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Chen D, Ejlskov L, Laustsen LM, Weye N, Sørensen CLB, Momen NC, Dreier JW, Zheng Y, Damgaard AJ, McGrath JJ, Sørensen HT, Plana-Ripoll O. The Role of Socioeconomic Position in the Association Between Mental Disorders and Mortality: A Systematic Review and Meta-Analysis. JAMA Psychiatry 2024; 81:125-134. [PMID: 37966825 PMCID: PMC10652216 DOI: 10.1001/jamapsychiatry.2023.4316] [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: 06/15/2023] [Accepted: 09/14/2023] [Indexed: 11/16/2023]
Abstract
Importance Studies are lacking summarizing how the association between mental disorders and mortality varies by socioeconomic position (SEP), particularly considering different aspects of SEP, specific types of mental disorders, and causes of death. Objective To investigate the role of SEP in the association between mental disorders and mortality and the association between SEP and mortality among people with mental disorders. Data Sources MEDLINE, Embase, PsycINFO, and Web of Science were searched from January 1, 1980, through April 3, 2023, and a snowball search of reference and citation lists was conducted. Study Selection Inclusion criteria were observational studies estimating the associations between different types of mental disorders and mortality, stratified by SEP and between SEP and mortality in people with mental disorders. Data Extraction and Synthesis Pairs of reviewers independently extracted data using a predefined data extraction form and assessed the risk of bias using the adapted Newcastle-Ottawa scale. Graphical analyses of the dose-response associations and random-effects meta-analyses were performed. Heterogeneity was explored through meta-regressions and sensitivity analyses. Main Outcomes and Measures All-cause and cause-specific mortality. Results Of 28 274 articles screened, 71 including more than 4 million people with mental disorders met the inclusion criteria (most of which were conducted in high-income countries). The relative associations between mental disorders and mortality were similar across SEP levels. Among people with mental disorders, belonging to the highest rather than the lowest SEP group was associated with lower all-cause mortality (pooled relative risk [RR], 0.79; 95% CI, 0.73-0.86) and mortality from natural causes (RR, 0.73; 95% CI, 0.62-0.85) and higher mortality from external causes (RR, 1.18; 95% CI, 0.99-1.41). Heterogeneity was high (I2 = 83% to 99%). Results from subgroup, sensitivity, and meta-regression analyses were consistent with those from the main analyses. Evidence on absolute scales, specific diagnoses, and specific causes of death was scarce. Conclusion and Relevance This study did not find a sufficient body of evidence that SEP moderated the relative association between mental disorders and mortality, but the underlying mortality rates may differ by SEP group, despite having scarcely been reported. This information gap, together with our findings related to SEP and a possible differential risk between natural and external causes of death in individuals with specific types of mental disorders, warrants further research.
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Affiliation(s)
- Danni Chen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Linda Ejlskov
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Lisbeth Mølgaard Laustsen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Nanna Weye
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
- Department of Disease Burden, Norwegian Institute of Public Health, Bergen, Norway
| | | | - Natalie C. Momen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | | | - Yan Zheng
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Astrid Jensen Damgaard
- Master Program in Health Science, Rehabilitation and Prevention, Aarhus University, Aarhus, Denmark
| | - John J. McGrath
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- Queensland Centre for Mental Health Research, University of Queensland, Wacol, Queensland, Australia
- Queensland Brain Institute, University of Queensland, St Lucia, Queensland, Australia
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Oleguer Plana-Ripoll
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
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Biazus TB, Beraldi GH, Tokeshi L, Rotenberg LDS, Dragioti E, Carvalho AF, Solmi M, Lafer B. All-cause and cause-specific mortality among people with bipolar disorder: a large-scale systematic review and meta-analysis. Mol Psychiatry 2023; 28:2508-2524. [PMID: 37491460 PMCID: PMC10611575 DOI: 10.1038/s41380-023-02109-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/26/2023] [Accepted: 05/05/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVE Bipolar disorder (BD) is associated with premature mortality. All-cause and specific mortality risks in this population remain unclear, and more studies are still needed to further understand this issue and guide individual and public strategies to prevent mortality in bipolar disorder Thus, a systematic review and meta-analysis of studies assessing mortality risk in people with BD versus the general population was conducted. The primary outcome was all-cause mortality, whilst secondary outcomes were mortality due to suicide, natural, unnatural, and specific-causes mortality. RESULTS Fifty-seven studies were included (BD; n = 678,353). All-cause mortality was increased in people with BD (RR = 2.02, 95% CI: 1.89-2.16, k = 39). Specific-cause mortality was highest for suicide (RR = 11.69, 95% CI: 9.22-14.81, k = 25). Risk of death due to unnatural causes (RR = 7.29, 95% CI: 6.41-8.28, k = 17) and natural causes (RR = 1.90, 95% CI: 1.75-2.06, k = 17) were also increased. Among specific natural causes analyzed, infectious causes had the higher RR (RR = 4,38, 95%CI: 1.5-12.69, k = 3), but the analysis was limited by the inclusion of few studies. Mortality risk due to respiratory (RR = 3.18, 95% CI: 2.55-3.96, k = 6), cardiovascular (RR = 1.76, 95% CI: 1.53-2.01, k = 27), and cerebrovascular (RR = 1.57, 95% CI: 1.34-1.84, k = 13) causes were increased as well. No difference was identified in mortality by cancer (RR = 0.99, 95% CI: 0.88-1.11, k = 16). Subgroup analyses and meta-regression did not affect the findings. CONCLUSION Results presented in this meta-analysis show that risk of premature death in BD is not only due to suicide and unnatural causes, but somatic comorbidities are also implicated. Not only the prevention of suicide, but also the promotion of physical health and the prevention of physical conditions in individuals with BD may mitigate the premature mortality in this population. Notwithstanding this is to our knowledge the largest synthesis of evidence on BD-related mortality, further well-designed studies are still warranted to inform this field.
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Affiliation(s)
- Taís Boeira Biazus
- Bipolar Disorder Research Program, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.
| | - Gabriel Henrique Beraldi
- Bipolar Disorder Research Program, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
- Schizophrenia Research Program (Projesq), Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Lucas Tokeshi
- Consultation Liaison, Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Luísa de Siqueira Rotenberg
- Bipolar Disorder Research Program, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Elena Dragioti
- Research Laboratory Psychology of Patients, Families & Health Professionals, Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, Greece
- Pain and Rehabilitation Center, and Department of Health, Medicine and Caring Sciences, Linköping University, SE 58185, Linköping, Sweden
| | - André F Carvalho
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Beny Lafer
- Bipolar Disorder Research Program, Department and Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
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3
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Kiejna A, Janus J, Cichoń E, Paciorek S, Zięba M, Gondek TM. Mortality in people with mental disorders in Poland: A nationwide, register-based cohort study. Eur Psychiatry 2022; 66:e2. [PMID: 36396605 PMCID: PMC9879895 DOI: 10.1192/j.eurpsy.2022.2341] [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] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Mortality among people with mental disorders is higher in comparison with the general population. There is a scarcity of studies on mortality in the abovementioned group of people in Central and Eastern European countries. METHODS The study aimed to assess all-cause mortality in people with mental disorders in Poland. We conducted a nationwide, register-based cohort study utilizing data from two nationwide registries in Poland: the registry of healthcare services reported to the National Health Fund (2009-2018) and the all-cause death registry from Statistics Poland (2019). We identified individuals who were consulted or hospitalized in public mental healthcare facilities and received at least one diagnosis of mental disorders (International Statistical Classification of Diseases and Health Problems [ICD-10]) from 2009 to 2018. Standardized mortality ratios (SMRs) were compared between people with a history of mental disorder and the general population. RESULTS The study comprised 4,038,517 people. The SMR for individuals with any mental disorder compared with the general population was 1.54. SMRs varied across diagnostic groups, with the highest values for substance use disorders (3.04; 95% CI 3.00-3.09), schizophrenia, schizotypal and delusional disorders (2.12; 95% CI 2.06-2.18), and pervasive and specific developmental disorders (1.68; 95% CI 1.08-2.29). When only inpatients were considered, all-cause mortality risk was almost threefold higher than in the general population (SMR 2.90; 95% CI 2.86-2.94). CONCLUSIONS In Poland, mortality in people with mental disorders is significantly higher than in the general population. The results provide a reference point for future longitudinal studies on mortality in Poland.
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Affiliation(s)
- A Kiejna
- Department of Psychology, WSB University in Toruń, Toruń, Poland.,Department of Psychology, Faculty of Applied Studies, Psychology Research Unit for Public Health, University of Lower Silesia, Wroclaw, Poland
| | - J Janus
- Department of Analyses and Strategy, Ministry of Health, Warsaw, Poland
| | - E Cichoń
- Department of Psychology, WSB University in Toruń, Toruń, Poland.,Department of Psychology, Faculty of Applied Studies, Psychology Research Unit for Public Health, University of Lower Silesia, Wroclaw, Poland
| | - S Paciorek
- Department of Analyses and Strategy, Ministry of Health, Warsaw, Poland
| | - M Zięba
- Department of Analyses and Strategy, Ministry of Health, Warsaw, Poland
| | - T M Gondek
- Institute of Clinical Improvement, Warsaw, Poland.,Iter Psychology Practices, Wroclaw, Poland
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Knudsen SV, Valentin JB, Videbech P, Mainz J, Johnsen SP. Inequities in Mental Health Care Quality and Clinical Outcomes Among Inpatients with Depression Within a Tax-Financed Universal Health Care System. Clin Epidemiol 2022; 14:803-813. [PMID: 35789690 PMCID: PMC9250345 DOI: 10.2147/clep.s322392] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 06/03/2022] [Indexed: 01/20/2023] Open
Abstract
Purpose The objective was to examine potential socioeconomic inequities in guideline recommended quality of care as well as several clinical outcomes among first-time inpatients with major depressive disorder (MDD) in a tax-financed universal health care system. Patients and Methods A nationwide cohort study was performed based on individual-level record linkage of public registers in Denmark. The study included all adult incident inpatients with MDD at Danish psychiatric hospitals in the period 2011–2017 (n=10,949). Socioeconomic position was assessed according to the level of education and income. Outcomes included quality of depression care for inpatients as reflected by the fulfillment of guideline recommended quality of care measures as well as clinical outcomes in terms of all-cause mortality, suicidal behavior, readmission for depression and all-cause readmission. Results Patients with low-level education or low-level income were statistically significantly less likely to receive high quality of in-hospital care, defined as fulfillment of at least 70% of relevant performance measures (adjusted relative risk (RR) 0.92 and 0.87, respectively). In addition, the same patients had a higher all-cause mortality (adjusted RR 1.22 and 1.41, respectively). Patients with low education or middle income were associated with a higher risk of suicidal behavior (adjusted RR 1.28 and 1.19, respectively). While no differences were found in the risk of all-cause readmission, low-level education and income was associated with a lower risk of readmission due to MDD (adjusted RR 0.91 and 0.87, respectively). Conclusion Inequities in quality of care and clinical outcomes were observed among MDD inpatients in a tax-financed universal health care system, indicating that lack of access to care and insurance is not the only explanation for inequity in health.
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Affiliation(s)
- Søren Valgreen Knudsen
- Danish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | - Jan Brink Valentin
- Danish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Poul Videbech
- Center for Neuropsychiatric Research, Mental Health Center Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Jan Mainz
- Danish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Psychiatry, Aalborg University Hospital, Aalborg, Denmark.,Department of Community Mental Health, Haifa University, Haifa, Israel.,Department of Health Economics, University of Southern Denmark, Odense, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Attar R, Valentin JB, Andell P, Nielsen RE, Jensen SE. Major adverse cardiovascular events following acute coronary syndrome in patients with bipolar disorder. Int J Cardiol 2022; 363:1-5. [PMID: 35716946 DOI: 10.1016/j.ijcard.2022.06.036] [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: 10/19/2021] [Revised: 05/19/2022] [Accepted: 06/10/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Persons with bipolar disorder (BD) have a higher cardiovascular mortality compared to the general population, partially explained by the increased burden of cardiovascular risk factors. Research regarding outcomes following acute coronary syndrome (ACS) in this population remains scarce. DESIGN This Danish register-based study included patients diagnosed with BD and ACS in the period between January 1st, 1995, to December 31st, 2013. Study participants were matched 1:2 to patients without BD on sex, date of birth, time of ACS diagnosis and comorbidities. The primary outcome of interest was major adverse cardiovascular events (MACE) a composite of all-cause mortality, reinfarction or stroke. MACE and its individual components were compared between patients with and without BD. RESULTS 796 patients with BD were compared to 1592 patients without BD, both groups had a mean age of first ACS of 66.5 years. MACE was 38% increased (HR 1.38 95% CI 1.25-1.54), all-cause mortality was 71% increased (HR 1.71 95% CI 1.52-1.92), stroke was 94% increased (HR 1.94 95% CI 1.56-2.41) and reinfarction rates were 17% lower (HR 0.83 95% CI 0.69-1.00) in the BD population compared to the population without BD. We also found higher prevalences of heart failure (9.1% vs. 6.5%), valve disease (5.3% vs. 3.5%), anemia (8.7% vs. 5.8%), chronic obstructive pulmonary disease (13.4% vs. 9.3%) and stroke (11.8% vs. 7.8%) in the population with BD at baseline, all p-values <0.05. CONCLUSION Bipolar disorder was associated with a higher risk of composite MACE, all-cause mortality, and stroke, after ACS compared to patients without BD.
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Affiliation(s)
- Rubina Attar
- Department of Cardiology, Department of Cardiology and Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden; Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
| | - Jan Brink Valentin
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Pontus Andell
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, and Heart and Vascular Division, Karolinska University Hospital, Stockholm, Sweden..
| | | | - Svend Eggert Jensen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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6
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Prestmo A, Høyen K, Vaaler AE, Torgersen T, Drange OK. Mortality Among Patients Discharged From an Acute Psychiatric Department: A 5-Year Prospective Study. Front Psychiatry 2020; 11:816. [PMID: 33013492 PMCID: PMC7461827 DOI: 10.3389/fpsyt.2020.00816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/29/2020] [Indexed: 11/13/2022] Open
Abstract
The primary aim of the study was to explore the post discharge standardized mortality ratio of patients from an acute psychiatric department in Norway. The secondary aims were to explore if the standardized mortality ratio is still increasing and to examine the causes of death in the defined population. We conducted a 5-year prospective study among patients admitted to an acute psychiatric department with catchment area responsibilities. A total of 380 patients were included in the study, and the number and causes of deaths were obtained from the Norwegian Cause of Death Registry. Excess mortality was found for the patient group. The standardized mortality ratio for all causes of death was 6.7 (95% CI, 4.6-8.8). The study finds an increased standardized mortality ratio relative to a previous corresponding study in Norway, and the suicide risk was especially elevated the first 2 years after discharge.
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Affiliation(s)
- Astrid Prestmo
- Department of Østmarka, Division of Mental Health Care, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Karina Høyen
- Department of Østmarka, Division of Mental Health Care, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arne Einar Vaaler
- Department of Østmarka, Division of Mental Health Care, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Terje Torgersen
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
- Orkdal District Psychiatric Centre, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Ole Kristian Drange
- Department of Østmarka, Division of Mental Health Care, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
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Forcano L, Fernández-Aranda F, Álvarez-Moya E, Bulik C, Granero R, Gratacòs M, Jiménez-Murcia S, Krug I, Mercader JM, Riesco N, Saus E, Santamaría JJ, Estivill X. Suicide attempts in bulimia nervosa: Personality and psychopathological correlates. Eur Psychiatry 2020; 24:91-7. [DOI: 10.1016/j.eurpsy.2008.10.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Revised: 10/06/2008] [Accepted: 10/14/2008] [Indexed: 10/21/2022] Open
Abstract
AbstractBackgroundLittle evidence exists about suicidal acts in eating disorders and its relation with personality. We explored the prevalence of lifetime suicide attempts (SA) in women with bulimia nervosa (BN), and compared eating disorder symptoms, general psychopathology, impulsivity and personality between individuals who had and had not attempted suicide. We also determined the variables that better correlate with of SA.MethodFive hundred sixty-six BN outpatients (417 BN purging, 47 BN non-purging and 102 subthreshold BN) participated in the study.ResultsLifetime prevalence of suicide attempts was 26.9%. BN subtype was not associated with lifetime SA (p = 0.36). Suicide attempters exhibited higher rates on eating symptomatology, general psychopathology, impulsive behaviors, more frequent history of childhood obesity and parental alcohol abuse (p < 0.004). Suicide attempters exhibited higher scores on harm avoidance and lower on self-directedness, reward dependence and cooperativeness (p < 0.002). The most strongly correlated variables with SA were: lower education, minimum BMI, previous eating disorder treatment, low self-directedness, and familial history of alcohol abuse (p < 0.006).ConclusionOur results support the notion that internalizing personality traits combined with impulsivity may increase the probability of suicidal behaviors in these patients. Future research may increase our understanding of the role of suicidality to work towards rational prevention of suicidal attempts.
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Rubin-Falcone H, Zanderigo F, Thapa-Chhetry B, Lan M, Miller JM, Sublette ME, Oquendo MA, Hellerstein DJ, McGrath PJ, Stewart JW, Mann JJ. Pattern recognition of magnetic resonance imaging-based gray matter volume measurements classifies bipolar disorder and major depressive disorder. J Affect Disord 2018; 227:498-505. [PMID: 29156364 PMCID: PMC5805651 DOI: 10.1016/j.jad.2017.11.043] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 11/06/2017] [Accepted: 11/11/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Bipolar Disorder (BD) cannot be reliably distinguished from Major Depressive Disorder (MDD) until the first manic or hypomanic episode. Consequently, many patients with BD are treated with antidepressants without mood stabilizers, a strategy that is often ineffective and carries a risk of inducing a manic episode. We previously reported reduced cortical thickness in right precuneus, right caudal middle-frontal cortex and left inferior parietal cortex in BD compared with MDD. METHODS This study extends our previous work by performing individual level classification of BD or MDD in an expanded, currently unmedicated, cohort using gray matter volume (GMV) based on Magnetic Resonance Imaging and a Support Vector Machine. All patients were in a Major Depressive Episode and a leave-two-out analysis was performed. RESULTS Nineteen out of 26 BD subjects and 20 out of 26 MDD subjects were correctly identified, for a combined accuracy of 75%. The three brain regions contributing to the classification were higher GMV in bilateral supramarginal gyrus and occipital cortex indicating MDD, and higher GMV in right dorsolateral prefrontal cortex indicating BD. LIMITATIONS This analysis included scans performed with two different headcoils and scan sequences, which limited the interpretability of results in an independent cohort analysis. CONCLUSIONS Our results add to previously published data which suggest that regional gray matter volume should be investigated further as a clinical diagnostic tool to predict BD before the appearance of a manic or hypomanic episode.
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Affiliation(s)
- Harry Rubin-Falcone
- Department of Psychiatry, Columbia University, New York, NY, USA; Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY, USA.
| | - Francesca Zanderigo
- Department of Psychiatry, Columbia University, New York, NY, USA; Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY, USA
| | - Binod Thapa-Chhetry
- Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY, USA
| | - Martin Lan
- Department of Psychiatry, Columbia University, New York, NY, USA; Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY, USA
| | - Jeffrey M Miller
- Department of Psychiatry, Columbia University, New York, NY, USA; Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY, USA
| | - M Elizabeth Sublette
- Department of Psychiatry, Columbia University, New York, NY, USA; Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY, USA
| | - Maria A Oquendo
- Now at Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, USA
| | - David J Hellerstein
- Department of Psychiatry, Columbia University, New York, NY, USA; Depression Evaluation Service, Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY, USA
| | - Patrick J McGrath
- Department of Psychiatry, Columbia University, New York, NY, USA; Depression Evaluation Service, Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY, USA
| | - Johnathan W Stewart
- Department of Psychiatry, Columbia University, New York, NY, USA; Depression Evaluation Service, Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY, USA
| | - J John Mann
- Department of Psychiatry, Columbia University, New York, NY, USA; Molecular Imaging and Neuropathology Division, New York State Psychiatric Institute, New York, NY, USA; Department of Radiology, Columbia University, New York, NY, USA
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Abstract
SummaryDepression is an illness that kills. The links between depression and medical illness are well established and bi-directional, but evidence is mounting that depression increases mortality as well as morbidity in adults, particularly older adults. We examine the evidence that the increase in mortality in depression applies to all-cause mortality as well as cardiac mortality, and describe plausible physiological theories for the association. We conclude that excess mortality arising from depression is a major public health problem that is largely unrecognised and needs to be addressed by a range of clinicians.
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10
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Knutsson J, Bäckström B, Daukantaitė D, Lecerof F. Adolescent and Family-focused Cognitive-behavioural Therapy for Paediatric Bipolar Disorders: A Case Series. Clin Psychol Psychother 2016; 24:589-617. [DOI: 10.1002/cpp.2027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 04/12/2016] [Accepted: 05/03/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Jens Knutsson
- Department of Psychology; Lund University; Lund Sweden
| | - Beata Bäckström
- Department of Psychoses and Bipolar Disorders; Clinic for Child and Adolescent Psychiatry; Lund Sweden
| | | | - Fredrik Lecerof
- Department of Psychoses and Bipolar Disorders; Clinic for Child and Adolescent Psychiatry; Lund Sweden
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11
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Hayes JF, Miles J, Walters K, King M, Osborn DPJ. A systematic review and meta-analysis of premature mortality in bipolar affective disorder. Acta Psychiatr Scand 2015; 131:417-25. [PMID: 25735195 PMCID: PMC4939858 DOI: 10.1111/acps.12408] [Citation(s) in RCA: 217] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To review and complete meta-analysis of studies estimating standardised mortality ratios (SMRs) in bipolar affective disorder (BPAD) for all-cause and cause-specific mortalities. METHOD Cause-specific mortality was grouped into natural and unnatural causes. These subgroups were further divided into circulatory, respiratory, neoplastic and infectious causes, and suicide and other violent deaths. Summary SMRs were calculated using random-effects meta-analysis. Heterogeneity was examined via subgroup analysis and meta-regression. RESULTS Systematic searching found 31 studies meeting inclusion criteria. Summary SMR for all-cause mortality = 2.05 (95% CI 1.89-2.23), but heterogeneity was high (I(2) = 96.2%). This heterogeneity could not be accounted for by date of publication, cohort size, mid-decade of data collection, population type or geographical region. Unnatural death summary SMR = 7.42 (95% CI 6.43-8.55) and natural death = 1.64 (95% CI 1.47-1.83). Specifically, suicide SMR = 14.44 (95% CI 12.43-16.78), other violent death SMR = 3.68 (95% CI 2.77-4.90), deaths from circulatory disease = 1.73 (95% CI 1.54-1.94), respiratory disease = 2.92 (95% CI 2.00-4.23), infection = 2.25 (95% CI 1.70-3.00) and neoplasm = 1.14 (95% CI 1.10-1.21). CONCLUSION Despite considerable heterogeneity, all summary SMR estimates and a large majority of individual studies showed elevated mortality in BPAD compared to the general population. This was true for all causes of mortality studied.
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Affiliation(s)
- J. F. Hayes
- Division of PsychiatryUCLLondonUK,Camden & Islington NHS Foundation TrustNHSLondonUK
| | - J. Miles
- Camden & Islington NHS Foundation TrustNHSLondonUK
| | - K. Walters
- Department of Primary Care and Population HealthUCLLondonUK
| | - M. King
- Division of PsychiatryUCLLondonUK
| | - D. P. J. Osborn
- Division of PsychiatryUCLLondonUK,Camden & Islington NHS Foundation TrustNHSLondonUK
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Mortality of people suffering from mental illness: a study of a cohort of patients hospitalised in psychiatry in the north of France. Soc Psychiatry Psychiatr Epidemiol 2015; 50:269-77. [PMID: 25028200 DOI: 10.1007/s00127-014-0913-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 05/30/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The mortality of people suffering from psychiatric illnesses is far higher than that of the general population, all categories of diagnosis combined; mortality statistics can be used as an index of quality of care. The aim of this study was to assess the all-cause mortality in psychiatric patients covering all diagnostic groups. METHODS The living or deceased status of 4,417 patients of majority age hospitalised in a public mental health establishment between 2004 and 2007 were requested from French National Institute for Statistics and Economic Studies on 1st January 2011. The cause of death of those people who had died was obtained from French National Institute for Health and Medical Research and comparative standardized mortality ratios (SMR) were established from the population in a region of northern France of the same age in 2006. RESULTS The study population was made up of 54% men and 46% women, median age 41 and 45 years old, respectively. Four hundred and seventy-three people died during the period studied. The SMR were 421 for men (95% CI 378-470) and 330 for women (95% CI 281-388). The highest SMRs were found in patients aged 35-54, with a 20-time higher mortality risk than the general population of the same age. CONCLUSION Our study confirms the considerably higher mortality in psychiatric patients than in general population, particularly in mean age and mostly due to an unnatural cause.
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Martin JL, McLean G, Park J, Martin DJ, Connolly M, Mercer SW, Smith DJ. Impact of socioeconomic deprivation on rate and cause of death in severe mental illness. BMC Psychiatry 2014; 14:261. [PMID: 25227899 PMCID: PMC4173101 DOI: 10.1186/s12888-014-0261-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 09/04/2014] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Socioeconomic status has important associations with disease-specific mortality in the general population. Although individuals with Severe Mental Illnesses (SMI) experience significant premature mortality, the relationship between socioeconomic status and mortality in this group remains under investigated. We aimed to assess the impact of socioeconomic status on rate and cause of death in individuals with SMI (schizophrenia and bipolar disorder) relative to the local (Glasgow) and wider (Scottish) populations. METHODS Cause and age of death during 2006-2010 inclusive for individuals with schizophrenia or bipolar disorder registered on the Glasgow Psychosis Clinical Information System (PsyCIS) were obtained by linkage to the Scottish General Register Office (GRO). Rate and cause of death by socioeconomic status, measured by Scottish Index of Multiple Deprivation (SIMD), were compared to the Glasgow and Scottish populations. RESULTS Death rates were higher in people with SMI across all socioeconomic quintiles compared to the Glasgow and Scottish populations, and persisted when suicide was excluded. Differences were largest in the most deprived quintile (794.6 per 10,000 population vs. 274.7 and 252.4 for Glasgow and Scotland respectively). Cause of death varied by socioeconomic status. For those living in the most deprived quintile, higher drug-related deaths occurred in those with SMI compared to local Glasgow and wider Scottish population rates (12.3% vs. 5.9%, p = <0.001 and 5.1% p = 0.002 respectively). A lower proportion of deaths due to cancer in those with SMI living in the most deprived quintile were also observed, relative to the local Glasgow and wider Scottish populations (12.3% vs. 25.1% p = 0.013 and 26.3% p = <0.001). The proportion of suicides was significantly higher in those with SMI living in the more affluent quintiles relative to Glasgow and Scotland (54.6% vs. 5.8%, p = <0.001 and 5.5%, p = <0.001). CONCLUSIONS Excess mortality in those with SMI occurred across all socioeconomic quintiles compared to the Glasgow and Scottish populations but was most marked in the most deprived quintiles when suicide was excluded as a cause of death. Further work assessing the impact of socioeconomic status on specific causes of premature mortality in SMI is needed.
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Affiliation(s)
- Julie Langan Martin
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, UK.
| | - Gary McLean
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G12 0XH UK
| | - John Park
- Lead Research Nurse PsyCIS Team, Stobhill Hospital, 300 Balgrayhill Road, Glasgow, G21 3UR UK
| | - Daniel J Martin
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G12 0XH UK
| | - Moira Connolly
- Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G12 0XH UK
| | - Stewart W Mercer
- Institute of Health and Wellbeing, University of Glasgow, General Practice & Primary Care, 1 Horselethill Road, Glasgow, G12 9LX UK
| | - Daniel J Smith
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G12 0XH UK
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Alcohol-related deaths and social factors in depression mortality: a register-based follow-up of depressed in-patients and antidepressant users in Finland. J Affect Disord 2013; 148:278-85. [PMID: 23357655 DOI: 10.1016/j.jad.2012.12.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 12/03/2012] [Accepted: 12/05/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND Excess mortality of depression is established for various causes of death, but evidence is scarce on alcohol-related causes. It also remains unclear whether the magnitude of the excess varies by social factors. This study aimed to quantify the contribution of alcohol-related causes of death and to assess modifying effects of socioeconomic position, employment status, and living arrangements in the excess mortality of depression. METHODS A 14% sample of community-dwelling Finns aged 40-64 at the end of 1997 was assessed for depression, using register data on psychiatric hospital care and antidepressant use in 1996-1997. Depressed in-patients (n=897), out-patients using antidepressants (n=13,658), and non-depressed individuals (n=217,140) were followed up for cause-specific mortality in 1998-2007, distinguishing between alcohol- and non-alcohol-related deaths, and testing for variation in the excess mortality according to baseline social factors. RESULTS Depressed in- and out-patients had significant excess mortality for suicide (age-adjusted rate ratios RR=3.77 for men and RR=6.35 for women), all accidental and violent causes (RR=3.47 and RR=4.43), and diseases (RR=1.67 and RR=1.41). Of the excess, alcohol-related causes accounted for 50% among depressed men and 30% among women. Excess mortality varied little by social factors, particularly in non-alcohol-related causes. Where variation was significant, the relative excess was larger among those with higher socioeconomic position and the employed. Absolute excess was, however, larger among those with lower socioeconomic position, the unemployed, and the unpartnered. LIMITATIONS Depression was measured indirectly by hospital and antidepressant use. CONCLUSIONS The results highlight the major role of alcohol in depression mortality.
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Sickness absence due to specific mental diagnoses and all-cause and cause-specific mortality: a cohort study of 4.9 million inhabitants of Sweden. PLoS One 2012; 7:e45788. [PMID: 23049861 PMCID: PMC3458091 DOI: 10.1371/journal.pone.0045788] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 08/23/2012] [Indexed: 12/19/2022] Open
Abstract
Background Despite the magnitude and increase of sickness absence due to mental diagnoses, little is known regarding long-term health outcomes. The aim of this nationwide population-based, prospective cohort study was to investigate the association between sickness absence due to specific mental diagnoses and the risk of all-cause and cause-specific mortality. Methods A cohort of all 4 857 943 individuals living in Sweden on 31.12.2004 (aged 16–64 years, not sickness absent, or on retirement or disability pension), was followed from 01.01.2005 through 31.12.2008 for all-cause and cause-specific mortality (suicide, cancer, circulatory disease) through linkage of individual register data. Individuals with at least one new sick-leave spell with a mental diagnosis in 2005 were compared to individuals with no sickness absence. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated by Cox regression, adjusting for age, sex, education, country of birth, family situation, area of residence, and pre-existing morbidity (diagnosis-specific hospital inpatient (2000–2005) and outpatient (2001–2005) care). Results In the multivariate analyses, mental sickness absence in 2005 was associated with an increased risk for all-cause mortality: HR: 1.65, 95% CI: 1.47–1.86 in women and in men: 1.73, 1.57–1.91; for suicide, cancer (both smoking and non-smoking related) as well as mortality due to circulatory disease only in men. Estimates for cause-specific mortality ranged from 1.48 to 3.37. Associations with all-cause mortality were found for all mental sickness absence diagnostic groups studied. Conclusions Knowledge about the prognosis of patients sickness absent with specific mental diagnoses is of crucial clinical importance in health care. Sickness absence due to specific mental diagnoses may here be used as a risk indictor for subsequent mortality.
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Depression and the role of genes involved in dopamine metabolism and signalling. Prog Neurobiol 2010; 92:112-33. [DOI: 10.1016/j.pneurobio.2010.06.003] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Revised: 06/01/2010] [Accepted: 06/07/2010] [Indexed: 01/11/2023]
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Fekadu A, Wooderson SC, Markopoulo K, Donaldson C, Papadopoulos A, Cleare AJ. What happens to patients with treatment-resistant depression? A systematic review of medium to long term outcome studies. J Affect Disord 2009; 116:4-11. [PMID: 19007996 DOI: 10.1016/j.jad.2008.10.014] [Citation(s) in RCA: 196] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2008] [Revised: 10/13/2008] [Accepted: 10/13/2008] [Indexed: 11/24/2022]
Abstract
BACKGROUND Treatment-resistant depression (TRD) is relatively common and accounts for a large proportion of the overall burden caused by depression. We conducted a systematic review of outcome studies of TRD in order to summarise findings on the longer term outcome of TRD and make recommendations. METHODS Studies were identified through MEDLINE (1960--June Week 1 2008), EMBASE (1974--June Week 1 2008) and PsycINFO (1967--June Week 1 2008) searches. We included studies that followed adults with highly probable TRD for a minimum of 6 months. Statistical analyses were conducted on selected outcome variables whenever possible. Methodological heterogeneity of studies prohibited formal meta-analysis. RESULTS We identified nine outcome studies with a total of 1279 participants and follow-up duration of between 1 and 10 years. In the short term, TRD was highly recurrent with as many as 80% of those requiring multiple treatments relapsing within a year of achieving remission. For those with a more protracted illness, the probability of recovery within 10 years was about 40%. TRD was also associated with poorer quality of life and increased mortality. LIMITATIONS Included primary studies were heterogeneous. CONCLUSIONS TRD is associated with poorer clinical outcome, particularly among those who require multiple antidepressant medications. The main limitations of the review arise from the variability in recruitment procedures, definitions and outcome assessments of the original studies. We recommend further follow-up studies of carefully identified samples in order to gain a more detailed understanding of this domain of depression and plan effective interventions.
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Affiliation(s)
- Abebaw Fekadu
- King's College London, Institute of Psychiatry, Division of Psychological Medicine, Section of Neurobiology of Mood Disorders, PO 074, 103 Denmark Hill, London, SE5 8AZ, UK.
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Fiedorowicz JG, Leon AC, Keller MB, Solomon DA, Rice JP, Coryell WH. Do risk factors for suicidal behavior differ by affective disorder polarity? Psychol Med 2009; 39:763-771. [PMID: 18667100 PMCID: PMC2775816 DOI: 10.1017/s0033291708004078] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Suicide is a leading cause of death and has been strongly associated with affective disorders. The influence of affective disorder polarity on subsequent suicide attempts or completions and any differential effect of suicide risk factors by polarity were assessed in a prospective cohort. METHOD Participants with major affective disorders in the National Institute of Mental Health (NIMH) Collaborative Depression Study (CDS) were followed prospectively for up to 25 years. A total of 909 participants meeting prospective diagnostic criteria for major depressive and bipolar disorders were followed through 4204 mood cycles. Suicidal behavior was defined as suicide attempts or completions. Mixed-effects, grouped-time survival analysis assessed risk of suicidal behavior and differential effects of risk factors for suicidal behavior by polarity. In addition to polarity, the main effects of age, gender, hopelessness, married status, prior suicide attempts and active substance abuse were modeled, with mood cycle as the unit of analysis. RESULTS After controlling for age of onset, there were no differences in prior suicide attempts by polarity although bipolar participants had more prior severe attempts. During follow-up, 40 cycles ended in suicide and 384 cycles contained at least one suicide attempt. Age, hopelessness and active substance abuse but not polarity predicted suicidal behavior. The effects of risk factors did not differ by polarity. CONCLUSIONS Bipolarity does not independently influence risk of suicidal behavior or alter the influence of well-established suicide risk factors within affective disorders. Suicide risk assessment strategies may continue to appraise these common risk factors without regard to mood polarity.
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Affiliation(s)
- J G Fiedorowicz
- Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA.
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Mortality of Finnish acute psychiatric hospital patients. Soc Psychiatry Psychiatr Epidemiol 2008; 43:660-6. [PMID: 18478169 DOI: 10.1007/s00127-008-0344-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2007] [Accepted: 03/13/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The mortality of psychiatric patients is higher than that of the general population. Earlier studies have typically focused on specific diagnostic categories or causes of death. The aim of this study was to assess the overall mortality in acute psychiatric hospital patients covering all diagnostic groups, with special emphasis on substance abuse. METHODS The sample consisted of all 18-64-year old patients (n = 3,835) treated or evaluated in the acute wards of the Department of Psychiatry at Tampere University Hospital between the years 1999 and 2003, who were followed-up until the end of the year 2005. We assessed the various causes of death according to background variables in bivariate and multivariate analyses and calculated the standardized mortality ratios (SMRs). RESULTS During the study period 379 subjects died (9.9% of the sample). Mortality among men was almost twice as high as among women. Of all deaths, 45.6% were considered to be alcohol or drug related. SMR covering all subjects was 6.55. The SMRs for unnatural causes were higher than those for natural causes. The highest SMRs for unnatural causes of death were found in patients with mood disorders and the highest SMRs for natural causes of death in patients with schizophrenia spectrum disorders. Use of coercive measures was associated with increased mortality. CONCLUSION Mortality among Finnish psychiatric acute hospital patients is considerably higher than in general population. Excessive alcohol consumption plays a major role in causing excess deaths that could be potentially avoided.
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Pompili M, Innamorati M, Raja M, Falcone I, Ducci G, Angeletti G, Lester D, Girardi P, Tatarelli R, De Pisa E. Suicide risk in depression and bipolar disorder: Do impulsiveness-aggressiveness and pharmacotherapy predict suicidal intent? Neuropsychiatr Dis Treat 2008; 4:247-55. [PMID: 18728807 PMCID: PMC2515901 DOI: 10.2147/ndt.s2192] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The aims of the present study were to examine clinical, personality, and sociodemographic predictors of suicide risk in a sample of inpatients affected by major affective disorders. The participants were 74 inpatients affected by major depressive disorder or bipolar disorder-I. Patients completed a semi-structured interview, the Beck Hopelessness Scale, the Aggression Questionnaire, the Barratt Impulsiveness Scale, and the Hamilton scales for depression and anxiety. Over 52% of the patients were high suicide risks. Those at risk reported more severe depressive-anxious symptomatology, more impulsivity and more hostility. Impulsivity, the use of antidepressants, anxiety/somatization, and the use of mood stabilizers (a negative predictor) resulted in accurate predicting of suicide intent. Impulsivity and antidepressant use were the strongest predictors even after controlling for several sociodemographic and clinical variables.
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Reis M, Prochazka J, Sitsen A, Ahlner J, Bengtsson F. Inter- and intraindividual pharmacokinetic variations of mirtazapine and its N-demethyl metabolite in patients treated for major depressive disorder: a 6-month therapeutic drug monitoring study. Ther Drug Monit 2006; 27:469-77. [PMID: 16044104 DOI: 10.1097/01.ftd.0000158873.54100.d4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Mirtazapine pharmacokinetic (PK) data from patients on long-term treatment for major depression have never been investigated. For this reason, in a large naturalistic outpatient study (prospective, multicenter, open-labeled, and noncomparative) conducted in Sweden in the period 2000-2002, one of the main objectives was to outline the inter- as well as intraindividual PK variance of mirtazapine and demethylmirtazapine serum concentrations in a patient cohort treated up to 6 (optionally 12) months. A total of 192 male and female outpatients aged 18 years or older were included. Serum samples of mirtazapine and demethylmirtazapine were collected, by the means of therapeutic drug monitoring, at weeks 1, 4, 8, and 24 (52). Altogether 683 serum samples were analyzed. A pronounced interindividual variability of mirtazapine and demethylmirtazapine, and the demethylmirtazapine/mirtazapine ratio was seen. The coefficient of variation was about 38%, 33%, and 36%, respectively. The intraindividual variation over time was low, about 20% on all variables. At the population level, no accumulation of mirtazapine, demethylmirtazapine, or change of the demethylmirtazapine/mirtazapine ratio was observed over time. Women had significantly higher dose-corrected concentrations of mirtazapine and demethylmirtazapine and demethylmirtazapine/mirtazapine ratio than men. Patients above 65 years of age had higher concentrations than their younger counterparts. Among patients with adverse events, lower demethylmirtazapine concentrations were observed than in patients with no adverse events. Patients on multiple drug treatment had higher dose-corrected mirtazapine and demethylmirtazapine serum concentrations than patients taking only mirtazapine. Weight and BMI had a significant negative correlation with demethylmirtazapine concentrations and with the demethylmirtazapine/mirtazapine ratio. Continued efforts are warranted to perform PK studies in a natural clinical setting to learn and understand inter- and intraindividual PK variances in real patients treated for longer periods of time. For mirtazapine as well as for most antidepressant drugs only relatively short term PK is available. To help clinicians improve their treatment of patients with major depressive disorder, the possible implications on the PK with a long-term treatment are important to study.
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Affiliation(s)
- Margareta Reis
- Department of Medicine and Care, Division of Clinical Pharmacology, Linköping University, Linköping, Sweden.
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Abstract
Lifestyle, illness and treatment factors in people with bipolar disorder (BD) may confer additional risk of morbidity and mortality to the increasing rates of obesity, metabolic syndrome, diabetes mellitus and cardiovascular mortality in the general population.The aim of this review is to examine whether the risk of obesity and related morbidity and mortality are raised in BD, and possible contributory effects of lifestyle, illness and treatment factors to this risk.Systematic search of Medline and Cochrane Collaboration for relevant studies followed by a critical review of literature was carried out.Mortality from cardiovascular causes and pulmonary embolism (standardized mortality ratio approximately 2.0), and morbidity from obesity and type 2 diabetes mellitus may be increased in BD compared to the general population. Reduced exercise and poor diet, frequent depressive episodes, comorbidity with substance misuse and poor quality general medical care contribute to the additional risk of these medical problems in people with BD. There is no evidence that patients with BD are more sensitive than other patients to weight gain and medical problems associated with long-term use of psychotropic medication; in fact long-term treatment with lithium, antipsychotics and tricyclic antidepressants may reduce overall mortality. Psychiatrists, general practitioners and other health professionals should work together to systematically assess and manage weight gain and related medical problems to reduce the morbidity and mortality associated with obesity in BD. There is insufficient evidence to associate any of these factors with specific drug treatments. More research is required to understand how BD changes the risk for physical health comorbidity.
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Affiliation(s)
- Richard Morriss
- Division of Psychiatry, University of Liverpool, Liverpool, UK.
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Holmans P, Zubenko GS, Crowe RR, DePaulo Jr. JR, Scheftner WA, Weissman MM, Zubenko WN, Boutelle S, Murphy-Eberenz K, MacKinnon D, McInnis MG, Marta DH, Adams P, Knowles JA, Gladis M, Thomas J, Chellis J, Miller E, Levinson DF. Genomewide significant linkage to recurrent, early-onset major depressive disorder on chromosome 15q. Am J Hum Genet 2004; 74:1154-67. [PMID: 15108123 PMCID: PMC1182079 DOI: 10.1086/421333] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2004] [Accepted: 03/12/2004] [Indexed: 02/04/2023] Open
Abstract
A genome scan was performed on the first phase sample of the Genetics of Recurrent Early-Onset Depression (GenRED) project. The sample consisted of 297 informative families containing 415 independent affected sibling pairs (ASPs), or, counting all possible pairs, 685 informative affected relative pairs (555 ASPs and 130 other pair types). Affected cases had recurrent major depressive disorder (MDD) with onset before age 31 years for probands or age 41 years for other affected relatives; the mean age at onset was 18.5 years, and the mean number of depressive episodes was 7.3. The Center for Inherited Disease Research genotyped 389 microsatellite markers (mean spacing of 9.3 cM). The primary linkage analysis considered allele sharing in all possible affected relative pairs with the use of the Z(lr) statistic computed by the ALLEGRO program. A secondary logistic regression analysis considered the effect of the sex of the pair as a covariate. Genomewide significant linkage was observed on chromosome 15q25.3-26.2 (Zlr=4.14, equivalent LOD = 3.73, empirical genomewide P=.023). The linkage was not sex specific. No other suggestive or significant results were observed in the primary analysis. The secondary analysis produced three regions of suggestive linkage, but these results should be interpreted cautiously because they depended primarily on the small subsample of 42 male-male pairs. Chromosome 15q25.3-26.2 deserves further study as a candidate region for susceptibility to MDD.
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Affiliation(s)
- Peter Holmans
- Biostatistics and Bioinformatics Unit, University of Wales College of Medicine, Cardiff, United Kingdom; MRC Biostatistics Unit, Cambridge, United Kingdom; Department of Psychiatry, University of Pittsburgh, Pittsburgh; Department of Psychiatry and Mental Health CRC, University of Iowa, Iowa City; Department of Psychiatry, Johns Hopkins University, Baltimore; Department of Psychiatry, Rush University Medical Center, Chicago; Department of Psychiatry, College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York; and Department of Psychiatry and Center for Neurobiology and Behavior, University of Pennsylvania, Philadelphia
| | - George S. Zubenko
- Biostatistics and Bioinformatics Unit, University of Wales College of Medicine, Cardiff, United Kingdom; MRC Biostatistics Unit, Cambridge, United Kingdom; Department of Psychiatry, University of Pittsburgh, Pittsburgh; Department of Psychiatry and Mental Health CRC, University of Iowa, Iowa City; Department of Psychiatry, Johns Hopkins University, Baltimore; Department of Psychiatry, Rush University Medical Center, Chicago; Department of Psychiatry, College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York; and Department of Psychiatry and Center for Neurobiology and Behavior, University of Pennsylvania, Philadelphia
| | - Raymond R. Crowe
- Biostatistics and Bioinformatics Unit, University of Wales College of Medicine, Cardiff, United Kingdom; MRC Biostatistics Unit, Cambridge, United Kingdom; Department of Psychiatry, University of Pittsburgh, Pittsburgh; Department of Psychiatry and Mental Health CRC, University of Iowa, Iowa City; Department of Psychiatry, Johns Hopkins University, Baltimore; Department of Psychiatry, Rush University Medical Center, Chicago; Department of Psychiatry, College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York; and Department of Psychiatry and Center for Neurobiology and Behavior, University of Pennsylvania, Philadelphia
| | - J. Raymond DePaulo Jr.
- Biostatistics and Bioinformatics Unit, University of Wales College of Medicine, Cardiff, United Kingdom; MRC Biostatistics Unit, Cambridge, United Kingdom; Department of Psychiatry, University of Pittsburgh, Pittsburgh; Department of Psychiatry and Mental Health CRC, University of Iowa, Iowa City; Department of Psychiatry, Johns Hopkins University, Baltimore; Department of Psychiatry, Rush University Medical Center, Chicago; Department of Psychiatry, College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York; and Department of Psychiatry and Center for Neurobiology and Behavior, University of Pennsylvania, Philadelphia
| | - William A. Scheftner
- Biostatistics and Bioinformatics Unit, University of Wales College of Medicine, Cardiff, United Kingdom; MRC Biostatistics Unit, Cambridge, United Kingdom; Department of Psychiatry, University of Pittsburgh, Pittsburgh; Department of Psychiatry and Mental Health CRC, University of Iowa, Iowa City; Department of Psychiatry, Johns Hopkins University, Baltimore; Department of Psychiatry, Rush University Medical Center, Chicago; Department of Psychiatry, College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York; and Department of Psychiatry and Center for Neurobiology and Behavior, University of Pennsylvania, Philadelphia
| | - Myrna M. Weissman
- Biostatistics and Bioinformatics Unit, University of Wales College of Medicine, Cardiff, United Kingdom; MRC Biostatistics Unit, Cambridge, United Kingdom; Department of Psychiatry, University of Pittsburgh, Pittsburgh; Department of Psychiatry and Mental Health CRC, University of Iowa, Iowa City; Department of Psychiatry, Johns Hopkins University, Baltimore; Department of Psychiatry, Rush University Medical Center, Chicago; Department of Psychiatry, College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York; and Department of Psychiatry and Center for Neurobiology and Behavior, University of Pennsylvania, Philadelphia
| | - Wendy N. Zubenko
- Biostatistics and Bioinformatics Unit, University of Wales College of Medicine, Cardiff, United Kingdom; MRC Biostatistics Unit, Cambridge, United Kingdom; Department of Psychiatry, University of Pittsburgh, Pittsburgh; Department of Psychiatry and Mental Health CRC, University of Iowa, Iowa City; Department of Psychiatry, Johns Hopkins University, Baltimore; Department of Psychiatry, Rush University Medical Center, Chicago; Department of Psychiatry, College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York; and Department of Psychiatry and Center for Neurobiology and Behavior, University of Pennsylvania, Philadelphia
| | - Sandra Boutelle
- Biostatistics and Bioinformatics Unit, University of Wales College of Medicine, Cardiff, United Kingdom; MRC Biostatistics Unit, Cambridge, United Kingdom; Department of Psychiatry, University of Pittsburgh, Pittsburgh; Department of Psychiatry and Mental Health CRC, University of Iowa, Iowa City; Department of Psychiatry, Johns Hopkins University, Baltimore; Department of Psychiatry, Rush University Medical Center, Chicago; Department of Psychiatry, College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York; and Department of Psychiatry and Center for Neurobiology and Behavior, University of Pennsylvania, Philadelphia
| | - Kathleen Murphy-Eberenz
- Biostatistics and Bioinformatics Unit, University of Wales College of Medicine, Cardiff, United Kingdom; MRC Biostatistics Unit, Cambridge, United Kingdom; Department of Psychiatry, University of Pittsburgh, Pittsburgh; Department of Psychiatry and Mental Health CRC, University of Iowa, Iowa City; Department of Psychiatry, Johns Hopkins University, Baltimore; Department of Psychiatry, Rush University Medical Center, Chicago; Department of Psychiatry, College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York; and Department of Psychiatry and Center for Neurobiology and Behavior, University of Pennsylvania, Philadelphia
| | - Dean MacKinnon
- Biostatistics and Bioinformatics Unit, University of Wales College of Medicine, Cardiff, United Kingdom; MRC Biostatistics Unit, Cambridge, United Kingdom; Department of Psychiatry, University of Pittsburgh, Pittsburgh; Department of Psychiatry and Mental Health CRC, University of Iowa, Iowa City; Department of Psychiatry, Johns Hopkins University, Baltimore; Department of Psychiatry, Rush University Medical Center, Chicago; Department of Psychiatry, College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York; and Department of Psychiatry and Center for Neurobiology and Behavior, University of Pennsylvania, Philadelphia
| | - Melvin G. McInnis
- Biostatistics and Bioinformatics Unit, University of Wales College of Medicine, Cardiff, United Kingdom; MRC Biostatistics Unit, Cambridge, United Kingdom; Department of Psychiatry, University of Pittsburgh, Pittsburgh; Department of Psychiatry and Mental Health CRC, University of Iowa, Iowa City; Department of Psychiatry, Johns Hopkins University, Baltimore; Department of Psychiatry, Rush University Medical Center, Chicago; Department of Psychiatry, College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York; and Department of Psychiatry and Center for Neurobiology and Behavior, University of Pennsylvania, Philadelphia
| | - Diana H. Marta
- Biostatistics and Bioinformatics Unit, University of Wales College of Medicine, Cardiff, United Kingdom; MRC Biostatistics Unit, Cambridge, United Kingdom; Department of Psychiatry, University of Pittsburgh, Pittsburgh; Department of Psychiatry and Mental Health CRC, University of Iowa, Iowa City; Department of Psychiatry, Johns Hopkins University, Baltimore; Department of Psychiatry, Rush University Medical Center, Chicago; Department of Psychiatry, College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York; and Department of Psychiatry and Center for Neurobiology and Behavior, University of Pennsylvania, Philadelphia
| | - Philip Adams
- Biostatistics and Bioinformatics Unit, University of Wales College of Medicine, Cardiff, United Kingdom; MRC Biostatistics Unit, Cambridge, United Kingdom; Department of Psychiatry, University of Pittsburgh, Pittsburgh; Department of Psychiatry and Mental Health CRC, University of Iowa, Iowa City; Department of Psychiatry, Johns Hopkins University, Baltimore; Department of Psychiatry, Rush University Medical Center, Chicago; Department of Psychiatry, College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York; and Department of Psychiatry and Center for Neurobiology and Behavior, University of Pennsylvania, Philadelphia
| | - James A. Knowles
- Biostatistics and Bioinformatics Unit, University of Wales College of Medicine, Cardiff, United Kingdom; MRC Biostatistics Unit, Cambridge, United Kingdom; Department of Psychiatry, University of Pittsburgh, Pittsburgh; Department of Psychiatry and Mental Health CRC, University of Iowa, Iowa City; Department of Psychiatry, Johns Hopkins University, Baltimore; Department of Psychiatry, Rush University Medical Center, Chicago; Department of Psychiatry, College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York; and Department of Psychiatry and Center for Neurobiology and Behavior, University of Pennsylvania, Philadelphia
| | - Madeleine Gladis
- Biostatistics and Bioinformatics Unit, University of Wales College of Medicine, Cardiff, United Kingdom; MRC Biostatistics Unit, Cambridge, United Kingdom; Department of Psychiatry, University of Pittsburgh, Pittsburgh; Department of Psychiatry and Mental Health CRC, University of Iowa, Iowa City; Department of Psychiatry, Johns Hopkins University, Baltimore; Department of Psychiatry, Rush University Medical Center, Chicago; Department of Psychiatry, College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York; and Department of Psychiatry and Center for Neurobiology and Behavior, University of Pennsylvania, Philadelphia
| | - Jo Thomas
- Biostatistics and Bioinformatics Unit, University of Wales College of Medicine, Cardiff, United Kingdom; MRC Biostatistics Unit, Cambridge, United Kingdom; Department of Psychiatry, University of Pittsburgh, Pittsburgh; Department of Psychiatry and Mental Health CRC, University of Iowa, Iowa City; Department of Psychiatry, Johns Hopkins University, Baltimore; Department of Psychiatry, Rush University Medical Center, Chicago; Department of Psychiatry, College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York; and Department of Psychiatry and Center for Neurobiology and Behavior, University of Pennsylvania, Philadelphia
| | - Jennifer Chellis
- Biostatistics and Bioinformatics Unit, University of Wales College of Medicine, Cardiff, United Kingdom; MRC Biostatistics Unit, Cambridge, United Kingdom; Department of Psychiatry, University of Pittsburgh, Pittsburgh; Department of Psychiatry and Mental Health CRC, University of Iowa, Iowa City; Department of Psychiatry, Johns Hopkins University, Baltimore; Department of Psychiatry, Rush University Medical Center, Chicago; Department of Psychiatry, College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York; and Department of Psychiatry and Center for Neurobiology and Behavior, University of Pennsylvania, Philadelphia
| | - Erin Miller
- Biostatistics and Bioinformatics Unit, University of Wales College of Medicine, Cardiff, United Kingdom; MRC Biostatistics Unit, Cambridge, United Kingdom; Department of Psychiatry, University of Pittsburgh, Pittsburgh; Department of Psychiatry and Mental Health CRC, University of Iowa, Iowa City; Department of Psychiatry, Johns Hopkins University, Baltimore; Department of Psychiatry, Rush University Medical Center, Chicago; Department of Psychiatry, College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York; and Department of Psychiatry and Center for Neurobiology and Behavior, University of Pennsylvania, Philadelphia
| | - Douglas F. Levinson
- Biostatistics and Bioinformatics Unit, University of Wales College of Medicine, Cardiff, United Kingdom; MRC Biostatistics Unit, Cambridge, United Kingdom; Department of Psychiatry, University of Pittsburgh, Pittsburgh; Department of Psychiatry and Mental Health CRC, University of Iowa, Iowa City; Department of Psychiatry, Johns Hopkins University, Baltimore; Department of Psychiatry, Rush University Medical Center, Chicago; Department of Psychiatry, College of Physicians and Surgeons, Columbia University, and New York State Psychiatric Institute, New York; and Department of Psychiatry and Center for Neurobiology and Behavior, University of Pennsylvania, Philadelphia
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26
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Abstract
Depression can be a consequence of medical illness and disability, yet recent literature suggests it may also influence morbidity and mortality through a variety of behavioral and biological mediators. Relatively little is known about the complex temporal relations among behavior, affect, motivation, and pathophysiology to account for the association between depression and mortality. We performed a systematic review of the recent literature (1997-2001) examining the evidence linking depression to non-suicide mortality, describe possible mediators of the depression mortality effect, and identify important next steps in this area of research, including: a) the development of well-specified a-priory mediator models that articulate how depression leads to mortality; b) the conduct of longitudinal studies in which depression and behavioral and pathophyisological mediators are assessed simultaneously; c) treatment studies for depression that include assessments of associated changes in health-related quality of life, medical morbidity, and mortality; and d) treatment studies for behavioral risk factors and medical conditions that include assessment of depressive symptoms.
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Affiliation(s)
- Richard Schulz
- Department of Psychiatry and University Center for Social and Urban Research, University of Pittsburgh, Pennsylvania 15260, USA
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