Monthly variation in prevalence rates of comorbid depression and anxiety in the general population at 63-65 degrees North: the HUNT study

Seasonal patterns of sickness absence due to diagnosed mental disorders: a nationwide 12-year register linkage study

AIMS

Although seasonality has been documented for mental disorders, it is unknown whether similar patterns can be observed in employee sickness absence from work due to a wide range of mental disorders with different severity level, and to what extent the rate of change in light exposure plays a role. To address these limitations, we used daily based sickness absence records to examine seasonal patterns in employee sickness absence due to mental disorders.

METHODS

We used nationwide diagnosis-specific psychiatric sickness absence claims data from 2006 to 2017 for adult individuals aged 16-67 (n = 636,543 sickness absence episodes) in Finland, a high-latitude country with a profound variation in daylength. The smoothed time-series of the ratio of observed and expected (O/E) daily counts of episodes were estimated, adjusted for variation in all-cause sickness absence rates during the year.

RESULTS

Unipolar depressive disorders peaked in October-November and dipped in July, with similar associations in all forms of depression. Also, anxiety and non-organic sleep disorders peaked in October-November. Anxiety disorders dipped in January-February and in July-August, while non-organic sleep disorders dipped in April-August. Manic episodes reached a peak from March to July and dipped in September-November and in January-February. Seasonality was not dependent on the severity of the depressive disorder.

CONCLUSIONS

These results suggest a seasonal variation in sickness absence due to common mental disorders and bipolar disorder, with high peaks in depressive, anxiety and sleep disorders towards the end of the year and a peak in manic episodes starting in spring. Rapid changes in light exposure may contribute to sickness absence due to bipolar disorder. The findings can help clinicians and workplaces prepare for seasonal variations in healthcare needs.

Patterns of Associations Between Maternal Symptoms and Child Problem Behaviors: The Mediating Role of Mentalization, Negative Intentionality, and Unsupportive Emotion Socialization

We examined how maternal depression, anxiety, hostility, mentalization, negative intentionality (NI), and unsupportive emotion socialization (UES) predict child internalizing and externalizing problem behaviors (CIEPB). Mothers (N = 537) of toddlers (M_age = 23.26 months, Range 10-44 months) completed the Brief Symptom Inventory, the Parental Reflective Functioning Questionnaire, the Infant Intentionality Questionnaire, the Coping with Children's Negative Emotions Scale, and the Child Behavior Checklist. All maternal symptoms negatively predicted mentalization and positively predicted NI, UES, and CIEPB. NI and UES mediated the relationship between maternal symptoms and CIEPB. Negative intentionality mediated the link between maternal hostility and internalizing behaviors, indicating a possible intervention area. Mentalization had an effect on externalizing behaviors only for high-SES, anxious mothers, underscoring the role of SES. Thus, the relationship between maternal symptoms, cognitive and behavioral parenting characteristics and CIEPB supports the multifinality principle for early childhood psychopathology development and shows the importance of screening for maternal symptoms and CIEPB.

Weather sensitivity associated with quality of life in patients with fibromyalgia

Background

Fibromyalgia is characterized by chronic widespread pain, and more than half of patients with fibromyalgia report that weather-related variables aggravate their symptoms. However, the differences in actual symptoms have not been measured between those with and without weather sensitivity. The present study aimed to investigate whether weather sensitivity associated with the minimal clinically important difference values of quality of life in patients with fibromyalgia, between those with and without weather sensitivity.

Methods

Sixty-four consecutive outpatients with fibromyalgia on their first visit to our tertiary center were included. Weather sensitivity was measured using self-perceived symptoms. Pain intensity was measured using the 0–10 Numerical Rating Scale (NRS). Quality of life was measured using the Euro Quality of life-5 Dimensions-3 level (EQ-5D-3L) scale. The variables were subjected to univariable and multivariable analysis using the EQ-5D-3L scale.

Results

The mean age of the patients was 50 years. Forty-eight patients (75%) were women. The mean EQ-5D-3L score was 0.55. Thirty-seven patients (58%) reported weather sensitivity. In univariable analysis, the welfare recipient, weather sensitivity, and NRS values were associated with EQ-5D-3L scale scores. In multivariable analysis, NRS value and weather sensitivity were independently associated with EQ-5D-3L scale scores. The NRS and EQ-5D-3L scale scores were significantly worse in those with weather sensitivity than those without weather sensitivity. The difference in NRS values was less than 1.5 points between groups. The differences in EQ-5D-3L scale scores were 0.16 points between groups.

Conclusions

Weather sensitivity was significantly associated with quality of life in patients with fibromyalgia. There was an association with weather sensitivity and the minimal clinically important difference values of quality of life in patients with fibromyalgia. The presence of weather sensitivity could have a key role in the quality of life in patients with fibromyalgia.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41927-021-00185-4.

Reduction in anxiety and depression symptoms one year after knee replacement: a register-based cohort study of 403 patients

Background

Anxiety and depression are associated with patient dissatisfaction after total knee arthroplasty (TKA). Understanding whether preoperative knee-related symptoms could be a cause of anxiety and depression might help prevent unnecessary delay of surgery for this group of patients. We investigated changes in prevalence of anxiety and depression symptoms one year after TKA, and compared demographic data between patients with and without anxiety and depression symptoms preoperatively.

Methods

This was a prospective cohort study of 403 patients scheduled for TKA. Data on patient-related outcome measures and the prevalence of anxiety and depression symptoms were collected preoperatively and one year postoperatively. Before–after differences in anxiety/depression prevalence were compared with a chi-square test, and differences in demographic data between the groups with and without anxiety and/or depression symptoms were compared with an independent t test.

Results

Among the 15% of patients with anxiety symptoms before surgery, 59% had improved in these symptoms one year after surgery; while among the 10% with depression symptoms before surgery, 60% had improved one year after surgery. Patients with preoperative anxiety and/or depression were younger, and had higher body mass index, lower general quality of life (EQ-5D-3L), higher pain scores (visual analog scale), and lower knee-related (KOOS) scores on all subscales except sport.

Conclusion

Presurgical symptoms of anxiety and depression seem to be partly caused by knee symptoms. Understanding of this issue would offer better strategies to prevent unnecessary delay of surgery in this group of patients.

The association between PM2.5 exposure and suicidal ideation: a prefectural panel study

Background

Suicidal ideation is subject to serious underestimation among existing public health studies. While numerous factors have been recognized in affecting suicidal thoughts and behaviors (STB), the associated environmental risks have been poorly understood. Foremost among the various environment risks were air pollution, in particular, the PM2.5. The present study attempted to examine the relationship between PM_2.5 level and local weekly index of suicidal ideation (ISI).

Methods

Using Internet search query volumes in Baidu (2017), the largest internet search engine in China, we constructed a prefectural panel data (278 prefectures, 52 weeks) and employed dynamic panel GMM system estimation to analyze the relationship between weekly concentration of PM2.5 (Mean = 87 μg·m^− 3) and the index of suicidal ideation (Mean = 49.9).

Results

The results indicate that in the spring and winter, a 10 μg·m^− 3 increase in the prior week’s PM_2.5 in a Chinese city is significantly associated with 0.020 increase in ISI in spring and a 0.007 increase in ISI in winter, after taking account other co-pollutants and meteorological conditions.

Conclusion

We innovatively proposed the measure of suicidal ideation and provided suggestive evidence of a positive association between suicidal ideation and PM_2.5 level.

Seasonal variation in salivary cortisol but not symptoms of depression and trait anxiety in pregnant women undergoing an elective caesarean section

OBJECTIVES

Seasonal changes in mood and behaviour are commonly reported in the general population but considerably less is known regarding seasonality and pregnancy. This study investigated the relationship between seasons and depression and anxiety symptoms, salivary cortisol concentrations, custom birthweight centiles (CBWC) and placenta weight for pregnant women living in South Wales.

METHODS

This study utilised data from the longitudinal Grown in Wales (GiW) cohort. Women were recruited at the presurgical elective caesarean section (ELCS) appointment, when they provided saliva samples and completed the Edinburgh Postnatal Depression Scale (EPDS) and trait subscale of the State-Trait Anxiety Inventory (STAI). Data on birthweight and placental weight was extracted from medical notes. Seasonal data was available for 316 participants.

RESULTS

No association was identified between seasons and EPDS (p = .178), STAI scores (p = .544), CBWC (p = .683) or placental weight (p = .857). Significance was identified between seasons and salivary cortisol concentration (p<.001), with highest levels in autumn and winter. Adjusted linear regression identified spring (B=-.05, p=.007, 95% CI -.09, -.01) and summer (B=-.06, p = .001, 95% CI -09, -.02) compared to autumn, and spring (B=-.05, p=.009, 95% CI -.09, -.01) and summer (B=-.06, p=.002, 95% CI -.10, -.02) compared to winter to be associated with decreased cortisol concentrations.

CONCLUSION

This study found no association between season and maternally-reported mental health symptoms, birthweight by CBWC or placental weight but did between season and term salivary cortisol. This finding will have implications for studies that do not account for seasonality when using salivary cortisol as a biomarker.

Pessimism predicts anxiety and depression in breast cancer survivors: A 5-year follow-up study

OBJECTIVE

We investigated the prevalence of anxiety and depression at diagnosis and at 1, 3, and 5 years after breast cancer diagnosis. We hypothesized that a low level of optimism (pessimism) at diagnosis could predict change in anxiety and depression 5 years later.

METHODS

Three hundred sixty-seven women with operable breast cancer were included, and data were collected at all five-time points for 293 of these. Anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS). Dispositional optimism/pessimism was measured using the Life Orientation Test-Revised (LOT-R). Frequency analysis was used to determine the prevalence of anxiety and depression. Logistic regression was used to examine dispositional optimism/pessimism as a predictor of change in anxiety and depression 5 years after diagnosis.

RESULTS

The prevalence rates of anxiety and depression 5 years after diagnosis were 26.3% and 9.6%, respectively. Predictors of change in anxiety 5 years after diagnosis were pessimism (odds ratio [OR] = 0.82; 95% confidence interval [CI]: 0.76-0.89, P < .001); younger age (OR = 0.96; 95% CI: 0.93-0.99, P = .005); and anxiety at diagnosis (OR = 2.41; 95% CI: 1.33-4.37, P = .004). Predictors of change in depression 5 years after diagnosis were pessimism (OR = 0.84; 95% CI: 0.77-0.94, P < .001) and comorbidity (OR = 1.51, 95% CI: 1.10-2.06, P = 0.01).

CONCLUSION

Anxiety and depression did not decrease after the first postoperative year. Pessimism was a predictor of change in both anxiety and depression 5 years after breast cancer diagnosis.

Seasonality and symptoms of depression: A systematic review of the literature

AIMS

Lay opinions and published papers alike suggest mood varies with the seasons, commonly framed as higher rates of depression mood in winter. Memory and confirmation bias may have influenced previous studies. We therefore systematically searched for and reviewed studies on the topic, but excluded study designs where explicit referrals to seasonality were included in questions, interviews or data collection.

METHODS

Systematic literature search in Cochrane database, DARE, Medline, Embase, PsychINFO and CINAHL, reporting according to the PRISMA framework, and study quality assessment using the Newcastle-Ottawa scale. Two authors independently assessed each study for inclusion and quality assessment. Due to large heterogeneity, we used a descriptive review of the studies.

RESULTS

Among the 41 included studies, there was great heterogeneity in regards to included symptoms and disorder definitions, operationalisation and measurement. We also observed important heterogeneity in how definitions of 'seasons' as well as study design, reporting and quality. This heterogeneity precluded meta-analysis and publication bias analysis. Thirteen of the studies suggested more depression in winter. The remaining studies suggested no seasonal pattern, seasonality outside winter, or inconclusive results.

CONCLUSIONS

The results of this review suggest that the research field of seasonal variations in mood disorders is fragmented, and important questions remain unanswered. There is some support for seasonal variation in clinical depression, but our results contest a general population shift towards lower mood and more sub-threshold symptoms at regular intervals throughout the year. We suggest future research on this issue should be aware of potential bias by design and take into account other biological and behavioural seasonal changes that may nullify or exacerbate any impact on mood.

Factors associated with alcohol consumption and prescribed drugs with addiction potential among older women and men - the Nord-Trøndelag health study (HUNT2 and HUNT3), Norway, a population-based longitudinal study

BACKGROUND

Little is known about factors associated with alcohol consumption and use of drugs with addiction potential in older adults. The aim of this study was to explore the association between socio-demographic variables, physical and mental health and the later (11 years) use of frequent drinking, prescribed drugs with addiction potential and the possible combination of frequent drinking and being prescribed drugs with addiction potential in older adults (≥ 65 years).

METHODS

In this longitudinal study, we used data from two surveys of the Nord-Trøndelag Health Study (HUNT2 1995-1997 and HUNT3 2006-2008), a population based study in Norway. We totally included 10,656 individuals (5683 women) aged 54 years and older when they participated in HUNT2. Frequent drinking was defined as drinking alcohol 4 days or more per week. Data on prescribed drugs with addiction potential were drawn from the Norwegian Prescription Database. Drugs with addiction potential were defined as at least one prescription of benzodiazepines, z-hypnotics or opioids during one year for a minimum of two consecutive years between 2005 and 2009.

RESULTS

The typical frequent drinker in HUNT3 was younger, more educated, lived in urban areas, and reported smoking and drinking frequently in HUNT2 compared to the non-frequent drinker in HUNT3. The typical user of prescribed drugs with addiction potential in HUNT3 was an older woman who smoked and was in poor health, suffered from anxiety, had been hospitalized in the last 5 years and used anxiety or sleep medication every week or more often in HUNT2. The typical individual in HUNT3 with the possible combination of frequent drinking and being prescribed drugs with addiction potential had more education, smoked, drank frequently and used anxiety or sleep medication in HUNT2.

CONCLUSION

Individuals who were identified as frequent drinkers in HUNT2 were more likely to be frequent drinkers in HUNT3, and to have the possible combination of frequent drinking and being prescribed drugs with addiction potential in HUNT3. Health care professionals need to be aware of use of alcohol among older adults using drugs with addiction potential.

Mortality in older adults with frequent alcohol consumption and use of drugs with addiction potential - The Nord Trøndelag Health Study 2006-2008 (HUNT3), Norway, a population-based study

Background

The aim of this study was to investigate whether frequent drinking, use of drugs with addiction potential and the possible combination of frequent drinking and use of prescribed drugs with addiction potential were associated with all-cause mortality in older adults.

Methods

We used data from the Nord-Trøndelag Health Study (HUNT3 2006–08), a population-based study in Norway. A total of 11,545 (6,084 women) individuals 65 years and older at baseline participated. We assessed frequent drinking (≥ 4 days a week), occasional drinking (i.e. a few times a year), never drinking and non-drinking in the last year. Drugs with addiction potential were defined as at least one prescription of benzodiazepines, z-hypnotics or opioids during one year for a minimum of two consecutive years between 2005 and 2009. This information was drawn from the Norwegian Prescription Database. The main outcome was all-cause mortality with information drawn from the Norwegian Cause of Death Registry. Follow-up continued until death or latest at 31 December 2013. Logistic regression analyses were used to investigate all-cause mortality since date of study entry and exact age at time of death was unknown.

Results

The adjusted logistic regression analyses showed that frequent drinking was not associated with all-cause mortality compared to occasional drinking. Men who reported to be never drinkers and non-drinkers in the last year had higher odds of mortality compared to those who drank occasionally. Use of prescribed drugs with addiction potential was associated with increased mortality in men, but not in women. No association was found between the possible combination of frequent drinking and use of prescribed drugs with addiction potential and mortality.

Conclusion

Neither frequent drinking nor the possible combination of frequent drinking and use of prescribed drugs with addiction potential were associated with all-cause mortality in older women and men. Use of prescribed drugs with addiction potential was associated with higher odds of mortality in men. This finding should lead to more caution in prescribing drugs with addiction potential to this group.

Ambient temperature and solar insolation are associated with decreased prevalence of SSRI-treated psychiatric disorders

Serotonergic function is known to fluctuate in association with light and temperature. Serotonin-related behaviors and disorders similarly vary with climatic exposure, but the associations are complex. This complexity may reflect the importance of dose and timing of exposure, as well as acclimation. This cross-sectional study tests how average climate exposures (ambient temperature and solar insolation) vary with the prevalence of a group of SSRI-treated disorders. For comparison, we similarly studied a group of disorders not treated by SSRIs (i.e substance use disorders). Psychiatric prevalence data were obtained from the Collaborative Psychiatric Epidemiology Surveys (CPES). Average yearly solar insolation was obtained from NASA's NLDAS-2 Forcing Dataset Information. Average yearly temperature was obtained from NOAA's US Climate Normals. Logistic regression models were generated to assess the relationship between these two climatic factors and the prevalence of SSRI-treated and substance use disorders. Age, gender, race, income, and education were included in the models to control for possible confounding. Temperature and insolation were significantly associated with the SSRI-responsive group. For an average 1 GJ/m²/year increase, OR was 0.90 (95% CI 0.85-0.96, p = 0.001), and for an average 10 °F increase, OR was 0.93 (95% CI 0.88-0.97, p = 0.001). This relationship was not seen with substance use disorders (insolation OR: 0.97, p = 0.682; temperature OR: 0.96, p = 0.481). These results warrant further investigation, but they support the hypothesis that chronic exposure to increased temperature and light positively impact serotonin function, and are associated with reduced prevalence of some psychiatric disorders. They also support further investigation of light and hyperthermia treatments.

Seasonal variation of spontaneous blink rate and beta EEG activity

Seasonal variations of the photoperiod have been shown to regulate biological and behavioral functions, with also effects on clinical symptom and course of several psychiatric conditions. Although melatonin is considered the principal signal used to transmit informations about the light and dark cycle, a dopamine (DA) role in regulating seasonal changes has been suggested. Few studies have addressed a seasonal pattern of dopamine, and human studies have been conducted on inter-subject differences, comparing measures obtained during fall-winter with those of spring-summer. We studied within-subject seasonal changes of blink rate (BR), a indirect marker of central DA activity, in 26 normal subjects (15 females and 11 males, mean age: 24.7 ± 4.0) during winter, spring, summer and fall. Occipital EEG activity and subjective measures of vigilance and mood were also assessed to account for variations on arousal and fatigue. A significant seasonal effect was found for BR, with higher rate in summer, and for EEG beta activity, with higher activity in spring and summer. Subjective fatigue was found higher in winter. According to our data, it is possible that higher BR and increased EEG beta activity result by an arousal activation sustained by dopamine systems during the months with a long photoperiod.

Risk Factors for Anxiety in Major Depressive Disorder Patients

Objective

To analyze the sociodemographic and clinical factors related to anxiety in patients with major depressive disorder (MDD).

Methods

This study involved a secondary analysis of data obtained from the Diagnostic Assessment Service for People with Bipolar Disorders in China (DASP), which was initiated by the Chinese Society of Psychiatry (CSP) and conducted from September 1, 2010 to February 28, 2011. Based on the presence or absence of anxiety-related characteristics, 1,178 MDD patients were classified as suffering from anxious depression (n=915) or non-anxious depression (n=263), respectively.

Results

Compared with the non-anxious group, the anxious-depression group had an older age at onset (t=−4.39, p<0.001), were older (t=−4.69, p<0.001), reported more lifetime depressive episodes (z=−3.24, p=0.001), were more likely to experience seasonal depressive episodes (χ²=6.896, p=0.009) and depressive episodes following stressful life events (χ²=59.350, p<0.001), and were more likely to have a family history of psychiatric disorders (χ²=6.091, p=0.014). Their positive and total scores on the Mood Disorder Questionnaire (MDQ) and the 32-item Hypomania Checklist (HCL-32) (p<0.05) were also lower. The logistic regression analysis indicated that age (odds ratio [OR]=1.03, p<0.001), a lower total MDQ score (OR=0.94, p=0.011), depressive episodes following stressful life events (OR=3.04, p<0.001), and seasonal depressive episodes (OR=1.75, p=0.039) were significantly associated with anxious depression.

Conclusion

These findings indicate that older age, fewer subclinical bipolar features, an increased number of depressive episodes following stressful life events, and seasonal depressive episodes may be risk factors for anxiety-related characteristics in patients with MDD.

Monthly variations in self-report of time-specified and typical alcohol use: the Nord-Trøndelag Health Study (HUNT3)

BACKGROUND

Aggregated measures are often employed when prevalence, risk factors and consequences of alcohol use in the population are monitored. In order to avoid time-dependent bias in aggregated measures, reference periods which assess alcohol use over longer time-periods or measures assessing typical alcohol use are considered superior to reference periods assessing recent or current alcohol consumption. Alcohol consumption in the population is found to vary through the months of the year, but it is not known whether monthly variations in actual alcohol use affects self-reports of long-term or typical alcohol consumption. Using data from a large, population-based study with data-collection over two years, the aim of the present study was to examine whether self-reported measures of alcohol use with different reference periods fluctuated across the months of the year.

METHODS

Participants in the third wave of the Nord-Trøndelag Health Survey (HUNT3) answered questions regarding alcohol use in the last 4 weeks, weekly alcohol consumption last twelve months, typical weekly binge drinking and typical number of alcoholic drinks consumed in a 14 day period. For each of the alcohol measures, monthly variations in reporting were estimated and compared to the overall average.

RESULTS

Monthly variations in self-reported alcohol use were found across all alcohol measures regardless of reference period. A general tendency was found for highest level of alcohol use being reported during the summer season, however, the highest number of individuals who reported alcohol use in the last 4 weeks was found in January. Women reported substantially larger increase in weekly binge drinking during the summer months than men.

CONCLUSIONS

Self-reports of alcohol use over longer time and typical alcohol use varies according to the month the respondents are assessed. Monthly variations should therefore be taken into account when designing, analyzing and interpreting data from population-based studies aimed to examine descriptive and analytical characteristics of alcohol use in the population.

Seasonal variation in clinical remission of primary care patients with depression: impact of gender

RATIONALE, AIMS AND OBJECTIVES

The impact of seasonal variation on clinical remission in patients with depression has not been well studied. The hypothesis for this study was that the clinical remission rate would be lower in the winter comparing to the other seasons, specifically evaluated by gender.

METHODS

The study cohort comprised 2873 primary care patients with depression as a longitudinal retrospective chart review analysis. The sample was limited to patients who were continuing in care; dropouts were excluded from the analysis.

RESULTS

Multivariate logistic regression analysis of the independent variables for those participants who achieved clinical remission demonstrated that for the male patients, the season of diagnosis did not impact the rate of remission at 6 months while controlling for all other independent variables. For female patients, those that were diagnosed with depression in the fall had increased likelihood of 6-month remission compared with those patients diagnosed in the winter months (OR 1.300, CI 1.006-1.680, P=0.045) and the spring and summer patients were not significantly different in their outcome rates. When both genders were combined, the odds of remission at 6 months were not statistically significant for any season of diagnosis.

CONCLUSIONS

This study demonstrates that in patients who were continuing care, women who were diagnosed with major depression or dysthymia in the fall season have improved 6-month clinical outcome of remission compared with those women diagnosed in the winter, when controlling for demographic and clinical characteristics. This effect was not seen in men or when the genders were combined into a single cohort. The assessment of the seasonality effect on depression outcomes requires further long-term follow-up studies.

Geographical and climatic factors and depression risk in the SUN project

BACKGROUND

Depression incidence has been related with seasonal periodicity and climate. The aim of the study was to estimate the possible association between depression and specific meteorological factors, namely temperature, light and rain.

METHODS

In total, 13,938 participants from the SUN (Seguimiento Universidad de Navarra) cohort study were included in the analysis. Subjects were classified according to daily mean temperature, number of daylight hours and amount of rain, by year, at their geographical area of residence, data supplied by the Spanish Agency of Meteorology. Participants were considered as incident cases of depression whenever they reported a physician diagnosis of depression or the use of antidepressant medication in any of the follow-up questionnaires. Cox regression models were fit to assess the relationship between climatic and geographical factors and the incidence of depression.

RESULTS

Male subjects living in the south and centre areas of Spain showed a higher risk to develop depression compared with those living in the north area (hazard ratio = 1.6, 95% CI = 1.16-2.23 and hazard ratio = 1.41, 95% CI = 1.06-1.87, respectively). Moreover, among males, a direct association between the number of daily light hours and mean temperature and the risk of depression was also found. For men, living in rainy areas was associated with a lower risk of developing depression.

CONCLUSION

Our results suggest that climate-depression relationship is more complex than previously thought, and strongly different between men and women.

Suicidal behavior in bipolar disorder: epidemiology, characteristics and major risk factors

BACKGROUND

Suicide is one of the leading causes of death and a major public health problem worldwide, and the majority of suicide attempters and completers suffer from some major affective disorder at the time of their death, which, in the majority of cases is unrecognized, under- or misdiagnosed and untreated.

METHODS

Based on a systematic literature search, the authors give a detailed and critical overview of established risk factors of suicide in bipolar disorder.

RESULTS

Among affective disorders, bipolar disorder carries the highest risk of suicide, yet not all bipolar patients commit or even attempt suicide during their illness. While the general suicide risk factors also apply for bipolar disorders, there are several disease-specific risk factors as well which should be taken into account when evaluating suicide risk in case of patients.

CONCLUSION

It is crucial to identify suicide risk factors in bipolar disorder to be able to differentiate those patients within this already increased-risk illness group who are at especially high risk and therefore to allow for better prediction and prevention of suicidal acts.

Suicide attempts versus nonsuicidal self-injury among individuals with anxiety disorders in a nationally representative sample

BACKGROUND

This study is aimed to determine whether anxiety disorders are associated with suicide attempts with intent to die and to further investigate the characteristics of deliberate self-harm (DSH) among anxiety disorders.

METHOD

Data came from the Collaborative Psychiatric Epidemiological Surveys (N = 20,130; age 18 years and older; response rate = 72.3%). DSM-IV anxiety disorders were assessed using the World Mental Health Composite International Diagnostic Interview. People with an anxiety disorder endorsing a history of DSH were subcategorized as those who made suicide attempts (n = 159; individuals who intended to die), versus those who made nonsuicidal self-injuries (n = 85; individuals who did not intend to die).

RESULTS

Anxiety disorders were associated with both suicide attempts and nonsuicidal self-injury (NSSI). People with generalized anxiety disorder and social phobia who engaged in DSH were more likely to have made a suicide attempt than a NSSI, independent of the effects of mood and substance use disorders. In addition, individuals with generalized anxiety disorder and social phobia who engaged in DSH were more likely to engage in this behavior multiple times, and at least one of those times was a suicide attempt.

CONCLUSION

This study suggests that anxiety disorders are associated with suicide attempts with intent to die. Social phobia and generalized anxiety disorder appear to be associated with the more worrisome patterns of DSH including multiple suicide attempts.

Increasing prevalence of depression from 2000 to 2006

AIM

Depression is the leading cause of disability and is projected to become the second highest burden of disease (measured in disability-adjusted life years) by 2020, but only a few studies have examined changes over time in the occurrence of depression. The aim of this study is to provide evidence to the hypothesis that the prevalence of depression is rising in the Danish population. We will do that in a longitudinal design among adult Danes by studying the trends from 2000 to 2006 of major depressive disorder (MDD) as well as the distribution across the whole Major Depression Inventory (MDI) scale. In addition, we will investigate whether the trend in MDD is similar across socioeconomic groups.

METHODS

A random sample of 4759 Danes in their forties and fifties were followed in a longitudinal study based on postal questionnaires answered in 2000 and 2006.

RESULTS

The prevalence of MDD increased from 2.0% to 4.9% during 2000-06. Also the distribution of the MDI score in its entirety moves higher up the scale, with the 90th percentile changing from 12 in year 2000 to 20 in 2006. The increasing prevalence is in absolute terms more pronounced among women in their forties and in lower socioeconomic positions.

CONCLUSIONS

The rising MDI score indicates that MDD as well as mental health generally is of public health concern.

Seasonal variations in sleep problems at latitude 63°-65° in Norway: The Nord-Trondelag Health Study, 1995-1997

Most studies on seasonal variability in sleep have asked participants if they think their sleep quality varies with the seasons, which reveals the research hypothesis to the participants. To date, the hypothesis of seasonal variation in sleep has not been tested in a large population-based fully blinded study. The aim of the current study was to investigate monthly variations in sleep problems in a geographic region of Norway with large seasonal differences in daytime light. Using data from a general health survey, the authors had access to information on sleep in the general population, collected across the seasons over 2 years without linking sleep to seasonal variation. In all, 43,045 participants (mean age, 44.6 years) of the Nord-Trøndelag Health Study, 1995-1997 (referred to as "HUNT-2"), provided reports of insomnia symptoms and time in bed in all months except July. The mean prevalence of insomnia symptoms was 12.4%. No evidence of a seasonal variation on reports of insomnia symptoms or time in bed was found. These null findings are in marked contrast to previous seasonality studies of sleep. Previous studies reporting seasonal variations in sleep and insomnia might have been subject to publication biases and lack of blinding to the research hypothesis.

Does the weather make us sad? Meteorological determinants of mood and depression in the general population

It is a common and well-spread belief that people feel more depressed when the weather is bad. However, whether meteorological factors such as temperature, sunshine and rainfall can actually account for variations in the prevalence of depression in the general population has yet to be investigated. We aimed to assess the influence of weather conditions on the seasonal variation of depression observed in the general population. We used data from a large-scale depression-screening programme in the south of the Netherlands. Seasonal prevalence of DSM-IV classified major depression and sad mood in a sample of 14,478 participants from the general population was calculated, and linked to mean daily temperature, duration of sunshine and duration of rainfall in logistic regression analyses. The prevalence of major depression and sad mood showed seasonal variation, with peaks in the summer and fall. Weather conditions were not associated with mood, and did not explain the seasonal variation we found. We conclude that, contrary to popular belief, weather conditions and sad mood or depression do not seem to be associated. Future studies might use daily measures of well-being as outcome.

A cross-sectional study of mental health and well-being and their associations in the UK veterinary profession

BACKGROUND

Veterinary surgeons are at elevated risk of suicide, with a proportional mortality ratio around four times that of the general population and approximately twice that of other healthcare professions. There has been much speculation regarding possible mechanisms underlying increased suicide risk in the profession but little empirical research. We aimed to assess the contribution of mental health and well-being to the elevated risk, through a postal questionnaire survey of a large stratified random sample of veterinary surgeons practising within the UK.

METHODS

A questionnaire was mailed twice to 3,200 veterinary surgeons. Anxiety and depressive symptoms, alcohol consumption, suicidal ideation, positive mental well-being, perceptions of psychosocial work characteristics, and work-home interaction were assessed using valid and reliable existing instruments and a series of bespoke questions previously developed through informal focus groups.

RESULTS

Evaluable questionnaires were returned by 1,796 participants, a response rate of 56.1%. The demographic and occupational profile of respondents was representative of the UK veterinary profession. The prevalence of 'caseness' (i.e. HADS subscale score >/=8) for anxiety, depression, and co-morbid anxiety and depression was 26.3, 5.8 and 4.5%. 5.4% of respondents were non-drinkers, 32.0% low-risk drinkers, and 62.6% 'at-risk' drinkers (i.e. AUDIT-C score >/=4 for women, >/=5 for men). The 12-month prevalence of suicidal thoughts was 21.3%.

CONCLUSIONS

Compared to the general population, the sample reported high levels of anxiety and depressive symptoms; higher 12-month prevalence of suicidal thoughts; less favourable psychosocial work characteristics, especially in regard to demands and managerial support; lower levels of positive mental well-being; and higher levels of negative work-home interaction. The levels of psychological distress reported suggest ready access to and knowledge of lethal means is probably not operating in isolation to increase suicide risk within the profession.

SPIFA-A presentation of the Structured Psychiatric Interview for General Practice

BACKGROUND

The diagnostic ability of general practitioners (GPs) concerning mental disorders is not optimal, and could be improved by structured diagnostic interviews. Various aspects of the Structured Psychiatric Interview for General Practice (SPIFA) are examined.

AIMS

The inter-rater reliability of the SPIFA, the time used by GPs and specialists and the GPs satisfaction are examined. The properties of the SPIFA are compared with those of the Prime-MD and the MINI schedules.

METHODS

Inter-rater reliability of the SPIFA was tested in 336 patients in general practice. The patients were randomized to two interview strategies. Either both GPs and psychiatrists used the SPIFA, or GPs used the SPIFA and psychiatrists a modified version of the SCID for Axis I disorders. The satisfaction was investigated by a questionnaire sent to 1000 GPs who had SPIFA training.

RESULTS

The SPIFA showed adequate inter-rater reliability for depression, anxiety disorders and increased suicidal risk for both interview strategies. In patients with more than two co-morbid disorders, the inter-rater reliability was poor. The mean duration of SPIFA was 21 min for SPIFA screening and 22 min for SPIFA manual. The 192 GPs responding to the questionnaire were mostly satisfied with the SPIFA.

CONCLUSIONS

The SPIFA seems to be a reliable, valid and helpful instrument for GPs making diagnoses of mental disorders in their patients. Compared with the Prime MD and the MINI, the SPIFA seemed to have comparable psychometric properties but better feasibility in primary care.