms were higher in women (PR=1.74; 95%CI 1.42-2.14), lower educational levels (PR=2.19; 95%CI 1.38-3.47), evangelical individuals (PR=1.28; 95%CI 1.05-1.57), having no religion (PR=1.72; 95%CI 1.24-2.38), life-threatening events (PR=3.26; 95%CI 2.41-4.41), tobacco dependence (PR=1.53; 95%CI 1.09-2.16), worse health statuses (p<0.001), and chronic diseases (PR=1.77; 95%CI 1.40-2.25). Depressive symptoms, anxiety symptoms, and life-threatening events were directly correlated with one another, while tobacco dependence and hazardous alcohol drinking were significantly intercorrelated (p<0.05).

LIMITATIONS

Cross-sectional design limits the assessment of causality. Recall bias was possible as responses were self-reported. GAD-7 scale was not validated in the Brazilian population.

CONCLUSION

Nearly a quarter of the population had depressive symptoms and one-fifth presented anxiety symptoms, which were associated with socioeconomic, behavioral, and health-related factors. Implementation of social well-being policies is required to minimize the burden of mental health disorders in the Amazonian population.

Coping with COVID-19 Prolonged and Cumulative Stressors: the Case Example of Egypt

The current study aimed to explore how COVID-19-traumatized populations cope using a coping model based on wills to exist, live, and survive (WTELS) that leads to positive coping and posttraumatic growth (PTG). We used data from 11 Arab countries (N = 2732), including Egypt (N = 831), and included measures for COVID-19 stressors (COVID-fear, economic, lockdown, and grief stressors), WTELS, resilience, religiosity, spirituality, social support, and PTG. We conducted ANOVA on the main sample to explore the differences between Arab countries, hierarchical regressions, and path analysis on the Egyptian subsample to test a model of the effects on WTELS. In the path model, WTELS was the independent variable. Other coping strategies were mediating variables, and COVID-19 stressor types were outcome variables. ANOVA on the main sample indicated that Egypt was the highest on COVID-19 stressors (infection fears, economic, lockdown, and grief stressors), actual infection, and WTELS. Hierarchical regression indicated that social support, resilience, and WTELS were positive predictors of PTG, with WTELS had the highest effect size (β = .41) and WTELS being a negative predictor of COVID-19 stressors, while resilience and social support were not. Path analysis indicated that WTELS predicted higher religiosity, spirituality, social support, resilience, and lower COVID-19 stressors. Religiosity predicted higher spirituality, social support, and resilience and lower COVID-19 stressors. Interfaith spirituality predicted higher resilience and lower COVID-19 grief stressors. The results validated the central role of WTELS. Results helped to identify potentially effective interventions with COVID-19 victims that focus on WTELS, spirituality, and religiosity.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s11469-021-00712-x.

Cognitive reserve may outperform age, mood and psychiatric comorbidities as a predictor of executive functioning in bipolar disorder and healthy adults

INTRODUCTION

Cognitive reserve plays a protective role against executive dysfunction in healthy adults and individuals with psychiatric illnesses such as bipolar disorder. However, the magnitude of the influence of cognitive reserve on specific executive functions (EFs), and its impact relative to variables such as depressive symptoms, age and psychiatric comorbidities, is unexplored. This study aimed to quantify the influence of cognitive reserve on specific EFs, and compare its impact with that of depressive symptoms, age and psychiatric comorbidities, in separate models for patients with bipolar disorder and healthy adults.

METHOD

This was a cross-sectional study of 121 adults with no mood disorders and 109 with bipolar disorder, all of whom underwent a comprehensive psychiatric assessment and evaluation of the EFs. Cognitive reserve was measured using years of education, IQ and reading and writing habits. The association between EFs and predictors (cognitive reserve, depressive symptoms, age and psychiatric comorbidities) was evaluated through structural equation modeling. Four models were constructed for each group independently (bipolar disorder and control), one each for working memory, verbal fluency, inhibition and flexibility, due to group differences in age and cognitive reserve.

RESULTS

Working memory, inhibition and flexibility were most significantly predicted by cognitive reserve and age. Verbal fluency was only predicted by cognitive reserve. Comorbidities and depressive symptoms were not significant in any of the models. Cognitive reserve had a positive influence on all EFs in models for patients with bipolar disorder and models for control participants. Age had a negative impact on three of the four EFs tested.

CONCLUSION

Fostering cognitive reserve through continued education and cognitively stimulating leisure activities may be an effective intervention for executive dysfunction in patients and non-patients alike. In some cases, the effects of these interventions may outweigh the negative cognitive impact of aging, depressive symptoms and psychiatric conditions.

Genes in treatment: Polygenic risk scores for different psychopathologies, neuroticism, educational attainment and IQ and the outcome of two different exposure-based fear treatments

OBJECTIVES

Evidence for a genetic influence on psychological treatment outcome so far has been inconsistent, likely due to the focus on candidate genes and the heterogeneity of the disorders treated. Using polygenic risk scores (PRS) in homogenous patient samples may increase the chance of detecting genetic influences.

METHODS

A sample of 342 phobic patients treated either for clinically relevant dental fear (n = 189) or other (mixed) phobic fears (n = 153) underwent highly standardised exposure-based CBT. A brief five-session format was used to treat dental fear, whereas longer multi-session treatments were used with the mixed-fear cohort. PRS were calculated based on large genetic studies of Neuroticism, Educational Attainment (EA), Intelligence, and four psychopathology domains. We compared PRS of post-treatment and follow-up remitters and non-remitters and regressed PRS on fear reduction percentages.

RESULTS

In the dental fear cohort, EA PRS were associated with treatment outcomes, i.e. drop-out, short- and long-term remission state, fear reduction, and attendance of subsequent dental appointments. In the mixed fear treatment cohort, no gene effects were observable.

CONCLUSIONS

Results indicate the importance of EA-related traits for outcomes following brief, but not long, standardised exposure-based CBT. Such use of PRS may help inform selection and tailoring of treatments.

Factors impacting resilience as a result of exposure to COVID-19: The ecological resilience model

Despite the severe psychological impact of the COVID-19 pandemic, some individuals do not develop high levels of psychological distress and can be termed resilient. Using the ecological resilience model, we examined factors promoting or hindering resilience in the COVID-19 pandemic. Of the 1034 participants (49.9±16.2 years; females 51.2%) from Italian general population, 70% displayed resilient outcomes and 30% reported moderate-severe anxiety and/or depression. A binary regression model revealed that factors promoting resilience were mostly psychological (e.g., trait resilience, conscientiousness) together with social distancing. Conversely, factors hindering resilience included COVID-19-anxiety, COVID-19-related PTSD symptoms, intolerance of uncertainty, loneliness, living with children, higher education, and living in regions where the virus was starting to spread. In conclusion, the ecological resilience model in the COVID-19 pandemic explained 64% of the variance and identified factors promoting or hindering resilient outcomes. Critically, these findings can inform psychological interventions supporting individuals by strengthening factors associated with resilience.

Residential green space structures are associated with a lower risk of bipolar disorder: A nationwide population-based study in Taiwan

Although many researchers have identified the potential psychological benefits offered by greenness, the association between green space structures and mental disorders is not well understood. The purpose of this study was to identify associations between green space structures and the incidence of bipolar disorder. To this end, we investigated 1,907,776 individuals collected from Taiwan's National Health Insurance Research Database. After a follow-up investigation from 2005 to 2016, among those with no history of bipolar disorder, 20,548 individuals were further found to be diagnosed with bipolar disorder. A geographic information system and landscape index were used to quantify three indices of green space structures: mean patch area (area and edge), mean fractal dimension index (shape), and mean proximity index (proximity). Additionally, greenness indices, the normalized difference vegetation index, and the enhanced vegetation index were used to confirm the association between greenness and incidence of bipolar disorder. These five indices were used to represent the individual's exposure according to the township of the hospital that they most frequently visited with symptoms of the common cold. Spearman's correlation analysis was performed to select variables by considering their collinearity. Subsequently, the frailty model for each index was used to examine the specific associations between those respective indices and the incidence of bipolar disorder by adjusting for related risk factors, such as socioeconomic status, metabolic syndrome, and air pollution. A negative association was identified between the mean patch area and the mean proximity index, and the incidence of bipolar disorder. In contrast, a positive association was found between the mean fractal dimension index and the incidence of bipolar disorder. We observed similar results in sensitivity testing and subgroup analysis. Exposure to green spaces with a larger area, greater proximity, lower complexity, and greener area may reduce the risk of bipolar disorder.

Identifying risk factors involved in the common versus specific liabilities to substance use: A genetically informed approach

Individuals most often use several rather than one substance among alcohol, cigarettes or cannabis. This widespread co-occurring use of multiple substances is thought to stem from a common liability that is partly genetic in origin. Genetic risk may indirectly contribute to a common liability to substance use through genetically influenced mental health vulnerabilities and individual traits. To test this possibility, we used polygenic scores indexing mental health and individual traits and examined their association with the common versus specific liabilities to substance use. We used data from the Avon Longitudinal Study of Parents and Children (N = 4218) and applied trait-state-occasion models to delineate the common and substance-specific factors based on four classes of substances (alcohol, cigarettes, cannabis and other illicit substances) assessed over time (ages 17, 20 and 22). We generated 18 polygenic scores indexing genetically influenced mental health vulnerabilities and individual traits. In multivariable regression, we then tested the independent contribution of selected polygenic scores to the common and substance-specific factors. Our results implicated several genetically influenced traits and vulnerabilities in the common liability to substance use, most notably risk taking (bstandardised = 0.14; 95% confidence interval [CI] [0.10, 0.17]), followed by extraversion (bstandardised = -0.10; 95% CI [-0.13, -0.06]), and schizophrenia risk (bstandardised = 0.06; 95% CI [0.02, 0.09]). Educational attainment (EA) and body mass index (BMI) had opposite effects on substance-specific liabilities such as cigarette use (bstandardised-EA = -0.15; 95% CI [-0.19, -0.12]; bstandardised-BMI = 0.05; 95% CI [0.02, 0.09]) and alcohol use (bstandardised-EA = 0.07; 95% CI [0.03, 0.11]; bstandardised-BMI = -0.06; 95% CI [-0.10, -0.02]). These findings point towards largely distinct sets of genetic influences on the common versus specific liabilities.

Depression and Anxiety During the COVID-19 Pandemic in an Urban, Low-Income Public University Sample

Mental health disparities in the aftermath of national disasters and the protective role of socioeconomic status are both well documented. We assessed the prevalence of depression and anxiety symptoms among underresourced public university students during the COVID-19 pandemic in New York City. Between April 8, 2020, and May 2, 2020, adult students (N = 1,821) across the CUNY system completed an online survey examining COVID-19-related stressors and mental health and sociodemographic factors. Using multivariable logistical regression to assess the association between COVID-19-related stressors and depression and anxiety symptoms, we found a high prevalence and severity of depression and anxiety symptoms. We also observed that more exposure to COVID-19-related stressors was associated with increased depressive (27.0%, 41.4%, and 63.1% for low-, medium-, and high-level stressors, respectively) and anxiety symptoms (19.3%, 34.6%, 52.2%). In addition, the degree of exposure to COVID-19-related stressors served as an important predictor of depression and anxiety symptoms. Compared to high levels of stressors, the odds of depression were 0.2, 95% CI [0.2, 0.3] for low- and 0.4, 95% CI [0.3, 0.5] for medium-level stressors; for anxiety, the odds were 0.2, 95% CI [0.2, 0.3] for low and 0.05, 95% CI [0.4, 0.6] for medium stressors. Finally, household savings of less than $5,000 increased the risk of anxiety but not depression symptoms, OR = 1.3, 95% CI [1.0,1.6]. Together, these findings tell a devastating story of psychological distress among students from lower socioeconomic groups living in the COVID-19 epicenter of the U.S. pandemic.

The practitioners' perspective on the upside and downside of applying social capital concept in therapeutic settings

Social capital, and more particularly the social networks that define its existence, is said to benefit health and well-being. In individuals recovering from alcohol and drug addiction, social capital accruing from social networks support treatment, recovery and maintenance. Therefore, the concept of social capital is important for public health practitioners working in recovery interventions. This qualitative study seeks to explore what practitioners perceive as the importance of social capital and how they apply the concept in interventions to support individuals recovering from drug and alcohol addiction. Eight public health practitioners involved in drug and substance abuse interventions in West Yorkshire, England, were interviewed. The results of the interview were then deductively coded using two priori themes of perceived impact of social capital on health outcomes and application of social capital theory in recovery interventions. The findings reveal that practitioners understand the impact of social capital as the effects of social networks on recovery and apply the concept in their interventions. However, the nature of interventions created based on similarities in condition (alcohol and substance addiction) and intended outcome (recovery) create bonding social capital with mixed outcomes. This paper argues that the wider benefits to service users are unintentionally inhibited by the overwhelming downsides of bonding social capital. For instance, closed support groups comprised of individuals with high similarities further exclude the already socioeconomically deprived service users from integrating and accessing resources outside their groups.

Genetic Associations Between Childhood Psychopathology and Adult Depression and Associated Traits in 42 998 Individuals: A Meta-analysis

Importance

Adult mood disorders are often preceded by behavioral and emotional problems in childhood. It is yet unclear what explains the associations between childhood psychopathology and adult traits.

Objective

To investigate whether genetic risk for adult mood disorders and associated traits is associated with childhood disorders.

Design, Setting, and Participants

This meta-analysis examined data from 7 ongoing longitudinal birth and childhood cohorts from the UK, the Netherlands, Sweden, Norway, and Finland. Starting points of data collection ranged from July 1985 to April 2002. Participants were repeatedly assessed for childhood psychopathology from ages 6 to 17 years. Data analysis occurred from September 2017 to May 2019.

Exposures

Individual polygenic scores (PGS) were constructed in children based on genome-wide association studies of adult major depression, bipolar disorder, subjective well-being, neuroticism, insomnia, educational attainment, and body mass index (BMI).

Main Outcomes and Measures

Regression meta-analyses were used to test associations between PGS and attention-deficit/hyperactivity disorder (ADHD) symptoms and internalizing and social problems measured repeatedly across childhood and adolescence and whether these associations depended on childhood phenotype, age, and rater.

Results

The sample included 42 998 participants aged 6 to 17 years. Male participants varied from 43.0% (1040 of 2417 participants) to 53.1% (2434 of 4583 participants) by age and across all cohorts. The PGS of adult major depression, neuroticism, BMI, and insomnia were positively associated with childhood psychopathology (β estimate range, 0.023-0.042 [95% CI, 0.017-0.049]), while associations with PGS of subjective well-being and educational attainment were negative (β, -0.026 to -0.046 [95% CI, -0.020 to -0.057]). There was no moderation of age, type of childhood phenotype, or rater with the associations. The exceptions were stronger associations between educational attainment PGS and ADHD compared with internalizing problems (Δβ, 0.0561 [Δ95% CI, 0.0318-0.0804]; ΔSE, 0.0124) and social problems (Δβ, 0.0528 [Δ95% CI, 0.0282-0.0775]; ΔSE, 0.0126), and between BMI PGS and ADHD and social problems (Δβ, -0.0001 [Δ95% CI, -0.0102 to 0.0100]; ΔSE, 0.0052), compared with internalizing problems (Δβ, -0.0310 [Δ95% CI, -0.0456 to -0.0164]; ΔSE, 0.0074). Furthermore, the association between educational attainment PGS and ADHD increased with age (Δβ, -0.0032 [Δ 95% CI, -0.0048 to -0.0017]; ΔSE, 0.0008).

Conclusions and Relevance

Results from this study suggest the existence of a set of genetic factors influencing a range of traits across the life span with stable associations present throughout childhood. Knowledge of underlying mechanisms may affect treatment and long-term outcomes of individuals with psychopathology.

Psychological symptoms of ordinary Chinese citizens based on SCL-90 during the level I emergency response to COVID-19

The World Health Organization (WHO) has declared that the Corona Virus (COVID-19) has become a global pandemic. This study aimed to investigate the psychological symptoms of ordinary Chinese citizens during the Level I Emergency Response throughout China. From January 31 to February 2 2020, an online questionnaire, Symptom Checklist 90 (SCL-90) was designed, and differences in GSI T-scores among subgroups were examined by ANOVA. Based on a cut-off point of the GSI T-scores of 63, the overall sample was divided into high and low-risk groups. of the 1,060 participants investigated in China, more than 70% of them have moderate and higher level of psychological symptoms specifically elevated scores for obsessive compulsion, interpersonal sensitivity, phobic anxiety, and psychoticism. There were no significant differences between males and females. Those who were of over 50 years old, had an undergraduate education and below, were divorced or widowed, and agricultural workers had significantly more symptoms. However, significantly more minors and medical staff were in the high-risk group. These results show that COVID-19 has a significant adverse socio-psychological influence on ordinary citizens. Therefore, governments should equip psychological health departments and pay attention to the people who are in high-risk groups, providing psychological interventions and assistance.

Suicidal Ideation, Suicidal Attempts, and Self-Harm in the UK Armed Forces

INTRODUCTION

In the UK military, suicide is infrequent and studies of self-harm behavior in this population are rare.

OBJECTIVES

To compare lifetime self-harm rates estimated on three occasions between 2004 and 2016 and to explore the associates of lifetime self-harm.

METHOD

Three phases of a UK AF cohort study (n = 10,272, 9,990, and 8,581, respectively) provided data. Telephone interviews assessed associates of self-harm among cohort members who reported subjective mental health problems in the past 3 years (n = 1,448). Validated measures of mental health and related stigmatization, social support, and help-seeking were obtained.

RESULTS

Lifetime self-harm increased significantly (p < .001) from 1.8% among serving personnel and 3.8% among veterans in 2004/06 to 1.9% and 4.5% in 2007/09 and to 4.2% and 6.6% in 2014/16 in the two groups, respectively. Veterans were consistently significantly more likely to report lifetime self-harm than serving personnel. Significant determinants of lifetime self-harm included current mental disorder symptoms, stigmatization, poor social support, suicidal ideation, and seeking help from formal medical sources.

CONCLUSION

Self-harm has increased over time in the UK serving and veteran community. Suicide prevention should focus on ameliorating mental disorder by encouraging engagement with health care, reducing negative views of mental illness, and fostering social support.

Large-Group One-Session Treatment: Feasibility in Highly Height Fearful Individuals and Predictors of Outcome

Objective

Exposure based large-group one-session treatments (LG-OSTs) proved feasible in different situational fears and showed promising short- and long-term outcomes. Based on prior LG-OST protocols we explored feasibility and effectiveness of an LG-OST protocol in four cohorts of individuals highly fearful of heights (N = 104). Moreover, we aimed to identify predictors of LG-OST outcome in order to provide individualized treatment recommendations in the future.

Methods

Participants’ fear of heights was assessed at pre- and post-treatment as well as at 5 months follow-up using questionnaires and a behavioral approach test (BAT). Pre-treatment indices of negative emotional traits and positive mental health, the extent by which fear-evoking expectancies were violated during exposure, and post-treatment group perception processes were assessed in order to predict the outcome.

Results

The LG-OST procedure proved feasible and effective in terms of both subjective and behavioral fear of heights. Post-treatment effects sizes of questionnaires assessing fear of heights ranged between d = 0.94 – 1.43. After the treatment, about half of the participants (49.5%) were able to ascend an aerial fire ladder up to a maximum of 30 m (vs. pre-treatment 17.3%). Follow up results showed the long-term stability of effects. Among psychological constructs, positive mental health and expectancy violation were the strongest predictors of LG-OST long-term outcome.

Conclusion

We conclude that exposure based LG-OSTs are feasible, effective and very efficient compared to individual face-to-face settings. Thus, they represent very promising treatment alternatives for situational fears including fear of heights. Moreover, clinical research may benefit from LG-OST protocols as its high standardization may facilitate the search for mediators and moderators of exposure outcomes.

Bipolar disorder and depression in early adulthood and long-term employment, income, and educational attainment: A nationwide cohort study of 2,390,127 individuals

BACKGROUND

Mood disorders are known to be associated with poor socioeconomic outcomes, but no study has examined these associations across the entire worklife course. Our goal was to estimate the associations between bipolar disorder and depression in early adulthood and subsequent employment, income, and educational attainment.

METHODS

We conducted a nationwide prospective cohort study including all individuals (n = 2,390,127; 49% female) born in Denmark between 1955 and 1990. Hospital-based diagnoses of depression and bipolar disorder before age 25 were obtained from the Danish psychiatric register. Yearly employment, earnings, and education status from ages 25 to 61 were obtained from the Danish labor market and education registers. We estimated both absolute and relative proportions.

RESULTS

Population rates of hospital-diagnosed depression and bipolar between ages 15-25 were 1% and 0.12%, respectively. Compared to individuals without mood disorders, those with depression and particularly bipolar disorder had consistently poor socioeconomic outcomes across the entire work-life span. For example, at age 30, 62% of bipolar and 53% of depression cases were outside the workforce compared to 19% of the general population, and 52% of bipolar and 42% of depression cases had no higher education compared to 27% of the general population. Overall, individuals with bipolar disorder or depression earned around 36% and 51%, respectively, of the income earned by individuals without mood disorders. All associations were smaller for individuals not rehospitalized after age 25.

CONCLUSIONS

Severe mood disorders with onset before age 25, particularly bipolar disorder, are associated with persistent poor socioeconomic outcomes across the entire work-life course.

Socio-economic predictors of depressive symptoms around old age retirement in Swedish women and men

OBJECTIVES

To estimate trajectories of depression around old age retirement in Swedish women and men and examine if socio-economic status predicted the trajectories Methods: The analytic sample comprised 907 women and 806 men from the Swedish Longitudinal Occupational Survey of Health. B-spline smoothers and group-based trajectory modelling were used to identify groups of individuals with similar trajectories of depressive symptoms around retirement. Multinomial regression analyses were conducted to investigate if socio-economic factors were associated with odds of belonging to trajectory groups with higher depression scores.

RESULTS

Four depressive symptoms trajectories were identified in both genders, all showing similar symptom levels across the retirement transition. Low levels of depressive symptoms were observed in the three largest groups. In the last trajectory group among women (2.5%) depression scores were moderate to severe and among men (3.3%) depression scores were persistent moderate. Higher educational level and lower subjectively rated social status were associated with higher odds of belonging to trajectory groups with higher levels of depressive symptoms in both genders.

CONCLUSION

Retirement transition was not associated with symptoms of depression. Higher educational level and lower subjective social status may predict higher depressive symptom levels the years around old age retirement.

Does social and professional establishment at age 30 mediate the association between school connectedness and family climate at age 16 and mental health symptoms at age 43?

BACKGROUND

The aim was to use a theoretical framework developed by Bronfenbrenner in order to investigate if the association between school connectedness and family climate at age 16 and mental health symptoms at age 43 is mediated by social and professional establishment at age 30.

METHODS

Data were drawn from The Northern Swedish Cohort, a prospective population-based cohort. The present study included 506 women and 577 men who responded to questionnaires at age 16 (in year 1981), age 30 (in 1995) and age 43 (in 2008). Mediation was tested by fitting structural equation models (SEM) and estimating direct effects between proximal processes (school connectedness and family climate) and symptoms of depression and anxiety respectively, and indirect effects via social and professional establishment (professional activity, educational level, and civil status).

RESULTS

The standardised estimate for the direct path from school connectedness to depression was -0.147 (p = .000) and the indirect effect mediated by professional activity -0.017 (p = .011) and by civil status -0.020 (p = .002). The standardised direct effect between school connectedness and anxiety was -0.147 (p = .000) and the indirect effect mediated by civil status -0.018 (p = .005). Family climate was not significantly associated with the outcomes or mediators.

LIMITATIONS

Self-reported data; mental health measures not diagnostic; closed cohort; intelligence, personality and home situation before age 16 not accounted for.

CONCLUSIONS

Professional and social establishment in early adulthood appear to partially mediate the association between adolescent school connectedness and mental health symptoms in middle-age.

Psychological distress, anger and quality of life in polycystic ovary syndrome: associations with biochemical, phenotypical andsocio-demographic factors

OBJECTIVE

To investigate the association between polycystic ovary syndrome (PCOS) and psychological disturbances, including anger. To analyze whether the biochemical/phenotypical features of PCOS play a role in the type and severity of psychological disorders.

MATERIAL AND METHODS

This case-control study included 30 PCOS patients meeting NIH criteria and 30 non-PCOS women referring to Reproductive Medicine Unit for infertility. Complete clinical and biochemical screening and the self-reported psychological data [Symptom Check List 90-R (SCL-90-R); Short-Form Health Survey 36 (SF-36); and State-Trait Anger Expression Inventory-2 (STAXI-2)] were collected. Statistical analyses were performed with SPSS-21.

RESULTS

Compared with control women, women with PCOS reported significantly higher scores on SCL-90-R scales of somatization, anxiety, hostility, psychoticism, overall psychological distress and a number of symptoms. At STAXI-2, patients with PCOS scored higher in trait-anger and in the outward expression of anger, while lower in outward anger-control; PCOS patients had significantly lower scores on SF-36 scales of physical functioning and bodily pain. Hirsutism was directly associated with anxiety. Regarding the associations between phenotypical/biochemical features and psychological distress in PCOS patients, results showed that waist-to-hip ratio is inversely related to anxiety, psychoticism, hostility and to the indexes of psychological distress; such inverse relationship was also seen between plasmatic levels of testosterone and trait-anger, and between total cholesterol and hostility.

CONCLUSIONS

Results were consistent with the previous literature on the well-being of PCOS women (in particular for anxiety and quality of life [QoL]) but failed to find evidence for depression. The relationship between psychological distress and the features of the syndrome highlighted the role of hirsutism. With respect to hyperandrogenemia, our data rejected its involvement in the elevated negative mood states and affects. Adopting an interdisciplinary approach in the PCOS patients' care, anger showed to be common and deserves major consideration.

Intergenerational Mobility and Changes in Drug Use Across the Life Course

The consequences of “falling from grace”—or experiencing downward intergenerational mobility—are indeed becoming an abrupt reality for many entering the labor force. Scholars of social mobility speculate that such life course trajectories can result in antisocial behavior, but few have examined whether these trajectories lead to drug use. Thus, with the United States in the midst of a drug epidemic, as well as recovering from an economic recession, the study of social mobility may contribute to a better understanding of what causes individuals to turn to drugs. Using data from The National Longitudinal Study of Adolescent to Adult Health (Add Health) and a series of logistic diagonal reference models, this study examines the association between intergenerational social mobility and drug use. Overall, I find evidence that downward mobility is associated with increases in drug use, with the relationship strongest among those experiencing the greatest loss in status.

Educational inequalities in falls mortality among older adults: population-based multiple cause of death data from Sweden

Background

Falls are the leading cause of fatal injuries among elderly adults. While socioeconomic status including education is a well-documented predictor of many individual health outcomes including mortality, little is known about socioeconomic inequalities in falls mortality among adults. This study aimed to assess educational inequalities in falls mortality among older adults in Sweden using multiple cause of death data.

Methods

All residents aged 50‒75 years in the Skåne region, Sweden, during 1998‒2013 (n=566 478) were followed until death, relocation outside Skåne or end of 2014. We identified any mention of falls on death certificates (n=1047). We defined three levels of education. We used an additive hazards model and Cox regression with age as time scale adjusted for marital status and country of birth to calculate slope and relative indices of inequality (SII/RII). We also computed the population attributable fraction of lower educational attainment. Analyses were performed separately for men and women.

Results

Both SII and RII revealed statistically significant educational inequalities in falls mortality among men in favour of high educated (SII (95% CI): 15.5 (9.8 to 21.3) per 100 000 person-years; RII: 2.19 (1.60 to 3.00)) but not among women. Among men, 34% (95% CI 19 to 46) of falls deaths were attributable to lower education.

Conclusions

There was an inverse association between education and deaths from falls among men but not women. The results suggest that individual’s education should be considered in falls reduction interventions.

Pensionnats autochtones : impact intergénérationnel

Les pensionnats autochtones sont des institutions ayant été en activité de la fin du 19e siècle à la fin du 20e siècle, que des enfants autochtones ont été forcés de fréquenter au Canada. Des enquêtes ont démontré que plusieurs jeunes fréquentant ces institutions y ont été victimes de négligence et de mauvais traitements. Les conséquences négatives découlant des mauvais traitements durant l’enfance ont été amplement documentées, notamment à travers les travaux de la Commission de vérité et réconciliation du Canada. Néanmoins, très peu d’études quantitatives ont été réalisées à ce sujet. L’objectif de cette recherche est de documenter, chez une population autochtone du Québec, les impacts associés à la fréquentation des pensionnats chez les survivants, mais également chez leurs enfants devenus adultes. Au total, 301 participants autochtones ont été rencontrés. Parmi les participants, 26,9 % ont fréquenté les pensionnats et 45,5 % ont un parent qui les a fréquentés. Les résultats indiquent que la fréquentation des pensionnats est associée à une probabilité plus élevée d’avoir vécu des traumas (agression sexuelle, agression physique, violence conjugale, etc.) dans l’enfance ou à l’âge adulte. Les résultats révèlent également que la fréquentation des pensionnats est associée à plusieurs difficultés, notamment à la consommation problématique d’alcool ou de drogues, au jeu problématique et à la détresse psychologique. Les résultats de cette étude soulignent l’importance de tenir compte des conséquences des traumatismes historiques et intergénérationnels liés aux pensionnats dans notre compréhension de la situation actuelle des peuples autochtones du Canada.