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Lyons J, Akbari A, Abrams KR, Azcoaga Lorenzo A, Ba Dhafari T, Chess J, Denaxas S, Fry R, Gale CP, Gallacher J, Griffiths LJ, Guthrie B, Hall M, Jalali-najafabadi F, John A, MacRae C, McCowan C, Peek N, O’Reilly D, Rafferty J, Lyons RA, Owen RK. Trajectories in chronic disease accrual and mortality across the lifespan in Wales, UK (2005-2019), by area deprivation profile: linked electronic health records cohort study on 965,905 individuals. THE LANCET REGIONAL HEALTH. EUROPE 2023; 32:100687. [PMID: 37520147 PMCID: PMC10372901 DOI: 10.1016/j.lanepe.2023.100687] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 08/01/2023]
Abstract
Background Understanding and quantifying the differences in disease development in different socioeconomic groups of people across the lifespan is important for planning healthcare and preventive services. The study aimed to measure chronic disease accrual, and examine the differences in time to individual morbidities, multimorbidity, and mortality between socioeconomic groups in Wales, UK. Methods Population-wide electronic linked cohort study, following Welsh residents for up to 20 years (2000-2019). Chronic disease diagnoses were obtained from general practice and hospitalisation records using the CALIBER disease phenotype register. Multi-state models were used to examine trajectories of accrual of 132 diseases and mortality, adjusted for sex, age and area-level deprivation. Restricted mean survival time was calculated to measure time spent free of chronic disease(s) or mortality between socioeconomic groups. Findings In total, 965,905 individuals aged 5-104 were included, from a possible 2.9 m individuals following a 5-year clearance period, with an average follow-up of 13.2 years (12.7 million person-years). Some 673,189 (69.7%) individuals developed at least one chronic disease or died within the study period. From ages 10 years upwards, the individuals living in the most deprived areas consistently experienced reduced time between health states, demonstrating accelerated transitions to first and subsequent morbidities and death compared to their demographic equivalent living in the least deprived areas. The largest difference were observed in 10 and 20 year old males developing multimorbidity (-0.45 years (99% CI: -0.45, -0.44)) and in 70 year old males dying after developing multimorbidity (-1.98 years (99% CI: -2.01, -1.95)). Interpretation This study adds to the existing literature on health inequalities by demonstrating that individuals living in more deprived areas consistently experience accelerated time to diagnosis of chronic disease and death across all ages, accounting for competing risks. Funding UK Medical Research Council, Health Data Research UK, and Administrative Data Research Wales.
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Affiliation(s)
- Jane Lyons
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, Wales, UK
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, Wales, UK
| | - Keith R. Abrams
- Department of Statistics, University of Warwick, Coventry, UK
- Centre for Health Economics, University of York, York, UK
| | - Amaya Azcoaga Lorenzo
- Instituto Investigación Sanitaria Fundación Jimenez Diaz, Madrid, Spain
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Thamer Ba Dhafari
- Division of Informatics, Imaging and Data Science, School of Health Sciences, University of Manchester, Manchester, UK
| | - James Chess
- Swansea Bay Health Board, Morriston Hospital, Swansea, Wales, UK
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, UK
| | - Richard Fry
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, Wales, UK
| | | | - John Gallacher
- Dementias Platform UK, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Lucy J. Griffiths
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, Wales, UK
| | - Bruce Guthrie
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Marlous Hall
- Leeds Institute of Cardiovascular and Metabolic Medicine and Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Farideh Jalali-najafabadi
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Ann John
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, Wales, UK
| | - Clare MacRae
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Colin McCowan
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Niels Peek
- Division of Informatics, Imaging and Data Science, School of Health Sciences, University of Manchester, Manchester, UK
| | - Dermot O’Reilly
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - James Rafferty
- Swansea Trials Unit, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, Wales, UK
| | - Ronan A. Lyons
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, Wales, UK
| | - Rhiannon K. Owen
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, Wales, UK
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Weckström T, Elovainio M, Pulkki-Råback L, Suokas K, Komulainen K, Mullola S, Böckerman P, Hakulinen C. School achievement in adolescence and the risk of mental disorders in early adulthood: a Finnish nationwide register study. Mol Psychiatry 2023; 28:3104-3110. [PMID: 37131077 PMCID: PMC10615737 DOI: 10.1038/s41380-023-02081-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/14/2023] [Accepted: 04/18/2023] [Indexed: 05/04/2023]
Abstract
School grades in adolescence have been linked to later psychiatric outcomes, but large-scale nationwide studies across the spectrum of mental disorders are scarce. In the present study, we examined the risk of a wide array of mental disorders in adulthood, as well as the risk of comorbidity, associated with school achievement in adolescence. We used population-based cohort data comprising all individuals born in Finland over the period 1980-2000 (N = 1,070,880) who were followed from age 15 or 16 until a diagnosis of mental disorder, emigration, death, or December 2017, whichever came first. Final grade average from comprehensive school was the exposure, and the first diagnosed mental disorder in a secondary healthcare setting was the outcome. The risks were assessed with Cox proportional hazards models, stratified Cox proportional hazard models within strata of full-siblings, and multinomial regression models. The cumulative incidence of mental disorders was estimated using competing risks regression. Better school achievement was associated with a smaller risk of all subsequent mental disorders and comorbidity, except for eating disorders, where better school achievement was associated with a higher risk. The largest associations were observed between school achievement and substance use disorders. Overall, individuals with school achievement more than two standard deviations below average had an absolute risk of 39.6% of a later mental disorder diagnosis. By contrast, for individuals with school achievement more than two standard deviations above average, the absolute risk of a later mental disorder diagnosis was 15.7%. The results show that the largest mental health burden accumulates among those with the poorest school achievement in adolescence.
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Affiliation(s)
- Tarja Weckström
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Research Program Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Marko Elovainio
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Research Program Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Laura Pulkki-Råback
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Kimmo Suokas
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Kaisla Komulainen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Research Program Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Sari Mullola
- Department of Education, University of Helsinki, Helsinki, Finland
- Teachers College Columbia University, National Center for Children and Families (NCCF), New York, NY, USA
| | - Petri Böckerman
- School of Business and Economics, University of Jyväskylä, Jyväskylä, Finland
- Labour Institute for Economic Research LABORE, Helsinki, Finland
- IZA Institute of Labor Economics, Bonn, Germany
| | - Christian Hakulinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
- Finnish Institute for Health and Welfare, Helsinki, Finland.
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Pergeline J, Rivière S, Rey S, Fresson J, Rachas A, Tuppin P. Social deprivation and the use of healthcare services over one year by children less than 18 years of age in 2018: A French nationwide observational study. PLoS One 2023; 18:e0285467. [PMID: 37224152 DOI: 10.1371/journal.pone.0285467] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 03/07/2023] [Indexed: 05/26/2023] Open
Abstract
This study aimed to describe the health status of children and how social deprivation affects their use of healthcare services and mortality. Children living in mainland France were selected from the national health data system (SNDS) on their date of birth or birthday in 2018 (< 18 years) and followed for one year. Information included data on healthcare reimbursements, long-term chronic diseases (LTDs) eligible for 100% reimbursement, geographic deprivation index (FDep) by quintile (Q5 most disadvantaged), and individual complementary universal insurance (CMUc) status, granted to households with an annual income below the French poverty level. The number of children who had at least one annual visit or hospital admission was compared using the ratio of geographic deprivation (rQ5/Q1) and CMUc (rCMUc/Not) after gender and age-standardization. Over 13 million children were included; 17.5% had CMUc, with an increase across quintiles (rQ5/Q1 = 3.5) and 4.0% a LTD (rQ5/Q1 = 1.44). The 10 most frequent LTDs (6 psychiatric) were more common as the deprivation increased. Visits to general practitioners (GPs) were similar (≈84%) for each FDep quintile and the density of GPs similar. The density decreased with increasing deprivation for specialists and visits: paediatricians (rQ5/Q1 = 0.46) and psychiatrists (rQ5/Q1 = 0.26). Dentist visits also decreased (rQ5/Q1 = 0.86) and deprived children were more often hospitalised for dental caries (rQ5/Q1 = 2.17, 2.1% vs 0.7%). Emergency department (ED) visits increased with deprivation (rCMUc/Not = 1.35, 30% vs 22%) but 50% of CMUc children lived in a municipality with an ED vs. 25% without. Approximately 9% of children were admitted for a short stay and 4.5% for a stay > 1 night (rQ5/Q1 = 1.44). Psychiatric hospitalization was more frequent for children with CMUc (rCMUc/Not = 3.5, 0.7% vs 0.2%). Higher mortality was observed for deprived children < 18 years (rQ5/Q1 = 1.59). Our results show a lower use of pediatricians, other specialists, and dentists among deprived children that may be due, in part, to an insufficient supply of care in their area of residence. These results have been used to recommend optimization and specifically adapted individual or area-wide policies on the use of healthcare services, their density, and activities.
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Affiliation(s)
- Jeanne Pergeline
- Caisse Nationale de l'assurance Maladie (Cnam), Direction de la Stratégie des études et des Statistiques, Paris, France
| | - Sébastien Rivière
- Caisse Nationale de l'assurance Maladie (Cnam), Direction de la Stratégie des études et des Statistiques, Paris, France
| | - Sylvie Rey
- Direction de la Recherche, des études, de l'évaluation et des Statistiques (Drees), Paris, France
| | - Jeanne Fresson
- Direction de la Recherche, des études, de l'évaluation et des Statistiques (Drees), Paris, France
| | - Antoine Rachas
- Caisse Nationale de l'assurance Maladie (Cnam), Direction de la Stratégie des études et des Statistiques, Paris, France
| | - Philippe Tuppin
- Caisse Nationale de l'assurance Maladie (Cnam), Direction de la Stratégie des études et des Statistiques, Paris, France
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Hakulinen C, Komulainen K, Suokas K, Pirkola S, Pulkki-Råback L, Lumme S, Elovainio M, Böckerman P. Socioeconomic position at the age of 30 and the later risk of a mental disorder: a nationwide population-based register study. J Epidemiol Community Health 2023; 77:298-304. [PMID: 36746629 PMCID: PMC10086472 DOI: 10.1136/jech-2022-219674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 12/07/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND A study was undertaken to examine the association between multiple indicators of socioeconomic position (SEP) at the age of 30 and the subsequent risk of the most common mental disorders. METHODS All persons born in Finland between 1966 and 1986 who were alive and living in Finland at the end of the year when they turned 30 were included. Educational attainment, employment status and personal total income were used as the alternative measures of SEP. Cox proportional hazards models were used to examine the association of SEP at the age of 30 with later risk of mental disorders. Additional analyses were conducted using a sibling design to account for otherwise unobserved shared family characteristics. Competing risks models were used to estimate absolute risks. RESULTS The study population included 1 268 768 persons, 26% of whom were later diagnosed with a mental disorder. Lower SEP at age 30 was consistently associated with a higher risk of being later diagnosed with a mental disorder, even after accounting for shared family characteristics and prior history of a mental disorder. Diagnosis-specific analyses showed that the associations were considerably stronger when substance misuse or schizophrenia spectrum disorders were used as an outcome. Absolute risk analyses showed that, by the age of 52 years, 58% of persons who had low educational attainment at the age of 30 were later diagnosed with a mental disorder. CONCLUSIONS Poor SEP at the age of 30 is associated with an increased risk of being later diagnosed with a mental disorder.
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Affiliation(s)
- Christian Hakulinen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland .,Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Kaisla Komulainen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Kimmo Suokas
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Sami Pirkola
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Laura Pulkki-Råback
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Sonja Lumme
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Marko Elovainio
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland.,Finnish Institute for Health and Welfare, Helsinki, Finland.,Research Program Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Petri Böckerman
- School of Business and Economics, University of Jyväskylä, Jyväskylä, Finland.,Labour Institute for Economic Research LABORE, Helsinki, Finland.,IZA Institute of Labor Economics, Bonn, Germany
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Golovina K, Elovainio M, Hakulinen C. Association between depression and the likelihood of having children: a nationwide register study in Finland. Am J Obstet Gynecol 2023; 228:211.e1-211.e11. [PMID: 36283480 DOI: 10.1016/j.ajog.2022.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 10/03/2022] [Accepted: 10/08/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Depression may be associated with a lower likelihood of having children, but the findings are inconsistent. Previous population-based studies on this topic are limited. OBJECTIVE We examined associations between depression and the likelihood of having children, the number of children, and the parental age at first birth. We also evaluated whether these associations differ for people with low, middle, and high educational levels. STUDY DESIGN We conducted a nationwide register cohort study including all individuals born in Finland from 1960 to 1980 (n=1,408,951). Depression diagnoses were identified from the Care Register for Health Care (containing records of inpatient hospital episodes for the period 1969 to 2017 and of specialist outpatient visits for the period 1996 to 2017). The main outcomes-having biological children, the number of biological children, and the parental age at first birth-were identified from the Population Register of Statistics Finland and were defined either in the last year of the follow-up in 2017 or the last year alive or living in Finland. The association between depression and the likelihood of having children was examined using a logistic regression analysis; the association between depression and the number of children was evaluated using Poisson regression analyses, and the association between depression and the age at first birth was evaluated using a linear regression analysis. All analyses were conducted separately for men and women. RESULTS For both men and women, secondary care-treated depression was associated with a lower likelihood of having children (odds ratio, 0.66; 95% confidence interval, 0.64-0.67 for men; odds ratio, 0.84; 95% confidence interval, 0.82-0.85 for women) and with having fewer children (incidence rate ratio, 0.86; 95% confidence interval, 0.86-0.87 for men; incidence rate ratio, 0.96; 95% confidence interval, 0.96-0.96 for women). Depression was associated with a slightly lower parental age at first birth (33.1 vs 34.0; P<.001 for men; 31.3 vs 32.1; P<.001 for women). Dose-response associations between the severity of depression and a decreased likelihood of having children, as well as having fewer children, were observed. Earlier onset of depression was related to a lower likelihood of having children and to having fewer children. Among men and women in middle- and high-level educational groups, depression was associated with a lower likelihood of having children and with having fewer children. Among men with a low level of education, no associations were observed. Among women with a low level of education, depression was associated with a higher likelihood of having children and with having more children. CONCLUSION Both men and women with secondary care-treated depression have a lower likelihood of having children and have fewer children. Our findings suggest that depression may be one of the factors that contribute to the likelihood of having children, which should be addressed by policy makers.
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Affiliation(s)
- Kateryna Golovina
- Helsinki Collegium for Advanced Studies, University of Helsinki, Helsinki, Finland.
| | - Marko Elovainio
- Research Program Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland; Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Christian Hakulinen
- Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland; Finnish Institute for Health and Welfare, Helsinki, Finland
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Vaalavuo M, Niemi R, Suvisaari J. Growing up unequal? Socioeconomic disparities in mental disorders throughout childhood in Finland. SSM Popul Health 2022; 20:101277. [PMID: 36353094 PMCID: PMC9637807 DOI: 10.1016/j.ssmph.2022.101277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
Abstract
Problems in mental health and socioeconomic health inequalities during childhood and adolescence are receiving important scientific and political attention. This in mind, we study how current family income and parental education are associated with psychiatric disorders among children in a well-developed welfare state, Finland. To gain a deeper understanding of how these disparities develop through early life course, we study the differences between genders, age groups, types of mental disorders, and also take into account the role of parental mental disorders. We exploit high-quality Finnish register data containing the whole population aged 4–17 with information on their families and parents. Our results of linear probability models show that lower parental education is consistently associated with higher probability of mental disorders throughout childhood, although some gender and disorder-specific differences are also identified. Interestingly, household income is related to mental health in more complex ways, having both negative and positive associations with psychiatric disorders. Inequalities are stronger among boys than girls, and the strongest associations are found among boys aged 7–12 and girls aged 13–17. Parental mental disorders increase the risk of children's psychiatric disorders but do not explain socioeconomic disparities. Considering the negative effects of mental problems on socioeconomic outcomes, inequalities in childhood mental health can be expected to reinforce other social inequalities in later life and should therefore be a focus of interventions. Inequalities in psychiatric disorders throughout childhood were examined using unique register data from Finland. Inequalities according to parental education were stronger and more consistent than according to family income. Parents' psychiatric disorders did not explain socioeconomic disparities.
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Carlén K, Suominen S, Augustine L, Saarinen MM, Aromaa M, Rautava P, Sourander A, Sillanpää M. Teenagers' mental health problems predict probable mental diagnosis 3 years later among girls, but what about the boys? Child Adolesc Psychiatry Ment Health 2022; 16:41. [PMID: 35681228 PMCID: PMC9185898 DOI: 10.1186/s13034-022-00473-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/11/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The prevalence of mental disorders is increasing, and there seems to be a gender difference in prevalence, with girls reporting more mental health problems than boys, especially regarding internalizing problems. Most mental disorders debut early but often remain untreated into adulthood. Early detection of mental disorders is essential for successful treatment, which is not always happening. The study aimed to estimate to what extent teenagers' self-reports predict probable mental diagnosis as they enter adulthood, particularly regarding gender differences. METHODS Self-reported mental health problems, Youth Self-Report (YSR) at 15 years (range 3-110, n = 504) from the ongoing Finnish family competence study (FFC) using modified multivariable Poisson regression analysis for prediction of DAWBA (Development and Wellbeing Assessment) interview outcomes 3 years later. RESULTS One unit's increase in YSR was estimated to correspond to an increase in the relative risk of a probable DAWBA-based diagnosis by 3.3% [RR (95% CI) 1.03 (1.03-1.04), p < 0.001]. In gender-specific analysis, the findings applied, particularly to girls. CONCLUSIONS Youth Self-Report (YSR) scores at pubertal age predicted the risk of a probable mental diagnosis at the onset of adulthood, particularly in girls. Further research is needed to explain the lower sensitivity of YSR among boys.
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Affiliation(s)
- Kristina Carlén
- School of Health Sciences, University of Skövde, Box 408, 54128, Skövde, Sweden. .,The Research School of Health and Welfare, Jönköping University, Jönköping, Sweden.
| | - Sakari Suominen
- grid.412798.10000 0001 2254 0954School of Health Sciences, University of Skövde, Box 408, 54128 Skövde, Sweden ,grid.1374.10000 0001 2097 1371Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
| | - Lilly Augustine
- grid.118888.00000 0004 0414 7587CHILD, School of Learning and Communication, Jönköping University, Jönköping, Sweden
| | - Maiju M. Saarinen
- grid.1374.10000 0001 2097 1371Departments of Child Neurology and General Practice, University of Turku and Turku University Hospital, Turku, Finland
| | - Minna Aromaa
- grid.1374.10000 0001 2097 1371Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland ,City of Turku Welfare Division, Turku, Finland
| | - Päivi Rautava
- grid.1374.10000 0001 2097 1371Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland ,grid.410552.70000 0004 0628 215XClinical Research Centre, Turku University Hospital, Turku, Finland
| | - André Sourander
- grid.1374.10000 0001 2097 1371Department of Child Psychiatry, University of Turku, Turku, Finland ,grid.410552.70000 0004 0628 215XDepartment of Child Psychiatry, Turku University Hospital, Turku, Finland
| | - Matti Sillanpää
- grid.1374.10000 0001 2097 1371Departments of Child Neurology and General Practice, University of Turku and Turku University Hospital, Turku, Finland
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Marchionatti LE, Caye A, Kieling C. The mental health of children and young people living in big cities in a revolving postpandemic world. Curr Opin Psychiatry 2022; 35:200-206. [PMID: 35579874 DOI: 10.1097/yco.0000000000000769] [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] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The world's population is increasingly urban, with most children and young people growing up and living in cities. Evidence suggests that urbanicity is linked to an increased risk for the development of mental health disorders. Rather than an accumulation of risk factors, urbanization is a complex process that profoundly structures living conditions. In this sense, it is timely to discuss what are the social and structural determinants of mental health of children and young people in such settings. RECENT FINDINGS Three domains of determinants of mental health were selected for discussion: economics and living conditions, crime and violence, and urban layouts. For each, we debated realities faced by urban children and young people, providing an overview of recent evidence on implications for mental disorders and well being. We also discuss the potential impacts of the covid-19 pandemic on each domain, as well as recommendations for future action. SUMMARY Structural factors are of major relevance for the mental health of children and young people living in cities. The agenda of mental health promotion and prevention must include whole-of-society interventions aimed at improving living conditions, including economic and social capital, violence prevention and urbanistic planning.
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Affiliation(s)
| | - Arthur Caye
- Department of Psychiatry
- Child and Adolescent Psychiatry Division, Hospital de Clinicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Christian Kieling
- Department of Psychiatry
- Child and Adolescent Psychiatry Division, Hospital de Clinicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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Schramm S, Møller SP, Tolstrup JS, Laursen B. Effects of individual and parental educational levels on multimorbidity classes: a register-based longitudinal study in a Danish population. BMJ Open 2022; 12:e053274. [PMID: 35197340 PMCID: PMC8867340 DOI: 10.1136/bmjopen-2021-053274] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To assess the effects of individual educational level in adulthood and parental educational level during childhood, as well as combinations of individual and parental educational levels, on multimorbidity classes. DESIGN AND SETTING In this longitudinal study, we used data from a random sample of the Danish population aged 32-56 years without multimorbidity in 2010 (n=102 818). The study population was followed until 2018. Information on individual and parental educational levels and chronic conditions was obtained from national registers. Multinomial logistic regression analyses were adjusted for sex, age and ethnicity. OUTCOME MEASURE Seven multimorbidity classes were identified using latent class analysis based on 47 chronic conditions. Persons deceased during follow-up comprised a separate class. RESULTS We found an independent effect of individual educational level on five multimorbidity groups and death, most pronounced for the multimorbidity group 'Many conditions' (OR=1.89, 95% CI 1.58 to 2.26 for medium and OR=3.22, 95% CI 2.68 to 3.87 for short compared with long educational level) and of parental education on four groups and death, most pronounced for the multimorbidity group 'Many conditions' (OR=1.36, 95% CI 1.07 to 1.73 for medium and OR=1.48, 95% CI 1.15 to 1.89 for short compared with long educational level). Odds of belonging to four multimorbidity classes increased with lower combination of individual and parental educational levels, most pronounced for the multimorbidity group 'Many conditions'. CONCLUSION As both individual and parental educational levels contribute to the risk of multimorbidity, it is important to address inequality throughout the life course to mitigate multimorbidity. Future studies could adopt a life course approach to investigate the mediating role of behavioural, clinical, environmental and other social factors.
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Affiliation(s)
- Stine Schramm
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Sanne Pagh Møller
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Bjarne Laursen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Leone M, Kuja-Halkola R, Leval A, D'Onofrio BM, Larsson H, Lichtenstein P, Bergen SE. Association of severe childhood infections with depression and intentional self-harm in adolescents and young adults. Brain Behav Immun 2022; 99:247-255. [PMID: 34655731 DOI: 10.1016/j.bbi.2021.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/16/2021] [Accepted: 10/11/2021] [Indexed: 02/08/2023] Open
Abstract
Early-life infections have been linked with subsequent depression and self-harm. Examination of specific groups of infections and the role of familial factors may elucidate this observed relationship. We addressed these considerations in our investigations of the association of severe childhood infections with the risks of depression and self-harm in adolescence and early-adulthood. This population-based cohort study included all individuals born in Sweden between 1982 and 1996, with follow-up through 2013 (N = 1,506,070). Severe childhood infections were identified using inpatient and outpatient diagnoses from birth through age 12. Any infection as well as specific groups of infections were investigated. We examined diagnoses of depression and self-harm within inpatient and outpatient care and death by self-harm between ages 13 and 31. Cox proportional hazards regression models were used to estimate absolute risks, hazard ratios (HRs), and 95% CIs. When adjusting for sex and birth year, individuals exposed to any childhood infection demonstrated increased absolute risk differences for both outcomes (2.42% [95% CI, 0.41-4.43%] of being diagnosed with depression up until age 31, and 0.73% [-2.05% to 3.51%] of self-harm up until age 31) and increased relative risks (HR, 1.22 [1.20-1.24] for depression and HR, 1.29 [1.25-1.32] for self-harm). When controlling for unmeasured factors shared between family members by comparing discordant siblings, no strong association persisted. Our findings show that childhood infections may not be involved in the etiology of later depression and self-harm, and highlight the importance of identifying these genetic and environmental familial risk factors, which may serve as targets for interventions.
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Affiliation(s)
- Marica Leone
- Janssen Pharmaceutical Companies of Johnson and Johnson, Solna, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Amy Leval
- Janssen Pharmaceutical Companies of Johnson and Johnson, Solna, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Brian M D'Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden; Department of Psychological and Brain Sciences, Indiana University, Bloomington, United States
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden; School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Sarah E Bergen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.
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