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Solberg BS, Kvalvik LG, Instanes JT, Hartman CA, Klungsøyr K, Li L, Larsson H, Magnus P, Njølstad PR, Johansson S, Andreassen OA, Bakken NR, Bekkhus M, Austerberry C, Smajlagic D, Havdahl A, Corfield EC, Haavik J, Gjestad R, Zayats T. Maternal Fiber Intake During Pregnancy and Development of Attention-Deficit/Hyperactivity Disorder Symptoms Across Childhood: The Norwegian Mother, Father, and Child Cohort Study. Biol Psychiatry 2024; 95:839-848. [PMID: 38142720 DOI: 10.1016/j.biopsych.2023.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 12/08/2023] [Accepted: 12/13/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Epidemiological studies suggest that maternal diet quality during pregnancy may influence the risk of neurodevelopmental disorders in offspring. Here, we investigated associations between maternal intake of dietary fiber and attention-deficit/hyperactivity disorder (ADHD) symptoms in early childhood. METHODS We used longitudinal data of up to 21,852 mother-father-child trios (49.2% female offspring) from MoBa (the Norwegian Mother, Father, and Child Cohort Study). The relationships between maternal fiber intake during pregnancy and offspring ADHD symptoms at ages 3, 5, and 8 years were examined using 1) multivariate regression (overall levels of ADHD symptoms), 2) latent class analysis (subclasses of ADHD symptoms by sex at each age), and 3) latent growth curves (longitudinal change in offspring ADHD symptoms). Covariates were ADHD polygenic scores in child and parents, total energy intake and energy-adjusted sugar intake, parental ages at birth of the child, and sociodemographic factors. RESULTS Higher maternal prenatal fiber intake was associated with lower offspring ADHD symptom scores at all ages (Bage3 = -0.14 [95% CI, -0.18 to -0.10]; Bage5 = -0.14 [95% CI, -0.19 to -0.09]; Bage8 = -0.14 [95% CI, -0.20 to -0.09]). Of the derived low/middle/high subclasses of ADHD symptoms, fiber was associated with lower risk of belonging to the middle subclass for boys and girls and to the high subclass for girls only (middle: odds ratioboys 0.91 [95% CI, 0.86 to 0.97]/odds ratiogirls 0.86 [95% CI, 0.81 to 0.91]; high: odds ratiogirls 0.82 [95% CI, 0.72 to 0.94]). Maternal fiber intake and rate of change in child ADHD symptoms across ages were not associated. CONCLUSIONS Low prenatal maternal fiber intake may increase symptom levels of ADHD in offspring during childhood, independently of genetic predisposition to ADHD, unhealthy dietary exposures, and sociodemographic factors.
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Affiliation(s)
- Berit Skretting Solberg
- Department of Biomedicine, University of Bergen, Norway; Child and Adolescent Psychiatric Outpatient Unit, Hospital Betanien, Bergen, Norway.
| | | | | | - Catharina A Hartman
- Interdisciplinary Center Psychiatry and Emotion Regulation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Kari Klungsøyr
- Department of Global Public Health and Primary Care, University of Bergen, Norway; Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Lin Li
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Per Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Pål Rasmus Njølstad
- Department of Clinical Science, Mohn Center for Diabetes Precision Medicine, University of Bergen, Bergen, Norway; Children and Youth Clinic, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Stefan Johansson
- Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - Ole A Andreassen
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Division of Mental Health and Addiciton, Oslo University Hospital, Oslo, Norway
| | - Nora Refsum Bakken
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Mona Bekkhus
- Promenta Research Centre, Department of Psychology, University of Oslo, Oslo, Norway
| | - Chloe Austerberry
- Centre for Family Research, University of Cambridge, Cambridge, United Kingdom; Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Dinka Smajlagic
- Promenta Research Centre, Department of Psychology, University of Oslo, Oslo, Norway
| | - Alexandra Havdahl
- Promenta Research Centre, Department of Psychology, University of Oslo, Oslo, Norway; Centre for Genetic Epidemiology and Mental Health, Norwegian Institute of Public Health, Oslo, Norway; Nic Waals Institute, Lovisenberg Diakonale Hospital, Oslo, Norway
| | - Elizabeth C Corfield
- Centre for Genetic Epidemiology and Mental Health, Norwegian Institute of Public Health, Oslo, Norway; Nic Waals Institute, Lovisenberg Diakonale Hospital, Oslo, Norway
| | - Jan Haavik
- Department of Biomedicine, University of Bergen, Norway; Bergen Center for Brain Plasticity, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Psychiatry, Research Department, Haukeland University Hospital, Bergen, Norway
| | - Rolf Gjestad
- Department of Psychiatry, Research Department, Haukeland University Hospital, Bergen, Norway; Center for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway; Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Tetyana Zayats
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Massachusetts; Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts
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Liu Y, Lichtenstein P, Kotov R, Larsson H, D'Onofrio BM, Pettersson E. Exploring the genetic etiology across the continuum of the general psychopathology factor: a Swedish population-based family and twin study. Mol Psychiatry 2024:10.1038/s41380-024-02552-2. [PMID: 38600227 DOI: 10.1038/s41380-024-02552-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 03/31/2024] [Accepted: 04/03/2024] [Indexed: 04/12/2024]
Abstract
Psychiatric comorbidity can be accounted for by a latent general psychopathology factor (p factor), which quantifies the variance that is shared to varying degrees by every dimension of psychopathology. It is unclear whether the entire continuum of the p factor shares the same genetic origin. We investigated whether mild, moderate, and extreme elevations on the p factor shared the same genetic etiology by, first, examining the linearity of the association between p factors across siblings (N = 580,891 pairs). Second, we estimated the group heritability in a twin sample (N = 17,170 pairs), which involves testing whether the same genetic variants influence both extreme and normal variations in the p factor. In both samples, the p factor was based on 10 register-based psychiatric diagnoses. Results showed that the association between siblings' p factors appeared linear, even into the extreme range. Likewise, the twin group heritabilities ranged from 0.42 to 0.45 (95% CI: 0.33-0.57) depending on the thresholds defining the probands (2-3.33 SD beyond the mean; >2 SD beyond the mean; >4.33 SD beyond the mean; and >5.33 SD beyond the mean), and these estimates were highly similar to the estimated individual differences heritability (0.41, 95% CI: 0.39-0.43), indicating that scores above and below these thresholds shared a common genetic origin. Together, these results suggest that the entire continuum of the p factor shares the same genetic origin, with common genetic variants likely playing an important role. This implies, first, genetic risk factors for the aspect that is shared between all forms of psychopathology (i.e., genetic risk factors for the p factor) might be generalizable between population-based cohorts with a higher prevalence of milder cases, and clinical samples with a preponderance of more severe cases. Second, prioritizing low-cost genome-wide association studies capable of identifying common genetic variants, rather than expensive whole genome sequencing that can identify rare variants, may increase the efficiency when studying the genetic architecture of the p factor.
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Affiliation(s)
- Yangjun Liu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Roman Kotov
- Department of Psychiatry and Behavioral Health, Stony Brook University, Stony Brook, NY, USA
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Brian M D'Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Erik Pettersson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Haan E, Krebs K, Võsa U, Brikell I, Larsson H, Lehto K. Associations between attention-deficit hyperactivity disorder genetic liability and ICD-10 medical conditions in adults: utilizing electronic health records in a Phenome-Wide Association Study. Psychol Med 2024:1-14. [PMID: 38563284 DOI: 10.1017/s0033291724000606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Attention-deficit hyperactivity disorder (ADHD) is often comorbid with other medical conditions in adult patients. However, ADHD is extremely underdiagnosed in adults and little is known about the medical comorbidities in undiagnosed adult individuals with high ADHD liability. In this study we investigated associations between ADHD genetic liability and electronic health record (EHR)-based ICD-10 diagnoses across all diagnostic categories, in individuals without ADHD diagnosis history. METHODS We used data from the Estonian Biobank cohort (N = 111 261) and generated polygenic risk scores (PRS) for ADHD (PRSADHD) based on the ADHD genome-wide association study. We performed a phenome-wide association study (PheWAS) to test for associations between standardized PRSADHD and 1515 EHR-based ICD-10 diagnoses in the full and sex-stratified sample. We compared the observed significant ICD-10 associations to associations with (1) ADHD diagnosis and (2) questionnaire-based high ADHD risk analyses. RESULTS After Bonferroni correction (p = 3.3 × 10-5) we identified 80 medical conditions associated with PRSADHD. The strongest evidence was seen with chronic obstructive pulmonary disease (OR 1.15, CI 1.11-1.18), obesity (OR 1.13, CI 1.11-1.15), and type 2 diabetes (OR 1.11, CI 1.09-1.14). Sex-stratified analysis generally showed similar associations in males and females. Out of all identified associations, 40% and 78% were also observed using ADHD diagnosis or questionnaire-based ADHD, respectively, as the predictor. CONCLUSIONS Overall our findings indicate that ADHD genetic liability is associated with an increased risk of a substantial number of medical conditions in undiagnosed individuals. These results highlight the need for timely detection and improved management of ADHD symptoms in adults.
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Affiliation(s)
- Elis Haan
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
- Viljandi Hospital, Psychiatric Clinic, Viljandi, Estonia
| | - Kristi Krebs
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Urmo Võsa
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Isabell Brikell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Deparment of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Kelli Lehto
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
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Bang Madsen K, Bliddal M, Skoglund CB, Larsson H, Munk-Olsen T, Madsen MG, Hove Thomsen P, Bergink V, Srinivas C, Cohen JM, Brikell I, Liu X. Attention-Deficit Hyperactivity Disorder (ADHD) Medication Use Trajectories Among Women in the Perinatal Period. CNS Drugs 2024; 38:303-314. [PMID: 38489019 PMCID: PMC10980654 DOI: 10.1007/s40263-024-01076-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND An increasing number of women of reproductive age are treated with attention-deficit hyperactivity disorder (ADHD) medication; however, patterns of ADHD medication use for women in the perinatal period have not been well described. OBJECTIVE This study aimed to describe ADHD medication use patterns from 1 year before pregnancy to 1 year after delivery, and to describe sociodemographic characteristics and clinical features by medication trajectories. METHODS The population-based cohort study included pregnancies in Denmark between 1997 and 2020, from the Medical Birth Register, by women who filled at least one prescription for ADHD medication from 12 months before pregnancy until 12 months after delivery. We applied group-based trajectory modeling to classify women into subgroups based on the identification of heterogeneous ADHD medication treatment patterns, and described the characteristics associated with these groups. RESULTS Overall, we included 4717 pregnancies leading to liveborn singletons by 4052 mothers with a mean (standard deviation) age of 27.5 (5.6) years. We identified four treatment trajectories across pregnancy and the postpartum period: continuers (23.3%), discontinuers (41.8%), interrupters who ceased filling prescriptions during pregnancy but resumed postpartum (17.2%), and postpartum initiators (17.7%). Continuers were older at the time of conception, gave birth in more recent years, were more likely to smoke during pregnancy, and used other psychotropic medications during pregnancy. A large proportion of continuers used methylphenidate (89.1%) compared with the other groups (75.9-84.1%) and had switched ADHD medication type during the whole period (16.4% vs. 7.4-14.8%). CONCLUSION We found that approximately 60% of women discontinued or interrupted their ADHD medication around pregnancy, and those who continued differed in sociodemographic and clinical factors that may reflect more severe ADHD.
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Affiliation(s)
- Kathrine Bang Madsen
- School of Business and Social Sciences, NCRR - National Centre for Register-based Research, Aarhus University, Fuglesangs Allé 26, Building R, 8210, Aarhus V, Denmark.
- CIRRAU - Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark.
| | - Mette Bliddal
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Charlotte Borg Skoglund
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- School of Medical Sciences, Örebro University, Örebro, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Trine Munk-Olsen
- School of Business and Social Sciences, NCRR - National Centre for Register-based Research, Aarhus University, Fuglesangs Allé 26, Building R, 8210, Aarhus V, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Malene Galle Madsen
- School of Business and Social Sciences, NCRR - National Centre for Register-based Research, Aarhus University, Fuglesangs Allé 26, Building R, 8210, Aarhus V, Denmark
| | - Per Hove Thomsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Research Center at the Department for Child and Adolescent Psychiatry, Aarhus University Hospital, Skejby, Denmark
| | - Veerle Bergink
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Chaitra Srinivas
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
- Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
| | - Jacqueline M Cohen
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Isabell Brikell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Xiaoqin Liu
- School of Business and Social Sciences, NCRR - National Centre for Register-based Research, Aarhus University, Fuglesangs Allé 26, Building R, 8210, Aarhus V, Denmark
- CIRRAU - Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
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5
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Chen Y, Shen Q, Lichtenstein P, Gradus JL, Arnberg FK, Larsson H, D’Onofrio BM, Fang F, Song H, Valdimarsdottir UA. Incidence Trajectories of Psychiatric Disorders After Assault, Injury, and Bereavement. JAMA Psychiatry 2024; 81:374-385. [PMID: 38231519 PMCID: PMC10794980 DOI: 10.1001/jamapsychiatry.2023.5156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/03/2023] [Indexed: 01/18/2024]
Abstract
Importance Traumatic events have been associated with elevated risks of psychiatric disorders, while the contributions of familial factors to these associations remain less clear. Objective To determine the contribution of familial factors to long-term incidence trajectories of psychiatric disorders following potentially traumatic events. Design, Setting, and Participants This cohort study evaluated 3 separate cohorts of individuals residing in Sweden who were free of previous diagnosed psychiatric disorders when first exposed to assault (n = 49 957), injury (n = 555 314), or bereavement (n = 321 263) from January 1987 to December 2013, together with their unexposed full siblings, and 10 age-, sex-, and birthplace-matched unexposed individuals (per exposed individual). Cohorts were created from the Swedish Total Population Register linked to health and population registers. Data were analyzed from March 2022 to April 2023. Exposures Potentially traumatic events, including various types of assault, injuries, and bereavement (death of a child or of a spouse or partner), were ascertained from the Swedish national registers. Main Outcomes and Measures Incident psychiatric disorders were ascertained from the Swedish Patient Register. Flexible parametric and Cox models were used to estimate associations of potentially traumatic events with incident psychiatric disorders after multivariable adjustment. Results The median (IQR) age at exposure to assault, injury, and bereavement was 22 (18-31), 19 (8-40), and 60 (51-68) years, respectively. During a median (IQR) follow-up of 4.9 (2.2-8.2), 9.1 (4.1-15.6), and 8.1 (3.4-14.8) years, the incidence rates of any psychiatric disorder were 38.1, 13.9, and 9.0 per 1000 person-years for the exposed groups of the 3 cohorts, respectively. Elevated risk of any psychiatric disorder was observed during the first year after exposure to any assault (hazard ratio [HR], 4.55; 95% CI, 4.34-4.77), injury (HR, 3.31; 95% CI,3.23-3.38), or bereavement (HR, 2.81; 95% CI, 2.72-2.91) and thereafter (assault HR, 2.50; 95% CI, 2.43-2.56; injury HR, 1.69; 95% CI, 1.68-1.70; bereavement HR, 1.42; 95% CI, 1.40-1.44). Comparable associations were obtained in sibling comparison (first year: assault HR, 3.70; 95% CI, 3.37-4.05; injury HR, 2.98; 95% CI, 2.85-3.12; bereavement HR, 2.72; 95% CI, 2.54-2.91; thereafter: assault HR, 1.93; 95% CI, 1.84-2.02; injury HR, 1.51; 95% CI, 1.48-1.53; bereavement HR, 1.35; 95% CI, 1.31-1.38). The risk elevation varied somewhat by type of traumatic events and psychiatric disorders, with the greatest HR noted for posttraumatic stress disorder after sexual assault (sibling comparison HR, 4.52; 95% CI, 3.56-5.73 during entire follow-up period). Conclusions and Relevance In this study, the long-term risk elevation of psychiatric disorders after potentially traumatic events was largely independent of familial factors. The risk elevation observed immediately after these events motivates early clinical surveillance and mental health services for these vulnerable populations.
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Affiliation(s)
- Yufeng Chen
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Qing Shen
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
- Institute for Advanced Study, Tongji University, Shanghai, China
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet
| | - Jaimie L. Gradus
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
- Department of Psychiatry, Boston University School of Public Health, Boston, Massachusetts
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Filip K. Arnberg
- National Centre for Disaster Psychiatry, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Brian M. D’Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana
| | - Fang Fang
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Huan Song
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Unnur A. Valdimarsdottir
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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6
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Strom NI, Burton CL, Iyegbe C, Silzer T, Antonyan L, Pool R, Lemire M, Crowley JJ, Hottenga JJ, Ivanov VZ, Larsson H, Lichtenstein P, Magnusson P, Rück C, Schachar R, Wu HM, Cath D, Crosbie J, Mataix-Cols D, Boomsma DI, Mattheisen M, Meier SM, Smit DJA, Arnold PD. Genome-Wide Association Study of Obsessive-Compulsive Symptoms including 33,943 individuals from the general population. Mol Psychiatry 2024:10.1038/s41380-024-02489-6. [PMID: 38548983 DOI: 10.1038/s41380-024-02489-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/18/2024] [Accepted: 02/15/2024] [Indexed: 04/24/2024]
Abstract
While 1-2% of individuals meet the criteria for a clinical diagnosis of obsessive-compulsive disorder (OCD), many more (~13-38%) experience subclinical obsessive-compulsive symptoms (OCS) during their life. To characterize the genetic underpinnings of OCS and its genetic relationship to OCD, we conducted the largest genome-wide association study (GWAS) meta-analysis of parent- or self-reported OCS to date (N = 33,943 with complete phenotypic and genome-wide data), combining the results from seven large-scale population-based cohorts from Sweden, the Netherlands, England, and Canada (including six twin cohorts and one cohort of unrelated individuals). We found no genome-wide significant associations at the single-nucleotide polymorphism (SNP) or gene-level, but a polygenic risk score (PRS) based on the OCD GWAS previously published by the Psychiatric Genetics Consortium (PGC-OCD) was significantly associated with OCS (Pfixed = 3.06 × 10-5). Also, one curated gene set (Mootha Gluconeogenesis) reached Bonferroni-corrected significance (Ngenes = 28, Beta = 0.79, SE = 0.16, Pbon = 0.008). Expression of genes in this set is high at sites of insulin mediated glucose disposal. Dysregulated insulin signaling in the etiology of OCS has been suggested by a previous study describing a genetic overlap of OCS with insulin signaling-related traits in children and adolescents. We report a SNP heritability of 4.1% (P = 0.0044) in the meta-analyzed GWAS, and heritability estimates based on the twin cohorts of 33-43%. Genetic correlation analysis showed that OCS were most strongly associated with OCD (rG = 0.72, p = 0.0007) among all tested psychiatric disorders (N = 11). Of all 97 tested phenotypes, 24 showed a significant genetic correlation with OCS, and 66 traits showed concordant directions of effect with OCS and OCD. OCS have a significant polygenic contribution and share genetic risk with diagnosed OCD, supporting the hypothesis that OCD represents the extreme end of widely distributed OCS in the population.
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Affiliation(s)
- Nora I Strom
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany.
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany.
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Sweden.
- Department of Biomedicine, Aarhus University, Aarhus, Denmark.
| | - Christie L Burton
- Neurosciences and Mental Health, Hospital for Sick Children, Toronto, ON, Canada
| | - Conrad Iyegbe
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England
- Department of Genetics and Genomic Sciences, Icahn School of Medicine, Mount Sinai, New York, USA
| | - Talisa Silzer
- Neurosciences and Mental Health, Hospital for Sick Children, Toronto, ON, Canada
| | - Lilit Antonyan
- The Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - René Pool
- Department of Biological Psychology, Vrije Universiteit, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Mathieu Lemire
- Neurosciences and Mental Health, Hospital for Sick Children, Toronto, ON, Canada
| | - James J Crowley
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Sweden
- Departments of Genetics and Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jouke-Jan Hottenga
- Netherlands Twin Register, Biological Psychology, Vrije Universiteit, Amsterdam, The Netherlands
| | - Volen Z Ivanov
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical sciences, Örebro University, Örebro, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Patrik Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Christian Rück
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Sweden
| | - Russell Schachar
- Neurosciences and Mental Health, Hospital for Sick Children, Toronto, ON, Canada
| | - Hei Man Wu
- Department of Genetics and Genomic Sciences, Icahn School of Medicine, Mount Sinai, New York, USA
| | - Danielle Cath
- Rijksuniversiteit Groningen and Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
- Department of Specialized Training, Drenthe Mental Health Care Institute, Assen, The Netherlands
| | - Jennifer Crosbie
- Neurosciences and Mental Health, Hospital for Sick Children, Toronto, ON, Canada
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Sweden
| | - Dorret I Boomsma
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Netherlands Twin Register, Biological Psychology, Vrije Universiteit, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Manuel Mattheisen
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Community Health & Epidemiology, Dalhousie University, NS, Halifax, Canada
| | - Sandra M Meier
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Community Health & Epidemiology, Dalhousie University, NS, Halifax, Canada
| | - Dirk J A Smit
- Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Compulsivity Impulsivity and Attention, Amsterdam, The Netherlands
| | - Paul D Arnold
- The Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Departments of Psychiatry and Medical Genetics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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7
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Curman P, Jebril W, Larsson H, Bachar-Wikstrom E, Cederlöf M, Wikstrom JD. Darier disease is associated with neurodegenerative disorders and epilepsy. Sci Rep 2024; 14:7109. [PMID: 38531956 DOI: 10.1038/s41598-024-57779-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 03/21/2024] [Indexed: 03/28/2024] Open
Abstract
Darier disease (DD) is a rare monogenetic skin disorder with limited data on its potential association with neurological disorders. This study aimed to investigate the association between DD and neurological disorders, specifically Parkinson's disease, dementias, and epilepsy. Using Swedish national registers in a period spanning between 1977 and 2013, 935 individuals with DD were compared with up to 100 comparison individuals each, randomly selected from the general population based on birth year, sex, and county of residence at the time of the first diagnosis of DD. Individuals with DD had increased risks of being diagnosed with Parkinson's disease (RR 2.1, CI 1.1; 4.4), vascular dementia (RR 2.1, CI 1.0; 4.2), and epilepsy, (RR 2.5, CI 1.8; 3.5). No association of DD with other dementias were detected. This study demonstrates a new association between DD and neurodegenerative disorders and epilepsy, underlining the need for increased awareness, interdisciplinary collaboration, and further research to understand the underlying mechanisms. Early identification and management of neurological complications in DD patients could improve treatment strategies and patient outcomes. The findings also highlight the role of SERCA2 in the pathophysiology of neurological disorders, offering new targets for future research and potentials for novel treatments.
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Affiliation(s)
- Philip Curman
- Dermatology and Venereology Division, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
- Dermato-Venereology Clinic, Karolinska University Hospital, Eugeniavägen 3, 17164, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - William Jebril
- Dermatology and Venereology Division, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
- Dermato-Venereology Clinic, Karolinska University Hospital, Eugeniavägen 3, 17164, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Etty Bachar-Wikstrom
- Dermatology and Venereology Division, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden
| | - Martin Cederlöf
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Jakob D Wikstrom
- Dermatology and Venereology Division, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden.
- Dermato-Venereology Clinic, Karolinska University Hospital, Eugeniavägen 3, 17164, Stockholm, Sweden.
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8
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Takami Lageborn C, Zhou M, Boman M, Sjölander A, Larsson H, D'Onofrio BM, Pettersson E, Lichtenstein P, Landén M. Childhood and adolescence outcomes in offspring to parents with bipolar disorder: the impact of lifetime parental comorbidity, parental sex, and bipolar subtype. J Child Psychol Psychiatry 2024. [PMID: 38527491 DOI: 10.1111/jcpp.13982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Offspring of parents with bipolar disorder have increased risks of their own psychopathology. However, a large-scale survey of psychiatric, somatic, and adverse social outcomes up to adulthood, which could aid in prioritizing and tailoring prevention, is lacking. It also remains to clarify how risks are modified by other parental factors. METHODS Swedish population registers were linked to compare offspring having (N = 24,788) and not having (N = 247,880) a parent with bipolar disorder with respect to psychiatric diagnoses and psychotropic medication, birth-related and somatic conditions, social outcomes, accidents, suicide attempts, and mortality. Individuals were followed until age 18. We estimated the influence of lifetime parental psychiatric comorbidity, bipolar disorder subtype, and sex on outcomes. RESULTS Children of parents with bipolar disorder had 2-3 times higher risks of all psychiatric diagnoses, except for bipolar disorder, for which the risk was 11-fold. Significantly increased risks were also found for several somatic conditions, low school grades, criminal behavior, victimization, accidents, and suicidal behavior. Adjusting for lifetime parental psychiatric comorbidity attenuated most associations. Offspring of a parent with bipolar disorder type 2 had statistically significantly higher risks of attention deficit hyperactivity disorder, respiratory tract conditions, and accidents compared with offspring of a parent with bipolar disorder type 1. Offspring of mothers with bipolar disorder had higher risks of several psychiatric diagnoses, respiratory tract conditions, low school grades, and accidents compared with offspring of fathers with bipolar disorder. Having two parents with bipolar disorder entailed the highest risks of psychiatric outcomes in offspring. CONCLUSIONS Early intervention and family support are particularly warranted for the offspring of a parent with bipolar disorder in the presence of lifetime parental psychiatric comorbidity, when the parent has bipolar disorder type 2, or when the mother or both parents have bipolar disorder.
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Affiliation(s)
| | - Mengping Zhou
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Marcus Boman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Arvid Sjölander
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Brian M D'Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana, USA
| | - Erik Pettersson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Landén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
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9
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Plate J, Söderbergh T, Bergqvist J, Lingblom C, Bergquist H, Larsson H. Eosinophilic esophagitis prevalence, incidence, and presenting features: a 22-year population-based observational study from southwest Sweden. Dis Esophagus 2024:doae025. [PMID: 38525937 DOI: 10.1093/dote/doae025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/19/2024] [Accepted: 03/12/2024] [Indexed: 03/26/2024]
Abstract
Eosinophilic esophagitis (EoE) is a chronic inflammatory condition of the esophagus that affects both children and adults. Symptoms in adults are mainly esophageal dysphagia, which ranges from mild symptoms to acute food bolus obstruction of the esophagus. Diagnosis is defined as symptoms of esophageal dysfunction and ≥ 15 eosinophils/high power field (HPF) in at least one of the biopsies taken from the esophagus. EoE appears to be increasing in both prevalence and incidence. The aim of this study was to investigate the prevalence, incidence, and presenting symptoms of patients with EoE within the catchment area of Northern Älvsborg County Hospital in Trollhättan. Patient records with the ICD code of EoE between 2012 and 2022 and pathology reports from esophageal biopsies from 2000-2022 were examined. Patients with symptoms of esophageal dysfunction and > 15 eosinophils/HPF were classified as having EoE. In total, 409 EoE patients (379 adults and 30 children) fulfilled the diagnostic criteria during the follow-up period. The overall prevalence was 113 cases/100 000 inhabitants (adults 127/100 000 and children 57/100 000) at 31 December 2022. The incidence was 7/100 000 and increased during the observation period. At diagnosis, 46% of the adults and 11% of the children had a history of acute bolus obstruction requiring hospitalization, while 51% of adults and 22% of children exhibited endoscopic findings of fibrosis. The prevalence of EoE is significantly higher than that generally reported in an area of southwest Sweden. The results indicate that the incidence is increasing; however, whether this is due to an actual increase or heightened awareness of EoE is inconclusive. Acute bolus obstruction is a common presenting symptom among EoE patients and is most likely an effect of late diagnosis.
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Affiliation(s)
- J Plate
- Department of Otorhinolaryngology Head and Neck Surgery, Region Västra Götaland, NU-Hospital Group, Trollhättan, Sweden
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - T Söderbergh
- Department of Otorhinolaryngology Head and Neck Surgery, Region Västra Götaland, NU-Hospital Group, Trollhättan, Sweden
| | - J Bergqvist
- Pulmonary Department, Sleep Disorders Centre, Sahlgrenska University Hospital, Gothenburg, Sweden
- Centre for Sleep and Wake Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - C Lingblom
- Department of Infectious Diseases, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Microbiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - H Bergquist
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - H Larsson
- Department of Otorhinolaryngology Head and Neck Surgery, Region Västra Götaland, NU-Hospital Group, Trollhättan, Sweden
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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10
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Wronski ML, Kuja-Halkola R, Hedlund E, Martini MI, Lichtenstein P, Lundström S, Larsson H, Taylor MJ, Micali N, Bulik CM, Dinkler L. Co-existing mental and somatic conditions in Swedish children with the avoidant restrictive food intake disorder phenotype. medRxiv 2024:2024.03.10.24304003. [PMID: 38558975 PMCID: PMC10980122 DOI: 10.1101/2024.03.10.24304003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Background Avoidant restrictive food intake disorder (ARFID) is a feeding and eating disorder, characterized by limited variety and/or quantity of food intake impacting physical health and psychosocial functioning. Children with ARFID often present with a range of psychiatric and somatic symptoms, and therefore consult various pediatric subspecialties; large-scale studies mapping comorbidities are however lacking. To characterize health care needs of people with ARFID, we systematically investigated ARFID-related mental and somatic conditions in 616 children with ARFID and >30,000 children without ARFID. Methods In a Swedish twin cohort, we identified the ARFID phenotype in 6-12-year-old children based on parent-reports and register data. From >1,000 diagnostic ICD-codes, we specified mental and somatic conditions within/across ICD-chapters, number of distinct per-person diagnoses, and inpatient treatment days between birth and 18th birthday (90 outcomes). Hazard ratios (HR) and incidence rate ratios (IRR) were calculated. Findings Relative risks of neurodevelopmental, gastrointestinal, endocrine/metabolic, respiratory, neurological, and allergic disorders were substantially increased in ARFID (e.g., autism HR[CI95%]=9.7[7.5-12.5], intellectual disability 10.3[7.6-13.9], gastroesophageal reflux disease 6.7[4.6-9.9], pituitary conditions 5.6[2.7-11.3], chronic lower respiratory diseases 4.9[2.4-10.1], epilepsy 5.8[4.1-8.2]). ARFID was not associated with elevated risks of autoimmune illnesses and obsessive-compulsive disorder. Children with ARFID had a significantly higher number of distinct mental diagnoses (IRR[CI95%]=4.7[4.0-5.4]) and longer duration of hospitalizations (IRR[CI95%]=5.5[1.7-17.6]) compared with children without ARFID. Children with ARFID were diagnosed earlier with a mental condition than children without ARFID. No sex-specific differences emerged. Interpretation This study yields the broadest and most detailed evidence of co-existing mental and somatic conditions in the largest sample of children with ARFID to date. Findings suggest a complex pattern of health needs in youth with ARFID, underscoring the critical importance of attention to the illness across all pediatric specialties. Funding Fredrik and Ingrid Thurings Foundation, Mental Health Foundation.
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Affiliation(s)
- Marie-Louis Wronski
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Neuroendocrine Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Elin Hedlund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Miriam I. Martini
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sebastian Lundström
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Mark J. Taylor
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Nadia Micali
- Center for Eating and Feeding Disorders Research, Mental Health Center Ballerup, Copenhagen University Hospital – Mental Health Services CPH, Denmark
- Institute for Biological Psychiatry, Mental Health Centre Sct Hans, Copenhagen University Hospital – Mental Health Services, Copenhagen, Denmark
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Cynthia M. Bulik
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychiatry, University of North Carolina at Chapel Hill, NC, USA
- Department of Nutrition, University of North Carolina at Chapel Hill, NC, USA
| | - Lisa Dinkler
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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11
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Simonsson O, Mosing MA, Osika W, Ullén F, Larsson H, Lu Y, Wesseldijk LW. Adolescent Psychedelic Use and Psychotic or Manic Symptoms. JAMA Psychiatry 2024:2816354. [PMID: 38477889 PMCID: PMC10938246 DOI: 10.1001/jamapsychiatry.2024.0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/03/2024] [Indexed: 03/14/2024]
Abstract
Importance While psychedelic-assisted therapy has shown promise in the treatment of certain psychiatric disorders, little is known about the potential risk of psychotic or manic symptoms following naturalistic psychedelic use, especially among adolescents. Objective To investigate associations between naturalistic psychedelic use and self-reported psychotic or manic symptoms in adolescents using a genetically informative design. Design, Setting, and Participants This study included a large sample of adolescent twins (assessed at age 15, 18, and 24 years) born between July 1992 and December 2005 from the Swedish Twin Registry and cross-sectionally evaluated the associations between past psychedelic use and psychotic or manic symptoms at age 15 years. Individuals were included if they answered questions related to past use of psychedelics. Data were analyzed from October 2022 to November 2023. Main Outcomes and Measures Primary outcome measures were self-reported psychotic and manic symptoms at age 15 years. Lifetime use of psychedelics and other drugs was also assessed at the same time point. Results Among the 16 255 participants included in the analyses, 8889 were female and 7366 were male. Among them, 541 participants reported past use of psychedelics, most of whom (535 of 541 [99%]) also reported past use of other drugs (ie, cannabis, stimulants, sedatives, opioids, inhalants, or performance enhancers). When adjusting for substance-specific and substance-aggregated drug use, psychedelic use was associated with reduced psychotic symptoms in both linear regression analyses (β, -0.79; 95% CI, -1.18 to -0.41 and β, -0.39; 95% CI, -0.50 to -0.27, respectively) and co-twin control analyses (β, -0.89; 95% CI, -1.61 to -0.16 and β, -0.24; 95% CI, -0.48 to -0.01, respectively). In relation to manic symptoms, likewise adjusting for substance-specific and substance-aggregated drug use, statistically significant interactions were found between psychedelic use and genetic vulnerability to schizophrenia (β, 0.17; 95% CI, 0.01 to 0.32 and β, 0.17; 95% CI, 0.02 to 0.32, respectively) or bipolar I disorder (β, 0.20; 95% CI, 0.04 to 0.36 and β, 0.17; 95% CI, 0.01 to 0.33, respectively). Conclusions and Relevance The findings in this study suggest that, after adjusting for other drug use, naturalistic use of psychedelic may be associated with lower rates of psychotic symptoms among adolescents. At the same time, the association between psychedelic use and manic symptoms seems to be associated with genetic vulnerability to schizophrenia or bipolar I disorder. These findings should be considered in light of the study's limitations and should therefore be interpreted with caution.
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Affiliation(s)
- Otto Simonsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Miriam A. Mosing
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Cognitive Neuropsychology, Max Planck Institute for Empirical Aesthetics, Frankfurt am Main, Germany
- Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Walter Osika
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Southern Stockholm Psychiatric District, Region Stockholm, Stockholm, Sweden
| | - Fredrik Ullén
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Cognitive Neuropsychology, Max Planck Institute for Empirical Aesthetics, Frankfurt am Main, Germany
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Yi Lu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Laura W. Wesseldijk
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Cognitive Neuropsychology, Max Planck Institute for Empirical Aesthetics, Frankfurt am Main, Germany
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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12
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Li L, Zhu N, Zhang L, Kuja-Halkola R, D’Onofrio BM, Brikell I, Lichtenstein P, Cortese S, Larsson H, Chang Z. ADHD Pharmacotherapy and Mortality in Individuals With ADHD. JAMA 2024; 331:850-860. [PMID: 38470385 PMCID: PMC10936112 DOI: 10.1001/jama.2024.0851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 01/19/2024] [Indexed: 03/13/2024]
Abstract
Importance Attention-deficit/hyperactivity disorder (ADHD) is associated with increased risks of adverse health outcomes including premature death, but it is unclear whether ADHD pharmacotherapy influences the mortality risk. Objective To investigate whether initiation of ADHD pharmacotherapy was associated with reduced mortality risk in individuals with ADHD. Design, Setting, and Participants In an observational nationwide cohort study in Sweden applying the target trial emulation framework, we identified individuals aged 6 through 64 years with an incident diagnosis of ADHD from 2007 through 2018 and no ADHD medication dispensation prior to diagnosis. Follow-up started from ADHD diagnosis until death, emigration, 2 years after ADHD diagnosis, or December 31, 2020, whichever came first. Exposures ADHD medication initiation was defined as dispensing of medication within 3 months of diagnosis. Main Outcomes and Measures We assessed all-cause mortality within 2 years of ADHD diagnosis, as well as natural-cause (eg, physical conditions) and unnatural-cause mortality (eg, unintentional injuries, suicide, and accidental poisonings). Results Of 148 578 individuals with ADHD (61 356 females [41.3%]), 84 204 (56.7%) initiated ADHD medication. The median age at diagnosis was 17.4 years (IQR, 11.6-29.1 years). The 2-year mortality risk was lower in the initiation treatment strategy group (39.1 per 10 000 individuals) than in the noninitiation treatment strategy group (48.1 per 10 000 individuals), with a risk difference of -8.9 per 10 000 individuals (95% CI, -17.3 to -0.6). ADHD medication initiation was associated with significantly lower rate of all-cause mortality (hazard ratio [HR], 0.79; 95% CI, 0.70 to 0.88) and unnatural-cause mortality (2-year mortality risk, 25.9 per 10 000 individuals vs 33.3 per 10 000 individuals; risk difference, -7.4 per 10 000 individuals; 95% CI, -14.2 to -0.5; HR, 0.75; 95% CI, 0.66 to 0.86), but not natural-cause mortality (2-year mortality risk, 13.1 per 10 000 individuals vs 14.7 per 10 000 individuals; risk difference, -1.6 per 10 000 individuals; 95% CI, -6.4 to 3.2; HR, 0.86; 95% CI, 0.71 to 1.05). Conclusions and Relevance Among individuals diagnosed with ADHD, medication initiation was associated with significantly lower all-cause mortality, particularly for death due to unnatural causes.
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Affiliation(s)
- Lin Li
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Nanbo Zhu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Le Zhang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Brian M. D’Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychological and Brain Sciences, Indiana University, Bloomington
| | - Isabell Brikell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Samuele Cortese
- Centre for Innovation in Mental Health–School of Psychology, Faculty of Environmental and Life Sciences, and Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- New York University Child Study Center, Hassenfeld Children’s Hospital at NYU Langone, New York
- Solent NHS Trust, Southampton, United Kingdom
- Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), University of Studies of Bari Aldo Moro, Bari, Italy
| | - Henrik Larsson
- School of medical sciences, Örebro University, Örebro, Sweden
| | - Zheng Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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13
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Daníelsdóttir HB, Aspelund T, Shen Q, Halldorsdottir T, Jakobsdóttir J, Song H, Lu D, Kuja-Halkola R, Larsson H, Fall K, Magnusson PKE, Fang F, Bergstedt J, Valdimarsdóttir UA. Adverse Childhood Experiences and Adult Mental Health Outcomes. JAMA Psychiatry 2024:2815834. [PMID: 38446452 PMCID: PMC10918580 DOI: 10.1001/jamapsychiatry.2024.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/31/2023] [Indexed: 03/07/2024]
Abstract
Importance Exposure to adverse childhood experiences (ACEs) has consistently been associated with multiple negative mental health outcomes extending into adulthood. However, given that ACEs and psychiatric disorders cluster within families, it remains to be comprehensively assessed to what extent familial confounding contributes to associations between ACEs and clinically confirmed adult psychiatric disorders. Objective To investigate whether associations between ACEs and adult mental health outcomes remain after adjusting for familial (genetic and environmental) confounding. Design, Setting, and Participants This Swedish twin cohort study used a discordant twin pair design based on monozygotic (MZ) and dizygotic (DZ) twins. A total of 25 252 adult twins (aged 18-47 years) from the Swedish Twin Registry born between 1959 and 1998 were followed up from age 19 years until 2016, with a maximum follow-up time of 39 years. Data were analyzed from April 2022 to November 2023. Exposures A total of 7 ACEs, including family violence, emotional abuse or neglect, physical neglect, physical abuse, sexual abuse, rape, and hate crime, were assessed with items from the Life Stressor Checklist-Revised in a web-based survey. Main Outcomes and Measures Adult (ages >18 years) clinical diagnosis of psychiatric disorders (ie, depressive, anxiety, alcohol or drug misuse, or stress-related disorders) were obtained from the Swedish National Patient Register. Results Of 25 252 twins included in the study (15 038 female [59.6%]; mean [SD] age at ACE assessment, 29.9 [8.7] years), 9751 individuals (38.6%) reported exposure to at least 1 ACE. A greater number of ACEs was associated with increased odds of any psychiatric disorder in the full cohort (odds ratio [OR] per additional ACE, 1.52; 95% CI, 1.48-1.57). The association remained but ORs per additional ACE were attenuated in DZ (1.29; 95% CI, 1.14-1.47) and MZ (1.20; 95% CI, 1.02-1.40) twin pairs. Individuals who were exposed to sexual abuse compared with those who were not exposed had increased odds of any clinically confirmed psychiatric disorder in all comparisons: full cohort (OR, 3.09; 95% CI, 2.68-3.56), DZ twin pairs (OR, 2.10; 95% CI, 1.33-3.32), and MZ twin pairs (1.80; 95% CI, 1.04-3.11). Conclusions and relevance This study found that associations between ACEs and adult mental health outcomes remained after controlling for shared genetic and environmental factors, which was particularly evident after multiple ACEs or sexual abuse. These findings suggest that targeted interventions may be associated with reduced risks of future psychopathology.
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Affiliation(s)
- Hilda Björk Daníelsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Thor Aspelund
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Qing Shen
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
- Institute for Advanced Study, Tongji University, Shanghai, China
| | | | - Jóhanna Jakobsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Huan Song
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Donghao Lu
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Katja Fall
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Patrik K. E. Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jacob Bergstedt
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Unnur Anna Valdimarsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts
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14
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Garcia-Argibay M, Bürkner PC, Lichtenstein P, Zhang L, D’Onofrio BM, Andell P, Chang Z, Cortese S, Larsson H. Methylphenidate and Short-Term Cardiovascular Risk. JAMA Netw Open 2024; 7:e241349. [PMID: 38446477 PMCID: PMC10918505 DOI: 10.1001/jamanetworkopen.2024.1349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/17/2024] [Indexed: 03/07/2024] Open
Abstract
Importance There are concerns about the safety of medications for treatment of attention-deficit/hyperactivity disorder (ADHD), with mixed evidence on possible cardiovascular risk. Objective To assess whether short-term methylphenidate use is associated with risk of cardiovascular events. Design, Setting, and Participants This retrospective, population-based cohort study was based on national Swedish registry data. Participants were individuals with ADHD aged 12 to 60 years with dispensed prescriptions of methylphenidate between January 1, 2007, and June 30, 2012. Each person receiving methylphenidate (n = 26 710) was matched on birth date, sex, and county to up to 10 nonusers without ADHD (n = 225 672). Statistical analyses were performed from September 13, 2022, to May 16, 2023. Main Outcomes and Measures Rates of cardiovascular events, including ischemic heart disease, venous thromboembolism, heart failure, or tachyarrhythmias, 1 year before methylphenidate treatment and 6 months after treatment initiation were compared between individuals receiving methylphenidate and matched controls using a bayesian within-individual design. Analyses were stratified by history of cardiovascular events. Results The cohort included 252 382 individuals (15 442 [57.8% men]; median age, 20 (IQR, 15-31) years). The overall incidence of cardiovascular events was 1.51 per 10 000 person-weeks (95% highest density interval [HDI], 1.35-1.69) for individuals receiving methylphenidate and 0.77 (95% HDI, 0.73-0.82) for the matched controls. Individuals treated with methylphenidate had an 87% posterior probability of having a higher rate of cardiovascular events after treatment initiation (incidence rate ratio [IRR], 1.41; 95% HDI, 1.09-1.88) compared with matched controls (IRR, 1.18; 95% HDI, 1.02-1.37). The posterior probabilities were 70% for at least a 10% increased risk of cardiovascular events in individuals receiving methylphenidate vs 49% in matched controls. No difference was found in this risk between individuals with and without a history of cardiovascular disease (IRR, 1.11; 95% HDI, 0.58-2.13). Conclusions and Relevance In this cohort study, individuals receiving methylphenidate had a small increased cardiovascular risk vs matched controls in the 6 months after treatment initiation. However, there was little evidence for an increased risk of 20% or higher and for differences in risk increase between people with and without a history of cardiovascular disease. Therefore, before treatment initiation, careful consideration of the risk-benefit trade-off of methylphenidate would be useful, regardless of cardiovascular history.
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Affiliation(s)
- Miguel Garcia-Argibay
- School of Medical Sciences, Örebro University, Faculty of Medicine and Health, Örebro, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | | | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Le Zhang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Brian M. D’Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- The Department of Psychological and Brain Sciences at Indiana University, Bloomington
| | - Pontus Andell
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Heart and Vascular Division, Karolinska University Hospital, Stockholm, Sweden
| | - Zheng Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Samuele Cortese
- School of Psychology, University of Southampton, Southampton, United Kingdom
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Solent NHS Trust, Southampton, United Kingdom
- Hassenfeld Children’s Hospital at NYU Langone, New York University Child Study Center, New York City
- DiMePRe-J-Department of Precision and Regenerative Medicine-Jonic Area, University of Bari Aldo Moro, Bari, Italy
| | - Henrik Larsson
- School of Medical Sciences, Örebro University, Faculty of Medicine and Health, Örebro, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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15
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Ångström A, Andersson A, Garcia‐Argibay M, Chang Z, Lichtenstein P, D’Onofrio BM, Tuvblad C, Ghirardi L, Larsson H. Criminal convictions in males and females diagnosed with attention deficit hyperactivity disorder: A Swedish national registry study. JCPP Adv 2024; 4:e12217. [PMID: 38486956 PMCID: PMC10933617 DOI: 10.1002/jcv2.12217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 10/05/2023] [Indexed: 03/17/2024] Open
Abstract
Background Individuals with Attention-Deficit/Hyperactivity Disorder (ADHD) face an elevated risk of criminal convictions compared to those without ADHD. However, understanding this link involves considering sex differences, coexisting psychiatric conditions, and unmeasured familial factors. This study aimed to explore the connection between ADHD and criminal convictions (both violent and non-violent) in males and females, while also assessing the impact of comorbid psychiatric disorders and familial factors. Methods Using Swedish national registers, we identified individuals born between 1986 and 1997 (635,391 males and 600,548 females). ADHD was defined through clinical diagnosis and prescribed medications, while criminal convictions were determined based on Swedish lower court records. Unmeasured familial factors were accounted for using a sibling design approach. Results Findings revealed that individuals with ADHD had a notably higher absolute and relative risk of both violent and non-violent criminal convictions compared to those without ADHD. While criminal convictions were more frequent among males with ADHD, females with ADHD exhibited higher relative risks (HR violent 10.50, non-violent 4.04) than their male counterparts (HR violent 6.03, non-violent 3.57). Additionally, lower socioeconomic status (SES) in individuals with ADHD was associated with increased relative risks for criminal convictions compared to individuals with ADHD who had higher SES. Adjusting for childhood and internalizing psychiatric disorders partially attenuated these associations, while substance use disorders (SUD) substantially attenuated them. SUD also contributed to an elevated absolute risk of criminal convictions in both male and female individuals with ADHD. Accounting for unmeasured shared familial factors slightly reduced the estimates, but the association between ADHD and criminal convictions persisted. Conclusion In conclusion, ADHD remains a potent independent risk factor for criminal convictions, with varying effects based on gender. This underscores the importance of tailored crime prevention strategies and early interventions for individuals with ADHD, especially when comorbid SUD is present.
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Affiliation(s)
| | - Anneli Andersson
- School of Psychology, Law and Social WorkÖrebro UniversityÖrebroSweden
| | | | - Zheng Chang
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetSolnaSweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetSolnaSweden
| | - Brian M. D’Onofrio
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetSolnaSweden
- Department of Psychological and Brain SciencesIndiana UniversityBloomingtonIndianaUSA
| | - Catherine Tuvblad
- School of Psychology, Law and Social WorkÖrebro UniversityÖrebroSweden
- Department of PsychologyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Laura Ghirardi
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetSolnaSweden
- MediNeos Observational Research ‐ IQVIA, Data Management & StatisticsModenaItaly
| | - Henrik Larsson
- School of Medical SciencesÖrebro UniversityÖrebroSweden
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetSolnaSweden
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16
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Mataix-Cols D, Isomura K, Sidorchuk A, Rautio D, Ivanov VZ, Rück C, Österman S, Lichtenstein P, Larsson H, Kuja-Halkola R, Chang Z, Brickell I, Hedman-Lagerlöf E, Fernández de la Cruz L. All-Cause and Cause-Specific Mortality Among Individuals With Hypochondriasis. JAMA Psychiatry 2024; 81:284-291. [PMID: 38091000 PMCID: PMC10719832 DOI: 10.1001/jamapsychiatry.2023.4744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/10/2023] [Indexed: 12/17/2023]
Abstract
Importance Hypochondriasis, also known as health anxiety disorder, is a prevalent, yet underdiagnosed psychiatric disorder characterized by persistent preoccupation about having serious and progressive physical disorders. The risk of mortality among individuals with hypochondriasis is unknown. Objective To investigate all-cause and cause-specific mortality among a large cohort of individuals with hypochondriasis. Design, Setting, and Participants This Swedish nationwide matched-cohort study included 4129 individuals with a validated International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnosis of hypochondriasis assigned between January 1, 1997, and December 31, 2020, and 41 290 demographically matched individuals without hypochondriasis. Individuals with diagnoses of dysmorphophobia (body dysmorphic disorder) assigned during the same period were excluded from the cohort. Statistical analyses were conducted between May 5 and September 27, 2023. Exposure Validated ICD-10 diagnoses of hypochondriasis in the National Patient Register. Main Outcome and Measures All-cause and cause-specific mortality in the Cause of Death Register. Covariates included birth year, sex, county of residence, country of birth (Sweden vs abroad), latest recorded education, civil status, family income, and lifetime psychiatric comorbidities. Stratified Cox proportional hazards regression models were used to estimate the hazard ratios (HRs) and 95% CIs of all-cause and cause-specific mortality. Results Of the 4129 individuals with hypochondriasis (2342 women [56.7%]; median age at first diagnosis, 34.5 years [IQR, 26.3-46.1 years]) and 41 290 demographically matched individuals without hypochondriasis (23 420 women [56.7%]; median age at matching, 34.5 years [IQR, 26.4-46.2 years]) in the study, 268 individuals with hypochondriasis and 1761 individuals without hypochondriasis died during the study period, corresponding to crude mortality rates of 8.5 and 5.5 per 1000 person-years, respectively. In models adjusted for sociodemographic variables, an increased rate of all-cause mortality was observed among individuals with hypochondriasis compared with individuals without hypochondriasis (HR, 1.69; 95% CI, 1.47-1.93). An increased rate was observed for both natural (HR, 1.60; 95% CI, 1.38-1.85) and unnatural (HR, 2.43; 95% CI, 1.61-3.68) causes of death. Most deaths from unnatural causes were attributed to suicide (HR, 4.14; 95% CI, 2.44-7.03). The results were generally robust to additional adjustment for lifetime psychiatric disorders. Conclusions and Relevance This cohort study suggests that individuals with hypochondriasis have an increased risk of death from both natural and unnatural causes, particularly suicide, compared with individuals from the general population without hypochondriasis. Improved detection and access to evidence-based care should be prioritized.
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Affiliation(s)
- David Mataix-Cols
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Kayoko Isomura
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Anna Sidorchuk
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Daniel Rautio
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Volen Z. Ivanov
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Christian Rück
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Susanna Österman
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Zheng Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Isabell Brickell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Erik Hedman-Lagerlöf
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Lorena Fernández de la Cruz
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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17
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Garcia-Argibay M, Brikell I, Thapar A, Lichtenstein P, Lundström S, Demontis D, Larsson H. Attention-Deficit/Hyperactivity Disorder and Major Depressive Disorder: Evidence From Multiple Genetically Informed Designs. Biol Psychiatry 2024; 95:444-452. [PMID: 37562520 DOI: 10.1016/j.biopsych.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/19/2023] [Accepted: 07/30/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) and major depressive disorder (MDD) are two highly prevalent disorders that frequently co-occur. Prior evidence from genetic and cohort studies supports an association between ADHD and MDD. However, the direction and mechanisms underlying their association remain unclear. As onset of ADHD occurs in early life, it has been hypothesized that ADHD may cause MDD. METHODS We examined the association of ADHD with MDD using 3 different genetically informed methods to disentangle causality from confounding: 1) a nationwide longitudinal register-based full sibling comparison (N = 1,018,489) adjusting for shared familial confounding; 2) a prospective co-twin control study comprising 16,477 twins (5084 monozygotic and 11,393 dizygotic); and 3) a two-sample Mendelian randomization analysis using the largest available ADHD (N = 225,534) and MDD (N = 500,199) genome-wide association study summary statistics, adjusting for correlated and uncorrelated horizontal pleiotropy. RESULTS Sibling and twin comparisons indicated that individuals with ADHD have an increased risk for subsequent development of MDD (hazard ratio = 4.12 [95% CI 3.62-4.69]) after adjusting for shared genetic and familial factors and that ADHD scores endorsed by parents are positively associated with subsequent MDD scores at ages 15 and 18 years (b = 0.07 [95% CI 0.05-0.08] and b = 0.09 [95% CI 0.08-0.11], respectively). Mendelian randomization analyses showed that genetic liability for ADHD is causally related to MDD (odds ratio = 1.15 [95% CI 1.08-1.23]). CONCLUSIONS Our study provides consistent results across 3 different genetically informative approaches, strengthening the hypothesis that ADHD is causally related to MDD.
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Affiliation(s)
- Miguel Garcia-Argibay
- School of Medical Sciences, Örebro University, Faculty of Medicine and Health, Örebro, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Isabell Brikell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Anita Thapar
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, United Kingdom
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sebastian Lundström
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Ditte Demontis
- Department of Biomedicine-Human Genetics, Aarhus University, Aarhus, Denmark; iPSYCH, Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark; Center for Genomics and Personalized Medicine, Aarhus, Denmark
| | - Henrik Larsson
- School of Medical Sciences, Örebro University, Faculty of Medicine and Health, Örebro, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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18
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Solmi M, Croatto G, Fornaro M, Schneider LK, Rohani-Montez SC, Fairley L, Smith N, Bitter I, Gorwood P, Taipale H, Tiihonen J, Cortese S, Dragioti E, Rietz ED, Nielsen RE, Firth J, Fusar-Poli P, Hartman C, Holt RIG, Høye A, Koyanagi A, Larsson H, Lehto K, Lindgren P, Manchia M, Nordentoft M, Skonieczna-Żydecka K, Stubbs B, Vancampfort D, Boyer L, De Prisco M, Vieta E, Correll CU. Regional differences in mortality risk and in attenuating or aggravating factors in schizophrenia: A systematic review and meta-analysis. Eur Neuropsychopharmacol 2024; 80:55-69. [PMID: 38368796 DOI: 10.1016/j.euroneuro.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 12/15/2023] [Accepted: 12/21/2023] [Indexed: 02/20/2024]
Abstract
People with schizophrenia die prematurely, yet regional differences are unclear. PRISMA 2020-compliant systematic review/random-effects meta-analysis of cohort studies assessing mortality relative risk (RR) versus any control group, and moderators, in people with ICD/DSM-defined schizophrenia, comparing countries and continents. We conducted subgroup, meta-regression analyses, and quality assessment. The primary outcome was all-cause mortality. Secondary outcomes were suicide-, /natural-cause- and other-cause-related mortality. We included 135 studies from Europe (n = 70), North-America (n = 29), Asia (n = 33), Oceania (n = 2), Africa (n = 1). In incident plus prevalent schizophrenia, differences across continents emerged for all-cause mortality (highest in Africa, RR=5.98, 95 %C.I.=4.09-8.74, k = 1, lowest in North-America, RR=2.14, 95 %C.I.=1.92-2.38, k = 16), suicide (highest in Oceania, RR=13.5, 95 %C.I.=10.08-18.07, k = 1, lowest in North-America, RR=4.4, 95 %C.I.=4.07-4.76, k = 6), but not for natural-cause mortality. Europe had the largest association between antipsychotics and lower all-cause mortality/suicide (Asia had the smallest or no significant association, respectively), without differences for natural-cause mortality. Higher country socio-demographic index significantly moderated larger suicide-related and smaller natural-cause-related mortality risk in incident schizophrenia, with reversed associations in prevalent schizophrenia. Antipsychotics had a larger/smaller protective association in incident/prevalent schizophrenia regarding all-cause mortality, and smaller protective association for suicide-related mortality in prevalent schizophrenia. Additional regional differences emerged in incident schizophrenia, across countries, and secondary outcomes. Significant regional differences emerged for all-cause, cause-specific and suicide-related mortality. Natural-cause death was homogeneously increased globally. Moderators differed across countries. Global initiatives are needed to improve physical health in people with schizophrenia, local studies to identify actionable moderators.
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Affiliation(s)
- Marco Solmi
- SCIENCES lab, Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada; Department of Mental Health, 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.
| | - Giovanni Croatto
- Mental Health Department, AULSS 3 Serenissima, Mestre, Venice, Italy
| | - Michele Fornaro
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Dentistry, Federico II University of Naples, Naples, Italy
| | | | | | | | | | - István Bitter
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Philip Gorwood
- INSERM U1266, Institute of Psychiatry and Neurosciences of Paris (IPNP), Paris, France; GHU Paris Psychiatrie et Neurosciences (CMME, Sainte-Anne Hospital), Université de Paris, Paris, France
| | - Heidi Taipale
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden; Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland; School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Jari Tiihonen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden; Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK; Solent NHS Trust, Southampton, UK; Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK; Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, USA; DiMePRe-J-Department of Precision and Rigenerative Medicine-Jonic Area, University of Bari Aldo Moro, Bari, Italy
| | - Elena Dragioti
- Research Laboratory Psychology of Patients, Families, and Health Professionals, Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, Greece; Pain and Rehabilitation Centre, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Ebba Du Rietz
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Rene Ernst Nielsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | - Joseph Firth
- Division of Psychology and Mental Health, The University of Manchester, Manchester, United Kingdom
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, King's College, London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Italy; Outreach and Support in South-London (OASIS) service, South London and Maudlsey (SLaM) NHS Foundation Trust, UK; Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilian-University (LMU), Munich, Germany
| | - Catharina Hartman
- University of Groningen, University Medical Center Groningen, Interdisciplinary Centre Psychopathology and Emotion regulation
| | - Richard I G Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Anne Høye
- Department of Clinical Medicine, UiT The Arctic University of Norway and Division of Mental Health and Substance Abuse, University Hospital of North Norway, Tromsø, Norway
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, 08830, Barcelona, Spain
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Kelli Lehto
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Peter Lindgren
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden; The Swedish Institute for Health Economics, Lund, Sweden
| | - Mirko Manchia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Unit of Clinical Psychiatry, University Hospital Agency of Cagliari, Cagliari, Italy; Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Merete Nordentoft
- Mental Health Centre Copenhagen, Department of Clinical Medicine, Copenhagen University Hospital, Denmark
| | | | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; University Psychiatric Centre KU Leuven, Kortenberg, Leuven, Belgium
| | - Laurent Boyer
- AP-HM, Aix-Marseille Univ., CEReSS-Health Service Research and Quality of Life Center, Marseille, France; FondaMental Foundation, Creteil, France
| | - Michele De Prisco
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany; Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA; Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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Falhammar H, Hirschberg AL, Nordenskjöld A, Larsson H, Nordenström A. Increased Prevalence of Accidents and Injuries in Congenital Adrenal Hyperplasia: A Population-based Cohort Study. J Clin Endocrinol Metab 2024; 109:e1175-e1184. [PMID: 37862468 PMCID: PMC10876393 DOI: 10.1210/clinem/dgad624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/05/2023] [Accepted: 10/18/2023] [Indexed: 10/22/2023]
Abstract
CONTEXT It has been suggested that injuries and accidents are increased in females with congenital adrenal hyperplasia (CAH), but the prevalence is unclear. OBJECTIVE To study the prevalence of injuries and accidents in females and males with CAH. DESIGN, SETTING, AND PARTICIPANTS Patients with CAH (n = 714, all 21-hydroxylase deficiency) were compared with matched controls (n = 71 400). Data were derived by linking National Population-Based Registers. MAIN OUTCOME MEASURES Prevalence of injuries and accidents. RESULTS Mean age was 29.8 ± 18.4 years. Injuries were more prevalent in patients with CAH than in controls (relative risk, 1.34; 95% CI, 1.24-1.44), and this was found in both sexes (females: 1.43; 1.29-1.58; males: 1.25; 1.12-1.38). In the classical phenotype, the prevalence of injuries was higher, especially in females but not in the nonclassic phenotype. In the genotype groups, injuries were mainly increased in females. Head injuries were increased in all patients with CAH and in the different phenotypes and were mainly driven by females. More patients with CAH born before the introduction of neonatal screening had had an injury compared with controls (1.48; 1.35-1.62); this was seen in both sexes. In patients with CAH born after the introduction of screening, the prevalence of injuries was overall increased (1.20; 1.07-1.35), and in females with CAH but not in males. Accidents showed a similar pattern to injuries in all comparisons. CONCLUSION Patients with CAH had an increased prevalence of both injuries and accidents, especially in females and in those born before the neonatal screening program. Patients with nonclassic phenotype were hardly affected.
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Affiliation(s)
- Henrik Falhammar
- Department of Endocrinology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, SE-171 76 Stockholm, Sweden
| | - Angelica Lindén Hirschberg
- Department of Women's and Children's Health, Karolinska Institutet, SE-171 76 Stockholm, Sweden
- Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - Agneta Nordenskjöld
- Department of Women's and Children's Health, Karolinska Institutet, SE-171 76 Stockholm, Sweden
- Center for Molecular Medicine, Karolinska Institutet, SE-171 76 Stockholm, Sweden
- Pediatric Surgery, Astrid Lindgren Children's Hospital, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - Henrik Larsson
- School of Medical Sciences, Örebro University, SE-702 81 Örebro, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, SE-171 65 Stockholm, Sweden
| | - Anna Nordenström
- Department of Women's and Children's Health, Karolinska Institutet, SE-171 76 Stockholm, Sweden
- Department of Pediatric Endocrinology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
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20
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Molero Y, Sharp DJ, D’Onofrio BM, Lichtenstein P, Larsson H, Fazel S, Rostami E. Medication utilization in traumatic brain injury patients-insights from a population-based matched cohort study. Front Neurol 2024; 15:1339290. [PMID: 38385038 PMCID: PMC10879380 DOI: 10.3389/fneur.2024.1339290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/23/2024] [Indexed: 02/23/2024] Open
Abstract
Introduction Traumatic brain injury (TBI) is associated with health problems across multiple domains and TBI patients are reported to have high rates of medication use. However, prior evidence is thin due to methodological limitations. Our aim was thus to examine the use of a wide spectrum of medications prescribed to address pain and somatic conditions in a population-based cohort of TBI patients, and to compare this to a sex- and age-matched cohort. We also examined how patient factors such as sex, age, and TBI severity were associated with medication use. Methods We assessed Swedish nationwide registers to include all individuals treated for TBI in hospitals or specialist outpatient care between 2006 and 2012. We examined dispensed prescriptions for eight different non-psychotropic medication classes for the 12 months before, and 12 months after, the TBI. We applied a fixed-effects model to compare TBI patients with the matched population cohort. We also stratified TBI patients by sex, age, TBI severity and carried out comparisons using a generalized linear model. Results We identified 239,425 individuals with an incident TBI and 239,425 matched individuals. TBI patients were more likely to use any medication [Odds ratio (OR) = 2.03, 95% Confidence Interval (CI) = 2.00-2.05], to present with polypharmacy (OR = 1.96, 95% CI = 1.90-2.02), and to use each of the eight medication classes before their TBI, as compared to the matched population cohort. Following the TBI, TBI patients were more likely to use any medication (OR = 1.83, 95% CI = 1.80-1.86), to present with polypharmacy (OR = 1.74, 95% CI = 1.67-1.80), and to use all medication classes, although differences were attenuated. However, differences increased for antibiotics/antivirals (OR = 2.02, 95% CI = 1.99-2.05) and NSAIDs/antirheumatics (OR = 1.62, 95% CI = 1.59-1.65) post-TBI. We also found that females and older patients were more likely to use medications after their TBI than males and younger patients, respectively. Patients with more severe TBIs demonstrated increased use of antibiotics/ antivirals and NSAIDs/antirheumatics than those with less severe TBIs. Discussion Taken together, our results point to poor overall health in TBI patients, suggesting that medical follow-up should be routine, particularly in females with TBI, and include a review of medication use to address potential polypharmacy.
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Affiliation(s)
- Yasmina Molero
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - David J. Sharp
- Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Brian M. D’Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, United States
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Elham Rostami
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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21
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Bränn E, Chen Y, Song H, László KD, D'Onofrio BM, Hysaj E, Almqvist C, Larsson H, Lichtenstein P, Valdimarsdottir UA, Lu D. Correction: Bidirectional association between autoimmune disease and perinatal depression: a nationwide study with sibling comparison. Mol Psychiatry 2024:10.1038/s41380-024-02438-3. [PMID: 38317013 DOI: 10.1038/s41380-024-02438-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Affiliation(s)
- Emma Bränn
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Yufeng Chen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Huan Song
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Krisztina D László
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Brian M D'Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Elgeta Hysaj
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Unnur A Valdimarsdottir
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Donghao Lu
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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22
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Brew BK, Gong T, Ohlin E, Hedman AM, Larsson H, Curman P, Lundholm C, Almqvist C. Maternal mental health disorders and offspring asthma and allergic diseases: The role of child mental health. Pediatr Allergy Immunol 2024; 35:e14085. [PMID: 38366746 DOI: 10.1111/pai.14085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/23/2024] [Accepted: 01/25/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Maternal psychological stress during pregnancy and postnatally has been shown to be associated with offspring atopic diseases (asthma, atopic dermatitis and allergic rhinitis). The aim of this study was to assess whether this association may be attributable to the child's own mental health disorders. METHOD The study population included 15,092 twin children born 2002-2010 in Sweden. Questionnaire data at age 9 years was linked to national patient- and prescription registers. Maternal mental health during pregnancy and 3 years postnatally were identified from diagnosis and medication data (depression, anxiety and stress disorders). Atopic diseases in children were identified from questionnaires, diagnosis and medication data. Child mental health status (depression and anxiety) was identified from questionnaires. Three-way decomposition methods tested for mediation or interaction by child mental health disorders. RESULTS Maternal mental health disorders were associated with most child atopic diseases including asthma aRR1.36 (95% CI 1.12, 1.60), and child mental health disorders, aRR1.73 (95% CI 1.56, 1.92). Children with mental health disorders were comorbid for atopic diseases with only asthma reaching statistical significance, aRR1.29 (95% CI 1.14, 1.47). Three-way decomposition found that mediation or interaction by child mental health disorders did not account for the mother mental health and child atopy associations except in parent-report asthma, where child mental health disorders mediated 13.4% (95% CI 2.1, 24.7) of the effect, but not for objectively defined (diagnosis and medication) asthma. CONCLUSION The associations between maternal mental health and child asthma and allergic diseases do not appear to be attributable to child mental health disorders.
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Affiliation(s)
- Bronwyn K Brew
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Centre for Big Data Research in Health and School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Tong Gong
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Emma Ohlin
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Surgical Unit, Mora Hospital, Mora, Sweden
| | - Anna M Hedman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Philip Curman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden
| | - Cecilia Lundholm
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Pediatric Allergy and Pulmonology Unit at Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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23
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Reed C, Cortese S, Larsson H, Galéra C, Cotton J, Brandt V. Longitudinal Associations Between Physical Health Conditions in Childhood and Attention-Deficit/Hyperactivity Disorder Symptoms at Age 17 Years. J Am Acad Child Adolesc Psychiatry 2024; 63:245-254. [PMID: 37406771 DOI: 10.1016/j.jaac.2023.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVE Although evidence suggests significant cross-sectional relationships between attention-deficit/hyperactivity disorder (ADHD) and several physical health conditions, less is known about their longitudinal associations. We investigated the cumulative effect of childhood physical health conditions on ADHD symptoms at age 17 years, controlling for environmental factors, ADHD medication status, and ADHD symptoms at age 3 years. METHOD Using Millennium Cohort Study data (weighted n = 8,059), we assessed whether 4 physical health clusters (sensory, neurological, atopic, and cardio-metabolic) were associated with scores on the ADHD subscale from the Strengths and Difficulties Questionnaire at age 17 years. Environmental factors were grouped into 5 cumulative risk indices: prenatal, perinatal, postnatal environment, postnatal maternal well-being, and sociodemographic factors. Regression analyses determined whether each physical health cluster was associated with ADHD score while controlling for environmental factors, ADHD medication, and earlier symptoms. RESULTS Sensory, neurological, and cardio-metabolic clusters were all significantly associated with ADHD symptoms (β range = 0.04-0.09, p < .001). The overall model explained 2% of the variance. This rose to 21% (ΔR2 = 0.06) after adjusting for confounders. The sensory (β = 0.06) and neurological (β = 0.06) clusters remained significant (R2 = 0.21, ΔR2 = 0.06), but the cardio-metabolic cluster was no longer a significant predictor. CONCLUSION Sensory or neurological conditions in childhood were associated with higher ADHD symptoms aged 17 after adjustment of confounders. This was not the case for atopic or cardio-metabolic conditions. These findings have implications for the care of children with sensory/neurological conditions and future research examining ADHD etiopathophysiology.
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Affiliation(s)
- Claire Reed
- University of Southampton, Southampton, United Kingdom.
| | - Samuele Cortese
- University of Southampton, Southampton, United Kingdom; Solent NHS Trust, Southampton, United Kingdom; University of Nottingham, Nottingham, United Kingdom; Hassenfeld Children's Hospital at NYU Langone, New York; University Child Study Center, New York
| | - Henrik Larsson
- Karolinska Institute, Stockholm, Sweden, and Örebro University, Örebro, Sweden
| | - Cédric Galéra
- University of Bordeaux, Bordeaux, France; INSERM, Bordeaux Population Health Center, UMR1219, Bordeaux, France; Centre Hospitalier Perrens, Bordeaux, France; Research Unit on Children's Psychosocial Maladjustment, Montreal, QC, Canada
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24
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Zhang L, Li L, Andell P, Garcia-Argibay M, Quinn PD, D’Onofrio BM, Brikell I, Kuja-Halkola R, Lichtenstein P, Johnell K, Larsson H, Chang Z. Attention-Deficit/Hyperactivity Disorder Medications and Long-Term Risk of Cardiovascular Diseases. JAMA Psychiatry 2024; 81:178-187. [PMID: 37991787 PMCID: PMC10851097 DOI: 10.1001/jamapsychiatry.2023.4294] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/29/2023] [Indexed: 11/23/2023]
Abstract
Importance Use of attention-deficit/hyperactivity disorder (ADHD) medications has increased substantially over the past decades. However, the potential risk of cardiovascular disease (CVD) associated with long-term ADHD medication use remains unclear. Objective To assess the association between long-term use of ADHD medication and the risk of CVD. Design, Setting, and Participants This case-control study included individuals in Sweden aged 6 to 64 years who received an incident diagnosis of ADHD or ADHD medication dispensation between January 1, 2007, and December 31, 2020. Data on ADHD and CVD diagnoses and ADHD medication dispensation were obtained from the Swedish National Inpatient Register and the Swedish Prescribed Drug Register, respectively. Cases included individuals with ADHD and an incident CVD diagnosis (ischemic heart diseases, cerebrovascular diseases, hypertension, heart failure, arrhythmias, thromboembolic disease, arterial disease, and other forms of heart disease). Incidence density sampling was used to match cases with up to 5 controls without CVD based on age, sex, and calendar time. Cases and controls had the same duration of follow-up. Exposure Cumulative duration of ADHD medication use up to 14 years. Main Outcomes and Measures The primary outcome was incident CVD. The association between CVD and cumulative duration of ADHD medication use was measured using adjusted odds ratios (AORs) with 95% CIs. Results Of 278 027 individuals with ADHD aged 6 to 64 years, 10 388 with CVD were identified (median [IQR] age, 34.6 [20.0-45.7] years; 6154 males [59.2%]) and matched with 51 672 control participants without CVD (median [IQR] age, 34.6 [19.8-45.6] years; 30 601 males [59.2%]). Median (IQR) follow-up time in both groups was 4.1 (1.9-6.8) years. Longer cumulative duration of ADHD medication use was associated with an increased risk of CVD compared with nonuse (0 to ≤1 year: AOR, 0.99 [95% CI, 0.93-1.06]; 1 to ≤2 years: AOR, 1.09 [95% CI, 1.01-1.18]; 2 to ≤3 years: AOR, 1.15 [95% CI, 1.05-1.25]; 3 to ≤5 years: AOR, 1.27 [95% CI, 1.17-1.39]; and >5 years: AOR, 1.23 [95% CI, 1.12-1.36]). Longer cumulative ADHD medication use was associated with an increased risk of hypertension (eg, 3 to ≤5 years: AOR, 1.72 [95% CI, 1.51-1.97] and >5 years: AOR, 1.80 [95% CI, 1.55-2.08]) and arterial disease (eg, 3 to ≤5 years: AOR, 1.65 [95% CI, 1.11-2.45] and >5 years: AOR, 1.49 [95% CI, 0.96-2.32]). Across the 14-year follow-up, each 1-year increase of ADHD medication use was associated with a 4% increased risk of CVD (AOR, 1.04 [95% CI, 1.03-1.05]), with a larger increase in risk in the first 3 years of cumulative use (AOR, 1.08 [95% CI, 1.04-1.11]) and stable risk over the remaining follow-up. Similar patterns were observed in children and youth (aged <25 years) and adults (aged ≥25 years). Conclusions and Relevance This case-control study found that long-term exposure to ADHD medications was associated with an increased risk of CVDs, especially hypertension and arterial disease. These findings highlight the importance of carefully weighing potential benefits and risks when making treatment decisions about long-term ADHD medication use. Clinicians should regularly and consistently monitor cardiovascular signs and symptoms throughout the course of treatment.
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Affiliation(s)
- Le Zhang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lin Li
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Pontus Andell
- Unit of Cardiology, Heart and Vascular Division, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Miguel Garcia-Argibay
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Patrick D. Quinn
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington
| | - Brian M. D’Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychological and Brain Sciences, Indiana University, Bloomington
| | - Isabell Brikell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Johnell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Zheng Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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25
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Chen C, Chang Z, Kuja-Halkola R, D'Onofrio BM, Larsson H, Andell P, Lichtenstein P, Pettersson E. Associations Between General and Specific Mental Health Conditions in Young Adulthood and Cardiometabolic Complications in Middle Adulthood: A 40-Year Longitudinal Familial Coaggregation Study of 672,823 Swedish Individuals. Am J Psychiatry 2024:appiajp20220951. [PMID: 38263878 DOI: 10.1176/appi.ajp.20220951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
OBJECTIVE Most mental disorders, when examined individually, are associated with an increased risk of cardiometabolic complications. However, these associations might be attributed to a general liability to psychopathology or confounded by unmeasured familial factors. The authors investigated the association between psychiatric conditions in young adulthood and the risk of cardiometabolic complications in middle adulthood, up to 40 years later. METHODS This cohort study (N=672,823) identified all individuals and their siblings born in Sweden between 1955 and 1962 and followed the cohort through 2013. Logistic regression models were used to estimate the bivariate associations between 10 psychiatric conditions or criminal convictions and five cardiometabolic complications in individuals. A general factor model was used to identify general, internalizing, externalizing, and psychotic factors based on the comorbidity among psychiatric conditions and criminal convictions. The cardiometabolic complications were then regressed on the latent general factor and three uncorrelated specific factors within a structural equation modeling framework in individuals and across sibling pairs. RESULTS Each psychiatric condition significantly increased the risk of cardiometabolic complications. These associations appeared nonspecific, as multivariate models indicated that most were attributable to the general factor of psychopathology, rather than to specific psychiatric conditions. There were no or only small associations between individuals' general psychopathology and their siblings' cardiometabolic complications. The same pattern was evident for the specific internalizing and psychotic factors. CONCLUSIONS Associations between mental disorders in early life and later long-term risk of cardiometabolic complications appeared to be attributable to a general liability to psychopathology. Familial coaggregation analyses suggested that the elevated risk could not be attributed to confounders shared within families. One possibility is that lifestyle-based interventions may reduce the risk of later cardiometabolic complications for patients with several mental disorders.
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Affiliation(s)
- Cen Chen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden (Chen, Chang, Kuja-Halkola, D'Onofrio, Larsson, Lichtenstein, Pettersson); Department of Psychological and Brain Sciences, Indiana University, Bloomington (D'Onofrio); School of Medical Sciences, Örebro University, Örebro, Sweden (Larsson); Unit of Cardiology, Department of Medicine, Karolinska Institutet, and Heart and Vascular Division, Karolinska University Hospital, Stockholm (Andell)
| | - Zheng Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden (Chen, Chang, Kuja-Halkola, D'Onofrio, Larsson, Lichtenstein, Pettersson); Department of Psychological and Brain Sciences, Indiana University, Bloomington (D'Onofrio); School of Medical Sciences, Örebro University, Örebro, Sweden (Larsson); Unit of Cardiology, Department of Medicine, Karolinska Institutet, and Heart and Vascular Division, Karolinska University Hospital, Stockholm (Andell)
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden (Chen, Chang, Kuja-Halkola, D'Onofrio, Larsson, Lichtenstein, Pettersson); Department of Psychological and Brain Sciences, Indiana University, Bloomington (D'Onofrio); School of Medical Sciences, Örebro University, Örebro, Sweden (Larsson); Unit of Cardiology, Department of Medicine, Karolinska Institutet, and Heart and Vascular Division, Karolinska University Hospital, Stockholm (Andell)
| | - Brian M D'Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden (Chen, Chang, Kuja-Halkola, D'Onofrio, Larsson, Lichtenstein, Pettersson); Department of Psychological and Brain Sciences, Indiana University, Bloomington (D'Onofrio); School of Medical Sciences, Örebro University, Örebro, Sweden (Larsson); Unit of Cardiology, Department of Medicine, Karolinska Institutet, and Heart and Vascular Division, Karolinska University Hospital, Stockholm (Andell)
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden (Chen, Chang, Kuja-Halkola, D'Onofrio, Larsson, Lichtenstein, Pettersson); Department of Psychological and Brain Sciences, Indiana University, Bloomington (D'Onofrio); School of Medical Sciences, Örebro University, Örebro, Sweden (Larsson); Unit of Cardiology, Department of Medicine, Karolinska Institutet, and Heart and Vascular Division, Karolinska University Hospital, Stockholm (Andell)
| | - Pontus Andell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden (Chen, Chang, Kuja-Halkola, D'Onofrio, Larsson, Lichtenstein, Pettersson); Department of Psychological and Brain Sciences, Indiana University, Bloomington (D'Onofrio); School of Medical Sciences, Örebro University, Örebro, Sweden (Larsson); Unit of Cardiology, Department of Medicine, Karolinska Institutet, and Heart and Vascular Division, Karolinska University Hospital, Stockholm (Andell)
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden (Chen, Chang, Kuja-Halkola, D'Onofrio, Larsson, Lichtenstein, Pettersson); Department of Psychological and Brain Sciences, Indiana University, Bloomington (D'Onofrio); School of Medical Sciences, Örebro University, Örebro, Sweden (Larsson); Unit of Cardiology, Department of Medicine, Karolinska Institutet, and Heart and Vascular Division, Karolinska University Hospital, Stockholm (Andell)
| | - Erik Pettersson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden (Chen, Chang, Kuja-Halkola, D'Onofrio, Larsson, Lichtenstein, Pettersson); Department of Psychological and Brain Sciences, Indiana University, Bloomington (D'Onofrio); School of Medical Sciences, Örebro University, Örebro, Sweden (Larsson); Unit of Cardiology, Department of Medicine, Karolinska Institutet, and Heart and Vascular Division, Karolinska University Hospital, Stockholm (Andell)
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26
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Cederlöf M, Jebril W, Larsson H, Curman P, Bachar-Wikström E, Wikström JD. Individuals with Darier disease have an increased risk of suicide and self-injurious behaviours. Br J Dermatol 2024; 190:284-285. [PMID: 37890021 DOI: 10.1093/bjd/ljad424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 10/17/2023] [Accepted: 10/29/2023] [Indexed: 10/29/2023]
Abstract
In a large population-based registry study of 935 patients in Sweden with Darier disease, we show that patients with the disease display significantly increased risks of suicide and self-injurious behaviours.
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Affiliation(s)
- Martin Cederlöf
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro
- Department of Medical Epidemiology and Biostatistics
| | - William Jebril
- Dermatology and Venereology Division, Department of Medicine (Solna), Karolinska Institutet, Stockholm
- Dermato-Venereology Clinic, Karolinska University Hospital, Stockholm, Sweden
| | - Henrik Larsson
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro
- Department of Medical Epidemiology and Biostatistics
| | - Philip Curman
- Department of Medical Epidemiology and Biostatistics
- Dermatology and Venereology Division, Department of Medicine (Solna), Karolinska Institutet, Stockholm
- Dermato-Venereology Clinic, Karolinska University Hospital, Stockholm, Sweden
| | - Etty Bachar-Wikström
- Dermatology and Venereology Division, Department of Medicine (Solna), Karolinska Institutet, Stockholm
| | - Jakob D Wikström
- Dermatology and Venereology Division, Department of Medicine (Solna), Karolinska Institutet, Stockholm
- Dermato-Venereology Clinic, Karolinska University Hospital, Stockholm, Sweden
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27
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Bolhuis K, Ghirardi L, Kuja-Halkola R, Lång U, Cederlöf M, Metsala J, Corcoran P, O'Connor K, Dodd P, Larsson H, Kelleher I. Risk of Psychosis Among Individuals Who Have Presented to Hospital With Self-harm: A Prospective Nationwide Register Study in Sweden. Schizophr Bull 2024:sbae002. [PMID: 38243843 DOI: 10.1093/schbul/sbae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
BACKGROUND AND HYPOTHESIS Recent research showed that young people who presented to hospital with self-harm in Finland had a significantly elevated risk of later psychosis. We investigated the prospective relationship between hospital presentation for self-harm and risk of psychosis in an unprecedentedly large national Swedish cohort. STUDY DESIGN We used inpatient and outpatient healthcare registers to identify all individuals born between 1981 and 1993 who were alive and living in Sweden on their 12th birthday and who presented to hospital one or more times with self-harm. We compared them with a matched cohort, followed up for up to 20 years, and compared the cumulative incidence of psychotic disorders. Furthermore, we examined whether the strength of the relationship between hospital presentation for self-harm and later psychosis changed over time by examining for cohort effects. STUDY RESULTS In total, 28 908 (2.0%) individuals presented to hospital with self-harm without prior psychosis diagnosis during the follow-up. For individuals who presented to hospital with self-harm, the cumulative incidence of diagnosed psychosis was 20.7% at 20 years follow-up (hazard radio = 13.9, 95% CI 13.3-14.6, P-value <5 × 10-308). There was no evidence of a dilution of the effect over time: while the incidence of hospital self-harm presentation increased, this did not result in an attenuation over time of the strength of the relationship between hospital self-harm presentation and subsequent psychosis. CONCLUSIONS Individuals who present to hospital with self-harm in their teens and 20s represent an important risk group for psychosis prediction and prevention.
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Affiliation(s)
- Koen Bolhuis
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Laura Ghirardi
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- MediNeos Observational Research-IQVIA, Data Management & Statistics, Modena, Italy
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ulla Lång
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Finnish Institute for Health and Welfare, Helsinki, Finland
- University of Oulu, School of Medicine, Oulu, Finland
| | - Martin Cederlöf
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Johanna Metsala
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Paul Corcoran
- National Suicide Research Foundation, University College Cork, Cork, Ireland
- School of Public Health, University College Cork, Cork, Ireland
| | - Karen O'Connor
- Rise, South Lee Mental Health Services, Cork & Department of Psychiatry, University College Cork, Cork, Ireland
- National Clinical Programme for Early Intervention in Psychosis, Health Service Executive Dublin, Dublin, Ireland
| | - Philip Dodd
- National Office for Suicide Prevention, Health Service Executive Dublin, Dublin, Ireland
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Ian Kelleher
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- University of Oulu, School of Medicine, Oulu, Finland
- University College Dublin, School of Medicine, Dublin, Ireland
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Martini MI, Butwicka A, Du Rietz E, Kanina A, Rosenqvist MA, Larsson H, Lichtenstein P, Taylor MJ. Age effects on autism heritability and etiological stability of autistic traits. J Child Psychol Psychiatry 2024. [PMID: 38239074 DOI: 10.1111/jcpp.13949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2023] [Indexed: 02/20/2024]
Abstract
BACKGROUND Autism and autistic traits onset in childhood but persist into adulthood. Little is known about how genetic and environmental factors influence autism and autistic traits into adulthood. We aimed to determine age effects on the heritability of clinically diagnosed autism and the etiological stability of autistic traits from childhood to adulthood using twin methods. METHODS From 23,849 twin pairs in the Swedish Twin Register born between 1959 and 2010, we identified 485 individuals (1.01%, 31.5% female) with a clinical autism diagnosis. We estimated and compared the relative contribution of genetic, shared, and nonshared environmental influences to autism in childhood and adulthood. We further used multivariate twin analysis with four measurement points among 1,348 twin pairs in the longitudinal Twin Study of Child and Adolescent Development to assess the phenotypic and etiological stability of autistic traits - measured with three scales from the Child Behavior Checklist - from childhood to adulthood. RESULTS Autism heritability was comparable from childhood, (96% [95% CI, 76-99%]) to adulthood (87% [67-96%]). Autistic traits were moderately stable (phenotypic correlation = 0.35-0.61) from childhood to adulthood, and their heritability varied between 52 and 71%. We observed stable as well as newly emerging genetic influences on autistic traits from ages 8-9 to 19-20, and unique nonshared environmental influences at each age. CONCLUSIONS Genetic factors are important for autism and autistic traits in adulthood and separate genetic studies in adults are warranted.
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Affiliation(s)
- Miriam I Martini
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Agnieszka Butwicka
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Division of Mental Health Services, R&D Department, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland
| | - Ebba Du Rietz
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Aleksandra Kanina
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mina A Rosenqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mark J Taylor
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Fernández de la Cruz L, Isomura K, Lichtenstein P, Larsson H, Kuja-Halkola R, Chang Z, D'Onofrio BM, Brikell I, Rück C, Sidorchuk A, Mataix-Cols D. All cause and cause specific mortality in obsessive-compulsive disorder: nationwide matched cohort and sibling cohort study. BMJ 2024; 384:e077564. [PMID: 38233033 PMCID: PMC10792686 DOI: 10.1136/bmj-2023-077564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVE To estimate the risk of all cause and cause specific mortality in people with obsessive-compulsive disorder (OCD) compared with matched unaffected people from the general population and with their unaffected siblings. DESIGN Population based matched cohort and sibling cohort study. SETTING Register linkage in Sweden. PARTICIPANTS Population based cohort including 61 378 people with OCD and 613 780 unaffected people matched (1:10) on sex, birth year, and county of residence; sibling cohort consisting of 34 085 people with OCD and 47 874 unaffected full siblings. Cohorts were followed up for a median time of 8.1 years during the period from 1 January 1973 to 31 December 2020. MAIN OUTCOME MEASURES All cause and cause specific mortality. RESULTS 4787 people with OCD and 30 619 unaffected people died during the study period (crude mortality rate 8.1 and 5.1 per 1000 person years, respectively). In stratified Cox proportional hazards models adjusted for birth year, sex, county, migrant status (born in Sweden versus abroad), and sociodemographic variables (latest recorded education, civil status, and family income), people with OCD had an increased risk of all cause mortality (hazard ratio 1.82, 95% confidence interval 1.76 to 1.89) and mortality due to natural causes (1.31, 1.27 to 1.37) and unnatural causes (3.30, 3.05 to 3.57). Among the natural causes of death, those due to endocrine, nutritional, and metabolic diseases, mental and behavioural disorders, and diseases of the nervous, circulatory, respiratory, digestive, and genitourinary systems were higher in the OCD cohort. Conversely, the risk of death due to neoplasms was lower in the OCD cohort compared with the unaffected cohort. Among the unnatural causes, suicide showed the highest hazard ratio, followed by accidents. The results were robust to adjustment for psychiatric comorbidities and familial confounding. CONCLUSIONS Non-communicable diseases and external causes of death, including suicides and accidents, were major contributors to the risk of mortality in people with OCD. Better surveillance, prevention, and early intervention strategies should be implemented to reduce the risk of fatal outcomes in people with OCD.
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Affiliation(s)
- Lorena Fernández de la Cruz
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, SE-11330 Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Kayoko Isomura
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, SE-11330 Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Zheng Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Brian M D'Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Isabell Brikell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Christian Rück
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, SE-11330 Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Anna Sidorchuk
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, SE-11330 Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, SE-11330 Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
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30
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Bränn E, Chen Y, Song H, László KD, D'Onofrio BM, Hysaj E, Almqvist C, Larsson H, Lichtenstein P, Valdimarsdottir UA, Lu D. Bidirectional association between autoimmune disease and perinatal depression: a nationwide study with sibling comparison. Mol Psychiatry 2024:10.1038/s41380-023-02351-1. [PMID: 38191927 DOI: 10.1038/s41380-023-02351-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 01/10/2024]
Abstract
Although major depression, characterized by a pro-inflammatory profile, genetically overlap with autoimmune disease (AD) and the perinatal period involve immune system adaptations and AD symptom alterations, the bidirectional link between perinatal depression (PND) and AD is largely unexplored. Hence, the objective of this study was to investigate the bidirectional association between PND and AD. Using nationwide Swedish population and health registers, we conducted a nested case-control study and a matched cohort study. From 1,347,901 pregnancies during 2001-2013, we included 55,299 incident PND, their unaffected full sisters, and 10 unaffected matched women per PND case. We identified 41 subtypes of AD diagnoses recorded in the registers and compared PND with unaffected population-matched women and full sisters, using multivariable regressions. Women with an AD had a 30% higher risk of subsequent PND (95% CI 1.2-1.5) and women exposed to PND had a 30% higher risk of a subsequent AD (95% CI 1.3-1.4). Comparable associations were found when comparing exposed women with their unaffected sisters (nested case-control OR: 1.3, 95% CI 1.2-1.5, matched cohort HR: 1.3, 95% CI 1.1-1.6), and when studying antepartum and postpartum depression. The bidirectional association was more pronounced among women without psychiatric comorbidities (nested case-control OR: 1.5, 95% CI 1.4-1.6, matched cohort HR: 1.4, 95% CI 1.4-1.5) and strongest for multiple sclerosis (nested case-control OR: 2.0, 95% CI 1.6-2.3, matched cohort HR: 1.8, 95% CI 1.0-3.1). These findings demonstrate a bidirectional association between AD and PND independent of psychiatric comorbidities, suggesting possibly shared biological mechanisms. If future translational science confirms the underlying mechanisms, healthcare providers need to be aware of the increased risk of PND among women with ADs and vice versa.
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Affiliation(s)
- Emma Bränn
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Yufeng Chen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Huan Song
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
| | - Krisztina D László
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Brian M D'Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Elgeta Hysaj
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Unnur A Valdimarsdottir
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Donghao Lu
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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31
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Brikell I, Yao H, Li L, Astrup A, Gao L, Gillies MB, Xie T, Zhang-James Y, Dalsgaard S, Engeland A, Faraone SV, Haavik J, Hartman C, Ip P, Jakobsdóttir Smári U, Larsson H, Man KK, de Oliveira Costa J, Pearson SA, Hostrup Nielsen NP, Snieder H, Wimberley T, Wong IC, Zhang L, Zoega H, Klungsøyr K, Chang Z. ADHD medication discontinuation and persistence across the lifespan: a retrospective observational study using population-based databases. Lancet Psychiatry 2024; 11:16-26. [PMID: 38035876 DOI: 10.1016/s2215-0366(23)00332-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/05/2023] [Accepted: 09/11/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Although often intended for long-term treatment, discontinuation of medication for ADHD is common. However, cross-national estimates of discontinuation are missing due to the absence of standardised measures. The aim of this study was to determine the rate of ADHD treatment discontinuation across the lifespan and to describe similarities and differences across countries to guide clinical practice. METHODS We did a retrospective, observational study using population-based databases from eight countries and one Special Administrative Region (Australia, Denmark, Hong Kong, Iceland, the Netherlands, Norway, Sweden, the UK, and the USA). We used a common analytical protocol approach and extracted prescription data to identify new users of ADHD medication. Eligible individuals were aged 3 years or older who had initiated ADHD medication between 2010 and 2020. We estimated treatment discontinuation and persistence in the 5 years after treatment initiation, stratified by age at initiation (children [age 4-11 years], adolescents [age 12-17 years], young adults [age 18-24 years], and adults [age ≥25 years]) and sex. Ethnicity data were not available. FINDINGS 1 229 972 individuals (735 503 [60%] males, 494 469 females [40%]; median age 8-21 years) were included in the study. Across countries, treatment discontinuation 1-5 years after initiation was lowest in children, and highest in young adults and adolescents. Within 1 year of initiation, 65% (95% CI 60-70) of children, 47% (43-51) of adolescents, 39% (36-42) of young adults, and 48% (44-52) of adults remained on treatment. The proportion of patients discontinuing was highest between age 18 and 19 years. Treatment persistence for up to 5 years was higher across countries when accounting for reinitiation of medication; at 5 years of follow-up, 50-60% of children and 30-40% of adolescents and adults were covered by treatment in most countries. Patterns were similar across sex. INTERPRETATION Early medication discontinuation is prevalent in ADHD treatment, particularly among young adults. Although reinitiation of medication is common, treatment persistence in adolescents and young adults is lower than expected based on previous estimates of ADHD symptom persistence in these age groups. This study highlights the scope of medication treatment discontinuation and persistence in ADHD across the lifespan and provides new knowledge about long-term ADHD medication use. FUNDING European Union Horizon 2020 Research and Innovation Programme.
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Affiliation(s)
- Isabell Brikell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Honghui Yao
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lin Li
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Aske Astrup
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - Le Gao
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, Centre for Safe Medication Practice and Research, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Malcolm B Gillies
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Tian Xie
- Department of Psychiatry, Interdisciplinary Center of Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Yanli Zhang-James
- Department of Psychiatry and Behavioral Sciences, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Søren Dalsgaard
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; Center for Child and Adolescent Psychiatry, Mental Health Services of the Capital Region, Glostrup, Denmark; Institute of Clinical Medicine, University of Copenhagen, København, Denmark
| | - Anders Engeland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Stephen V Faraone
- Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Jan Haavik
- Department of Biomedicine, University of Bergen, Bergen, Norway; Bergen Center of Brain Plasticity, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Catharina Hartman
- Department of Psychiatry, Interdisciplinary Center of Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, Centre for Safe Medication Practice and Research, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Unnur Jakobsdóttir Smári
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Kenneth Kc Man
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, Centre for Safe Medication Practice and Research, The University of Hong Kong, Hong Kong Special Administrative Region, China; Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK; Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK; Laboratory of Data Discovery for Health, Hong Kong Special Administrative Region, China
| | - Juliana de Oliveira Costa
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Sallie-Anne Pearson
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
| | - Nina Pil Hostrup Nielsen
- Center for Child and Adolescent Psychiatry, Mental Health Services of the Capital Region, Glostrup, Denmark
| | - Harold Snieder
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Theresa Wimberley
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - Ian Ck Wong
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, Centre for Safe Medication Practice and Research, The University of Hong Kong, Hong Kong Special Administrative Region, China; Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK; Laboratory of Data Discovery for Health, Hong Kong Special Administrative Region, China; Aston Pharmacy School, Aston University, Birmingham, UK
| | - Le Zhang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Helga Zoega
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia; Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Kari Klungsøyr
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
| | - Zheng Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
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Galera C, Collet O, Orri M, Navarro M, Castel L, Galesne C, Reed C, Brandt V, Larsson H, Boivin M, Tremblay R, Côté S, Cortese S. Prospective associations between ADHD symptoms and physical conditions from early childhood to adolescence: a population-based longitudinal study. Lancet Child Adolesc Health 2023; 7:863-874. [PMID: 37973252 DOI: 10.1016/s2352-4642(23)00226-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 08/31/2023] [Accepted: 08/31/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND The co-occurrence between attention-deficit hyperactivity disorder (ADHD) and physical conditions is frequent but often goes unrecognised. Most available evidence on the links between ADHD and physical conditions relies on cross-sectional studies. Understanding temporal sequences of associations is key to inform appropriate treatment and preventive strategies. We aimed to assess possible longitudinal associations between ADHD symptoms and a broad range of physical conditions, adjusting for several confounding factors. METHODS Participants came from the population-based Quebec Longitudinal Study of Child Development. Participants were selected from the Quebec Birth Registry, recruited between October, 1997, and July, 1998, from the province of Quebec, Canada, and followed up in early childhood (n=2120; age 5 months-5 years), middle childhood (n=1750; age 6-12 years), and adolescence (n=1573; age 13-17 years). Main outcome measures included ADHD symptom severity and physical conditions, which were reported by the person most knowledgeable of the child in early childhood, by teachers in middle childhood, and self-reported in adolescence. Multivariable regression analyses were conducted to study the prospective associations between ADHD symptoms and later physical conditions, and physical conditions and later ADHD symptoms, adjusting for multiple confounders. FINDINGS We found several prospective associations between ADHD symptoms and physical conditions including asthma, high BMI (≥1 SD above the mean), epilepsy, dental caries, acute infections, injuries, and sleep problems. After adjusting for key confounding factors, several associations remained: ADHD symptoms in early childhood were associated with later high BMI during middle childhood (odds ratio [OR] 1·19 [95% CI 1·05-1·35]) and adolescence (OR 1·14 [1·01-1·29]), and with unintentional injuries during adolescence (OR 1·10 [1·01-1·21]). ADHD symptoms in middle childhood were significantly associated with later dental caries during adolescence (OR 1·10 [1·01-1·20]). Unintentional injuries in early childhood were associated with later ADHD symptoms in middle childhood (standardised mean difference [SMD] 0·15 [0·05-0·24]) and adolescence (SMD 0·13 [0·04-0·23]), and restless legs syndrome symptoms in middle childhood were associated with later ADHD symptoms in adolescence (SMD 0·15 [0·05-0·25]). INTERPRETATION Our results point to the need to carefully monitor children with ADHD in early or middle childhood for several physical conditions, and to monitor children with particular physical conditions for ADHD symptoms. Our study also calls for policies to promote more integrated health-care systems for children with complex mental and physical needs, bridging the current gap between mental and physical health-care services. FUNDING Québec Government's Ministry of Health, Ministry of Education, and Ministry of Family Affairs; The Lucie and André Chagnon Foundation; the Robert-Sauvé Research Institute of Health and Safety at Work; the Québec Statistics Institute; the Fonds de Recherche du Québec-Santé; the Fonds de Recherche du Québec-Societé et Culture; Canada's Social Science and Humanities Research Council; the Canadian Institutes of Health Research, the Sainte-Justine Research Center; and the French National Research Agency. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Cédric Galera
- Department of Child and Adolescent Psychiatry, University of Bordeaux, Bordeaux, France; INSERM, Bordeaux Population Health Center, Bordeaux, France; Centre Hospitalier Perrens, Bordeaux, France; Research Unit on Children's Psychosocial Maladjustment, Montreal, QC, Canada.
| | - Ophélie Collet
- Research Unit on Children's Psychosocial Maladjustment, Montreal, QC, Canada; Department of Social and Preventive Medicine, University of Montreal, Montreal, QC, Canada
| | - Massimiliano Orri
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Marie Navarro
- Department of Child and Adolescent Psychiatry, University of Bordeaux, Bordeaux, France; INSERM, Bordeaux Population Health Center, Bordeaux, France
| | - Laura Castel
- Department of Child and Adolescent Psychiatry, University of Bordeaux, Bordeaux, France; INSERM, Bordeaux Population Health Center, Bordeaux, France; Centre Hospitalier Perrens, Bordeaux, France
| | - Charline Galesne
- Department of Child and Adolescent Psychiatry, University of Bordeaux, Bordeaux, France; INSERM, Bordeaux Population Health Center, Bordeaux, France
| | - Claire Reed
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Valerie Brandt
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK; Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden; School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Michel Boivin
- Research Unit on Children's Psychosocial Maladjustment, Montreal, QC, Canada; School of Psychology, Université Laval, Quebec City, QC, Canada
| | - Richard Tremblay
- Research Unit on Children's Psychosocial Maladjustment, Montreal, QC, Canada; Department of Psychology, University of Montreal, Montreal, QC, Canada; CHU Ste-Justine Research Centre, Montreal, QC, Canada
| | - Sylvana Côté
- Research Unit on Children's Psychosocial Maladjustment, Montreal, QC, Canada; Department of Social and Preventive Medicine, University of Montreal, Montreal, QC, Canada; CHU Ste-Justine Research Centre, Montreal, QC, Canada
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK; Department of Psychiatry, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; Solent NHS Trust, Southampton, UK; Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK; Hassenfeld Children's Hospital at NYU Langone, New York, NY, USA; Department of Precision and Regenerative Medicine-Jonic Area, University of Bari Aldo Moro, Bari, Italy
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Ahlberg R, Garcia-Argibay M, Rietz ED, Butwicka A, Cortese S, D'Onofrio BM, Ludvigsson JF, Larsson H. Associations Between Attention-Deficit/Hyperactivity Disorder (ADHD), ADHD Medication, and Shorter Height: A Quasi-Experimental and Family-Based Study. J Am Acad Child Adolesc Psychiatry 2023; 62:1316-1325. [PMID: 37084883 DOI: 10.1016/j.jaac.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 03/04/2023] [Accepted: 04/12/2023] [Indexed: 04/23/2023]
Abstract
OBJECTIVE The association between attention-deficit/hyperactivity disorder (ADHD) and shorter height is unclear. This study examined the risk of shorter height in individuals with ADHD, and the influence of prenatal factors, ADHD medication, psychiatric comorbidity, socioeconomic factors, and familial liability. METHOD We drew on Swedish National Registers for 2 different study designs. First, height data for 14,268 individuals with ADHD and 71,339 controls were stratified into 2 groups: (1) before stimulant treatment was introduced in Sweden, and (2) after stimulant treatment was introduced in Sweden. Second, we used a family-based design including 833,172 relatives without ADHD with different levels of relatedness to the individuals with ADHD and matched controls. RESULTS ADHD was associated with shorter height both before (below-average height: OR = 1.31, 95% CI = 1.22-1.41) and after (below-average height: OR = 1.21, 95% CI = 1.13-1.31) stimulants for ADHD were introduced in Sweden, and was of similar magnitude in both cohorts. The association between ADHD and shorter height attenuated after adjustment for prenatal factors, psychiatric disorders, and socioeconomic status. Relatives of individuals with ADHD had an increased risk of shorter height (below-average height in full siblings: OR = 1.14, 95% CI = 1.09-1.19; maternal half siblings: OR = 1.10, 95% CI = 1.01-1.20; paternal half siblings: OR = 1.15, 95% CI = 1.07-1.24, first full cousins: OR = 1.10, 95% CI = 1.08-1.12). CONCLUSION Our findings suggest that ADHD is associated with shorter height. On a population level, this association was present both before and after ADHD medications were available in Sweden. The association between ADHD and height was partly explained by prenatal factors, psychiatric comorbidity, low socioeconomic status, and a shared familial liability for ADHD.
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Affiliation(s)
- Rickard Ahlberg
- School of Medical Sciences, Örebro University, Örebro, Sweden.
| | - Miguel Garcia-Argibay
- School of Medical Sciences, Örebro University, Örebro, Sweden; Karolinska Institutet, Stockholm, Sweden
| | | | - Agnieszka Butwicka
- Karolinska Institutet, Stockholm, Sweden; Child and Adolescent Psychiatry Stockholm, Stockholm Health Care Services, Region Stockholm, Sweden
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life sciences, University of Southampton, Southampton, United Kingdom; Solent NHS Trust, Southampton, United Kingdom; Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom; Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, United Kingdom; Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, New York; Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Brian M D'Onofrio
- Karolinska Institutet, Stockholm, Sweden; Indiana University, Bloomington, Indiana
| | - Jonas F Ludvigsson
- School of Medical Sciences, Örebro University, Örebro, Sweden; Karolinska Institutet, Stockholm, Sweden; Örebro University Hospital, Örebro University, Örebro, Sweden
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Gosling CJ, Caparos S, Pinabiaux C, Schwarzer G, Rücker G, Agha SS, Alrouh H, Ambler A, Anderson P, Andiarena A, Arnold LE, Arseneault L, Asherson P, Babinski L, Barbati V, Barkley R, Barros AJD, Barros F, Bates JE, Bell LJ, Berenguer C, van Bergen E, Biederman J, Birmaher B, B⊘e T, Boomsma DI, Brandt VC, Bressan RA, Brocki K, Broughton TR, Bufferd SJ, Bussing R, Cao M, Cartigny A, Casas AM, Caspi A, Castellanos FX, Caye A, Cederkvist L, Collishaw S, Copeland WE, Cote SM, Coventry WL, Debes NMM, Denyer H, Dodge KA, Dogru H, Efron D, Eller J, Abd Elmaksoud M, Ercan ES, Faraone SV, Fenesy M, Fernández MF, Fernández-Somoano A, Findling R, Fombonne E, Fossum IN, Freire C, Friedman NP, Fristad MA, Galera C, Garcia-Argibay M, Garvan CS, González-Safont L, Groenman AP, Guxens M, Halperin JM, Hamadeh RR, Hartman CA, Hill SY, Hinshaw SP, Hipwell A, Hokkanen L, Holz N, Íñiguez C, Jahrami HA, Jansen PW, Jónsdóttir LK, Julvez J, Kaiser A, Keenan K, Klein DN, Klein RG, Kuntsi J, Langfus J, Langley K, Lansford JE, Larsen SA, Larsson H, Law E, Lee SS, Lertxundi N, Li X, Li Y, Lichtenstein P, Liu J, Lundervold AJ, Lundström S, Marks DJ, Martin J, Masi G, Matijasevich A, Melchior M, Moffitt TE, Monninger M, Morrison CL, Mulraney M, Muratori P, Nguyen PT, Nicholson JM, Øie MG, O'Neill S, O'Connor C, Orri M, Pan PM, Pascoe L, Pettit GS, Price J, Rebagliato M, Riaño-Galán I, Rohde LA, Roisman GI, Rosa M, Rosenbaum JF, Salum GA, Sammallahti S, Santos IS, Schiavone NS, Schmid L, Sciberras E, Shaw P, Silk TJ, Simpson JA, Skogli EW, Stepp S, Strandberg-Larsen K, Sudre G, Sunyer J, Tandon M, Thapar A, Thomson P, Thorell LB, Tinchant H, Torrent M, Tovo-Rodrigues L, Tripp G, Ukoumunne O, Van Goozen SHM, Vos M, Wallez S, Wang Y, Westermaier FG, Whalen DJ, Yoncheva Y, Youngstrom EA, Sayal K, Solmi M, Delorme R, Cortese S. Association between relative age at school and persistence of ADHD in prospective studies: an individual participant data meta-analysis. Lancet Psychiatry 2023; 10:922-933. [PMID: 37898142 DOI: 10.1016/s2215-0366(23)00272-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/27/2023] [Accepted: 08/03/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND The youngest children in a school class are more likely than the oldest to be diagnosed with ADHD, but this relative age effect is less frequent in older than in younger school-grade children. However, no study has explored the association between relative age and the persistence of ADHD diagnosis at older ages. We aimed to quantify the association between relative age and persistence of ADHD at older ages. METHODS For this meta-analysis, we searched MEDLINE, Embase, CINAHL, PsycINFO, and PubPsych up to April 1, 2022, with terms related to "cohort" and "ADHD" with no date, publication type, or language restrictions. We gathered individual participant data from prospective cohorts that included at least ten children identified with ADHD before age 10 years. ADHD was defined by either a clinical diagnosis or symptoms exceeding clinical cutoffs. Relative age was recorded as the month of birth in relation to the school-entry cutoff date. Study authors were invited to share raw data or to apply a script to analyse data locally and generate anonymised results. Our outcome was ADHD status at a diagnostic reassessment, conducted at least 4 years after the initial assessment and after age 10 years. No information on sex, gender, or ethnicity was collected. We did a two-stage random-effects individual participant data meta-analysis to assess the association of relative age with persistence of ADHD at follow-up. This study was registered with PROSPERO, CRD42020212650. FINDINGS Of 33 119 studies generated by our search, we identified 130 eligible unique studies and were able to gather individual participant data from 57 prospective studies following up 6504 children with ADHD. After exclusion of 16 studies in regions with a flexible school entry system that did not allow confident linkage of birthdate to relative age, the primary analysis included 41 studies in 15 countries following up 4708 children for a period of 4 to 33 years. We found that younger relative age was not statistically significantly associated with ADHD persistence at follow-up (odds ratio 1·02, 95% CI 0·99-1·06; p=0·19). We observed statistically significant heterogeneity in our model (Q=75·82, p=0·0011, I2=45%). Participant-level sensitivity analyses showed similar results in cohorts with a robust relative age effect at baseline and when restricting to cohorts involving children with a clinical diagnosis of ADHD or with a follow-up duration of more than 10 years. INTERPRETATION The diagnosis of ADHD in younger children in a class is no more likely to be disconfirmed over time than that of older children in the class. One interpretation is that the relative age effect decreases the likelihood of children of older relative age receiving a diagnosis of ADHD, and another is that assigning a diagnostic label of ADHD leads to unexplored carryover effects of the initial diagnosis that persist over time. Future studies should be conducted to explore these interpretations further. FUNDING None.
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Nilsson A, Kuja‐Halkola R, Lichtenstein P, Larsson H, Lundström S, Fatouros‐Bergman H, Jayaram‐Lindström N, Molero Y. The genetics of gaming: A longitudinal twin study. JCPP Adv 2023; 3:e12179. [PMID: 38054048 PMCID: PMC10694538 DOI: 10.1002/jcv2.12179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 04/21/2023] [Indexed: 12/07/2023] Open
Abstract
Background Gaming is a popular past-time activity among children and adolescents, but it there is also a possible link to negative consequences such as psychological distress and lowered academic achievement. However, there are fundamental knowledge gaps remaining regarding central characteristics of gaming such as heritability, stability over time, and sex differences. We examined the genetic and environmental contribution to gaming behavior, including sex differences, continuity and change, in a longitudinal cohort of twins. Methods This is the first longitudinal twin study on gaming, involving 32,006 twins in Sweden. Parents were asked about the twins' gaming at ages 9, 15 and 18. We used univariate and multivariate twin analyses to estimate the relative contribution of genetic and environmental influences at each time-point as well as across time. Sex-differences were also explored. Results The results showed large sex differences, where genetics explained more of the variance for boys (31.3%-62.5% depending on age) than for girls (19.4%-23.4%). Genetic factors explained an increasing amount of the variance for boys (31.3% at age 9, 62.5% at age 15 and 53.9% at age 18). Shared environmental factors explained a larger proportion of the variance among girls, which remained relatively stable over time (70.5% at age 9, 61.8% at age 15 and 60.5% at age 18). The results also indicated that most of the variance came from genetic and environmental sources specific to each age. Conclusions Compared to many other behavioral phenotypes, such as gambling, gaming was relatively unstable with a large degree of genetic innovation. There were large sex differences in the contribution of genetic and environmental factors. This suggests that excessive gaming could be the result of age- and sex-specific genetic and environmental factors, and should be taken into account when mapping gaming behaviors, since these behaviors might be under continual etiological transformation.
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Affiliation(s)
- Anders Nilsson
- Department of Clinical NeuroscienceCentre for Psychiatry ResearchKarolinska InstitutetStockholmSweden
- Stockholm Health Care ServicesStockholmSweden
| | - Ralf Kuja‐Halkola
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Henrik Larsson
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Sebastian Lundström
- Gillberg Neuropsychiatry CentreInstitute of Neuroscience and PhysiologyUniversity of GothenburgGothenburgSweden
- Center for Ethics, Law and Mental Health (CELAM)Institute of Neuroscience and PhysiologyUniversity of GothenburgGothenburgSweden
| | - Helena Fatouros‐Bergman
- Department of Clinical NeuroscienceCentre for Psychiatry ResearchKarolinska InstitutetStockholmSweden
- Stockholm Health Care ServicesStockholmSweden
| | - Nitya Jayaram‐Lindström
- Department of Clinical NeuroscienceCentre for Psychiatry ResearchKarolinska InstitutetStockholmSweden
- Stockholm Health Care ServicesStockholmSweden
| | - Yasmina Molero
- Department of Clinical NeuroscienceCentre for Psychiatry ResearchKarolinska InstitutetStockholmSweden
- Stockholm Health Care ServicesStockholmSweden
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
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Klang A, Molero Y, Lichtenstein P, Larsson H, D’Onofrio BM, Marklund N, Oldenburg C, Rostami E. Access to Rehabilitation After Hospitalization for Traumatic Brain Injury: A National Longitudinal Cohort Study in Sweden. Neurorehabil Neural Repair 2023; 37:763-774. [PMID: 37953612 PMCID: PMC10685696 DOI: 10.1177/15459683231209315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
BACKGROUND Rehabilitation is suggested to improve outcomes following traumatic brain injury (TBI), however, the extent of access to rehabilitation among TBI patients remains unclear. OBJECTIVE To examine the level of access to rehabilitation after TBI, and its association with health and sociodemographic factors. METHOD We conducted a longitudinal cohort study using Swedish nationwide healthcare and sociodemographic registers. We identified 15 880 TBI patients ≥18 years hospitalized ≥3 days from 2008 to 2012 who were stratified into 3 severity groups; grade I (n = 1366; most severe), grade II (n = 5228), and grade III (n = 9268; least severe). We examined registered contacts with specialized rehabilitation or geriatric care (for patients ≥65 years) during the hospital stay, and/or within 1 year post-discharge. We performed a generalized linear model analysis to estimate the risk ratio (RR) for receiving specialized rehabilitation or geriatric care after a TBI based on sociodemographic and health factors. RESULTS Among TBI patients, 46/35% (grade I), 14/40% (grade II), and 5/18% (grade III) received specialized rehabilitation or geriatric care, respectively. Being currently employed or studying was positively associated (RR 1.7, 2.3), while living outside of a city area was negatively associated (RR 0.36, 0.79) with receiving specialized rehabilitation or geriatric care. Older age and a prior substance use disorder were negatively associated with receiving specialized rehabilitation (RR 0.51 and 0.81). CONCLUSION Our results suggest insufficient and unequal access to rehabilitation for TBI patients, highlighting the importance of organizing and standardizing post-TBI rehabilitation to meet the needs of patients, regardless of their age, socioeconomic status, or living area.
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Affiliation(s)
- Andrea Klang
- Department of Medical Sciences, Rehabilitation Medicine, Uppsala University, Uppsala, Sweden
| | - Yasmina Molero
- Department of Clinical Neuroscience, Karolinska Institutet Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Sciences, Örebro University, Örebro, Sweden
| | - Brian Matthew D’Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Niklas Marklund
- Department of Medical Sciences, Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Christian Oldenburg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Elham Rostami
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Sciences Lund, Neurosurgery, Lund University, Skåne University Hospital, Lund, Sweden
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Zhou M, Larsson H, D’Onofrio BM, Landén M, Lichtenstein P, Pettersson E. Intergenerational Transmission of Psychiatric Conditions and Psychiatric, Behavioral, and Psychosocial Outcomes in Offspring. JAMA Netw Open 2023; 6:e2348439. [PMID: 38117496 PMCID: PMC10733806 DOI: 10.1001/jamanetworkopen.2023.48439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/03/2023] [Indexed: 12/21/2023] Open
Abstract
Importance Psychiatric conditions in parents are associated with many psychiatric and nonpsychiatric outcomes in offspring. However, it remains unknown whether this intergenerational transmission is attributable to broader psychopathology comorbidity or to specific conditions. Objective To estimate associations between general and specific psychopathology factors in parents and a wide range of register-based outcomes in their offspring. Design, Setting, and Participants This Swedish national register-based cohort study included 2 947 703 individuals born between 1970 and 2000 and followed up with participants through December 31, 2013. Statistical analysis was performed from October 2022 to October 2023. Exposures Hierarchical factor model consisting of 1 general and 3 specific psychopathology factors fit to 9 parental psychiatric diagnoses and violent criminal court convictions. Main Outcomes and Measures A total of 31 outcomes were measured in offspring and sorted into 6 broad clusters: psychotic-like outcomes, neurodevelopmental outcomes, internalizing outcomes, externalizing outcomes, behavior and accidents, and psychosocial outcomes. Results Of 2 947 703 individuals, 1 518 252 (51.5%) were male, and the mean (SD) age at the end of follow-up was 28.7 (8.9) years. The general psychopathology factor in parents was significantly associated with all 31 offspring outcomes (range: odds ratio [OR] for accidents, 1.08 [95% CI, 1.07-1.08] to OR for social welfare recipiency, 1.40 [95% CI, 1.39-1.40]), which means that children whose parents scored 1 SD above the mean on the general psychopathology factor had an 8% to 40% higher odds of different studied outcomes. The specific psychotic factor in parents was primarily associated with all 5 psychotic-like outcomes (range: OR for prescription of antiepileptics, 1.05 [95% CI, 1.04-1.06] to OR for schizophrenia, 1.25 [95% CI, 1.23-1.28]) and the specific internalizing factor in parents was primarily associated with all 6 internalizing outcomes (range: OR for prescription of anxiolytics, 1.10 [95% CI, 1.09-1.10] to OR for depression, 1.13 [95% CI, 1.12-1.13]) and all 6 neurodevelopmental outcomes (range: OR for intellectual disability, 1.02 [95% CI, 1.01-1.03] to OR for autism spectrum disorder, 1.10 [95% CI, 1.09-1.11]) in offspring. The specific externalizing factor in parents was associated with all 6 externalizing outcomes (range: OR for violent crimes, 1.21 [95% CI, 1.19-1.23] to OR for oppositional defiant disorder, 1.32 [95% CI, 1.32-1.33]) and all 6 internalizing outcomes (range: OR for obsessive-compulsive disorder, 1.01 [95% CI, 1.00-1.02] to OR for posttraumatic stress disorder, 1.13 [95% CI, 1.12-1.13]) in offspring. Conclusions and Relevance This cohort study of the Swedish population suggests that the intergenerational transmission of psychiatric conditions across different types of spectra may largely be attributable to a parental general psychopathology factor, whereas specific factors appeared to be primarily responsible for within-spectrum associations between parents and their offspring. Professionals who work with children (eg, child psychologists, psychiatrists, teachers, and social workers) might benefit from taking the total number of parental psychiatric conditions into account, regardless of type, when forecasting child mental health and social functions.
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Affiliation(s)
- Mengping Zhou
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Brian M. D’Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychological and Brain Sciences, Indiana University, Bloomington
| | - Mikael Landén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Erik Pettersson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Larsson H. Children of parents with depression or anxiety: Long-term follow-up, causality and resilience. JCPP Adv 2023; 3:e12211. [PMID: 38054050 PMCID: PMC10694529 DOI: 10.1002/jcv2.12211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Abstract
Three papers in the December issue (2023) of JCPP Advances focus on children of parents with depression or anxiety. They highlight the value of using prospective longitudinal data to improve the understanding about the development of children of parents with depression or anxiety from early childhood to young adulthood. They contribute to an advanced understanding of long-term outcomes, causality and resilience for children of parents with depression or anxiety.
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Curman P, Jebril W, Evans-Molina C, Bachar-Wikstrom E, Larsson H, Cederlöf M, Wikström JD. Hailey-Hailey Disease is Associated with Diabetes: A Population-based Cohort Study, Clinical Cohort Study, and Pedigree Analysis. Acta Derm Venereol 2023; 103:adv10436. [PMID: 38014829 PMCID: PMC10695124 DOI: 10.2340/actadv.v103.10436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 09/27/2023] [Indexed: 11/29/2023] Open
Abstract
Hailey-Hailey disease is a rare hereditary skin disease caused by mutations in the ATP2C1 gene encoding the secretory pathway Ca2+/Mn2+-ATPase 1 (SPCA1) protein. Extracutaneous manifestations of Hailey-Hailey disease are plausible but still largely unknown. The aim of this study was to explore the association between Hailey-Hailey disease and diabetes. A population-based cohort study of 347 individuals with Hailey-Hailey disease was performed to assess the risks of type 1 diabetes and type 2 diabetes, using Swedish nationwide registries. Pedigrees from 2 Swedish families with Hailey-Hailey disease were also investigated: 1 with concurrent type 1 diabetes and HLA-DQ3, the other with type 2 diabetes. Lastly, a clinical cohort with 23 individuals with Hailey-Hailey disease and matched healthy controls was evaluated regarding diabetes. In the register data males with Hailey-Hailey disease had a 70% elevated risk of type 2 diabetes, whereas no excess risk among women could be confirmed. In both pedigrees an unusually high inheritance for diabetes was observed. In the clinical cohort, individuals with Hailey-Hailey disease displayed a metabolic phenotype indicative of type 2 diabetes. Hailey-Hailey disease seems to act as a synergistic risk factor for diabetes. This study indicates, for the first time, an association between Hailey-Hailey disease and diabetes and represents human evidence that SPCA1 and the Golgi apparatus may be implicated in diabetes pathophysiology.
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Affiliation(s)
- Philip Curman
- Dermatology and Venereology Division, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden; Dermato-Venereology Clinic, Karolinska University Hospital, Stockholm, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - William Jebril
- Dermatology and Venereology Division, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden; Dermato-Venereology Clinic, Karolinska University Hospital, Stockholm, Sweden
| | - Carmella Evans-Molina
- Departments of Anatomy, Cell Biology, and Physiology; Biochemistry and Molecular Biology; Medicine; Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202; The Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN 46202; Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN 46202; Roudebush VA Medical Center, Indianapolis, IN 46202, USA
| | - Etty Bachar-Wikstrom
- Dermatology and Venereology Division, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden; Dermato-Venereology Clinic, Karolinska University Hospital, Stockholm, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Martin Cederlöf
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Jakob D Wikström
- Dermatology and Venereology Division, Department of Medicine (Solna), Karolinska Institutet, Stockholm, Sweden; Dermato-Venereology Clinic, Karolinska University Hospital, Stockholm, Sweden
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Dobrosavljevic M, Kuja-Halkola R, Li L, Chang Z, Larsson H, Du Rietz E. Attention-deficit/hyperactivity disorder symptoms and subsequent cardiometabolic disorders in adults: investigating underlying mechanisms using a longitudinal twin study. BMC Med 2023; 21:452. [PMID: 37993878 PMCID: PMC10664476 DOI: 10.1186/s12916-023-03174-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 11/13/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Emerging research suggests that attention-deficit/hyperactivity disorder (ADHD) increases the risk for cardiovascular (CVDs) and metabolic disorders (i.e., cardiometabolic disorders) in adulthood. Yet, available studies are scarce and have mainly been focused on individuals receiving clinical ADHD diagnoses. We aimed to investigate the prospective associations of ADHD symptoms in young and mid-adulthood with subsequent cardiometabolic disorders and the underlying mechanisms. METHODS We studied 10,394 twins from the Swedish Twin Registry (STR), born between 1958 and 1985 without previous medical history of cardiometabolic disorders. They provided self-assessment of ADHD symptoms (score range 0-36) via a validated, DSM-IV-based scale in a web-based questionnaire/telephone interview within the Study of Twin Adults: Genes and Environment (STAGE), in 2005-2006 (aged 19-47 years), and were followed until the end of 2018 (33-59 years) to identify incident clinical diagnoses/medication prescriptions for cardiometabolic disorders acquired from Swedish national registers. We used Cox regression models to investigate the associations between ADHD symptoms score and cardiometabolic outcomes, with and without adjustment for relevant covariates, and a co-twin control design to study familial confounding. RESULTS A one-unit increase in the level of ADHD symptoms was associated with a 2% increase in the rate of CVDs (hazard ratio [HR] = 1.02, 95% confidence interval 1.01-1.04) and a 3% increase in the rate of metabolic disorders (HR = 1.03, 1.02-1.05), after adjusting for birth year and sex. The associations were no longer significant after adjusting for educational attainment, lifestyle factors, and comorbid psychiatric disorders. The associations remained significant after adjusting for familial factors shared by dizygotic twin pairs but became nonsignificant after adjusting for factors shared by monozygotic twin pairs. However, the strength of the associations attenuated significantly in monozygotic twins compared to dizygotic twins for CVDs only, suggesting genetic confounding. CONCLUSIONS ADHD symptom score is associated with a higher risk for cardiometabolic disorders, which may be explained by lower educational attainment, adverse lifestyle factors, and psychiatric comorbidities. Moreover, the associations appear to be partly confounded by shared genetic factors, especially for CVDs. Further research is needed to investigate the identified associations at the level of individual cardiometabolic disorders and to follow-up participants until a more advanced older age.
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Affiliation(s)
- Maja Dobrosavljevic
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, SE-701 82, Örebro, Sweden.
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lin Li
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Zheng Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, SE-701 82, Örebro, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ebba Du Rietz
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Ojala O, Kuja-Halkola R, Bjureberg J, Ohlis A, Cederlöf M, Norén Selinus E, Lichtenstein P, Larsson H, Lundström S, Hellner C. Correction: Associations of impulsivity, hyperactivity, and inattention with nonsuicidal self-injury and suicidal behavior: longitudinal cohort study following children at risk for neurodevelopmental disorders into mid-adolescence. BMC Psychiatry 2023; 23:864. [PMID: 37990195 PMCID: PMC10664592 DOI: 10.1186/s12888-023-05338-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
Affiliation(s)
- Olivia Ojala
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Norra Stationsgatan 69 7th fl., Stockholm, SE-11,364, Sweden.
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Johan Bjureberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Norra Stationsgatan 69 7th fl., Stockholm, SE-11,364, Sweden
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Anna Ohlis
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Norra Stationsgatan 69 7th fl., Stockholm, SE-11,364, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Martin Cederlöf
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Norra Stationsgatan 69 7th fl., Stockholm, SE-11,364, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Eva Norén Selinus
- region vastmanland - Uppsala University, Centre for Clinical Research, Vastmanland Hospital, Vasteras, Sweden
- the Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Sebastian Lundström
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Centre for Ethics, Law and Mental health (CELAM), Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Clara Hellner
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Norra Stationsgatan 69 7th fl., Stockholm, SE-11,364, Sweden
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Smari UJ, Valdimarsdottir UA, Aspelund T, Hauksdottir A, Thordardottir EB, Hartman CA, Andell P, Larsson H, Zoega H. Psychiatric comorbidities in women with cardiometabolic conditions with and without ADHD: a population-based study. BMC Med 2023; 21:450. [PMID: 37981673 PMCID: PMC10659052 DOI: 10.1186/s12916-023-03160-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 11/06/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND Leveraging a large nationwide study of Icelandic women, we aimed to narrow the evidence gap around female attention-deficit/hyperactivity disorder (ADHD) and cardiometabolic comorbidities by determining the prevalence of obesity, hypertension, type 2 diabetes, and cardiovascular diseases among women with ADHD and examine the association between cardiometabolic conditions and co-occurring ADHD with anxiety and mood disorders, alcoholism/substance use disorder (SUD), self-harm, and suicide attempts. METHODS We conducted a cross-sectional analysis of the nationwide, all-female, population-based SAGA Cohort Study (n = 26,668). To ascertain diagnoses and symptoms, we used self-reported history of ADHD diagnoses, selected cardiometabolic conditions and psychiatric disorders, and measured current depressive, anxiety, and PTSD symptoms through appropriate questionnaires (PHQ-9, GAD-7, and PCL-5). We calculated age-adjusted prevalences of cardiometabolic conditions by women's ADHD status and estimated adjusted prevalence ratios (PR) and 95% confidence intervals (CI), using modified Poisson regression models. Similarly, we assessed the association of cardiometabolic conditions and co-occurring ADHD with current psychiatric symptoms and psychiatric disorders, using adjusted PRs and 95% CIs. RESULTS We identified 2299 (8.6%) women with a history of ADHD diagnosis. The age-adjusted prevalence of having at least one cardiometabolic condition was higher among women with ADHD (49.5%) than those without (41.7%), (PR = 1.19, 95% CI 1.14-1.25), with higher prevalence of all measured cardiometabolic conditions (myocardial infarctions (PR = 2.53, 95% CI 1.83--3.49), type 2 diabetes (PR = 2.08, 95% CI 1.66-2.61), hypertension (PR = 1.23, 95% CI 1.12-1.34), and obesity (PR = 1.18, 95% CI 1.11-1.25)). Women with cardiometabolic conditions and co-occurring ADHD had, compared with those without ADHD, substantially increased prevalence of (a) all measured mood and anxiety disorders, e.g., depression (PR = 2.38, 95% CI 2.19-2.58), bipolar disorder (PR = 4.81, 95% CI 3.65-6.35), posttraumatic stress disorder (PR = 2.78, 95% CI 2.52-3.07), social phobia (PR = 2.96, 95% CI 2.64-3.32); (b) moderate/severe depressive, anxiety, and PTSD symptoms with PR = 1.76 (95% CI 1.67-1.85), PR = 1.97 (95% CI 1.82-2.12), and PR = 2.01 (95% CI 1.88-2.15), respectively; (c) alcoholism/SUD, PR = 4.79 (95% CI 3.90-5.89); and (d) self-harm, PR = 1.47 (95% CI 1.29-1.67) and suicide attempts, PR = 2.37 (95% CI 2.05-2.73). CONCLUSIONS ADHD is overrepresented among women with cardiometabolic conditions and contributes substantially to other psychiatric comorbidities among women with cardiometabolic conditions.
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Affiliation(s)
- Unnur Jakobsdottir Smari
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Sturlugata 8, Reykjavík, 102, Iceland.
| | - Unnur Anna Valdimarsdottir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Sturlugata 8, Reykjavík, 102, Iceland
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Thor Aspelund
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Sturlugata 8, Reykjavík, 102, Iceland
| | - Arna Hauksdottir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Sturlugata 8, Reykjavík, 102, Iceland
| | - Edda Bjork Thordardottir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Sturlugata 8, Reykjavík, 102, Iceland
- Mental Health Services, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | - Catharina A Hartman
- Interdisciplinary Center Psychopathology and Emotion Regulations (ICPE), Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Pontus Andell
- Unit of Cardiology, Department of Medicine, Karolinska Institutet, Heart and Vascular Division, Karolinska University Hospital, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Helga Zoega
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Sturlugata 8, Reykjavík, 102, Iceland
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
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Sidorchuk A, Brander G, Pérez-Vigil A, Crowley JJ, Larsson H, Lichtenstein P, Mataix-Cols D, Nordsletten AE. One versus two biological parents with mental disorders: Relationship to educational attainment in the next generation. Psychol Med 2023; 53:7025-7041. [PMID: 36545765 PMCID: PMC10719631 DOI: 10.1017/s0033291722003506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 10/17/2022] [Accepted: 10/19/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Both maternal and, separately, paternal mental illness are associated with diminished academic attainment among children. However, the differential impacts of diagnostic type and degree of parental burden (e.g. one v. both parents affected) on these functional outcomes are unknown. METHODS Using the Swedish national patient (NPR) and multi-generation (MGR) registers, 2 226 451 children (1 290 157 parental pairs), born 1 January 1973-31 December 1997, were followed through 31 December 2013. Diagnostic status of all cohort members was defined for eleven psychiatric disorders, and families classed by exposure: (1) parents affected with any disorder, (2) parents affected with a disorder group (e.g. neuropsychiatric disorders), and (3) parents affected with a specific disorder (e.g. ADHD). Pairs were further defined as 'unaffected,' 'single-affected,', or 'dual-affected.' Among offspring, the study evaluated fulfillment of four academic milestones, from compulsory (primary) school through University (college). Sensitivity analyses considered the impact of child's own mental health, as well as parental education, on main effects. RESULTS Marked reductions in the odds of achievement were observed, emerging at the earliest levels of schooling for both single-affected [adjusted odds ratio (aOR), 0.50; 95% CI 0.49-0.51] and dual-affected (aOR 0.29, 95% CI 0.28-0.30) pairs and persisting thereafter [aOR range (single), 0.52-0.65; aOR range (dual), 0.30-0.40]. This pattern was repeated for analyses within diagnosis/diagnostic group. Main results were robust to adjustment for offspring mental health and parent education level. CONCLUSIONS Parental mental illness is associated with profound reductions in educational attainment in the subsequent generation, with children from dual-affected families at uniquely high risk.
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Affiliation(s)
- Anna Sidorchuk
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Gustaf Brander
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Medical Biochemistry and Microbiology, Uppsala Universitet, Uppsala, Sweden
| | - Ana Pérez-Vigil
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain
| | - James J. Crowley
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Departments of Genetics and Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro Universitet, Örebro, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - David Mataix-Cols
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Ashley E. Nordsletten
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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Cortese S, Song M, Farhat LC, Yon DK, Lee SW, Kim MS, Park S, Oh JW, Lee S, Cheon KA, Smith L, Gosling CJ, Polanczyk GV, Larsson H, Rohde LA, Faraone SV, Koyanagi A, Dragioti E, Radua J, Carvalho AF, Il Shin J, Solmi M. Incidence, prevalence, and global burden of ADHD from 1990 to 2019 across 204 countries: data, with critical re-analysis, from the Global Burden of Disease study. Mol Psychiatry 2023; 28:4823-4830. [PMID: 37684322 DOI: 10.1038/s41380-023-02228-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 08/02/2023] [Accepted: 08/09/2023] [Indexed: 09/10/2023]
Abstract
Data on incidence, prevalence and burden of ADHD are crucial for clinicians, patients, and stakeholders. We present the incidence, prevalence, and burden of ADHD globally and across countries from 1990 to 2019 from the Global Burden of Disease (GBD) study. We also: (1) calculated the ADHD prevalence based on data actually collected as opposed to the prevalence estimated by the GBD with data imputation for countries without prevalence data; (2) discussed the GBD estimated ADHD burden in the light of recent meta-analytic evidence on ADHD-related mortality. In 2019, GBD estimated global age-standardized incidence and prevalence of ADHD across the lifespan at 0.061% (95%UI = 0.040-0.087) and 1.13% (95%UI = 0.831-1.494), respectively. ADHD accounted for 0.8% of the global mental disorder DALYs, with mortality set at zero by the GBD. From 1990 to 2019 there was a decrease of -8.75% in the global age-standardized prevalence and of -4.77% in the global age-standardized incidence. The largest increase in incidence, prevalence, and burden from 1990 to 2019 was observed in the USA; the largest decrease occurred in Finland. Incidence, prevalence, and DALYs remained approximately 2.5 times higher in males than females from 1990 to 2019. Incidence peaked at age 5-9 years, and prevalence and DALYs at age 10-14 years. Our re-analysis of data prior to 2013 showed a prevalence in children/adolescents two-fold higher (5.41%, 95% CI: 4.67-6.15%) compared to the corresponding GBD estimated prevalence (2.68%, 1.83-3.72%), with no significant differences between low- and middle- and high-income countries. We also found meta-analytic evidence of significantly increased ADHD-related mortality due to unnatural causes. While it provides the most detailed evidence on temporal trends, as well as on geographic and sex variations in incidence, prevalence, and burden of ADHD, the GBD may have underestimated the ADHD prevalence and burden. Given the influence of the GBD on research and policies, methodological issues should be addressed in its future editions.
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Affiliation(s)
- Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK.
- Solent NHS Trust, Southampton, UK.
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, NY, USA.
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK.
| | - Minjin Song
- Yonsei University College of Medicine, Seoul, South Korea
| | | | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Seung Won Lee
- Department of Precision Medicine, Sungkyunkwan University School of Medicine, Suwon, South Korea
| | - Min Seo Kim
- Department of digital health, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Samsung Medical Center, Seoul, Republic of Korea
| | - Seoyeon Park
- Yonsei University College of Medicine, Seoul, South Korea
| | - Jae Won Oh
- Department of Psychiatry, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - San Lee
- Department of Psychiatry, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Keun-Ah Cheon
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Severance Hospital, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Lee Smith
- Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Corentin J Gosling
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- DysCo Lab, Department of Psychology, Université Paris Nanterre, Nanterre, France
- Laboratoire de Psychopathologie et Processus de Santé, Université de Paris, Boulogne-Billancourt, France
| | | | - Henrik Larsson
- School of Medical Sciences, Örebro University, Faculty of Medicine and Health, Örebro, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Luis A Rohde
- ADHD Outpatient Program & Developmental Psychiatry Program, Hospital de Clinica de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- UNIEDUK, National Institute of Developmental Psychiatry, São Paulo, Brazil
| | - Stephen V Faraone
- Department of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Barcelona, Spain
- ICREA, Pg. Lluis Companys, Barcelona, Spain
| | - Elena Dragioti
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Research Laboratory Psychology of Patients, Families and Health Professionals, Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Joaquim Radua
- Institut d'Investigacions Biomediques August Pi i Sunyer, CIBERSAM, Instituto de Salud Carlos III, University of Barcelona, Barcelona, Spain
| | - Andre F Carvalho
- IMPACT (Innovation in Mental and Physical Health and Clinical Treatment) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea.
- Severance Underwood Meta-research Center, Institute of Convergence Science, Yonsei University, Seoul, Republic of Korea.
| | - Marco Solmi
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute (OHRI), Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
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Taylor MJ, Martin J, Butwicka A, Lichtenstein P, D'Onofrio B, Lundström S, Larsson H, Rosenqvist MA. A twin study of genetic and environmental contributions to attention-deficit/hyperactivity disorder over time. J Child Psychol Psychiatry 2023; 64:1608-1616. [PMID: 37409759 DOI: 10.1111/jcpp.13854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) is an increasingly commonly diagnosed neurodevelopmental condition. One possibility is that this reflects a genuine increase in the prevalence of ADHD due to secular environmental changes, yet this hypothesis remains untested. We therefore investigated whether the genetic and environmental variance underlying ADHD, and traits of ADHD, has changed over time. METHODS We identified twins born from 1982 to 2008 from the Swedish Twin Registry (STR). We linked the STR with the Swedish National Patient Register and Prescribed Drug Register to identify diagnoses of ADHD and prescriptions of ADHD medication for these twins. We also utilized data collected from participants in the Child and Adolescent Twin Study in Sweden (CATSS), born from 1992 to 2008. Their parents completed a structured ADHD screening tool, which was used to measure traits of ADHD and assign broad screening diagnoses of ADHD. We used the classical twin design to test whether the degree to which variation in these measures was influenced by genetic and environmental variation changed over time. RESULTS We included 22,678 twin pairs from the STR and 15,036 pairs from CATSS. The heritability of ADHD in the STR ranged from 66% to 86% over time, although these fluctuations were not statistically significant. We observed a modest increase in variance in ADHD traits, from 0.98 to 1.09. This was driven by small increases in the underlying genetic and environmental variance, with heritability estimated as 64%-65%. No statistically significant changes in variance in screening diagnoses were observed. CONCLUSIONS The relative contribution of genetic and environmental factors to ADHD has remained stable over time, despite its increasing prevalence. Thus, changes in the underlying etiology of ADHD over time are unlikely to explain the increase in ADHD diagnoses.
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Affiliation(s)
- Mark J Taylor
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Joanna Martin
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Agnieszka Butwicka
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Child Psychiatry, Medical University of Warsaw, Warsaw, Poland
- Child and Adolescent Psychiatry, Stockholm Health Care Service, Region Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Brian D'Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychological and Brain Science, Indiana University, Bloomington, IN, USA
| | - Sebastian Lundström
- Gillberg Neuropsychiatry Centre, Centre for Ethics, Law and Mental Health, University of Gothenburg, Gothenburg, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Mina A Rosenqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Taylor MJ, van Leeuwen TM, Kuja-Halkola R, Lundström S, Larsson H, Lichtenstein P, Bölte S, Neufeld J. Genetic and environmental architecture of synaesthesia and its association with the autism spectrum-a twin study. Proc Biol Sci 2023; 290:20231888. [PMID: 37876199 PMCID: PMC10598415 DOI: 10.1098/rspb.2023.1888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 09/26/2023] [Indexed: 10/26/2023] Open
Abstract
Synaesthesia is a sensory phenomenon where external stimuli, such as sounds or letters, trigger additional sensations (e.g. colours). Synaesthesia aggregates in families but its heritability is unknown. The phenomenon is more common in people on the autism spectrum compared with the general population and associated with higher autistic traits. Using classical twin design, we assessed the heritability of individual differences in self-reported synaesthesia and the genetic and environmental contributions to their association with autistic traits within a population twin cohort (n = 4262, age = 18 years). We estimated individual differences in synaesthesia to be heritable and influenced by environmental factors not shared between twins. The association between individual differences in synaesthesia and autistic traits was estimated to be predominantly under genetic influence and seemed to be mainly driven by non-social autistic traits (repetitive behaviours, restricted interests and attention to detail). Our study suggests that the link between synaesthesia and autism might reside in shared genetic causes, related to non-social autistic traits such as alterations in perception. Future studies building on these findings may attempt to identify specific groups of genes that influence both autism, synaesthesia and perception.
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Affiliation(s)
- Mark J. Taylor
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17165 Stockholm, Sweden
| | - Tessa M. van Leeuwen
- Tilburg School of Humanities and Digital Sciences, Department of Communication and Cognition, Tilburg University, 5037 AB Tilburg, The Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6525 XZ Nijmegen, The Netherlands
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17165 Stockholm, Sweden
| | - Sebastian Lundström
- Gillberg Neuropsychiatry Centre, Centre for Ethics, Law and Mental Health, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17165 Stockholm, Sweden
- School of Medical Sciences, Örebro University, 70281 Örebro, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17165 Stockholm, Sweden
| | - Sven Bölte
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, 11364 Stockholm, Sweden
- Curtin Autism Research Group, Curtin School of Allied Health, Curtin University, WA 66102 Perth, Western Australia
- Child and Adolescent Psychiatry, Stockholm Health Care Services, Region Stockholm, 11364 Stockholm, Sweden
| | - Janina Neufeld
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, 11364 Stockholm, Sweden
- Swedish Collegium for Advanced Study (SCAS), 75238 Uppsala, Sweden
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Solares C, Zhang L, Chang Z, Andershed H, Persson J, Larsson H. Externalizing Behaviors and Alzheimer's Disease and Any Dementia: A Multigeneration Cohort Study in Sweden. Innov Aging 2023; 7:igad117. [PMID: 38024330 PMCID: PMC10652177 DOI: 10.1093/geroni/igad117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Indexed: 12/01/2023] Open
Abstract
Background and Objectives We examined the extent to which externalizing behaviors such as violent and nonviolent criminal behavior, and substance use disorders (SUD) are associate with the onset of Alzheimer's disease (AD) and any dementia in prior generations. Research Design and Methods A nationwide cohort of 2,463,033 individuals born between 1973 and 1997 (index persons) were linked to their biological relatives (parents, grandparents, and uncles/aunts) using Swedish national registers. Cox regression models were used to examine the association between each measure of externalizing behaviors with AD and any dementia in each of the relative cohorts. Results Parents of index persons with externalizing behaviors had an increased risk for AD compared with parents of index persons without externalizing behaviors-nonviolent criminal behavior: Hazard Ratio (HR) = 1.16, 95% Confidence Intervals (CI) 1.10-1.22; violent criminal behavior: HR = 1.32 (95% CI: 1.19-1.45); SUD: HR = 1.28 (95% CI: 1.17, 1.40). The associations attenuated with decreasing familial relatedness. Relatives of individuals with externalizing behaviors compared with relatives of individuals without, showed an increased risk of having both early-onset and late-onset AD but the strength of the associations was higher for early-onset AD than for late-onset AD. A similar pattern of results was observed for the association with any dementia. Discussion and Implications Externalizing behaviors are associated with AD and any dementia in prior generations. The associations were stronger for parents in comparison with grandparents and uncles/aunts, suggesting shared familial risks between conditions. This warrants further studies examining common genetic and family-wide environmental factors that may contribute to identifying common underlying mechanisms to the development of externalizing behaviors, AD, and any dementia.
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Affiliation(s)
- Carmen Solares
- School of Behavioural, Social and Legal Sciences, Örebro University, Örebro, Sweden
| | - Le Zhang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Zheng Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Andershed
- School of Behavioural, Social and Legal Sciences, Örebro University, Örebro, Sweden
| | - Jonas Persson
- School of Behavioural, Social and Legal Sciences, Örebro University, Örebro, Sweden
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
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48
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Liu S, Lagerberg T, Ludvigsson JF, Taylor MJ, Chang Z, D’Onofrio BM, Larsson H, Lichtenstein P, Gudbjörnsdottir S, Kuja-Halkola R, Butwicka A. Psychotropic Medication Use in Children and Adolescents With Type 1 Diabetes. JAMA Netw Open 2023; 6:e2336621. [PMID: 37787995 PMCID: PMC10548296 DOI: 10.1001/jamanetworkopen.2023.36621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/22/2023] [Indexed: 10/04/2023] Open
Abstract
Importance Children and adolescents with type 1 diabetes (T1D) face elevated risks of psychiatric disorders. Despite their nonnegligible adverse effects, psychotropic medications are a common cost-effective approach to alleviating psychiatric symptoms, but evidence regarding their dispensation to children and adolescents with T1D remains lacking. Objective To examine the trends and patterns of psychotropic medication dispensation among children and adolescents with T1D in Sweden between 2006 and 2019. Design, Setting, and Participants This cohort study used data from multiple Swedish registers. The main study cohort included children and adolescents residing in Sweden from 2006 to 2019 and was followed up until the earliest of December 31, 2019, 18th birthday, emigration, or death. Data analyses were conducted from November 1, 2022, to April 30, 2023. Exposures Type 1 diabetes. Main Outcomes and Measures The primary outcomes were trends and patterns of psychotropic medication dispensation (including antipsychotics, antidepressants, anxiolytics, hypnotics, mood stabilizers, and medications for attention-deficit/hyperactivity disorder [ADHD]), psychotropic medication initiation, and history of neurodevelopmental and psychiatric diagnosis. Cumulative incidence curves and Cox proportional hazard models were used to estimate the aggregated incidence and hazard ratios of medication initiation after diabetes onset. Results Of 3 723 745 children and adolescents (1 896 199 boys [50.9%]), 13 200 (0.4%; 7242 boys [54.9%]) had T1D (median [IQR] age at diagnosis, 11.1 [7.6-14.7] years). Between 2006 and 2019, psychotropic medication dispensation increased from 0.85% (95% CI, 0.65%-1.10%) to 3.84% (3.11%-4.69%) among children and from 2.72% (95% CI, 2.15%-3.39%) to 13.54% (95% CI, 12.88%-14.23%) among adolescents with T1D, consistently higher than their peers without T1D. The most commonly dispensed medications included hypnotics, ADHD medications, anxiolytics, and selective serotonin reuptake inhibitors, and all exhibited increasing trends. For those with T1D, psychiatric care was the primary prescription source, and up to 50.1% of treatments lasted more than 12 months. In addition, children and adolescents with T1D showed higher cumulative incidence and hazard ratios of medication initiation after diabetes onset than their same-age and same-sex counterparts. Conclusions and Relevance This cohort study found an increasing trend in psychotropic medication dispensation among children and adolescents with T1D from 2006 to 2019, persistently higher than those without T1D. These findings call for further in-depth investigations into the benefits and risks of psychotropic medications within this population and highlight the importance of integrating pediatric diabetes care and mental health care for early detection of psychological needs and careful monitoring of medication use.
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Affiliation(s)
- Shengxin Liu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Tyra Lagerberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
| | - Jonas F. Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
- Department of Paediatrics, Örebro University Hospital, Örebro, Sweden
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Mark J. Taylor
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Zheng Chang
- 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
| | - 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
| | - Soffia Gudbjörnsdottir
- Swedish National Diabetes Register, Centre of Registers, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Agnieszka Butwicka
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health Services, R&D Department, Akershus University Hospital, Lørenskog, Norway
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Lodz, Poland
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49
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Nguyen TD, Kowalec K, Pasman J, Larsson H, Lichtenstein P, Dalman C, Sullivan PF, Kuja-Halkola R, Lu Y. Genetic Contribution to the Heterogeneity of Major Depressive Disorder: Evidence From a Sibling-Based Design Using Swedish National Registers. Am J Psychiatry 2023; 180:714-722. [PMID: 37644812 PMCID: PMC10632940 DOI: 10.1176/appi.ajp.20220906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
OBJECTIVE Major depressive disorder (MDD) is highly heterogeneous. Standard typology partly captures the disorder's symptomatic heterogeneity, although whether it adequately captures etiological heterogeneity remains elusive. The aim of this study was to investigate the genetic characterization of MDD heterogeneity. METHODS Using Swedish patient register data on 1.5 million individuals, the authors identified 46,255 individuals with specialist-diagnosed MDD. Eighteen subgroups were identified based on nine comparison groups defined by clinical and psychosocial features, including severity, recurrence, comorbidities, suicidality, impairment, disability, care unit, and age at diagnosis. A sibling-based design and classic quantitative genetic models were applied to estimate heritability of MDD subgroups and genetic correlations between subgroups. RESULTS Estimates of heritability ranged from 30.5% to 58.3% across subgroups. The disabled and youth-onset subgroups showed significantly higher heritability (55.1%-58.3%) than the overall MDD sample (45.3%, 95% CI=43.0-47.5), and the subgroups with single-episode MDD and without psychiatric comorbidity showed significantly lower estimates (30.5%-34.4%). Estimates of genetic correlations between the subgroups within comparison groups ranged from 0.33 to 0.90. Seven of nine genetic correlations were significantly smaller than 1, suggesting differences in underlying genetic architecture. These results were largely consistent with previous work using genomic data. CONCLUSIONS The findings of differential heritability and partially distinct genetic components in subgroups provide important insights into the genetic heterogeneity of MDD and a deeper etiological understanding of MDD clinical subgroups.
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Affiliation(s)
- Thuy-Dung Nguyen
- Department of Medical Epidemiology and Biostatistics (Nguyen, Kowalec, Pasman, Larsson, Lichtenstein, Sullivan, Kuja-Halkola, Lu) and Department of Global Public Health (Nguyen, Dalman, Lu), Karolinska Institutet, Stockholm; College of Pharmacy, University of Manitoba, Winnipeg, Canada (Kowalec); School of Medical Sciences, Örebro University, Örebro, Sweden (Larsson); Departments of Genetics and Psychiatry, University of North Carolina, Chapel Hill (Sullivan)
| | - Kaarina Kowalec
- Department of Medical Epidemiology and Biostatistics (Nguyen, Kowalec, Pasman, Larsson, Lichtenstein, Sullivan, Kuja-Halkola, Lu) and Department of Global Public Health (Nguyen, Dalman, Lu), Karolinska Institutet, Stockholm; College of Pharmacy, University of Manitoba, Winnipeg, Canada (Kowalec); School of Medical Sciences, Örebro University, Örebro, Sweden (Larsson); Departments of Genetics and Psychiatry, University of North Carolina, Chapel Hill (Sullivan)
| | - Joëlle Pasman
- Department of Medical Epidemiology and Biostatistics (Nguyen, Kowalec, Pasman, Larsson, Lichtenstein, Sullivan, Kuja-Halkola, Lu) and Department of Global Public Health (Nguyen, Dalman, Lu), Karolinska Institutet, Stockholm; College of Pharmacy, University of Manitoba, Winnipeg, Canada (Kowalec); School of Medical Sciences, Örebro University, Örebro, Sweden (Larsson); Departments of Genetics and Psychiatry, University of North Carolina, Chapel Hill (Sullivan)
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics (Nguyen, Kowalec, Pasman, Larsson, Lichtenstein, Sullivan, Kuja-Halkola, Lu) and Department of Global Public Health (Nguyen, Dalman, Lu), Karolinska Institutet, Stockholm; College of Pharmacy, University of Manitoba, Winnipeg, Canada (Kowalec); School of Medical Sciences, Örebro University, Örebro, Sweden (Larsson); Departments of Genetics and Psychiatry, University of North Carolina, Chapel Hill (Sullivan)
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics (Nguyen, Kowalec, Pasman, Larsson, Lichtenstein, Sullivan, Kuja-Halkola, Lu) and Department of Global Public Health (Nguyen, Dalman, Lu), Karolinska Institutet, Stockholm; College of Pharmacy, University of Manitoba, Winnipeg, Canada (Kowalec); School of Medical Sciences, Örebro University, Örebro, Sweden (Larsson); Departments of Genetics and Psychiatry, University of North Carolina, Chapel Hill (Sullivan)
| | - Christina Dalman
- Department of Medical Epidemiology and Biostatistics (Nguyen, Kowalec, Pasman, Larsson, Lichtenstein, Sullivan, Kuja-Halkola, Lu) and Department of Global Public Health (Nguyen, Dalman, Lu), Karolinska Institutet, Stockholm; College of Pharmacy, University of Manitoba, Winnipeg, Canada (Kowalec); School of Medical Sciences, Örebro University, Örebro, Sweden (Larsson); Departments of Genetics and Psychiatry, University of North Carolina, Chapel Hill (Sullivan)
| | - Patrick F Sullivan
- Department of Medical Epidemiology and Biostatistics (Nguyen, Kowalec, Pasman, Larsson, Lichtenstein, Sullivan, Kuja-Halkola, Lu) and Department of Global Public Health (Nguyen, Dalman, Lu), Karolinska Institutet, Stockholm; College of Pharmacy, University of Manitoba, Winnipeg, Canada (Kowalec); School of Medical Sciences, Örebro University, Örebro, Sweden (Larsson); Departments of Genetics and Psychiatry, University of North Carolina, Chapel Hill (Sullivan)
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics (Nguyen, Kowalec, Pasman, Larsson, Lichtenstein, Sullivan, Kuja-Halkola, Lu) and Department of Global Public Health (Nguyen, Dalman, Lu), Karolinska Institutet, Stockholm; College of Pharmacy, University of Manitoba, Winnipeg, Canada (Kowalec); School of Medical Sciences, Örebro University, Örebro, Sweden (Larsson); Departments of Genetics and Psychiatry, University of North Carolina, Chapel Hill (Sullivan)
| | - Yi Lu
- Department of Medical Epidemiology and Biostatistics (Nguyen, Kowalec, Pasman, Larsson, Lichtenstein, Sullivan, Kuja-Halkola, Lu) and Department of Global Public Health (Nguyen, Dalman, Lu), Karolinska Institutet, Stockholm; College of Pharmacy, University of Manitoba, Winnipeg, Canada (Kowalec); School of Medical Sciences, Örebro University, Örebro, Sweden (Larsson); Departments of Genetics and Psychiatry, University of North Carolina, Chapel Hill (Sullivan)
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50
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Nordsletten AE, Isomura K, Crowley JJ, Cervin M, Larsson H, Lichtenstein P, Mataix-Cols D, Sidorchuk A. Labour market marginalization in children of persons with major psychiatric disorders: a Swedish national cohort study. World Psychiatry 2023; 22:483-484. [PMID: 37713580 PMCID: PMC10503925 DOI: 10.1002/wps.21127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/17/2023] Open
Affiliation(s)
- Ashley E Nordsletten
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Kayoko Isomura
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - James J Crowley
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Departments of Genetics and Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Matti Cervin
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro Universitet, Örebro, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - David Mataix-Cols
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Anna Sidorchuk
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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