Influence of early life characteristics on psychiatric admissions and impact of psychiatric disease on inflammatory biomarkers and survival: a Danish cohort study

Risk of alcohol-associated liver disease in the offspring of parents with alcohol-associated liver disease: A nationwide cohort study

BACKGROUND AND AIMS

Offspring of patients with alcohol-associated liver disease (ALD) may have a higher risk of ALD. We examined their risk of ALD and survival with ALD.

APPROACH AND RESULTS

We used Danish nationwide registries to identify the offspring of patients diagnosed with ALD in 1996-2018 and 20:1 matched comparators from the general population. They were followed for ALD diagnosis through 2018. We used landmark competing risk analysis to estimate the age-specific absolute and relative 10-year risks of ALD. ALD was diagnosed in 385 of 60,707 offspring and 2842 of 1,213,357 comparators during 0.7 and 14.0 million person-years of follow-up, respectively, yielding an incidence rate ratio of 2.73 (95% CI: 2.44-3.03). The risk of being diagnosed with ALD within the next 10 years peaked at age 55 years for offspring and age 57 years for comparators with 10-year risks of 1.66% (95% CI: 1.16-2.30) in offspring and 0.81% (95% CI: 0.68-0.97) in comparators at these ages. Offspring were younger at ALD diagnosis than comparators (median age of 47.4 vs. 48.9 years), yet slightly more of them had developed cirrhosis (60.3% vs. 58.7%). Survival after ALD diagnosis was similar in offspring and comparators, adjusted hazard ratio=1.03 (95% CI: 0.88-1.21), so on average offspring died younger due to their younger age at diagnosis.

CONCLUSIONS

Offspring of patients with ALD had a low but increased risk of ALD. Screening offspring for chronic liver disease may be unnecessary, but other interventions to mitigate alcohol-associated harm should be considered.

Data-Driven Model Building for Life-Course Epidemiology

Life-course epidemiology is useful for describing and analyzing complex etiological mechanisms for disease development, but existing statistical methods are essentially confirmatory, because they rely on a priori model specification. This limits the scope of causal inquiries that can be made, because these methods are suited mostly to examine well-known hypotheses that do not question our established view of health, which could lead to confirmation bias. We propose an exploratory alternative. Instead of specifying a life-course model prior to data analysis, our method infers the life-course model directly from the data. Our proposed method extends the well-known Peter-Clark (PC) algorithm (named after its authors) for causal discovery, and it facilitates including temporal information for inferring a model from observational data. The extended algorithm is called temporal PC. The obtained life-course model can afterward be perused for interesting causal hypotheses. Our method complements classical confirmatory methods and guides researchers in expanding their models in new directions. We showcase the method using a data set encompassing almost 3,000 Danish men followed from birth until age 65 years. Using this data set, we inferred life-course models for the role of socioeconomic and health-related factors on development of depression.

Self-harm, suicidal ideation, and the positive symptoms of psychosis: Cross-sectional and prospective data from a national household survey

BACKGROUND

Schizophrenia is associated with premature mortality, partly through increased suicide rates.

AIMS

To examine (1) if persecutory ideas, auditory hallucinations, and probable cases of psychosis are associated with suicidal thoughts or attempts cross-sectionally and prospectively, and (2) if such links are mediated by specific affective factors (depression, impulsivity, mood instability).

METHOD

We analysed the 2000, 2007, and 2014 British Adult Psychiatric Morbidity Surveys (APMS) separately. Measures of psychosis provided independent variables for multi-stage logistic regressions, with suicidal thoughts and attempts as dependent variables. We also conducted analyses to assess mediation by affective variables, and longitudinal analyses on a subset of the 2000 dataset.

RESULTS

In every dataset, persecutory ideas, auditory hallucinations and probable psychosis were associated cross-sectionally with lifetime suicidal attempts and thoughts, even after controlling for confounders, with a single exception (persecutory ideation and suicide attempts were unconnected in APMS 2014). Cross-sectional associations between auditory hallucinations and suicidal phenomena were moderated by persecutory ideation. In the 2000 follow-up, initial persecutory ideas were associated with later suicidal thoughts (O.R. 1.77, p < 0.05); there were no other longitudinal associations. In the 2007 and 2014 datasets, mood instability mediated the effects of psychotic phenomena on suicidality more strongly than impulsivity; depression was also an important mediator. There were appreciable direct effects of positive symptoms on suicidal thoughts and behaviour.

CONCLUSIONS

Improving psychotic symptoms and ameliorating co-morbid distress may in itself be effective in reducing suicidal risk in schizophrenia. Given their potential mediating role, mood instability and depression may also be targets for intervention.

Body mass index in young adulthood and risk of subsequent dementia at different levels of intelligence and education in Danish men

The risk of dementia seems to be established already early in life, which leads to the question if overweight early in life is an important risk factor for dementia as it appears to be later in life. We examined the association between body mass index (BMI) at entry to adult life and subsequent risk of dementia in men and assessed whether the relationship differed by levels of intelligence and education. The study population consisted of 377,598 Danish men born 1939-1959 with measures of height, weight, intelligence test score (ITS), and educational level (EL) at conscript board examinations around the age of 19 years. Dementia outcomes were obtained from National Patient and Prescription Registries between 1969 and 2016. The association between BMI and dementia was analysed using Cox proportional hazard regression including interactions between BMI and ITS and EL, respectively. During the follow-up through age 77 years, 6144 (1.6%) developed dementia. The frequency was highest in men with lowest BMI, lowest ITS and lowest EL. Young adult BMI below the mean of 21.8 kg/m² was inversely associated with subsequent dementia, whereas there was no association with higher levels of BMI. Adjustment for young adult ITS and EL attenuated the risk estimates slightly, and interaction analyses showed that the shape of the association between BMI and dementia was unaffected by the levels of ITS and EL. Regardless of levels of ITS and EL, young adult BMI below the mean is inversely associated with subsequent dementia, whereas there is no association with higher levels of BMI.

Young adult cognitive ability and subsequent major depression in a cohort of 666,804 Danish men

BACKGROUND

Early life cognitive ability (CA) might influence the risk of developing major depression (MD). The aim was to investigate the association between young adult CA and subsequent MD in relation to different MD disease characteristics.

METHODS

Information on CA was assessed at conscription board examinations 1957-1984 (mean age 19 years) and information on MD was based on hospital diagnosis retrieved from Danish Patient registers 1969-2015. Associations between CA and MD were examined using Cox regression analyses.

RESULTS

A total of 666,804 men (born 1939-1959) were followed and 25,841 (3.9%) developed MD during a mean follow-up of 40.8 years. Lower CA was associated with an increased risk of incident MD. The association was stronger for early-onset (<60 years) (HR_{per1SDdecrease} = 1.23; 95%CI:1.21,1.24) compared to late-onset (≥60 years) MD (HR_{per1SDdecrease} = 1.14; 95%CI:1.11,1.16), but CA was not related to number of depressive episodes. The association was stronger for single depressive episodes (HR_{per1SDdecrease} = 1.21; 95%CI:1.19,1.23) compared to recurrent depression (HR_{per1SDdecrease} = 1.13; 95%CI:1.09,1.16), while the strength of the association did not differ according to MD disease severity (ICD10: mild, moderate, and severe depression).

LIMITATIONS

The study sample only included men and only MD cases diagnosed at hospital were included which limits the generalizability.

CONCLUSION

Low CA could be a risk factor for especially early onset MD in men, whereas the influence of CA on re-occurrence seems less strong. Lower pre-morbid CA increases the risk of MD and should therefore be part of the depression risk assessment in clinical practice.

Schizophrenia and Suicide Attempts: Findings from a Representative Community-Based Canadian Sample

This study examined factors associated with suicide attempts among those with schizophrenia (n = 101) versus those without (n = 21,643) in a representative sample of noninstitutionalized Canadians. The lifetime prevalence of suicide attempts among persons with schizophrenia was 39.2% versus 2.8% of nonafflicted individuals. After adjusting for sociodemographics, childhood adversities, substance abuse/dependence, depression/anxiety, and chronic pain, those with schizophrenia had 6 times the odds (OR = 6.47) of attempting suicide. Among persons with schizophrenia, suicide attempts were associated with female gender (OR = 4.59), substance abuse/dependence (OR = 6.31), depression (OR = 4.93), and childhood physical abuse (OR = 5.75). Community-dwelling persons with schizophrenia appear to be at high risk for suicide attempts.