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Chiu YM, Huang WL, Wang SH, Wu MS, Chen YL, Hsu CC, Wu CS. Estimating expected years of life lost of psychiatric disorders in Taiwan: A Nationwide cohort study. Gen Hosp Psychiatry 2024; 91:25-32. [PMID: 39260189 DOI: 10.1016/j.genhosppsych.2024.08.006] [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: 05/04/2024] [Revised: 08/08/2024] [Accepted: 08/15/2024] [Indexed: 09/13/2024]
Abstract
OBJECTIVES This study employed a national longitudinal cohort to assess expected years of life lost (EYLL) in newly diagnosed psychiatric patients. METHODS Data from Taiwan's National Death Registry and Health Insurance Research Database were scrutinized to identify patients with various psychiatric disorders. Disorders were ranked hierarchically, and age groups were categorized as young, middle-aged, and older adults. We utilized the semiparametric survival extrapolation method to estimate life expectancy (LE) and EYLL. Modifying effect of comorbid conditions and socioeconomic characteristics were also explored. RESULTS Among the 5,757,431 cases, young adults with dementia, alcohol use disorder, schizophrenia, and bipolar disorder experienced an excess of 15 years of EYLL. Middle-aged adults faced approximately 9 years or more of EYLL, while older adults had lower EYLL values. Comorbid conditions, low income levels, and living in rural areas were associated with higher EYLL. CONCLUSIONS This study underscores the substantial EYLL among young adults with psychiatric disorders and the significant impact of specific disorders on EYLL. Early intervention, tailored support, and healthcare system readiness are imperative for improved outcomes. Resource allocation and targeted interventions focusing on early detection and comprehensive treatment can alleviate the economic burden.
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Affiliation(s)
- Ying-Ming Chiu
- Department of Allergy, Immunology, and Rheumatology, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan; Department of Nursing, Jen Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
| | - Wei-Lieh Huang
- Department of Psychiatry, National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan; Department of Psychiatry, College of Medicine, National Taiwan University, Taiwan
| | - Shih-Heng Wang
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan City 350401, Taiwan; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Ming-Shiang Wu
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan City 350401, Taiwan
| | - Yu-Ling Chen
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan City 350401, Taiwan; Department of Physical Education, National Taiwan University of Sport, Taichung City, Taiwan
| | - Chih-Cheng Hsu
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan City 350401, Taiwan; Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Chi-Shin Wu
- Department of Psychiatry, National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan; National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan City 350401, Taiwan.
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Shalaeva E, Bano A, Kasimov U, Atakov S, Mirakhmedova K, Dadabaeva N, Laimer M, Saner H. Depression and anxiety symptoms are underestimated risk factors for postoperative prognosis in patients with Type 2 diabetes and peripheral artery disease undergoing partial foot amputation: Results from a prospective cohort study. J Psychosom Res 2024; 183:111824. [PMID: 38865804 DOI: 10.1016/j.jpsychores.2024.111824] [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: 11/25/2023] [Revised: 06/03/2024] [Accepted: 06/03/2024] [Indexed: 06/14/2024]
Abstract
OBJECTIVE The aim of this study was to evaluate the prevalence and impact of depression and anxiety symptoms on post-operative prognosis and 1-year all-cause mortality in a large unique cohort of patients with Type 2 diabetes (T2D) and peripheral artery disease (PAD) after partial foot amputation (PFA). METHODS Prospective cohort study with 1-year follow-up of 785 consecutive patients (mean age 60.9 ± 9.1 years; 64.1% males) with T2D and PAD after PFA. Depressive symptoms were assessed by Patient Health Questionnaire-9 (PHQ-9) and anxiety symptoms by Hamilton Anxiety Rating Scale (HARS). We used multivariable Cox proportional hazard models to examine the association of depression and anxiety with all-cause mortality. RESULTS One-year all-cause mortality was 16.9% (n = 133). 331 (42.1%) patients had PHQ-9 score ≥ 10 indicating major depressive disorder. After adjusting for confounders, PHQ-9 score ≥ 10 was associated with an increased risk of 1-year all-cause mortality (HR = 1.68 (95%CI[1.16-2.44], p = 0.006). Depression dimensions of negative self-feeling and suicidal ideations were independently associated with 1-year mortality (HR = 1.26 (95%CI[1.24-1.55], p = 0.029 and HR = 2.37 (95%CI[1.89-2.96], p < 0.001, respectively). Compared to no depression, severe depressive symptoms (cut-off≥20) were associated with increased all-cause mortality (HR = 3.9 (95%CI [1.48-10.29], p = 0.006). Compared to no anxiety, severe anxiety symptoms (cut-off>30) were associated with increased 1-year mortality (HR = 2.25(95%CI [1.26-4.05], p = 0.006). CONCLUSION Depressive symptoms and severe anxiety have shown independently increased risk of 1-year all-cause mortality in patients with T2D and PAD requiring PFA. Our results indicate that screening for anxiety and depression should be considered under these circumstances to identify patients at increased risk to allow appropriate intervention.
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Affiliation(s)
- Evgeniya Shalaeva
- Graduate School for Health Sciences, University of Bern, Hochschulstrasse 4, 3012 Bern, Switzerland; School of Medicine, Central Asian University, 264, Milliy bog St, Mirzo Ulugbek dist, Tashkent 111221, Uzbekistan; Tashkent Medical Academy, 2, Farobiy Street, Таshkent 100109, Uzbekistan.
| | - Arjola Bano
- Institute for Social and Preventive Medicine, University of Bern, Hochschulstrasse 4, 3012 Bern, Switzerland; Department of Cardiology, Inselspital, Bern University Hospital, University Hospital Bern: Inselspital, 3010 Bern, Switzerland.
| | - Ulugbek Kasimov
- Tashkent Medical Academy, 2, Farobiy Street, Таshkent 100109, Uzbekistan
| | - Sarvar Atakov
- Tashkent Medical Academy, 2, Farobiy Street, Таshkent 100109, Uzbekistan
| | | | - Nailya Dadabaeva
- Tashkent Medical Academy, 2, Farobiy Street, Таshkent 100109, Uzbekistan
| | - Markus Laimer
- Clinic for Diabetology, Endocrinology, Nutrition and Metabolism, University Hospital Bern: Inselspital, 3010 Bern, Switzerland.
| | - Hugo Saner
- Institute for Social and Preventive Medicine, University of Bern, Hochschulstrasse 4, 3012 Bern, Switzerland.
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Lundberg J, Cars T, Lampa E, Ekholm Selling K, Leval A, Gannedahl A, Själin M, Björkholm C, Hellner C. Determinants and Outcomes of Suicidal Behavior Among Patients With Major Depressive Disorder. JAMA Psychiatry 2023; 80:1218-1225. [PMID: 37585196 PMCID: PMC10433143 DOI: 10.1001/jamapsychiatry.2023.2833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/09/2023] [Indexed: 08/17/2023]
Abstract
Importance Major depressive disorder (MDD) is an important risk factor of suicidal behavior, but the added burden of suicidal behavior and MDD on the patient and societal level, including all-cause mortality, is not well studied. Also, the contribution of various prognostic factors for suicidal behavior has not been quantified in larger samples. Objective To describe the clinical and societal outcomes, including all-cause mortality, of suicidal behavior in patients with MDD and to explore associated risk factors and clinical management to inform future research and guidelines. Design, Setting, and Participants This population-based cohort study used health care data from the Stockholm MDD Cohort. Patients aged 18 years or older with episodes of MDD diagnosed between January 1, 2012, and December 31, 2017, in any health care setting were included. The dates of the data analysis were February 1 to November 1, 2022. Exposures Patients with MDD with and without records of suicidal behavior. Main Outcomes and Measures The main outcome was all-cause mortality. Secondary outcomes were comorbid conditions, medications, health care resource utilization (HCRU), and work loss. Using Region Stockholm registry variables, a risk score for factors associated with suicidal behavior within 1 year after the start of an MDD episode was calculated. Results A total of 158 169 unipolar MDD episodes were identified in 145 577 patients; 2240 (1.4%) of these episodes, in 2219 patients, included records of suicidal behavior (mean [SD] patient age, 40.9 [18.6] years; 1415 episodes [63.2%] in women and 825 [36.8%] in men). A total of 11 109 MDD episodes in 9574 matched patients with MDD without records of suicidal behavior were included as controls (mean [SD] patient age, 40.8 [18.5] years; 7046 episodes [63.4%] in women and 4063 [36.6%] in men). The all-cause mortality rate was 2.5 per 100 person-years at risk for the MDD-SB group and 1.0 per 100 person-years at risk for the MDD-non-SB group, based on 466 deaths. Suicidal behavior was associated with higher all-cause mortality (hazard ratio, 2.62 [95% CI, 2.15-3.20]), as well as with HCRU and work loss, compared with the matched controls. Patients with MDD and suicidal behavior were younger and more prone to have psychiatric comorbid conditions, such as personality disorders, substance use, and anxiety, at the start of their episode. The most important factors associated with suicidal behavior within 1 year after the start of an MDD episode were history of suicidal behavior and age, history of substance use and sleep disorders, and care setting in which MDD was diagnosed. Conclusions and Relevance This cohort study's findings suggest that high mortality, morbidity, HCRU, and work loss associated with MDD may be substantially accentuated in patients with MDD and suicidal behavior. Use of medication aimed at decreasing the risk of all-cause mortality during MDD episodes should be systematically evaluated to improve long-term outcomes.
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Affiliation(s)
- Johan Lundberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Stockholm, Sweden
| | - Thomas Cars
- Sence Research AB, Uppsala, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Erik Lampa
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Katarina Ekholm Selling
- Sence Research AB, Uppsala, Sweden
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Amy Leval
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Janssen-Cilag AB, Solna, Sweden
| | | | | | | | - Clara Hellner
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Stockholm, Sweden
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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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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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Karpov B, Lipsanen JO, Ritola V, Rosenström T, Saarni S, Pihlaja S, Stenberg JH, Laizane P, Joffe G. The Overall Anxiety Severity and Impairment Scale as an Outcome Measure in Internet-Delivered Cognitive Behavioral Therapy for Anxiety Disorders: Observational Study. J Med Internet Res 2023; 25:e45362. [PMID: 37590055 PMCID: PMC10472172 DOI: 10.2196/45362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 06/20/2023] [Accepted: 06/30/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Internet-delivered cognitive behavioral therapy (iCBT) is effective in the treatment of anxiety disorders. iCBT clinical trials use relatively long and time-consuming disorder-specific rather than transdiagnostic anxiety measurements. Overall Anxiety Severity and Impairment Scale (OASIS) is a brief self-report scale that could offer a universal, easy-to-use anxiety measurement option in disorder-specific and transdiagnostic iCBT programs. OBJECTIVE We aimed to investigate relationships between OASIS and disorder-specific instruments in iCBT. We expected these relationships to be positive. METHODS We investigated patients in original nationwide iCBT programs for generalized anxiety disorder (GAD), obsessive-compulsive disorder, panic disorder, and social anxiety disorder, which were administered by Helsinki University Hospital, Finland. In each program, anxiety symptoms were measured using both disorder-specific scales (the 7-item Generalized Anxiety Disorder scale, Penn State Worry Questionnaire, revised Obsessive-Compulsive Inventory, Panic Disorder Severity Scale, and Social Phobia Inventory) and by OASIS. A general linear model for repeated measures (mixed models) and interaction analysis were used for investigating the changes and relationships in the mean scores of OASIS and disorder-specific scales from the first session to the last one. RESULTS The main effect of linear mixed models indicated a distinct positive association between OASIS and disorder-specific scale scores. Interaction analysis demonstrated relatively stable associations between OASIS and the revised Obsessive-Compulsive Inventory (F822.9=0.09; 95% CI 0.090-0.277; P=.32), and OASIS and the Panic Disorder Severity Scale (F596.6=-0.02; 95% CI -0.108 to -0.065; P=.63) from first the session to the last one, while the 7-item Generalized Anxiety Disorder scale (F4345.8=-0.06; 95% CI -0.109 to -0.017; P=.007), Penn State Worry Questionnaire (F4270.8=-0.52; 95% CI -0.620 to -0.437; P<.001), and Social Phobia Inventory (F862.1=-0.39; 95% CI -0.596 to -0.187; P<.001) interrelated with OASIS more strongly at the last session than at the first one. CONCLUSIONS OASIS demonstrates clear and relatively stable associations with disorder-specific symptom measures. Thus, OASIS might serve as an outcome measurement instrument for disorder-specific and plausibly transdiagnostic iCBT programs for anxiety disorders in regular clinical practice.
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Affiliation(s)
- Boris Karpov
- Department of Psychiatry, Helsinki University Hospital, Helsinki, Finland
| | | | - Ville Ritola
- Department of Psychiatry, Helsinki University Hospital, Helsinki, Finland
| | - Tom Rosenström
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Suoma Saarni
- Department of Psychiatry, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Satu Pihlaja
- Department of Psychiatry, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Jan-Henry Stenberg
- Department of Psychiatry, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | | | - Grigori Joffe
- Department of Psychiatry, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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Russell R, Minhas S, Chandan JS, Subramanian A, McCarthy N, Nirantharakumar K. The risk of all-cause mortality associated with anxiety: a retrospective cohort study using 'The Health Improvement Network' database. BMC Psychiatry 2023; 23:400. [PMID: 37277749 DOI: 10.1186/s12888-023-04877-8] [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: 01/11/2023] [Accepted: 05/16/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Anxiety is a prevalent condition with a substantial associated burden of morbidity. Previous literature investigating effects of anxiety on mortality rates has found conflicting results. This is in part due to inadequate consideration of comorbid depression as a confounder and analysing sub-types of anxiety together. The objective of this study was to compare mortality risks in people diagnosed with anxiety. METHODS We undertook a retrospective cohort study using the 'The Health Improvement Network' database (a UK primary care dataset) between 1st January 2005 to 1st January 2018. 345 903 patients with anxiety (exposed group) were matched to 691 449 unexposed patients. Cox regression analyses were used to adjusted hazard ratios (HRs) for mortality risk. RESULTS During the study period 18 962 patients (5·5%) died in the exposed group compared to 32 288 (4·7%) in the unexposed group. This translated into a crude HR for all of 1·14 (95% CI 1·12 - 1·16), which remained significant after adjustment for key co-variates (including depression) giving a final HR of 1·05 (95% CI 1·03 - 1·07). When broken down by sub-type of anxiety (10·3% (35, 581) had phobias, 82·7% (385,882) has 'other' types, and 7·0% (24,262) had stress related anxiety) there were markedly different effect sizes. The adjusted model for the stress-related anxiety sub-type demonstrated a HR of 0·88 (95% CI 0·80 - 0·97). Conversely, the HR was increased in 'other' sub-types to 1·07 (95% CI 1·05 - 1·09) and non-significant in phobia types of anxiety. CONCLUSION A complex relationship is found between anxiety and mortality. The presence of anxiety slightly increased the risk of death, but this risk varies depending on the type of anxiety diagnosed.
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Affiliation(s)
- Rebecca Russell
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B152TT, UK
| | - Sonica Minhas
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B152TT, UK
| | - Joht Singh Chandan
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B152TT, UK.
| | - Anuradhaa Subramanian
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B152TT, UK
| | | | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B152TT, UK
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Cancer mortality in Common Mental Disorders: A 10-year retrospective cohort study. Soc Psychiatry Psychiatr Epidemiol 2023; 58:309-318. [PMID: 36394636 PMCID: PMC9922233 DOI: 10.1007/s00127-022-02376-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 10/28/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE Individuals with Common Mental Disorders (CMDs) may have a higher cancer mortality. The purpose of this study was to examine cancer-related mortality among patients with CMDs and verify which cancer types are predominantly involved. METHODS We used the Regional Mental Health Registry of the Emilia-Romagna region, in Northern Italy to identify patients aged ≥ 18 years who received an ICD 9-CM diagnosis of CMDs (i.e., depressive and neurotic disorders) over a 10 year period (2008-2017). Information on cause of death was retrieved from the Regional Cause of Death Registry. Comparisons were made with data from the regional population without CMDs. RESULTS Among 101,487 patients suffering from CMDs (55.7% depression; 44.3% neurotic disorders), 3,087 (37.8%) died from neoplasms. The total standardized mortality ratio (SMR) was 1.82 (95% CI 1.78-1.86) while the SMR for all neoplasms was 2.08 (95% CI 2.01-2.16). Individuals of both genders, with both depressive and neurotic disorders had a higher risk of death from almost all cancers compared with the regional population. CONCLUSION Patients with CMDs have considerably higher cancer mortality risk than the general population. Higher mortality was observed for a broad range of cancers associated with different aetiologies. It is imperative to promote cancer awareness, prevention and treatment for people with CMDs.
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Gagnon-Sanschagrin P, Schein J, Urganus A, Serra E, Liang Y, Musingarimi P, Cloutier M, Guérin A, Davis LL. Identifying individuals with undiagnosed post-traumatic stress disorder in a large United States civilian population - a machine learning approach. BMC Psychiatry 2022; 22:630. [PMID: 36171558 PMCID: PMC9519190 DOI: 10.1186/s12888-022-04267-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 09/16/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The proportion of patients with post-traumatic stress disorder (PTSD) that remain undiagnosed may be substantial. Without an accurate diagnosis, these patients may lack PTSD-targeted treatments and experience adverse health outcomes. This study used a machine learning approach to identify and describe civilian patients likely to have undiagnosed PTSD in the US commercial population. METHODS The IBM® MarketScan® Commercial Subset (10/01/2015-12/31/2018) was used. A random forest machine learning model was developed and trained to differentiate between patients with and without PTSD using non-trauma-based features. The model was applied to patients for whom PTSD status could not be confirmed to identify individuals likely and unlikely to have undiagnosed PTSD. Patient characteristics, symptoms and complications potentially related to PTSD, treatments received, healthcare costs, and healthcare resource utilization were described separately for patients with PTSD (Actual Positive PTSD cohort), patients likely to have PTSD (Likely PTSD cohort), and patients without PTSD (Without PTSD cohort). RESULTS A total of 44,342 patients were classified in the Actual Positive PTSD cohort, 5683 in the Likely PTSD cohort, and 2,074,471 in the Without PTSD cohort. While several symptoms/comorbidities were similar between the Actual Positive and Likely PTSD cohorts, others, including depression and anxiety disorders, suicidal thoughts/actions, and substance use, were more common in the Likely PTSD cohort, suggesting that certain symptoms may be exacerbated among those without a formal diagnosis. Mean per-patient-per-6-month healthcare costs were similar between the Actual Positive and Likely PTSD cohorts ($11,156 and $11,723) and were higher than those of the Without PTSD cohort ($3616); however, cost drivers differed between cohorts, with the Likely PTSD cohort experiencing more inpatient admissions and less outpatient visits than the Actual Positive PTSD cohort. CONCLUSIONS These findings suggest that the lack of a PTSD diagnosis and targeted management of PTSD may result in a greater burden among undiagnosed patients and highlights the need for increased awareness of PTSD in clinical practice and among the civilian population.
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Affiliation(s)
- Patrick Gagnon-Sanschagrin
- Analysis Group, Inc., 1190 avenue des Canadiens-de-Montréal, 1190 avenue des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montréal, QC H3B 0G7 Canada
| | - Jeff Schein
- Otsuka Pharmaceutical Development & Commercialization, Inc., 508 Carnegie Center, Princeton, NJ 08540 USA
| | | | - Elizabeth Serra
- Analysis Group, Inc., 1190 avenue des Canadiens-de-Montréal, 1190 avenue des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montréal, QC H3B 0G7 Canada
| | - Yawen Liang
- Analysis Group, Inc., 1190 avenue des Canadiens-de-Montréal, 1190 avenue des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montréal, QC H3B 0G7 Canada
| | | | - Martin Cloutier
- Analysis Group, Inc., 1190 avenue des Canadiens-de-Montréal, 1190 avenue des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montréal, QC H3B 0G7 Canada
| | - Annie Guérin
- Analysis Group, Inc., 1190 avenue des Canadiens-de-Montréal, 1190 avenue des Canadiens-de-Montréal, Tour Deloitte, Suite 1500, Montréal, QC H3B 0G7 Canada
| | - Lori L. Davis
- Research Service, Tuscaloosa Veterans Affairs Medical Center, 3701 Loop Rd East, Tuscaloosa, AL 35404 USA
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama Heersink School of Medicine, 1720 7th Avenue South, Birmingham, AL 35233 USA
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10
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Jaber D, Basheer HA, Elsalem L, Dweib M, Khadra M, Abduljabbar R, Ghazwi R, Alhamad H. Prevalence and Predictive Factors of Masked Depression and Anxiety among Jordanian and Palestinian Couples: A Cross-Sectional Study. Healthcare (Basel) 2022; 10:healthcare10091679. [PMID: 36141291 PMCID: PMC9498670 DOI: 10.3390/healthcare10091679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/22/2022] [Accepted: 08/29/2022] [Indexed: 11/30/2022] Open
Abstract
Although anxiety and depression are among the most prevalent mental disorders worldwide, they continue to gain less attention than their physical counterparts in terms of health care provision and population mentalisation. This cross-sectional study explores and compares the national prevalence of depression and anxiety signs/symptoms and well as identifying associated socio-demographic factors among Jordanian and Palestinian fertile couples. Four-hundred and sixty-nine participants were eligible for inclusion and agreed to participate in the study. The mean score for HAM-A and BDI-II were 12.3 ± 8.2 and 15.30 ± 10.0, respectively. According to the grading of HAM-A and BDI-II, the majority of the participants have graded themselves to be mildly anxious (N = 323, 68.9%) and around one third of participants (N = 148, 31.6%) moderately to severe depressed. The suicidal intent was remarkable and of concern where around 18.6% of participants had suicidal thoughts and wishes. There was a significant correlation between both HAM-score and BDI-II score and age [p = 0.01, p = 0.011, respectively], body weight [p = 0.01, p = 0.006, respectively], and total monthly income [p < 0.001, p < 0.001, respectively]. Our findings ought to alert healthcare professionals and other interested parties that there is a high burden of anxiety and depression symptoms among Jordanian and Palestinian couples. To support Jordanian and Palestinian couples’ mental health, healthcare professionals, researchers, and educators favoured to concentrate on creating efficient and culturally relevant education, preventive, and intervention procedures utilising evidence-based guidelines.
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Affiliation(s)
- Deema Jaber
- Department of Clinical Pharmacy, Faculty of Pharmacy, Zarqa University, Zarqa 13110, Jordan
- Correspondence:
| | - Haneen A. Basheer
- Department of Clinical Pharmacy, Faculty of Pharmacy, Zarqa University, Zarqa 13110, Jordan
| | - Lina Elsalem
- Department of Pharmacology, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Mohammad Dweib
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hebron University, Hebron P720, Palestine
| | - Maysa Khadra
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Jordan, Amman 11942, Jordan
| | - Rami Abduljabbar
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Jordan, Amman 11942, Jordan
| | - Rawan Ghazwi
- Department of Pharmacology, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Hamza Alhamad
- Department of Clinical Pharmacy, Faculty of Pharmacy, Zarqa University, Zarqa 13110, Jordan
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11
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Lindekilde N, Skov O, Skovbakke SJ, Johansen JB, Nielsen JC, Pedersen SS. Anxiety and depression as risk factors for ICD shocks and mortality in patients with an implantable cardioverter defibrillator - A systematic review. Gen Hosp Psychiatry 2022; 78:96-107. [PMID: 35933929 DOI: 10.1016/j.genhosppsych.2022.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/14/2022] [Accepted: 07/19/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine associations between baseline anxiety and depression and occurrence of ICD shocks and risk of mortality in patients with an implantable cardioverter defibrillator (ICD). METHOD We systematically searched EMBASE, PubMed, PsycINFO, and CINAHL for eligible studies fulfilling the predefined criteria. RESULTS We included 37 studies based on 25 different cohorts following 35,003 participants for up to seven years. We observed no association between baseline anxiety nor depression and the occurrence of ICD shocks. More than half of the identified studies (respectively 56% and 60%) indicated a significant association between baseline anxiety or depression and increased risk of mortality (anxiety: n = 5, ranging from Hazard ratios (HR):1.02 [Confidence intervals (CI) 95% 1.00-1.03] to HR:3.45 [CI 95% 1.57-7.60]; depression: n = 6, ranging from HR:1.03 [CI 95% 1.00-1.06] to HR:2.10 [CI 95% 1.44-3.05]). We found a significant association between high methodological quality of the primary study and the detection of a significant association (p < 0.01). CONCLUSIONS Baseline anxiety and depression are associated with increased risk of mortality in patients with an ICD, but not with occurrence of ICD shocks. Inclusion of baseline anxiety and depression in risk stratification of mortality may be warranted.
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Affiliation(s)
- Nanna Lindekilde
- Department of Psychology, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark.
| | - Ole Skov
- Department of Psychology, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Søren J Skovbakke
- Department of Psychology, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Jens B Johansen
- Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark
| | - Jens C Nielsen
- Department of Cardiology, Aarhus University Hospital, Brendstrupgårdsvej, 8200 Aarhus, Denmark & Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark; Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark
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12
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Chang HM, Pan CH, Chen PH, Chen YL, Su SS, Tsai SY, Chen CC, Kuo CJ. Premature death and causes of death among patients with panic disorder and comorbid psychiatric disorders: A nationwide cohort study. J Psychiatr Res 2022; 148:340-347. [PMID: 35202994 DOI: 10.1016/j.jpsychires.2022.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 12/17/2021] [Accepted: 02/14/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Panic disorder (PD) is associated with high psychiatric and physical comorbidity, but the cause of mortality has not been well studied. This study investigated mortality rates and causes of death in an Asian cohort with PD. METHODS We enrolled a nationwide retrospective cohort of 298,466 persons diagnosed with PD from January 1, 2001, to December 31, 2016. Each cohort member was matched with a comparison one randomly selected from the general population with the same sex, age at entry, and birth year. The data of both the PD cohort and the comparison group were linked with the national mortality database to obtain each individual's mortality status. We used mortality rate ratios (MRRs) to compare mortality risks between the patients with PD and the general population. Stratified analysis of mortality risks was performed based on sex and psychiatric comorbidities. RESULTS PD was associated with a slightly increased mortality risk (MRR, 1.14 [99% CI, 1.11-1.17]). The risk of unnatural death (MRR, 2.83 [99% CI, 2.59-3.10]) was significantly higher among the individuals with PD than among the general population, whereas the risk of overall natural death across all categories was not (MRR, 1.01 [99% CI, 0.98-1.04]). The mortality risk was the highest for suicide (MRR, 4.94 [99% CI, 4.32-5.72]) and was higher in women (MRR, 6.37 [99% CI, 5.25-7.96]) than in men (MRR, 3.77 [99% CI, 3.14-4.64]). Comorbid substance use disorders increased the risk of mortality from natural (MRR, 3.23 [99% CI, 2.59-4.14]) and unnatural (MRR, 9.45 [99% CI, 6.29-17.85]) causes. CONCLUSION PD was associated with increased all-cause mortality, especially suicide. Substance use further increased mortality risk in persons with PD. Targeted treatment for substance use and suicide prevention are essential among persons with PD.
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Affiliation(s)
- Hu-Ming Chang
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Chun-Hung Pan
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; Department of Psychology, National Chengchi University, Taipei, Taiwan
| | - Pao-Huan Chen
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yi-Lung Chen
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Sheng-Siang Su
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
| | - Shang-Ying Tsai
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chiao-Chicy Chen
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan; Department of Psychiatry, Mackay Medical College, Taipei, Taiwan
| | - Chian-Jue Kuo
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan.
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13
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Jiang W. Anxiety in individuals with cardiovascular diseases: A narrative review and expert opinion. HEART AND MIND 2022. [DOI: 10.4103/hm.hm_5_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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14
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Ask H, Cheesman R, Jami ES, Levey DF, Purves KL, Weber H. Genetic contributions to anxiety disorders: where we are and where we are heading. Psychol Med 2021; 51:2231-2246. [PMID: 33557968 DOI: 10.1017/s0033291720005486] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Anxiety disorders are among the most common psychiatric disorders worldwide. They often onset early in life, with symptoms and consequences that can persist for decades. This makes anxiety disorders some of the most debilitating and costly disorders of our time. Although much is known about the synaptic and circuit mechanisms of fear and anxiety, research on the underlying genetics has lagged behind that of other psychiatric disorders. However, alongside the formation of the Psychiatric Genomic Consortium Anxiety workgroup, progress is rapidly advancing, offering opportunities for future research.Here we review current knowledge about the genetics of anxiety across the lifespan from genetically informative designs (i.e. twin studies and molecular genetics). We include studies of specific anxiety disorders (e.g. panic disorder, generalised anxiety disorder) as well as those using dimensional measures of trait anxiety. We particularly address findings from large-scale genome-wide association studies and show how such discoveries may provide opportunities for translation into improved or new therapeutics for affected individuals. Finally, we describe how discoveries in anxiety genetics open the door to numerous new research possibilities, such as the investigation of specific gene-environment interactions and the disentangling of causal associations with related traits and disorders.We discuss how the field of anxiety genetics is expected to move forward. In addition to the obvious need for larger sample sizes in genome-wide studies, we highlight the need for studies among young people, focusing on specific underlying dimensional traits or components of anxiety.
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Affiliation(s)
- Helga Ask
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
| | - Rosa Cheesman
- PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Eshim S Jami
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
| | - Daniel F Levey
- Division of Human Genetics, Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- Department of Psychiatry, Veterans Affairs Connecticut Healthcare Center, West Haven, Connecticut
| | - Kirstin L Purves
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Heike Weber
- Department of Psychology, Psychosomatics and Psychotherapy, University of Würzburg, Würzburg, Germany
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15
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Oude Voshaar RC, Aprahamian I, Borges MK, van den Brink RHS, Marijnissen RM, Hoogendijk EO, van Munster B, Jeuring HW. Excess mortality in depressive and anxiety disorders: The Lifelines Cohort Study. Eur Psychiatry 2021; 64:e54. [PMID: 34462033 PMCID: PMC8446070 DOI: 10.1192/j.eurpsy.2021.2229] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background To examine the mortality risk of current and life-time depressive as well as anxiety disorders, whether this risk is moderated by sex or age, and whether this risk can be explained by lifestyle and/or somatic health status. Methods A cohort study (Lifelines) including 141,377 participants (18–93 years) which were followed-up regarding mortality for 8.6 years (range 3.0–13.7). Baseline depressive and anxiety disorders according to Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria were assessed with the Mini International Neuropsychiatric Interview and lifetime diagnoses by self-report. All-cause mortality was retrieved from Statistics Netherlands. Cox-regression was applied to calculate proportional hazard ratios, adjusted for lifestyle (physical activity, alcohol use, smoking, and body mass index) and somatic health status (multimorbidity and frailty) in different models. Results The mortality rate of depressive and anxiety disorders was conditional upon age but not on sex. Only in people below 60 years, current depressive and anxiety disorders were associated with mortality. Only depressive disorder and panic disorder independently predicted mortality when all mental disorders were included simultaneously in one overall model (hazard ratio [HR] = 2.18 [95% confidence intervals (CI): 1.56–3.05], p < 0.001 and HR = 2.39 [95% CI: 1.15–4.98], p = 0.020). Life-time depressive and anxiety disorders, however, were independent of each other associated with mortality. Associations hardly changed when adjusted for lifestyle characteristics but decreased substantially when adjusted for somatic health status (in particular physical frailty). Conclusions In particular, depressive disorder is associated with excess mortality in people below 60 years, independent of their lifestyle. This effect seems partly explained by multimorbidity and frailty, which suggest that chronic disease management of depression-associated somatic morbidity needs to be (further) improved.
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Affiliation(s)
- R C Oude Voshaar
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - I Aprahamian
- Faculty of Medicine of Jundiaí, Internal Medicine Department, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Jundiaí, Brazil
| | - M K Borges
- Department of Psychiatry, Universidade Federal do Paraná, Curitiba, Brazil
| | - R H S van den Brink
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - R M Marijnissen
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - E O Hoogendijk
- Department of Epidemiology and Data Science, Amsterdam Public Health research institute, Amsterdam UMC - location VU University Medical Center, Amsterdam, The Netherlands
| | - B van Munster
- Department of Internal Medicine and Geriatrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - H W Jeuring
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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16
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Kim H, Turiano NA, Forbes MK, Kotov R, Krueger RF, Eaton NR. Internalizing psychopathology and all-cause mortality: a comparison of transdiagnostic vs. diagnosis-based risk prediction. World Psychiatry 2021; 20:276-282. [PMID: 34002512 PMCID: PMC8129836 DOI: 10.1002/wps.20859] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Previous studies have documented the utility of a transdiagnostic internalizing factor in predicting important future outcomes (e.g., subsequent mental disorder diagnoses). To date, however, no study has investigated whether an internalizing factor predicts mortality risk. Also, while pre-vious studies of mortality risk have emphasized its associations with particular internalizing disorders, no study has assessed how the transdiagnostic internalizing factor vs. disorder-specific variance differently predict that risk. The primary aims of this study were to explore: a) whether the internalizing factor predicts mortality risk, b) whether particular internalizing psychopathologies uniquely predict mortality risk over and beyond the transdiagnostic internalizing factor, and c) whether there is a significant interaction of internalizing with self-reported health in the prediction of mortality risk. We utilized a large national sample of American adults from the Midlife in the United States (MIDUS), a longitudinal study that examined midlife development of individuals across multiple waves between 1995 and 2015. Data were analyzed for the 6,329 participants who completed the phone interview and self-administered questionnaire in MIDUS 1 (1995-1996) and were then followed up until October 31, 2015 or until death. To investigate the association between internalizing and mortality risk, we used the semi-parametric proportional hazards Cox model, where survival time was regressed on a latent internalizing factor. Overall findings indicate that a transdiagnostic internalizing factor significantly predicts mortality risk over a 20-year period (hazard ratio, HR=1.12, 95% CI: 1.05-1.16, p<0.01) and that internalizing outperforms disorder-specific variance (e.g., depression-specific variance) in the prediction of that risk. Further, there was a significant interaction between transdiagnostic internalizing and self-reported health, whereby internalizing psychopathology had a specific association with early death for individuals with excellent self-reported health condition (HR=1.50, 95% CI: 1.17-1.84, p<0.05). This highlights the clinical utility of using the transdiagnostic internalizing factor for prediction of an important future outcome, and supports the argument that internalizing psychopathology can be a meaningful liability to explore in public health practice.
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Affiliation(s)
- Hyunsik Kim
- Department of PsychologySogang UniversitySeoulSouth Korea
| | | | | | - Roman Kotov
- Department of PsychiatryStony Brook UniversityStony Brook, New YorkNYUSA
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17
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Prevalence and risk factors for anxiety symptoms during the outbreak of COVID-19: A large survey among 373216 junior and senior high school students in China. J Affect Disord 2021; 288:17-22. [PMID: 33839554 PMCID: PMC9754660 DOI: 10.1016/j.jad.2021.03.080] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/23/2021] [Accepted: 03/26/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND The increasing menace of the COVID-19 epidemic led to an atmosphere of anxiety around the world, however the evidence among Chinese students aged 12 to 18 years has been limited. METHODS A total of 373216 junior and senior high school students were recruited using a cluster sampling method in Zhengzhou, Xinxiang, Xinyang city of Henan Province, China, during February 4-12, 2020. Presence of anxiety symptoms was determined by Generalized Anxiety Disorder tool (GAD-7). Multiple logistic regression was performed to estimate the potential risk factors. RESULTS Among the participants, junior and senior high school students were found to have anxiety symptoms, producing an overall prevalence of 9.89%. The prevalence was lower in female than in male (9.66% vs. 10.11%) and the prevalence was higher for junior high school students than senior high school students (13.89% vs. 12.93%). The prevalence of anxiety symptoms was highest among rural students and lowest among urban students (11.33% vs. 8.77%). The cognitive level was negatively associated with the prevalence of anxiety symptoms. After adjusting for potential confounders, age, gender, residential location, worried level, fear level and behavior status were found to be associated with anxiety symptoms. LIMITATIONS Prevalence may be skewed by assessing anxiety symptoms using self-reported scales rather than clinical interviews. CONCLUSIONS This large-scale study assesses the prevalence of anxiety symptoms and its potential influencing factors in junior and senior high school students. These findings suggest that governments need to pay more attention to the mental health of young people in combating COVID-19.
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18
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Hagen JM, Sutterland AL, Liefers T, Schirmbeck F, Cohn DM, Lok A, Tan HL, Zwinderman AH, de Haan L. Skin autofluorescence of advanced glycation end products and mortality in affective disorders in the lifelines cohort study: A mediation analysis. J Affect Disord 2021; 282:1082-1089. [PMID: 33601681 DOI: 10.1016/j.jad.2020.12.202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 12/21/2020] [Accepted: 12/31/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Life expectancy in patients suffering from affective disorders is considerably diminished. We investigated whether skin autofluorescence (SAF), indicating concentration of advanced glycation end products in the skin and oxidative stress, mediates the association between affective disorders and excess mortality. METHODS Included were 81,041 participants of the Lifelines cohort study. Presence of major depressive disorder, dysthymia, generalised anxiety disorder, panic disorder or social phobia was assessed with the Mini-International Neuropsychiatric Interview. SAF was assessed as mediator in Cox proportional hazards models for all-cause or natural-cause mortality. RESULTS Mortality was increased in cases with major depression compared to controls (36.4 vs. 22.5 per 100,000 person years). Partial mediation by SAF of the association between affective disorders and mortality was shown (9.0-10.5%, P<.001-.002), although attenuated by cardiometabolic parameters and history of physical illness. For major depressive disorder, partial mediation by 5.5-10.3% was shown (crude model: P<.001; fully adjusted model: P=.03). LIMITATIONS The relatively short duration of follow-up and the relatively young cohort resulted in a lack of power to detect an association between mortality and dysthymia, social phobia and two or more comorbid disorders. CONCLUSION Evidence of partial mediation by SAF of the association between affective disorders and all-cause and natural-cause mortality was demonstrated, although attenuated by health factors. For major depression, mediation by SAF was largest and remained significant after adjustment for sociodemographic and health factors, identifying oxidative stress as possible determinant of premature death.
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Affiliation(s)
- Julia M Hagen
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands.
| | - Arjen L Sutterland
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands
| | - Tessa Liefers
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands
| | - Frederike Schirmbeck
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands; Arkin Mental Health Institute, Amsterdam, the Netherlands
| | - Danny M Cohn
- Amsterdam UMC, University of Amsterdam, Department of Vascular Medicine, Amsterdam, the Netherlands
| | - Anja Lok
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands; The Amsterdam Public Health research institute, Amsterdam UMC, Amsterdam, the Netherlands
| | - Hanno L Tan
- The Amsterdam Public Health research institute, Amsterdam UMC, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Cardiology, Heart Center, Amsterdam, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands
| | - Aeilko H Zwinderman
- Amsterdam UMC, University of Amsterdam, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam, the Netherlands
| | - Lieuwe de Haan
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam, the Netherlands; Arkin Mental Health Institute, Amsterdam, the Netherlands; The Amsterdam Public Health research institute, Amsterdam UMC, Amsterdam, the Netherlands
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19
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Karlsen HR, Saksvik-Lehouillier I, Stone KL, Schernhammer E, Yaffe K, Langvik E. Anxiety as a risk factor for cardiovascular disease independent of depression: a prospective examination of community-dwelling men (the MrOS study). Psychol Health 2021; 36:148-163. [PMID: 32584189 PMCID: PMC7759580 DOI: 10.1080/08870446.2020.1779273] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Anxiety and depression have been linked to increased risk of cardiovascular disease (CVD). Whether anxiety is a risk factor independent from depression, and if associations are limited to specific CVD outcomes remains unclear. Design: Participants (N = 3135) of the prospective Osteoporotic Fracturs in Men Sleep ancillary study were community-dwelling men (age ≥ 65) living in the US. Main outcome measures: The Goldberg Anxiety and Depression Scales, coronary heart disease (CHD) and cerebrovascular disease (CER). We used Cox proportional hazards models to calculate adjusted hazard ratios and 95% confidence intervals. Results: During 12 years of follow-up, we accrued 612 cases of CHD and 291 cases of CER (incident or repeat-event). Overall, we observed no association between anxiety or depression and CER. Anxiety was significantly associated with CHD, but this effect was attenuated after controlling for depression and covariates. Depression was significantly associated with CHD after similar adjustments. For men without prior history of CVD, neither anxiety nor depression were associated with incident CHD. Conclusions: Anxiety was not a significant independent predictor of CHD or CER, suggesting that previous findings of anxiety as a risk factor of CVD might be attributed to failure to control for the effect of depression.
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Affiliation(s)
- Håvard R. Karlsen
- Department of Psychology, Norwegian University of Science and Technology, Norway
| | | | - Katie L. Stone
- California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - Eva Schernhammer
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Kristine Yaffe
- San Francisco VA Medical Center, San Francisco VA Health Care System, San Francisco, USA; Department of Psychiatry, University of California, San Francisco, San Francisco, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, USA; Department of Neurology, University of California, San Francisco, San Francisco, USA
| | - Eva Langvik
- Department of Psychology, Norwegian University of Science and Technology, Norway
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20
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Discrimination and anxiety: Using multiple polygenic scores to control for genetic liability. Proc Natl Acad Sci U S A 2021; 118:2017224118. [PMID: 33384325 DOI: 10.1073/pnas.2017224118] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
An established body of research indicates that discrimination is associated with increased symptoms of anxiety and negative affect. However, the association cannot be interpreted unambiguously as an exposure effect because a common set of genetic factors can simultaneously contribute to increased liability for symptoms of anxiety, negative affect, and the perception of discrimination. The present study elucidates the association between discrimination and anxiety/negative affect by implementing strict genetic controls in a large sample of adults. We used data from the biomarker project of the Study of Midlife Development in the United States (MIDUS), a national probability sample of noninstitutionalized, English-speaking respondents aged 25 to 74 y. Participants who consented to provide genetic data were biologically unrelated and of European ancestry as determined by genotype principal components analysis (n = 1,146). A single structural regression model was fit to the data with three measures of discrimination specified to load onto a latent factor and six measures of anxiety and negative affect specified to load onto a second latent factor. After accounting for potential genetic confounds-polygenic scores for anxiety, depression, and neuroticism and the first five genetic principal components-greater discrimination was associated with greater anxiety/negative affect (β = 0.53, SE = 0.04, P < 0.001). Findings suggest that measures of perceived discrimination should be considered environmental risk factors for anxiety/negative affect rather than indices of genetic liability for anxiety, depression, or neuroticism. Clinical interventions and prevention measures should focus on ways to mitigate the impact of discrimination to improve mental health at the population level.
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Li Q, Miao Y, Zeng X, Tarimo CS, Wu C, Wu J. Prevalence and factors for anxiety during the coronavirus disease 2019 (COVID-19) epidemic among the teachers in China. J Affect Disord 2020; 277:153-158. [PMID: 32828002 PMCID: PMC7425543 DOI: 10.1016/j.jad.2020.08.017] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/02/2020] [Accepted: 08/05/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To assess the prevalence of anxiety and explore its factors during the Coronavirus Disease 2019 (COVID-19) epidemic among the teachers in China. METHODS We involved 88611 teachers (response rate: 94.75%) from three cities of Henan Province, China, during February 4, 2020 and February 12, 2020. Anxiety was assessed by using Generalized Anxiety Disorder tool (GAD-7). Odds ratios (OR) with 95% Confidence intervals (CI) for potential factors of anxiety were estimated using multiple logistic regression models. RESULTS The overall prevalence of anxiety was 13.67%. The prevalence was higher for women than men (13.89% vs. 12.93%). The highest prevalence of anxiety was 14.06% (SE 2.51%) with age of 60 to 100 years in men, and 14.70% (SE 0.56%) with age of 50 to 60 years in women. Participants located in country-level city school had the lowest prevalence of anxiety across all age categories (12.01% for age of 18-30 years; 12.50% for age of 30-40 years; 12.13% for age of 40-50 years; 9.52% for age of 60-100 years). After adjusting for potential confounders, age, sex, education status, type of teachers, school location, information source, worried level, fear level, and behavior status were found to be associated with anxiety. CONCLUSIONS This large-scale study assessed the prevalence of anxiety in teachers, as well as its potential influence of factors, which is useful for international and national decision-makers.
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Affiliation(s)
- Quanman Li
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, 100, Science Avenue, Gaoxin District, Zhengzhou, Henan 450001, P R China
| | - Yudong Miao
- Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan, P R China
| | - Xin Zeng
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, 100, Science Avenue, Gaoxin District, Zhengzhou, Henan 450001, P R China
| | - Clifford Silver Tarimo
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, 100, Science Avenue, Gaoxin District, Zhengzhou, Henan 450001, P R China
| | - Cuiping Wu
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, 100, Science Avenue, Gaoxin District, Zhengzhou, Henan 450001, P R China
| | - Jian Wu
- Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, 100, Science Avenue, Gaoxin District, Zhengzhou, Henan 450001, P R China.
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22
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Neuvonen E, Hall A, Tolppanen AM, Ngandu T, Rusanen M, Laatikainen T, Soininen H, Kivipelto M, Solomon A. Late-life personality traits, cognitive impairment, and mortality in a population-based cohort. Int J Geriatr Psychiatry 2020; 35:989-999. [PMID: 32363652 DOI: 10.1002/gps.5321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/21/2020] [Accepted: 04/25/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES We examined longitudinal associations between late-life personality traits and cognitive impairment, dementia, and mortality in the population-based Cardiovascular Risk Factors, Aging and Dementia (CAIDE) Study. METHODS Anger expression and trait anger (State-Trait Anger Expression Inventory), anxiety (State-Trait Anxiety Inventory), and sense of coherence (Sense of Coherence Scale) were assessed at the 1998 CAIDE visit (1266 cognitively normal individuals, mean age 71.0 years). Totally, 582 participants had complete re-examination in 2005-2008 (105 mild cognitive impairment, MCI; and 29 dementia). National registers data until 2008 were also used for both participants and nonparticipants to ascertain incident dementia (96 cases) and mortality (227 died). Analyses were adjusted for age, sex, education, follow-up time, cardiovascular and lifestyle factors, and depressive symptoms. RESULTS Higher anxiety was associated with higher risk of MCI/dementia (OR 1.68, 95% CI 1.07-2.63) and death (HR 1.46, 95% CI 1.08-1.98). High sense of coherence was associated with lower mortality (HR 0.65, 95% CI 0.45-0.93). These associations were attenuated after accounting for depressive symptoms (OR 1.57, 95% CI 0.96-2.58 for anxiety-MCI/dementia; HR 1.35, 95% CI 0.97-1.86 for anxiety-mortality; and HR 0.68, 95% CI 0.45-1.04 for sense of coherence-mortality). Trait anger was associated with higher dementia risk even after adjustments (HR 1.90, 95% CI 1.14-3.18). CONCLUSIONS Anxiety was linked to worse cognitive outcome and mortality and sense of coherence to lower mortality. Depressive symptoms attenuated the associations. As a novel finding, trait anger was connected to dementia risk. These findings emphasize the importance of personality-related risk factors for dementia and mortality. J Am Geriatr Soc 68:-, 2020.
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Affiliation(s)
- Elisa Neuvonen
- Institute of Clinical Medicine/Neurology, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Anette Hall
- Institute of Clinical Medicine/Neurology, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Anna-Maija Tolppanen
- Research Centre for Comparative Effectiveness and Patient Safety, University of Eastern Finland, Kuopio, Finland.,School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Tiia Ngandu
- Public Health Promotion Unit, Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland.,Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
| | - Minna Rusanen
- Institute of Clinical Medicine/Neurology, School of Medicine, University of Eastern Finland, Kuopio, Finland.,Public Health Promotion Unit, Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland.,Neurocenter, Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Tiina Laatikainen
- Public Health Promotion Unit, Department of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland.,Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, Kuopio, Finland.,Joint Municipal Authority for North Karelia Social and Health Services (Siun sote), Joensuu, Finland
| | - Hilkka Soininen
- Institute of Clinical Medicine/Neurology, School of Medicine, University of Eastern Finland, Kuopio, Finland.,Neurocenter, Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Miia Kivipelto
- Institute of Clinical Medicine/Neurology, School of Medicine, University of Eastern Finland, Kuopio, Finland.,Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden.,Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, Kuopio, Finland.,Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College London, London, UK
| | - Alina Solomon
- Institute of Clinical Medicine/Neurology, School of Medicine, University of Eastern Finland, Kuopio, Finland.,Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
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23
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The association of anxiety and depression with mortality in a COPD cohort. The HUNT study, Norway. Respir Med 2020; 171:106089. [DOI: 10.1016/j.rmed.2020.106089] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 07/05/2020] [Accepted: 07/10/2020] [Indexed: 02/07/2023]
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24
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Reiner IC, Tibubos AN, Werner AM, Ernst M, Brähler E, Wiltink J, Michal M, Schulz A, Wild PS, Münzel T, Arnold N, Mahmoudpour SH, Lackner KJ, Pfeiffer N, Beutel ME. The association of chronic anxiousness with cardiovascular disease and mortality in the community: results from the Gutenberg Health Study. Sci Rep 2020; 10:12436. [PMID: 32709910 PMCID: PMC7381650 DOI: 10.1038/s41598-020-69427-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 07/03/2020] [Indexed: 11/09/2022] Open
Abstract
In a large German community sample of adults, we investigated the association of chronic anxiousness with cardiovascular disease and mortality. Self-reported anxiousness from 11,643 German adults between 40 and 80 years of age from the Gutenberg Health Study (GHS) was analyzed over 5 years. Multivariable regression modeling assessed the relation between the variables, cardiovascular disease and mortality. Twelve percent of the participants reported consistently raised (chronic) anxiousness over at least 2.5 years. Anxiousness was more often reported by female, younger participants with a lower socioeconomic status, smokers and those with a family history of stroke and myocardial infarction. New onset of cardiovascular disease was linked to chronic anxiousness in men and new onset of anxiousness in women. However, chronic anxiousness did not predict all-cause mortality. Our results revealed that anxiousness is highly prevalent in German adults from middle to old age, affecting women in particular. In our study, we found sex-specific associations between new onset of cardiovascular disease and different forms of anxiousness in men and women. We suggest that even subclinical levels of anxiety need to be considered as cardiovascular risk factors. To elucidate potential harm of anxiousness for mental and physical health, we propose sex-specific analyses in further research studies, taking age and the course of anxiousness into account.
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Affiliation(s)
- Iris C Reiner
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Str. 8, 55131, Mainz, Germany.
| | - Ana N Tibubos
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Str. 8, 55131, Mainz, Germany
| | - Antonia M Werner
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Str. 8, 55131, Mainz, Germany
| | - Mareike Ernst
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Str. 8, 55131, Mainz, Germany
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Str. 8, 55131, Mainz, Germany
| | - Jörg Wiltink
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Str. 8, 55131, Mainz, Germany
| | - Matthias Michal
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Str. 8, 55131, Mainz, Germany
| | - Andreas Schulz
- Preventive Cardiology and Preventive Medicine-Center for Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.,Center for Translational Vascular Biology (CTVB), University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Philipp S Wild
- Preventive Cardiology and Preventive Medicine-Center for Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.,Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Langenbeckstr. 1, 55131, Mainz, Germany.,Center for Translational Vascular Biology (CTVB), University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Thomas Münzel
- Center for Cardiology-Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Langenbeckstr. 1, 55131, Mainz, Germany.,Center for Translational Vascular Biology (CTVB), University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Natalie Arnold
- Center for Cardiology-Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Langenbeckstr. 1, 55131, Mainz, Germany.,Center for Translational Vascular Biology (CTVB), University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Seyed Hamidreza Mahmoudpour
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, Obere Zahlbacher Str. 69, 55131, Mainz, Germany.,Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Karl J Lackner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Norbert Pfeiffer
- Center for Cardiology-Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.,Department of Ophthalmology, University Medical Center Mainz of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Untere Zahlbacher Str. 8, 55131, Mainz, Germany
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25
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Wu Y, Kralj C, Acosta D, Guerra M, Huang Y, Jotheeswaran AT, Jimenez‐Velazquez IZ, Liu Z, Llibre Rodriguez JJ, Salas A, Sosa AL, Alkholy R, Prince M, Prina AM. The association between, depression, anxiety, and mortality in older people across eight low- and middle-income countries: Results from the 10/66 cohort study. Int J Geriatr Psychiatry 2020; 35:29-36. [PMID: 31608478 PMCID: PMC6916169 DOI: 10.1002/gps.5211] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 09/15/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Depression and anxiety are common mental disorders in later life. Few population-based studies have investigated their potential impacts on mortality in low- and middle-income countries (LMICs). The aim of this study is to examine the associations between depression, anxiety, their comorbidity, and mortality in later life using a population-based cohort study across eight LMICs. METHODS This analysis was based on the 10/66 cohort study including 15 991 people aged 65 years or above in Cuba, Dominican Republic, Venezuela, Mexico, Peru, Puerto Rico, China, and India, with an average follow-up time of 3.9 years. Subthreshold and clinical levels of depression were determined using EURO-D and ICD-10 criteria, and anxiety was based on Geriatric Mental State (GMS)-Automated Geriatric Examination for Computer Assisted Taxonomy (AGECAT). Cox proportional hazard modelling was used to estimate how having depression, anxiety, or both was associated with mortality adjusting for sociodemographic and health factors. RESULTS Participants with clinical depression (hazard ratio [HR]: 1.45; 95% CI, 1.24-1.70) and subthreshold anxiety (HR: 1.26; 95% CI, 1.15-1.38) had higher risk of mortality than those without the conditions after adjusting for sociodemographic factors and health conditions. Comorbidity of depression and anxiety was associated with a 30% increased risk of mortality but the effect sizes varied across countries (Higgins I2 = 58.8%), with the strongest association in India (HR: 1.99; 95% CI, 1.21-3.27). CONCLUSIONS Depression and anxiety appear to be associated with mortality in older people living in LMICs. Variation in effect sizes may indicate different barriers to health service access across countries. Future studies may investigate underlying mechanisms and identify potential interventions to reduce the impact of common mental disorders.
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Affiliation(s)
- Yu‐Tzu Wu
- King's College London, Social Epidemiology Research Group, Health Service and Population ResearchInstitute of Psychiatry, Psychology & NeuroscienceLondonUK
| | | | - Daisy Acosta
- Internal Medicine Department, Geriatric SectionUniversidad Nacional Pedro Henriquez Ureña (UNPHU)Santo DomingoDominican Republic
| | - Mariella Guerra
- Psychogeriatric UnitNational Institute of Mental Health Honorio Delgado Hideyo Noguchi, Lima, Peru and Centro de la Memoria y Desordenes RelacionadosLimaPerú
| | - Yueqin Huang
- Peking University, Institute of Mental HealthBeijingChina
| | | | - Ivonne Z. Jimenez‐Velazquez
- Internal Medicine Department, Geriatrics Program, School of Medicine, Medical Sciences CampusUniversity of Puerto RicoSan JuanPuerto Rico
| | - Zhaorui Liu
- Peking University, Institute of Mental HealthBeijingChina
| | | | - Aquiles Salas
- Medicine Department, Caracas University Hospital, Faculty of MedicineUniversidad Central de VenezuelaCaracasVenezuela
| | - Ana Luisa Sosa
- National Institute of Neurology and Neurosurgery of MexicoNational Autonomous University of MexicoMexico CityMexico
| | - Rasha Alkholy
- King's College London, Social Epidemiology Research Group, Health Service and Population ResearchInstitute of Psychiatry, Psychology & NeuroscienceLondonUK
| | - Martin Prince
- King's College LondonGlobal Health InstituteLondonUK
| | - A. Matthew Prina
- King's College London, Social Epidemiology Research Group, Health Service and Population ResearchInstitute of Psychiatry, Psychology & NeuroscienceLondonUK
- King's College LondonGlobal Health InstituteLondonUK
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26
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Schonmann Y, Mansfield KE, Hayes JF, Abuabara K, Roberts A, Smeeth L, Langan SM. Atopic Eczema in Adulthood and Risk of Depression and Anxiety: A Population-Based Cohort Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2020; 8:248-257.e16. [PMID: 31479767 PMCID: PMC6947493 DOI: 10.1016/j.jaip.2019.08.030] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 08/16/2019] [Accepted: 08/16/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Atopic eczema is a common and debilitating condition associated with depression and anxiety, but the nature of this association remains unclear. OBJECTIVE To explore the temporal relationship between atopic eczema and new depression/anxiety. METHODS This matched cohort study used routinely collected data from the UK Clinical Practice Research Datalink, linked to hospital admissions data. We identified adults with atopic eczema (1998-2016) using a validated algorithm, and up to 5 individuals without atopic eczema matched on date of diagnosis, age, sex, and general practice. We estimated the hazard ratio (HR) for new depression/anxiety using stratified Cox regression to account for age, sex, calendar period, Index of Multiple Deprivation, glucocorticoid treatment, obesity, smoking, and harmful alcohol use. RESULTS We identified 526,808 adults with atopic eczema who were matched to 2,569,030 without. Atopic eczema was associated with increased incidence of new depression (HR, 1.14; 99% CI, 1.12-1.16) and anxiety (HR, 1.17; 99% CI, 1.14-1.19). We observed a stronger effect of atopic eczema on depression with increasing atopic eczema severity (HR [99% CI] compared with no atopic eczema: mild, 1.10 [1.08-1.13]; moderate, 1.19 [1.15-1.23]; and severe, 1.26 [1.17-1.37]). A dose-response association, however, was less apparent for new anxiety diagnosis (HR [99% CI] compared with no atopic eczema: mild, 1.14 [1.11-1.18]; moderate, 1.21 [1.17-1.26]; and severe, 1.15; [1.05-1.25]). CONCLUSIONS Adults with atopic eczema are more likely to develop new depression and anxiety. For depression, we observed a dose-response relationship with atopic eczema severity.
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Affiliation(s)
- Yochai Schonmann
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; Clalit Health Services, Department of Family Medicine, Rabin Medical Center, Petah Tikva, Israel; Department of Family Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Kathryn E Mansfield
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Joseph F Hayes
- Division of Psychiatry, University College London, London, United Kingdom; Camden and Islington National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Katrina Abuabara
- Department of Dermatology, University of California San Francisco, San Francisco, Calif
| | - Amanda Roberts
- Nottingham Support Group for Carers of Children with Eczema, Nottingham, United Kingdom
| | - Liam Smeeth
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sinéad M Langan
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; St John's Institute of Dermatology, Guy's & St Thomas' Hospital National Health Service (NHS) Foundation Trust and King's College London, London, United Kingdom; Health Data Research UK, London, United Kingdom
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27
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Himmerich H, Hotopf M, Shetty H, Schmidt U, Treasure J, Hayes RD, Stewart R, Chang CK. Psychiatric comorbidity as a risk factor for the mortality of people with bulimia nervosa. Soc Psychiatry Psychiatr Epidemiol 2019; 54:813-821. [PMID: 30756148 DOI: 10.1007/s00127-019-01667-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 02/04/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Bulimia nervosa (BN) is associated with increased mortality. Frequent comorbidities of BN include substance use disorders, affective disorders and personality disorders (PD). These comorbidities may add an additional risk for mortality. METHODS We investigated the influence of these psychiatric comorbidities on all-cause mortality with demographic and socioeconomic factors considered as confounders over an observation period from January 2007 to March 2016 for 1501 people with BN using anonymised health records data from the South London and Maudsley NHS Foundation Trust (SLaM), retrieved through its Clinical Records Interactive Search (CRIS) data resource. Mortality was ascertained through monthly linkages to the nationwide tracing system administered by the Office for National Statistics (ONS). We used Cox proportional hazards regression to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Multivariable analyses were also performed to estimate effects when controlling for confounding of age, sex, ethnicity, borough, marital status and deprivation score. RESULTS A total of 18 patients with BN died during the observation period. The standardised mortality ratio (SMR) for our study cohort (against the population of England and Wales in 2012 as a standard) was 2.52 (95% CI 1.49-3.97). Cox regressions revealed significant associations of mortality with older age and male gender. Comorbid PD (HR: 3.36; 95% CI 1.05-10.73) was significantly associated with all-cause mortality, even after controlling for demographic and socioeconomic covariates. CONCLUSIONS These results highlight increased mortality in patients with BN and the importance of recognising and treating PDs in patients with BN.
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Affiliation(s)
- Hubertus Himmerich
- Department of Psychological Medicine, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Hitesh Shetty
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Ulrike Schmidt
- Department of Psychological Medicine, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Janet Treasure
- Department of Psychological Medicine, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Richard D Hayes
- Department of Psychological Medicine, King's College London, London, UK
| | - Robert Stewart
- Department of Psychological Medicine, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Chin-Kuo Chang
- Department of Psychological Medicine, King's College London, London, UK.
- South London and Maudsley NHS Foundation Trust, London, UK.
- Department of Health and Welfare, University of Taipei, No. 101, Sec. 2, Jhongcheng Rd, Shilin District, Taipei, 111, Taiwan.
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28
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Santabárbara J, Villagrasa B, López-Antón R, Olaya B, Bueno-Notivol J, de la Cámara C, Gracia-García P, Lobo E, Lobo A. Clinically relevant anxiety and risk of Alzheimer's disease in an elderly community sample: 4.5 years of follow-up. J Affect Disord 2019; 250:16-20. [PMID: 30825716 DOI: 10.1016/j.jad.2019.02.050] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/04/2019] [Accepted: 02/17/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To investigate whether clinically relevant anxiety increased the risk for developing Alzheimer's disease (AD) while controlling for the presence of depression and other confounders; and to report the population attributable fraction (PAF) associated with anxiety disorder. METHOD We used data from the longitudinal, community-based Zaragoza Dementia and Depression (ZARADEMP) study. A random sample of 4057 dementia-free community dwellers aged ≥55 years were followed for 4.5 years. The Geriatric Mental State-Automated Geriatric Examination for Computer Assisted Taxonomy package was used for the diagnosis of clinically significant cases and subcases of anxiety; and AD was diagnosed by a panel of research psychiatrists according to DSM-IV criteria. Multivariate survival analysis with competing risk regression model was performed. RESULTS We observed a significant association between anxiety cases at baseline and AD risk in the univariate analysis that persisted in the fully adjusted model (SHR: 3.90; 95% CI: 1.59-9.60; p = 0.003), with a PAF for AD of 6.11% (95% CI: 1.30%-16.17%). No significant association between 'subcases' of anxiety at baseline and AD risk was found. LIMITATIONS Data on apolipoprotein E were not available. The hospital-based diagnosis was not completed in all cases of dementia. CONCLUSION Late-life, clinically significant anxiety (but not subclinical anxiety) seems to increase the risk of AD, independently of the effect of several confounders, including depression. Taking into account the high prevalence of anxiety among the elderly, future studies are warranted to determine potential risk reduction of AD.
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Affiliation(s)
- J Santabárbara
- Department of Preventive Medicine and Public Health, Universidad de Zaragoza, Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM). Ministry of Science and Innovation, Madrid, Spain
| | - B Villagrasa
- Psychiatry Service. Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - R López-Antón
- Department of Psychology and Sociology. Universidad de Zaragoza, Zaragoza, Spain.
| | - B Olaya
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM). Ministry of Science and Innovation, Madrid, Spain; Research, Innovation and Teaching Unit, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain; Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, Spain
| | - J Bueno-Notivol
- Department of Preventive Medicine and Public Health, Universidad de Zaragoza, Zaragoza, Spain; Psychiatry Service. Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - C de la Cámara
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM). Ministry of Science and Innovation, Madrid, Spain; Psychiatry Service. Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Psychiatry Service. Hospital Universitario Miguel Servet, Zaragoza, Spain; Department of Medicine and Psychiatry. Universidad de Zaragoza, Zaragoza, Spain
| | - P Gracia-García
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM). Ministry of Science and Innovation, Madrid, Spain; Psychiatry Service. Hospital Universitario Miguel Servet, Zaragoza, Spain; Department of Medicine and Psychiatry. Universidad de Zaragoza, Zaragoza, Spain
| | - E Lobo
- Department of Preventive Medicine and Public Health, Universidad de Zaragoza, Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM). Ministry of Science and Innovation, Madrid, Spain
| | - A Lobo
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM). Ministry of Science and Innovation, Madrid, Spain; Department of Medicine and Psychiatry. Universidad de Zaragoza, Zaragoza, Spain
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Park CHK, Lee JW, Lee SY, Shim SH, Kim SG, Lee J, Kim MH, Paik JW, Cho SJ, Moon JJ, Jeon DW, Kim S, Park JH, You S, Jeon HJ, Ahn YM. Characteristics of the "young-old" and "old-old" community-dwelling suicidal Ideators: A longitudinal 6-month follow-up study. Compr Psychiatry 2019; 89:67-77. [PMID: 30597426 DOI: 10.1016/j.comppsych.2018.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 11/20/2018] [Accepted: 12/04/2018] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Despite heterogeneity of older people in suicidal behavior, research identifying characteristics by age groups is scarce. We examined baseline features of older community-dwelling suicidal ideators by dichotomized age groups and the 6-month trajectory of their suicidal ideation along with its related psychopathology. Predictors of suicidal ideation within each group were investigated. METHODS Older community-dwelling suicidal ideators enrolled in the Korean Cohort for the Model Predicting a Suicide and Suicide-related Behavior study were subdivided into the "young-old (65-74 years)" and "old-old (≥75 years)" group. Baseline, 1-, and 6-month assessments were compared. Within each group, multiple regression analysis using rating scales (Patient Health Questionnaire-9, Beck Anxiety Inventory, Alcohol Use Disorders Identification Test, Stress Questionnaire for Korean National Health and Nutrition Examination Survey-Short Form, and Social Relationships Scale) was conducted to identify predictors of suicidal ideation measured with the intensity subscale of the Columbia-Suicide Severity Rating Scale. Two-way repeated-measures analysis of variance (RM-ANOVA) was used to compare changes in suicidal ideation, depression, anxiety between age groups over time, and one-way RM-ANOVA to examine changes within each age group. RESULTS Among 29 "young-old" and 53 "old-old" ideators, the latter were less likely to be receiving psychiatric treatment (odds ratio [OR] = 4.065) and make suicide attempts (OR = 2.874), whereas the former revealed greater levels of anxiety and stress. Baseline depression and stress in the "young-old" group and the "old-old" group, respectively, predicted the intensity of suicidal ideation at both baseline and 1-month assessments. No significant age group x time interactions on suicidal ideation and depression were found. However, within each age group, both suicidal ideation and depression significantly decreased only during the first month with no further improvement. CONCLUSION We speculate cautiously that more attention may need to be paid to the "old-old" ideators in the evaluation of psychiatric issues and for referral to psychiatrists. To decrease suicidal ideation, tailored approaches involving proactive, timely management of depression in the "young-old" and interventions focusing on stress reduction in the "old-old," would be helpful.
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Affiliation(s)
- C Hyung Keun Park
- Department of Neuropsychiatry, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
| | - Jae Won Lee
- Department of Neuropsychiatry, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Sang Yeol Lee
- Department of Psychiatry, Wonkwang University Hospital, 895 Muwang-ro, Iksan, Jeollabuk-do 54538, Republic of Korea
| | - Se-Hoon Shim
- Department of Psychiatry, Soon Chun Hyang University Cheonan Hospital, Soon Chun Hyang University, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan, Chungcheongnam-do 31151, Republic of Korea
| | - Shin Gyeom Kim
- Department of Neuropsychiatry, Soon Chun Hyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon, Gyeonggi-do 14854, Republic of Korea.
| | - Jeewon Lee
- Department of Neuropsychiatry, Soon Chun Hyang University Bucheon Hospital, 170 Jomaru-ro, Wonmi-gu, Bucheon, Gyeonggi-do 14854, Republic of Korea
| | - Min-Hyuk Kim
- Department of Psychiatry, Wonju Severance Christian Hospital, 20 Ilsan-ro, Wonju, Gangwon-do 26426, Republic of Korea.
| | - Jong-Woo Paik
- Department of Psychiatry, Kyung Hee University Medical Center, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Republic of Korea
| | - Seong-Jin Cho
- Department of Psychiatry, Gachon University Gil Medical Center, 21 Namdongdae-ro 774 gil, Namdong-gu, Incheon 21565, Republic of Korea.
| | - Jung-Joon Moon
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan 47392, Republic of Korea
| | - Dong-Wook Jeon
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-ro, Busanjin-gu, Busan 47392, Republic of Korea
| | - Seokho Kim
- Department of Sociology, College of Social Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Jae-Hyun Park
- Department of Social and Preventive Medicine, Sungkyunkwan University College of Medicine, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeonggi-do 16419, Republic of Korea
| | - Sungeun You
- Department of Psychology, College of Social Sciences, Chungbuk National University, 1 Chungdae-ro, Seowon-gu, Cheongju, Chungcheongbuk-do 28644, Republic of Korea.
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea.
| | - Yong Min Ahn
- Department of Neuropsychiatry, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea; Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
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Santabárbara J, Lopez-Anton R, de la Cámara C, Lobo E, Gracia-García P, Villagrasa B, Bueno-Notivol J, Marcos G, Lobo A. Clinically significant anxiety as a risk factor for dementia in the elderly community. Acta Psychiatr Scand 2019; 139:6-14. [PMID: 30306539 DOI: 10.1111/acps.12966] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/03/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate whether clinically significant anxiety is an independent risk factor for dementia, taking into account both depression among potentially confounding factors and the competing risk of death. METHOD During the Zaragoza Dementia and Depression (ZARADEMP) study, a random sample of community dwellers aged 55 years or older was assessed (n = 4803), and a two-wave, 4.5-year follow-up was completed. Geriatric Mental State (GMS)-AGECAT criteria were used to diagnose anxiety and DSM-IV criteria were applied to diagnose incident dementia. The multivariate Fine and Gray regression model was implemented to calculate dementia risk. RESULTS Compared with non-cases (GMS-AGECAT criteria), the incidence rate of dementia was significantly higher in subcases of anxiety, and particularly significant in the cases of anxiety (incidence rate ratio (IRR): 2.77; P = 0.010). Cases of anxiety, but not subcases, at baseline were significantly associated with dementia risk (adjusted subdistribution hazard ratio (SHR): 2.7; P = 0.019). CONCLUSION Clinically significant anxiety is associated with an almost threefold increase in the risk of dementia in the population, even when controlling for depression and considering mortality in the competing risks model.
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Affiliation(s)
- J Santabárbara
- Department of Microbiology, Preventive Medicine and Public Health, Universidad de Zaragoza, Zaragoza, Spain.,Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain
| | - R Lopez-Anton
- Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain.,Department of Psychology and Sociology, Universidad de Zaragoza, Zaragoza, Spain
| | - C de la Cámara
- Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain.,Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain.,Psychiatry Service, Hospital Clínico Universitario, Zaragoza, Spain
| | - E Lobo
- Department of Microbiology, Preventive Medicine and Public Health, Universidad de Zaragoza, Zaragoza, Spain.,Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain
| | - P Gracia-García
- Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain.,Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain.,Psychiatry Service, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - B Villagrasa
- Psychiatry Service, Hospital Clínico Universitario, Zaragoza, Spain
| | - J Bueno-Notivol
- Department of Microbiology, Preventive Medicine and Public Health, Universidad de Zaragoza, Zaragoza, Spain
| | - G Marcos
- Department of Microbiology, Preventive Medicine and Public Health, Universidad de Zaragoza, Zaragoza, Spain.,Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain
| | - A Lobo
- Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain.,Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain
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Mortality Rates and Trends Among Bologna Community Mental Health Service Users: A 13-Year Cohort Study. J Nerv Ment Dis 2018; 206:944-949. [PMID: 30507736 DOI: 10.1097/nmd.0000000000000906] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The present study aimed to determine mortality rates and trends among community mental health service users in Bologna (Italy) between 2001 and 2013. Standardized mortality ratios (SMRs) were calculated, and Poisson multiple regression analysis was performed. The cohort comprised 42,357 patients, of which 3556 died. The overall SMR was 1.62 (95% confidence interval = 1.57-1.67). SMRs for natural causes of death ranged from 1.25 to 2.30, whereas the SMR for violent deaths was 3.45. Both serious and common mental disorders showed a significant excess of mortality, although higher rates were found in severe mental disorders, especially in personality disorders. Different from most published studies, the overall SMR slightly decreased during the study period. The present study, though confirming that people with mental disorders present a higher risk of mortality, calls for prevention strategies oriented to all psychiatric diagnoses.
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Kapitány-Fövény M, Richman MJ, Demetrovics Z, Sulyok M. Do you let me symptomatize? The potential role of cultural values in cross-national variability of mental disorders' prevalence. Int J Soc Psychiatry 2018; 64:756-766. [PMID: 30417725 DOI: 10.1177/0020764018811361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Mental disorders may show inherent cross-national variability in their prevalence. A considerable number of meta-analyses attribute this heterogeneity to the methodological diversity in published epidemiological studies. Cultural values are characteristically not assessed in meta-regression models as potential covariates. AIM Our aim was to conduct a meta-regression analysis to explore to what extent certain cultural values and immigration rates (as indicator of cultural diversity) might be associated with the cross-national heterogeneity of prevalence rates. METHOD To minimize methodological differences that may exert a confounding effect, prevalence rates were obtained from the World Health Organization's (WHO) World Mental Health Survey Initiative. Cultural indices (overall emancipative values; overall secular values) were collected from the World Value Survey, while immigration rates were registered by utilizing the data of the United Nations' World Population Policies 2005 report. RESULTS Meta-regression analysis indicated that overall emancipative values (i.e. promoting self-expression, non-violent protest) showed significant connection with lifetime and last year prevalence of any mood disorders (Z = 4.71, p = .001; Z = 2.35, p = .02) and any internalizing disorders (a merged category that combined mood and anxiety disorders; Z = 2.82, p = .004; Z = 2.34, p = .02). Overall secular values (i.e. rejecting authority and obedience) were negatively associated with last year prevalence of depression (Z = -2.75, p = .06). Multistep regression analysis indicated that immigration rate moderated the connection between cultural values and mental disorders. Countries with higher immigration rates showed higher emancipative and secular values. CONCLUSION Our findings might function as potential foundation for formulating hypotheses regarding the cultural context's influence on the population's mental health.
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Affiliation(s)
- Máté Kapitány-Fövény
- Faculty of Health Sciences, Semmelweis University, Budapest, Hungary.,Nyírő Gyula Hospital Drug Outpatient and Prevention Center, Budapest, Hungary
| | - Mara J Richman
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Zsolt Demetrovics
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Mihály Sulyok
- Department of Neurology and Stroke, Eberhard Karls University, Tübingen, Germany
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Levula A, Harré M, Wilson A. The Association Between Social Network Factors with Depression and Anxiety at Different Life Stages. Community Ment Health J 2018; 54:842-854. [PMID: 29127564 DOI: 10.1007/s10597-017-0195-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 11/04/2017] [Indexed: 10/25/2022]
Abstract
This study examines whether social network factors influence individual's depression and anxiety outcomes at different life stages. Data was drawn from the Household, Income and Labour Dynamics in Australia survey. Hierarchical regression modelling was applied to examine the effects within and across different life stages. The depression and anxiety measures were taken from the Kessler Psychological Distress Scale (K10) and the social network factors were taken from the self-completion questionnaire. With the exception of social trust in seniors, the social network factors were significant predictors of depression and anxiety. This has practical implications for the design of social policy initiatives.
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Affiliation(s)
- Andrew Levula
- Complex Systems Research Group, Faculty of Engineering and Information Technology, The University of Sydney, Sydney, Australia.
| | - Michael Harré
- Complex Systems Research Group, Faculty of Engineering and Information Technology, The University of Sydney, Sydney, Australia
| | - Andrew Wilson
- Menzies Centre for Health Policy, School of Public Health, The University of Sydney, Sydney, Australia
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Colman I, Kingsbury M, Sucha E, Horton NJ, Murphy JM, Gilman SE. Depressive and anxious symptoms and 20-year mortality: Evidence from the Stirling County study. Depress Anxiety 2018; 35:638-647. [PMID: 29719088 PMCID: PMC6035782 DOI: 10.1002/da.22750] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 01/10/2018] [Accepted: 02/17/2018] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Depression and anxiety disorders are highly comorbid, and share significant symptom overlap. Whereas depression has been consistently associated with excess mortality, the association between anxiety and mortality is less clear. Our aim was to identify constellations of anxious and depressive symptoms and examine their associations with mortality. METHOD This study considers respondents from the 1970 (n = 1203) and 1992 (n = 1402) cohorts of the Stirling County study. Symptoms of depression and anxiety were assessed using structured at-home interviews. Vital status of participants through 2011 was determined using probabilistic linkages to the Canadian Mortality Database. RESULTS Exploratory factor analysis yielded three correlated factors in each cohort. Items loading on each factor varied slightly between cohorts, but roughly corresponded to (1) depressive symptoms, (2) anxious symptoms, and (3) somatic symptoms. The depressive factor was associated with increased risk of mortality in both the 1970 (HR: 1.35, 95% CI: 1.12, 1.62) and 1992 (HR: 1.25, 95% CI: 1.05, 1.48) cohorts. Anxious symptoms were associated with a reduced risk of mortality in the 1992 sample (HR: 0.72; 95% CI: 0.53, 0.90). Somatic symptoms were associated with a reduced risk of mortality in the 1970 sample (HR: 0.83, 95% CI: 0.69, 0.99), but an elevated risk of mortality in the 1992 sample (HR: 1.29; 95% CI: 1.11, 1.51). CONCLUSIONS This study provides evidence that symptoms of depression and anxiety may have differential associations with early mortality. Somatic symptoms such as upset stomach and loss of appetite may be protective against mortality, perhaps through increased use of health care services. Conversely, symptoms such as weakness and cold sweats may be indicative of failing health.
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Affiliation(s)
- Ian Colman
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Mila Kingsbury
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Ewa Sucha
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | | | - Jane M. Murphy
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA; Department of Psychiatry, Dalhousie University Faculty of Medicine, Halifax, NS, Canada
| | - Stephen E. Gilman
- Health Behavior Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Stein DJ, Scott KM, de Jonge P, Kessler RC. Epidemiology of anxiety disorders: from surveys to nosology and back. DIALOGUES IN CLINICAL NEUROSCIENCE 2018. [PMID: 28867937 PMCID: PMC5573557 DOI: 10.31887/dcns.2017.19.2/dstein] [Citation(s) in RCA: 127] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
On the basis of epidemiological survey findings, anxiety disorders are the most prevalent mental disorders around the world and are associated with significant comorbidity and morbidity. Such surveys rely on advances in psychiatric nosology and may also contribute usefully to revisions of the nosology. There are a number of questions at the intersection of psychiatric epidemiology and nosology. This review addresses the following: What is the prevalence of anxiety disorders and how do we best explain cross-national differences in prevalence estimates? What are the optimal diagnostic criteria for anxiety disorders, and how can epidemiological data shed light on this question? What are the comorbidities of anxiety disorders, and how do we best understand the high comorbidities seen in these conditions? What is the current treatment gap for anxiety disorders, and what are the implications of current understandings of psychiatric epidemiology and nosology for policy-making relevant to anxiety disorders? Here, we emphasize that anxiety disorders are the most prevalent of the psychiatric conditions, and that rather than merely contrasting cross-national prevalence in anxiety disorders, it is more productive to delineate cross-national themes that emerge about the epidemiology of these conditions. We discuss that optimizing diagnostic criteria for anxiety disorders is an iterative process to which epidemiological data can make a crucial contribution. Additionally, high comorbidity in anxiety disorders is not merely artefactual; it provides key opportunities to explore pathways to mental disorders and to intervene accordingly. Finally, work on the epidemiology and nosology of anxiety disorders has provided a number of important targets for mental health policy and for future integrative work to move between bench and bedside, as well as between clinic and community.
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Affiliation(s)
- Dan J Stein
- University of Cape Town and MRC Unit on Risk & Resilience in Mental Disorders, South Africa
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Huang CJ, Hsieh HM, Chiu HC, Wang PW, Lee MH, Li CY, Lin CH. Impact of Anxiety Disorders on Mortality for Persons With Diabetes: A National Population-Based Cohort Study. PSYCHOSOMATICS 2016; 58:266-273. [PMID: 28189286 DOI: 10.1016/j.psym.2016.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/12/2016] [Accepted: 11/14/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Most studies of the relationship between psychiatric disorders and mortality in patients with diabetes mellitus (DM) have focused on the role of depression. OBJECTIVE The aim of this study was to investigate the impact of anxiety disorders (ADs) on mortality in persons with DM in Taiwan. METHODS We used Taiwan׳s National Health Insurance claims database interlinked externally with Taiwan׳s Death Registry to study mortality in diabetic patients with and without ADs during the study period 2000-2004. Five-year survival cures were calculated using the Kaplan-Meier method for DM with ADs and DM without ADs. Cox regression analysis was used to analyze the predictive factors for DM mortality. RESULTS We identified 5685 persons with DM, including 732 (12.88%) who also had ADs. The 5-year survival was longer for diabetic patients with ADs than those without it. A higher risk of mortality was found in diabetic patients who were male. It was also higher for those who were 45-64 years old and ≥65 years old, those who resided in rural areas, those who had incomes <US$ 666 (NT$ 20,000) or were living on dependent incomes. ADs were found to confer a lower risk of mortality regardless of diabetes type. CONCLUSIONS ADs confer some protection from mortality in patients with DM. Our findings add valuable epidemiological information from a different ethnic population.
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Affiliation(s)
- Chun-Jen Huang
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hui-Min Hsieh
- Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Herng-Chia Chiu
- Department of Healthcare Administration and Medical Informatics, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Peng-Wei Wang
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mei-Hsuan Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chih-Yi Li
- Division of Secretary, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Hua Lin
- Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan.
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