Impact of physical and sexual abuse on risk of hospitalisations for physical and mental illnesses: insights from two large prospective cohort studies

Background

Physical abuse can lead to severe health consequences that extend beyond immediate harm. We explored the associations of physical abuse experienced during childhood and adulthood with a wide range of adult health conditions requiring hospital treatment.

Methods

We utilised data from a sub-cohort of 157,366 UK Biobank participants (46.4% of the baseline population; age range 45-81; 89,101 women) and repeated analyses in an independent population of 85,929 adults from the Finnish Public Sector (FPS) study (age range 17-78; 68,544 women). Participants in both cohorts reported instances of physical and sexual abuse at study baseline. Follow-up included 77 common health conditions ascertained from linkage data to national hospital and mortality registries.

Findings

Mean follow-up duration was 4.6 years (SD 0.14) in UK Biobank and 10.6 years (4.3) in FPS. Physical and sexual abuse was associated with 22 mental and physical health conditions. After multivariable adjustments, participants who experienced abuse during both early and later stages of life had a 2.12- (95% confidence interval 1.39-3.23) to 3.37-fold (1.52-7.45) increased risk of mental and behavioural disorders, a 1.46 (1.20-1.79) to 1.83 (1.05-3.20) times increased risk of metabolic, haematologic, and respiratory diseases, and a 1.24 (1.07-1.45) times higher risk of inflammatory diseases compared with non-exposed participants. The absolute risk difference between these groups was greatest for metabolic and haematologic conditions (rate 381 and risk difference 160 per 100,000 person-years). Frailty, comorbidities, and competing risk of death did not modify these associations, but the possibility of bias or residual confounding cannot be excluded.

Interpretation

Repeated exposure to physical and sexual abuse amplifies the risk of hospitalisations from mental disorders and physical diseases spanning diverse organ systems. Addressing this issue may necessitate multifaceted strategies, including shifts in societal norms, legal measures, and increased healthcare provision for affected individuals and their families.

Funding

Wellcome Trust, UK Medical Research Council, U.S. National Institute on Aging, Academy of Finland.

Physical activity and specific symptoms of depression: A pooled analysis of six cohort studies

BACKGROUND

The association between physical activity (PA) and depression is well-established, but the details that explain this association remain elusive. We examined whether PA is differentially associated with specific symptoms of depression (e.g., cognitive vs somatic symptoms), and whether these associations follow a dose-response pattern with respect to intensity or frequency of PA.

METHODS

Cross-sectional analyses were based on 6 samples of the continuous U.S. National Health and Nutrition Examination Surveys (NHANES) carried out between 2007 and 2018 (n = 28,520). Depressive symptoms were assessed with Patient Health Questionnaire 9 (PHQ-9). Information about PA (vigorous, moderate, and daily commuting by foot or bike) and covariates was self-reported.

RESULTS

After adjusting for education, health behaviors, body-mass index, physical functioning, and all the other depressive symptoms, lower PA was specifically associated with four depressive symptoms: loss of interest/pleasure, feeling down/hopeless, fatigue, and changes in appetite (odds ratios from 0.94 to 0.59). A monotonic dose-response pattern on PA amount was observed only for interest/pleasure and fatigue, and these associations were independent of PA intensity.

LIMITATIONS

Cross-sectional data did not allow us to assess temporal ordering. Both depressive symptoms and PA were self-reported, which may induce bias.

CONCLUSION

Low PA may be linked to depressive symptoms particularly through the symptoms of anhedonia and fatigue. Given that their association with PA amount follows a dose-response pattern and is independent of PA intensity, we hypothesize that behavioral activation and exposure to rewarding experiences might help to explain why PA alleviates depression.

Associations between early family environment and ideal number of children

Childhood family is vital for the formation of fertility preferences and attitudes towards family life. Yet previous studies mainly focused on structural aspects of the family, whereas the role of perceptions of one's family in relation to fertility preferences remained largely understudied. This study examined how different aspects of the early family environment (i.e. relationships with parents, happiness in childhood, parental conflicts, family resources, as well as family structure) are related to the ideal number of children reported in adulthood. Using representative cross-sectional survey data from the Finnish Family Barometer 2015, the sample comprised men and women aged 20-45 with and without children. Poisson regression models indicated that a higher number of siblings was associated with a higher ideal number of children, whereas living in a single-parent household and overall negative perceptions of parents were related to a lower ideal number of children independent of various socio-demographic characteristics. Further analyses showed that these family characteristics were associated with the ideal number of children mainly among childless people but not among parents. The findings suggest that the early family environment is related to the formation of the ideal number of children, especially for childless people.

Loneliness and cognitive function in older adults: Longitudinal analysis in 15 countries

This study aims to evaluate the directionality of the association between loneliness and cognitive performance in older adults, accounting for confounding factors. Data were from 55,662 adults aged ≥ 50 years who participated in Waves 5-8 of the Survey of Health, Ageing and Retirement in Europe (SHARE). Loneliness was assessed with the Three-Item Loneliness Scale (TILS) and with a one-item direct question. Cognitive performance was assessed with four measures: verbal fluency, numeracy, immediate recall, and delayed recall. Age, sex, geographical area, educational attainment, partnership status, depressive symptoms, and previous chronic diseases at baseline were used as covariates. We analyzed the associations with three-wave random intercept cross-lagged panel models (RI-CLPM) and conducted age-stratified analysis among those younger versus older than 65 years. Full information maximum likelihood estimators were used to handle missing values in Waves 6-8 in the main analyses. We also conducted additional sensitivity analyses stratified by retirement status (retired vs. not) at baseline. At the within-person level, loneliness and cognitive performance were not associated with each other among those aged 50-64 years in the main time-lagged analysis. Among those aged ≥ 65 years, loneliness was associated with lower cognitive performance in the next wave in all four cognitive domains. In addition, lower verbal fluency predicted greater loneliness in the next waves among this age group. Similar patterns were found independently of retirement status at baseline. These results suggest that loneliness is a psychosocial risk factor for cognitive decline among older adults (≥ 65 years). (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Association Between Depression and Physical Conditions Requiring Hospitalization

Importance

Depression is associated with an increased risk of physical illness, but the most common causes of hospitalization among people with depression are unclear.

Objective

To examine the association of depression with an array of physical conditions requiring hospital treatment.

Design, Setting, and Participants

In this outcomewide prospective multicohort study, primary analysis was based on data from the UK Biobank, a population-based study in the United Kingdom. Analyses were repeated in an independent data set of 2 cohorts in Finland, a population-based study and an occupational cohort. Data analysis was conducted between April and September 2022.

Exposures

Self-reported depression, recurrent severe major depression, recurrent moderate major depression, and a single major depressive episode.

Main Outcomes and Measures

A total of 77 common health conditions ascertained from linkage data to national hospital and mortality registries.

Results

The analytical sample of UK Biobank participants consisted of 130 652 individuals (71 565 women [54.8%]; 59 087 men [45.2%]; mean [SD] age at baseline, 63.3 [7.8] years). The pooled data from the Finnish replication cohorts included 109 781 participants (82 921 women [78.6%]; 26 860 men [21.4%]; mean [SD] age, 42 [10.8] years). In the main analysis, severe/moderately severe depression was associated with the incidence of 29 nonoverlapping conditions requiring hospital treatment during a 5-year follow-up. Twenty-five of these associations remained after adjustment for confounders and multiple testing (adjusted hazard ratio [HR] range, 1.52-23.03) and were confirmed in the analysis of the Finnish cohorts. These included sleep disorders (HR, 5.97; 95% CI, 3.27-10.89), diabetes (HR, 5.15; 95% CI, 2.52-10.50), ischemic heart disease (HR, 1.76; 95% CI, 1.36-2.29), chronic obstructive bronchitis (HR, 4.11; 95% CI, 2.56-6.60), bacterial infections (HR, 2.52; 95% CI, 1.99-3.19), back pain (HR, 3.99; 95% CI, 2.96-5.38), and osteoarthritis (HR, 1.80; 95% CI, 1.46-2.20). The highest cumulative incidence was observed for endocrine and related internal organ diseases (245 per 1000 persons with depression; risk difference relative to unaffected individuals: 9.8%), musculoskeletal diseases (91 per 1000 persons; risk difference, 3.7%), and diseases of the circulatory system and blood (86 per 1000 persons; risk difference, 3.9%). The cumulative incidence was lower for hospital-treated mental, behavioral, and neurological disorders (20 in 1000 persons; risk difference, 1.7%). Depression was also associated with disease progression in people with prevalent heart disease or diabetes, and for 12 conditions, there was evidence of a bidirectional relationship.

Conclusions and Relevance

In this study, the most common causes of hospitalization in people with depression were endocrine, musculoskeletal, and vascular diseases, not psychiatric disorders. These findings suggest that depression should be considered as a target for the prevention of physical and mental disease.

Obesity as a causal risk factor for depression: Systematic review and meta-analysis of Mendelian Randomization studies and implications for population mental health

BACKGROUND/OBJECTIVES

Obesity has been associated with elevated risk of depression. If this association is causal, the increasing obesity prevalence might lead to worsening population mental health, but the strength of the causal effect has not been systematically evaluated.

SUBJECTS/METHODS

The current study provides a systematic review and meta-analysis of studies examining associations between body mass index and depression using Mendelian randomization with multiple genetic variants as instruments for body mass index. We used this estimate to calculate the expected changes in prevalence of population psychological distress from the 1990s-2010s, which were compared with the empirically observed trends in psychological distress in the Health Survey for England (HSE) and U.S. National Health Interview Surveys (NHIS).

RESULTS

Meta-analysis of 8 Mendelian randomization studies indicated an OR = 1.33 higher depression risk associated with obesity (95% confidence interval 1.19, 1.48). Between 15% and 20% of the participants of HSE and NHIS reported at least moderate psychological distress. The increase of obesity prevalence from the 1990s-2010s in HSE and NHIS would have led to a 0.6 percentage-point increase in population psychological distress.

CONCLUSIONS

Mendelian randomization studies suggest that obesity is a causal risk factor for elevated risk of depression. The increasing obesity rates may have modestly increased the prevalence of depressive symptoms in the general population. Mendelian randomization relies on methodological assumptions that may not always hold, so other quasi-experimental methods are needed to confirm the current conclusions.

Health trajectories of individuals who quit active religious attendance: analysis of four prospective cohort studies in the United States

PURPOSE

To examine whether trajectories of health (depressive symptoms, psychological wellbeing, self-rated health, and body mass index) and health behaviors (smoking, heavy alcohol consumption, physical inactivity, and cannabis use) changed for individuals who first reported at least monthly religious attendance and then in subsequent study waves reported no active religious attendance.

METHODS

Data were from four cohort studies from the United States collected between 1996 and 2018: National Longitudinal Survey of 1997 (NLSY1997); National Longitudinal Survey of Young Adults (NLSY-YA); Transition to Adulthood Supplement of the Panel Study of Income Dynamics (PSID-TA); and Health and Retirement Study (HRS) with a total n = 6592 individuals and 37,743 person-observations.

RESULTS

None of the 10-year trajectories of health or health behaviors changed for the worse after the change from active to inactive religious attendance. Instead, the adverse trends were observed already during the time of active religious attendance.

CONCLUSION

These results suggest that religious disengagement is a correlate-not a cause-of a life course characterized by poorer health and health behaviors. The religious decline caused by people leaving their religion is unlikely to influence population health.

Predicting work disability among people with chronic conditions: a prospective cohort study

Few risk prediction scores are available to identify people at increased risk of work disability, particularly for those with an existing morbidity. We examined the predictive performance of disability risk scores for employees with chronic disease. We used prospective data from 88,521 employed participants (mean age 43.1) in the Finnish Public Sector Study including people with chronic disorders: musculoskeletal disorder, depression, migraine, respiratory disease, hypertension, cancer, coronary heart disease, diabetes, comorbid depression and cardiometabolic disease. A total of 105 predictors were assessed at baseline. During a mean follow-up of 8.6 years, 6836 (7.7%) participants were granted a disability pension. C-statistics for the 8-item Finnish Institute of Occupational Health (FIOH) risk score, comprising age, self-rated health, number of sickness absences, socioeconomic position, number of chronic illnesses, sleep problems, BMI, and smoking at baseline, exceeded 0.72 for all disease groups and was 0.80 (95% CI 0.80-0.81) for participants with musculoskeletal disorders, 0.83 (0.82-0.84) for those with migraine, and 0.82 (0.81-0.83) for individuals with respiratory disease. Predictive performance was not significantly improved in models with re-estimated coefficients or a new set of predictors. These findings suggest that the 8-item FIOH work disability risk score may serve as a scalable screening tool in identifying individuals with increased risk for work disability.

Predictive validity of psychosis risk models when applied to adolescent psychiatric patients

BACKGROUND

Several multivariate algorithms have been developed for predicting psychosis, as attempts to obtain better prognosis prediction than with current clinical high-risk (CHR) criteria. The models have typically been based on samples from specialized clinics. We evaluated the generalizability of 19 prediction models to clinical practice in an unselected adolescent psychiatric sample.

METHODS

In total, 153 adolescent psychiatric patients in the Helsinki Prodromal Study underwent an extensive baseline assessment including the SIPS interview and a neurocognitive battery, with 50 participants (33%) fulfilling CHR criteria. The adolescents were followed up for 7 years using comprehensive national registers. Assessed outcomes were (1) any psychotic disorder diagnosis (n = 18, 12%) and (2) first psychiatric hospitalization (n = 25, 16%) as an index of overall deterioration of functioning.

RESULTS

Most models improved the overall prediction accuracy over standard CHR criteria (area under the curve estimates ranging between 0.51 and 0.82), although the accuracy was worse than that in the samples used to develop the models, also when applied only to the CHR subsample. The best models for transition to psychosis included the severity of positive symptoms, especially delusions, and negative symptoms. Exploratory models revealed baseline negative symptoms, low functioning, delusions, and sleep problems in combination to be the best predictor of psychiatric hospitalization in the upcoming years.

CONCLUSIONS

Including the severity levels of both positive and negative symptomatology proved beneficial in predicting psychosis. Despite these advances, the applicability of extended psychosis-risk models to general psychiatric practice appears limited.

Changing associations between socioeconomic status and self-reported discrimination from the 1990s to the 2010s in the United States

We examined whether prevalence of social class discrimination-and its association with psychological distress-has changed between 1990s and 2010s in the United States. Data were from the original Midlife in the United States (MIDUS) study with data collections in 1995-1996 (n = 2931) and 2004-2005 (n = 1708), and the new MIDUS Refresher sample from 2011 to 2014 (n = 2543). Socioeconomic status (SES) became more strongly associated with self-rated discrimination over time, with individuals with the lowest SES experiencing more discrimination (B = 0.75, p < .001) and those with the highest SES less discrimination (B = 0.36, p < .001) over time: at baseline, the difference in self-rated discrimination between the highest and lowest SES groups was 15.3% versus 10.8% (4.7% point difference). This difference increased to 20.0% versus 7.4% in the last study wave (12.6% point difference). Association between self-reported discrimination and psychological distress strengthened over time, but the associations between socioeconomic indicators and distress did not change. The results suggest that people with low SES had higher risk of encountering unfair and disrespectful treatment in the 2010s compared to the 1990s.

A measure for assessment of beneficial and harmful fortitude: development and initial validation of the sisu scale

Sisu is a Finnish cultural concept that denotes determination and resoluteness in the face of adversity. We propose that sisu will supplement the English-language based research on mental fortitude traits. Sisu has not been the focus of systematic research until very recently. We created a new questionnaire measuring sisu (the Sisu Scale), sought to validate the sisu construct and its sub-factor structure as postulated in a recent qualitative study. We investigated associations of sisu with other measures of mental fortitude and well-being. More generally we aimed to enrichen the cross-cultural understanding of human experience of overcoming adversity across life's challenges.

We describe and validate a questionnaire that effectively measures both beneficial and harmful sisu, each comprising three sub-factors. Beneficial sisu was associated with other measures of fortitude, but less with personality dimensions. We also confirmed the existence of an independent harmful sisu factor. Beneficial sisu was associated with higher well-being and lower depressive symptoms, and harmful sisu with lower well-being and higher levels of general stress, work stress and depressive symptoms. Together the two factors were superior compared to pre-existing measures when predicting well-being-related variables. Results suggest that the new Sisu Scale we developed may provide a valuable addition to research on mental fortitude, resilience and their consequences for well-being.

Association between alexithymia and substance use: A systematic review and meta-analysis

Alexithymia has been associated with substance use, but the magnitude of the association has not been evaluated and sub-group differences, if any, are unknown. The aim of this meta-analysis is to systematically review the association between alexithymia and substance use (alcohol or illicit drugs). We identified studies through a systematic review of PubMed and Web of Science and obtained a total of 52 publications using the Toronto Alexithymia Scale-20 scale. Random effects meta-analysis was used to evaluate the overall and sub-group associations. Of the studies, 50 were cross-sectional and two longitudinal. Alexithymia was associated with any substance use (Cohen's d = 0.62, 95% confidence interval [CI] 0.49-0.76), with little difference between estimates for use of alcohol or illicit drugs. A stronger association was observed for the alexithymia dimension "Difficulty in Identifying Feelings" (d = 0.64, 95% CI = 0.47-0.81) and "Difficulty in Describing Feelings" (d = 0.44, 95% CI = 0.32-0.55) than for "Externally Oriented Thinking" (d = 0.19, 95% CI = 0.09-0.28). The association was stronger in studies with clinical patient populations (d = 0.83, 95% CI = 0.62-1.05) than in those investigating general or student populations, and in studies with a majority of male rather than female participants. These findings suggest a strong overall association between alexithymia and substance use and a very strong association among clinical patient populations. The association may be stronger with the emotion-related dimensions than with the cognition-related dimension of alexithymia. As nearly all the studies were cross-sectional, more longitudinal studies are needed.

Overweight, obesity, and individual symptoms of depression: A multicohort study with replication in UK Biobank

OBJECTIVES

Obesity is associated with increased risk of depression, but the extent to which this association is symptom-specific is unknown. We examined the associations of overweight and obesity with individual depressive symptoms.

METHODS

We pooled data from 15 population-based cohorts comprising 57,532 individuals aged 18 to 100 years at study entry. Primary analyses were replicated in an independent cohort, the UK Biobank study (n = 122,341, age range 38 to 72). Height and weight were assessed at baseline and body mass index (BMI) was computed. Using validated self-report measures, 24 depressive symptoms were ascertained once in 16 cross-sectional, and twice in 7 prospective cohort studies (mean follow-up 3.2 years).

RESULTS

In the pooled analysis of the primary cohorts, 22,045 (38.3 %) participants were overweight (BMI between 25 and 29.9 kg/m2), 12,025 (20.9 %) class I obese (BMI between 30 and 34.9 kg/m2), 7,467 (13.0 %) class II-III obese (BMI ≥ 35 kg/m2); and 7,046 (12.3 %) were classified as depressed. After multivariable adjustment, obesity class I was cross-sectionally associated with 1.11-fold (95 % confidence interval 1.01-1.22), and obesity class II-III with 1.31-fold (1.16-1.49) higher odds of overall depression. In symptom-specific analyses, robust associations were apparent for 4 of the 24 depressive symptoms ('could not get going/lack of energy', 'little interest in doing things', 'feeling bad about yourself, and 'feeling depressed'), with confounder-adjusted odds ratios of having 3 or 4 of these symptoms being 1.32 (1.10-1.57) for individuals with obesity class I, and 1.70 (1.34-2.14) for those with obesity class II-III. Elevated C-reactive protein and 21 obesity-related diseases explained 23 %-31 % of these associations. Symptom-specific associations were confirmed in longitudinal analyses where obesity preceded symptom onset, were stronger in women compared with men, and were replicated in UK Biobank.

CONCLUSIONS

Obesity is associated with a distinct set of depressive symptoms. These associations are partially explained by systemic inflammation and obesity-related morbidity. Awareness of this obesity-related symptom profile and its underlying biological correlates may inform better targeted treatments for comorbid obesity and depression.

Association of alcohol use with years lived without major chronic diseases: A multicohort study from the IPD-Work consortium and UK Biobank

Background

Heavy alcohol consumption increases the risk of several chronic diseases. In this multicohort study, we estimated the number of life-years without major chronic diseases according to different characteristics of alcohol use.

Methods

In primary analysis, we pooled individual-level data from up to 129,942 adults across 12 cohort studies with baseline data collection on alcohol consumption, drinking patterns, and history between 1986 and 2005 (the IPD-Work Consortium). Self-reported alcohol consumption was categorised according to UK guidelines - non-drinking (never or former drinkers); moderate consumption (1-14 units); heavy consumption (>14 units per week). We further subdivided moderate and heavy drinkers by binge drinking pattern (alcohol-induced loss of consciousness). In addition, we assessed problem drinking using linked data on hospitalisations due to alcohol abuse or poisoning. Follow-up for chronic diseases for all participants included incident type 2 diabetes, coronary heart disease, stroke, cancer, and respiratory disease (asthma and chronic obstructive pulmonary disease) as ascertained via linkage to national morbidity and mortality registries, repeated medical examinations, and/or self-report. We estimated years lived without any of these diseases between 40 and 75 years of age according to sex and characteristics of alcohol use. We repeated the main analyses using data from 427,621 participants in the UK Biobank cohort study.

Findings

During 1·73 million person-years at risk, 22,676 participants in IPD-Work cohorts developed at least one chronic condition. From age 40 to 75 years, never-drinkers [men: 29·3 (95%CI 27·9-30·8) years, women 29·8 (29·2-30·4) years)] and moderate drinkers with no binge drinking habit [men 28·7 (28·4-29·0) years, women 29·6 (29·4-29·7) years] had the longest disease-free life span. A much shorter disease-free life span was apparent in participants who experienced alcohol poisoning [men 23·4 (20·9-26·0) years, women 24·0 (21·4-26·5) years] and those with self-reported heavy overall consumption and binge drinking [men: 26·0 (25·3-26·8), women 27·5 (26·4-28·5) years]. The pattern of results for alcohol poisoning and self-reported alcohol consumption was similar in UK Biobank. In IPD-Work and UK Biobank, differences in disease-free years between self-reported moderate drinkers and heavy drinkers were 1·5 years or less.

Interpretation

Individuals with alcohol poisonings or heavy self-reported overall consumption combined with a binge drinking habit have a marked 3- to 6-year loss in healthy longevity. Differences in disease-free life between categories of self-reported weekly alcohol consumption were smaller.

Funding

Medical Research Council, National Institute on Aging, NordForsk, Academy of Finland, Finnish Work Environment Fund.

Body-mass index and risk of obesity-related complex multimorbidity: an observational multicohort study

BACKGROUND

The accumulation of disparate diseases in complex multimorbidity makes prevention difficult if each disease is targeted separately. We aimed to examine obesity as a shared risk factor for common diseases, determine associations between obesity-related diseases, and examine the role of obesity in the development of complex multimorbidity (four or more comorbid diseases).

METHODS

We did an observational study and used pooled prospective data from two Finnish cohort studies (the Health and Social Support Study and the Finnish Public Sector Study) comprising 114 657 adults aged 16-78 years at study entry (1998-2013). A cohort of 499 357 adults (aged 38-73 years at study entry; 2006-10) from the UK Biobank provided replication in an independent population. BMI and clinical characteristics were assessed at baseline. BMIs were categorised as obesity (≥30·0 kg/m2), overweight (25·0-29·9 kg/m2), healthy weight (18·5-24·9 kg/m2), and underweight (<18·5 kg/m2). Via linkage to national health records, participants were followed-up for death and diseases diagnosed according to the International Classification of Diseases 10th Revision (ICD-10). Hazard ratios (HRs) with 95% CIs and population attributable fractions (PAFs) for associations between BMI and multimorbidity were calculated.

FINDINGS

Mean follow-up duration was 12·1 years (SD 3·8) in the Finnish cohorts and 11·8 years (1·7) in the UK Biobank cohort. Obesity was associated with 21 non-overlapping cardiometabolic, digestive, respiratory, neurological, musculoskeletal, and infectious diseases after Bonferroni multiple testing adjustment and ignoring HRs of less than 1·50. Compared with healthy weight, the confounder-adjusted HR for obesity was 2·83 (95% CI 2·74-2·93; PAF 19·9% [95% CI 19·3-20·5]) for developing at least one obesity-related disease, 5·17 (4·84-5·53; 34·4% [33·2-35·5]) for two diseases, and 12·39 (9·26-16·58; 55·2% [50·9-57·5]) for complex multimorbidity. The proportion of participants of healthy weight with complex multimorbidity by age 75 years was observed by age 55 years in participants with obesity, and degree of obesity was associated with complex multimorbidity in a dose-response relationship. Compared with obesity, the association between overweight and complex multimorbidity was more modest (HR 2·67, 95% CI 1·94-3·68; PAF 13·3% [95% CI 9·6-16·3]). The same pattern of results was observed in the UK Biobank cohort.

INTERPRETATION

Obesity is associated with diverse, increasing disease burdens, and might represent an important target for multimorbidity prevention that avoids the complexities of multitarget preventive regimens.

FUNDING

Wellcome Trust, Medical Research Council, National Institute on Aging.

Religiosity, Psychological Distress, and Well-Being: Evaluating Familial Confounding With Multicohort Sibling Data

Several studies have associated religiosity with better mental health, but these studies have only partially addressed the problem of confounding. The present study pooled data from multiple cohort studies with siblings to examine whether associations between religiosity and mental health are confounded by familial factors (i.e., shared family background and siblings' shared genetics). Data were collected between 1982 and 2017. Mental health was assessed with self-reported psychological distress (including depressive symptoms) and psychological well-being. Religious attendance was associated with lower psychological distress (standard-deviation difference between weekly vs. never attendance, B = -0.14, confidence interval (CI): -0.19, -0.09; n = 24,598 pairs), and this was attenuated by almost half in the sibling analysis (B = -0.08, CI: = -0.13, -0.04). Religious attendance was also related to higher well-being (B = 0.29, CI: = 0.14, 0.45; n = 3,728 pairs), and this estimate remained unchanged in sibling analysis. Results were similar for religiousness. The findings suggest that previous longitudinal studies may have overestimated the association between religiosity and psychological distress, as the sibling estimate was only one-third of the previously reported meta-analytical association (standardized correlation -0.03 vs. -0.08).

Antidepressant use among immigrants with depressive disorder living in Finland: A register-based study

BACKGROUND

The aim of this study was to examine differences in the initiation and discontinuation of antidepressants between immigrants and the Finnish-born population diagnosed with depression in specialized health care.

METHODS

The study utilized register-based data, which includes all immigrants living in Finland at the end of 2010 and matched Finnish-born controls. For this study, we selected individuals who had received a diagnosis of depression during 2011-2014 (immigrants n = 2244, Finnish-born n = 2773). Their antidepressant use was studied for a one-year period from initiation. A logistic regression was used to predict initiation and a Cox regression was used to predict discontinuation.

RESULTS

Immigrants were more likely to initiate the use of antidepressants than the Finnish-born controls (adjusted OR = 1.25, 95% CI = 1.07-1.46), but they also discontinued the medication earlier than the Finnish-born controls (adjusted HR = 1.48, 95% CI = 1.31-1.68). Immigrants from Sub Saharan Africa, the Middle East and Northern Africa were most likely to discontinue antidepressants earlier. More severe depression, a longer length of residence in Finland and more intensive psychiatric treatment were associated with decreased risk of discontinuation.

LIMITATIONS

The registers do not provide information on the perceived reasons for the discontinuation.

CONCLUSIONS

Immigrants with depression initiate antidepressants more often than the Finnish-born population, but they also discontinue them earlier. Early discontinuation may be a sign of insufficient treatment suggesting that there could be a need for improvement in mental health care for immigrants in Finland.

Urban–Rural Residential Mobility Associated With Political Party Affiliation: The U.S. National Longitudinal Surveys of Youth and Young Adults

The current study used longitudinal panel data from the National Longitudinal Survey of Youth 1979 (NLSY79; n = 7,064) and National Longitudinal Survey of Young Adults (NLSY-YA; n = 2,985) to examine whether political party affiliation was related to residential mobility between rural regions, urban regions, and major cities in the United States. Over a follow-up of 4–6 years, stronger Republican affiliation was associated with lower probability of moving from rural regions to major cities (relative risk [RR] = 0.71, confidence interval [CI] = [0.54, 0.93]) and higher probability of moving away from major cities to urban or rural regions (RR = 1.17, CI = [1.03, 1.33]). The empirical correlation between party affiliation and urban–rural residence was r = −0.15 [−0.17, −0.13]. Simulated data based on the regression models produced a correlation of r = −0.06 [−0.10, −0.03], suggesting that selective residential mobility could account almost half of the empirically observed association between party affiliation and urban–rural residence.

Association Between Systemic Inflammation and Individual Symptoms of Depression: A Pooled Analysis of 15 Population-Based Cohort Studies

OBJECTIVE

Evidence from anti-inflammatory drug trials for the treatment of depression has been inconsistent. This may be ascribed to the differing symptom-specific effects of inflammation. Accordingly, the authors explored the associations between systemic inflammation and an array of individual symptoms of depression across multiple studies.

METHODS

This random-effects pooled analysis included 15 population-based cohorts and 56,351 individuals age 18 years and older. Serum or plasma concentrations of C-reactive protein (CRP) and interleukin-6 (IL-6) were measured at baseline. Using validated self-report measures, 24 depressive symptoms were ascertained in 15 cross-sectional studies, and, in seven cohorts, were also assessed at follow-up (mean follow-up period, 3.2 years).

RESULTS

The prevalence of depressive symptoms ranged from 1.1% (suicidal ideation) to 21.5% (sleep problems). In cross-sectional analyses, higher concentrations of CRP were robustly associated with an increased risk of experiencing four physical symptoms (changes in appetite, felt everything was an effort, loss of energy, sleep problems) and one cognitive symptom (little interest in doing things). These associations remained after adjustment for sociodemographic variables, behavioral factors, and chronic conditions; in sex- and age-stratified analyses; in longitudinal analyses; when using IL-6 as the inflammatory marker of interest; in depressed individuals; and after excluding chronically ill individuals. For four exclusively emotional symptoms (bothered by things, hopelessness about the future, felt fearful, life had been a failure), the overall evidence was strongly against an association with inflammation.

CONCLUSIONS

These findings suggest symptom-specific rather than generalized effects of systemic inflammation on depression. Future trials exploring anti-inflammatory treatment regimens for depression may benefit from targeting individuals presenting with symptom profiles characterized by distinct inflammation-related physical and cognitive symptoms.

Big Five personality traits and COVID-19 precautionary behaviors among older adults in Europe

OBJECTIVES

Taking precautions against COVID-19 is important among older adults who have a greater risk for severe illness if infected. We examined whether Big Five personality traits are associated with COVID-19 precautionary behaviors among older adults in Europe.

METHOD

We used data from the Survey of Health, Aging, and Retirement in Europe (N = 34 629). Personality was self-reported in 2017 using the BFI-10 inventory. COVID-19 precautionary behaviors - wearing a mask, limiting in-person contacts, keeping a distance to others, washing hands, and using a disinfectant - were assessed in the summer of 2020 through self-reports. Associations between personality and precautionary behaviors were examined with multilevel random-intercept logistic regression models. The models were adjusted for age, gender, and educational attainment.

RESULTS

Personality traits were differentially associated with precautionary behaviors, with higher openness, conscientiousness, and neuroticism showing the most consistent associations. The pattern of associations between personality traits and precautionary behaviors varied depending on the specific behavior. The associations were relatively weak in comparison to those between sociodemographic factors and precautionary behaviors.

CONCLUSIONS

Among older adults, taking COVID-19 precautionary behaviors was most consistently related to higher openness, conscientiousness, and neuroticism, suggesting that precautionary behaviors may be motivated by multiple psychological differences.

A Changing Landscape of Health Opportunity in the United States: Increases in the Strength of Association Between Childhood Socioeconomic Disadvantage and Adult Health Between the 1990s and the 2010s

Understanding the changing health consequences of childhood socioeconomic disadvantage (SED) is highly relevant to policy debates on inequality and national and state goals to improve population health. However, changes in the strength of association between childhood SED and adult health over historic time are largely unexamined in the United States. The present study begins to address this knowledge gap. Data were from 2 national samples of adults collected in 1995 (n = 7,108) and 2012 (n = 3,577) as part of the Midlife in the United States study. Three measures of childhood SED (parents' occupational prestige, childhood poverty exposure, and parents' education) were combined into an aggregate index and examined separately. The association between childhood SED (aggregate index) and 5 health outcomes (body mass index, waist circumference, chronic conditions, functional limitations, and self-rated health) was stronger in the 2012 sample than the 1995 sample, with the magnitude of associations being approximately twice as large in the more recent sample. Results persisted after adjusting for age, sex, race, marital status, and number of children, and were similar across all 3 measures of childhood SED. The findings suggest that the socioeconomic circumstances of childhood might have become a stronger predictor of adult health in recent decades.

Specific symptoms of the General Health Questionnaire (GHQ) in predicting persistence of psychological distress: Data from two prospective cohort studies

Persistent psychological distress is more harmful than transient psychological distress, but little is known about the development of persistent distress. We examined whether some specific symptoms of the 12-item General Health Questionnaire (GHQ-12) were more important than others in predicting the persistence of psychological distress over a 3-year follow-up period among individuals who had at least moderate psychological distress at baseline (GHQ≥3). Participants were from the UK Household Longitudinal Study (UKHLS; n = 6430) and British Household Panel Survey (BHPS; n = 5954). Sense of worthlessness, loss of self-confidence, loss of sleep over worry, and feelings of strain were associated with increasingly persistent distress. General happiness, feelings of unhappiness or depressed mood, and enjoyment of activities showed no such increasing associations. Symptoms of social functioning (capability of making decisions, concentration problems, feelings of usefulness, ability to face problems) showed some but not consistent associations. These results suggest that feelings of worthlessness, loss of self-confidence, loss of sleep over worry, and strain may be particularly important markers for persistent psychological distress.

Socioeconomic inequalities in impairment associated with depressive symptoms: Evidence from the National Survey on Drug Use and Health

OBJECTIVE

Individuals with low socioeconomic status have higher rates of depression, but it is unknown whether the socioeconomically disadvantaged also have more disabling depressive symptoms. We examined (1) the associations of three indicators of socioeconomic status with depression-related severe role impairment, and (2) whether socioeconomic factors moderate the association between individual depression symptoms and depression-related severe role impairment.

METHODS

We used data from the National Survey on Drug Use and Health (NSDUH). Depressive symptoms, role impairment and socioeconomic indicators (poverty, participation in workforce, educational attainment) were self-reported by participants. The analytic sample consisted of participants who screened positive for a depressive episode during past 12 months (n = 32 661). We used survey-weighted logistic models to examine the associations of depressive symptoms with severe role impairment and the modifying effects of socioeconomic indicators.

RESULTS

The association between depression symptom count and severe role impairment was stronger among those not in workforce (OR = 1.12[1.02-1.23]). The association between specific depression symptoms and severe role impairment was stronger for conditions of poverty (fatigue, OR = 2.97 [1.54-5.73]; and anhedonia, OR = 1.93[1.13-3.30]), workforce non-participation (inability to concentrate/indecisiveness, OR = 1.54[1.12-2.12]), and lower educational attainment (anhedonia, OR = 0.77 [0.59-0.99]). Feelings of worthlessness was the only symptom with independent associations for all socioeconomic groups (adjusted OR = 1.91[1.35-2.70]).

CONCLUSION

Depression was more frequent and also more disabling for socioeconomically disadvantaged groups, especially when assessed with workforce participation. Additionally, some specific symptoms showed socioeconomic differences. Our findings highlight the need to prioritize population groups with more severe impairment associated with depressive symptoms.

Clinical symptoms of anxiety disorders as predictors of political attitudes: A prospective cohort study

Conservative political ideologies have been suggested to correlate with elevated sensitivity to threat. However, it is unclear whether the associations between threat sensitivity and political attitudes can be observed with clinical measures of mental health. We examined how anxiety disorders predicted attitudes on several political issues. Participants were 7253 individuals from the 1958 British Birth Cohort study. Symptoms of generalised anxiety disorder, phobia and panic were assessed in a clinical interview at age 44, and opinions about political issues were self-reported by the participants 6 years later. Anxiety symptoms were associated with higher concerns about economic inequality, preservation of the environment, distrust in politics and lower work ethic. No associations were observed with racist or authoritarian attitudes, or support for traditional family values. We also assessed how political attitudes at ages 33 and 42 predicted anxiety disorder symptoms at age 44, revealing a possible bidirectional association between concern for economic inequality and anxiety disorder symptoms. These findings do not support an association between conservative political attitudes and elevated threat sensitivity. Rather, elevated anxiety may increase concerns about social inequality and the environment.

Post-traumatic stress disorder among immigrants living in Finland: Comorbidity and mental health service use

The aim of this study was to compare differences in comorbidity between immigrants and Finnish-born controls, and to examine the treatment received by immigrants with PTSD. Our original data included all the immigrants living in Finland by the end of 2010 and matched controls. For this study, we selected individuals who had received a diagnosis of PTSD during 2010-2015 (immigrants: n = 754, Finnish-born controls: n = 311). We compared the frequency of different comorbid conditions between immigrants and natives. Multinomial logistic regression was used to predict categorized treatment intensity with the region of origin and length of residence among the immigrants. Psychiatric comorbidity was much more extensive among the Finnish-born controls than among immigrants. Immigrants from Africa and the Middle East more often received treatment of low intensity compared with immigrants from Western countries. The length of residence was associated with more frequent treatment. The important differences in comorbidity and background characteristics between immigrants and natives should be taken into account in planning treatment guidelines for PTSD. The disparities in treatment intensity across different immigrant groups indicate a need to improve the services for immigrants with PTSD.

Depression and anxiety disorders among immigrants living in Finland: Comorbidity and mental health service use

BACKGROUND

The aims of this study were to (1) compare differences in psychiatric comorbidity of depression and anxiety disorders between immigrants and native Finns and to (2) compare differences in the intensity of psychiatric care received by different immigrant groups and Finnish-born controls with depression and/or anxiety disorders.

METHODS

The study uses registered-based data, which includes all immigrants living in Finland at the end of 2010 and matched Finnish-born controls. For this study, we selected individuals who had received a diagnosis of depression and/or an anxiety disorder during the follow-up (2011-2015) (immigrants n = 6542, Finnish-born controls n = 9281). We compared differences in comorbidity between the immigrants and the Finnish-born controls using chi-squared tests. Multinomial logistic regression was used to predict psychiatric treatment intensity by immigrant status, region of origin, and other background factors.

RESULTS

In both diagnosis groups, Finnish-born participants exhibited greater comorbidity of other psychiatric disorders. Immigrants more often received lower intensity treatment and less often higher intensity treatment. These differences were most striking among those from Eastern Europe, the Middle East, and Africa.

LIMITATIONS

We did not have the information on the perceived need for the services, which limits us from drawing further conclusions about the mechanisms behind the observed patterns.

CONCLUSIONS

Immigrants in Finland receive less intensive treatment for depression and anxiety disorders compared to the Finnish-born population. Since lower symptom levels can unlikely alone explain these differences, they could reflect a need for improvement in the psychiatric services for immigrants.

Testosterone and specific symptoms of depression: Evidence from NHANES 2011–2016

Testosterone is one possible biomarker for depression risk among men and women. Both high and low levels of testosterone have been associated with depression, at least among men. Testosterone may be associated only with specific symptoms of depression, which might help to explain inconsistencies in previous results.

We examined the cross-sectional associations between total testosterone and the specific symptoms of depression using pooled data across three cycles of NHANES (2011–2012, 2013–2014, and 2015–2016). The sample included 4253 men and 5102 women. Testosterone was modelled as 1) a dichotomous (low testosterone cut-off <300 ​ng/dL for men and 15 ​ng/dL for women) and 2) a continuous variable using cubic splines.

In men, very low testosterone was weakly associated with problems with appetite, whereas very high testosterone was associated with sleep problems and weakly associated with tiredness. There were no consistent symptom-specific associations among women.

These findings provide only suggestive evidence for symptom-specific associations between testosterone and depression, mainly related to somatic complaints. Further data are needed to assess the reliability of these associations.

•

Testosterone and depression have been associated in some past studies.

•

To find a possible explanation for the inconsistencies of some of the previous studies, we studied the association between testosterone and depression in men and women.

•

Very high testosterone was associated with sleep problems and weakly associated with tiredness among men.

•

Very low testosterone was weakly associated with appetite problems among men.

•

There was some evidence that very low testosterone may be associated with appetite problems among women.

Association of depressive symptoms with health care utilization in older adults: Longitudinal evidence from the Survey of Health, Aging, and Retirement in Europe

OBJECTIVES

Many older adults with depression do not receive adequate treatment. Differences in treatment utilization may reflect the heterogeneous nature of depression, encompassing multiple distinct symptoms. We assessed whether depressive symptoms are differentially associated with subsequent health care utilization with respect to three outcomes as follows: (1) contact with a medical doctor (MD), (2) depression-specific treatment, and (3) inpatient psychiatric admission.

METHODS/DESIGN

Longitudinal analyses were based on data from three follow-up cycles conducted between 2004 and 2013 among 53,139 participants from the Survey of Health, Aging, and Retirement in Europe. Depressive symptoms were self-reported at baseline of each follow-up cycle using the 12-item EURO-D scale. Health care utilization was self-reported at the end of each follow-up cycle.

RESULTS

After adjustment for sex, age, country of interview, follow-up time, educational attainment, presence of a partner in household, body-mass index, the number of chronic diseases, disability, average/prior frequency of contact with an MD, and all other depressive symptoms, people with more frequent contact with an MD had most often reported sleep problems (IRR = 1.10) and fatigue (IRR = 1.10), followed by sad/depressed mood, tearfulness, concentration problems, guilt, irritability, and changes in appetite. Those treated for depression had most often reported sad/depressed mood (OR = 2.18) and suicidal ideation (OR = 1.72), but also sleep problems, changes in appetite, fatigue, concentration problems, hopelessness, and irritability. Sad/depressed mood (OR = 2.87) was also associated with psychiatric inpatient admission. Similarly to other outcomes, appetite change, fatigue, and sleep problems were associated with inpatient admission.

CONCLUSIONS

Specific symptoms of depression may determine utilization of different types of health care among elderly.

Positive affect state is a good predictor of movement and stress: combining data from ESM/EMA, mobile HRV measurements and trait questionnaires

Personality describes the average behaviour and responses of individuals across situations; but personality traits are often poor predictors of behaviour in specific situations. This is known as the "personality paradox". We evaluated the interrelations between various trait and state variables in participants' everyday lives. As state measures, we used 1) experience sampling methodology (ESM/EMA) to measure perceived affect, stress, and presence of social company; and 2) heart rate variability and 3) real-time movement (accelerometer data) to indicate physiological stress and physical movement. These data were linked with self-report measures of personality and personality-like traits. Trait variables predicted affect states and multiple associations were found: traits neuroticism and rumination decreased positive affect state and increased negative affect state. Positive affect state, in turn, was the strongest predictor of observed movement. Positive affect was also associated with heart rate and heart rate variability (HRV). Negative affect, in turn, was not associated with neither movement, HR or HRV. The study provides evidence on the influence of personality-like traits and social context to affect states, and, in turn, their influence to movement and stress variables.

Longitudinal associations between specific symptoms of depression: Network analysis in a prospective cohort study

BACKGROUND

Network perspective to mental disorders suggests that depression develops due to interrelated associations between individual symptoms rather than due to a common cause. However, it is unclear whether long-term longitudinal associations between specific symptoms of depression demonstrate coherent patterns. We examined the temporal sequences and changes in depressive symptoms over time, and whether some symptoms are more central than others in inducing changes in the rest of the symptoms over time. We also compared the network structure of depressive symptoms between people who were and were not taking medication for depression or anxiety.

METHODS

Data were from the Survey of Health, Aging and Retirement in Europe, with five follow-ups conducted between 2004 and 2017. Participants who had data on depressive symptoms from at least two study waves were analyzed (n = 72,971). Depressive symptoms were self-reported using the 12-item EURO-D scale.

RESULTS

All individual symptoms were longitudinally associated with each other. Changes in sad or depressed mood, diminished interest, and suicidal ideation were the most strongly associated with changes in other symptoms. There were no consistent differences in symptom associations between individuals taking versus not taking psychotropic medication.

LIMITATIONS

Depressive symptoms were self-reported and measured every two years, which may dilute some short-term temporal sequences of the symptoms.

CONCLUSIONS

Our findings demonstrate differences between depressive symptoms in their long-term associations with other depressive symptoms in the general population. Changes in sad or depressed mood, diminished interest, and suicidal ideation have the strongest associations with changes in the rest of the symptoms.

Adult temperament and childbearing over the life course

Emerging evidence suggests that temperament may predict childbearing. We examined the association between four temperament traits (novelty seeking, harm avoidance, reward dependence and persistence of the Temperament and Character Inventory) and childbearing over the life course in the population‐based Cardiovascular Risk in Young Finns study (n = 1535; 985 women, 550 men). Temperament was assessed when the participants were aged 20–35 and fertility history from adolescence to adulthood was reported by the participants at age 30–45. Discrete‐time survival analysis modelling indicated that high childbearing probability was predicted by low novelty seeking (standardized OR = 0.92; 95% confidence interval 0.88–0.97), low harm avoidance (OR = 0.90; 0.85–0.95), high reward dependence (OR = 1.09; 1.03–1.15) and low persistence (OR = 0.91; 0.87–0.96) with no sex differences or quadratic effects. These associations grew stronger with increase in numbers of children. The findings were substantially the same in a completely prospective analysis. Adjusting for education did not influence the associations. Despite its negative association with overall childbearing, high novelty seeking increased the probability of having children in participants who were not living with a partner (OR = 1.29; 1.12–1.49). These data provide novel evidence for the role of temperament in influencing childbearing, and suggest possible weak natural selection of temperament traits in contemporary humans. Copyright © 2009 John Wiley & Sons, Ltd.

Association of Alcohol-Induced Loss of Consciousness and Overall Alcohol Consumption With Risk for Dementia

IMPORTANCE

Evidence on alcohol consumption as a risk factor for dementia usually relates to overall consumption. The role of alcohol-induced loss of consciousness is uncertain.

OBJECTIVE

To examine the risk of future dementia associated with overall alcohol consumption and alcohol-induced loss of consciousness in a population of current drinkers.

DESIGN, SETTING, AND PARTICIPANTS

Seven cohort studies from the UK, France, Sweden, and Finland (IPD-Work consortium) including 131 415 participants were examined. At baseline (1986-2012), participants were aged 18 to 77 years, reported alcohol consumption, and were free of diagnosed dementia. Dementia was examined during a mean follow-up of 14.4 years (range, 12.3-30.1). Data analysis was conducted from November 17, 2019, to May 23, 2020.

EXPOSURES

Self-reported overall consumption and loss of consciousness due to alcohol consumption were assessed at baseline. Two thresholds were used to define heavy overall consumption: greater than 14 units (U) (UK definition) and greater than 21 U (US definition) per week.

MAIN OUTCOMES AND MEASURES

Dementia and alcohol-related disorders to 2016 were ascertained from linked electronic health records.

RESULTS

Of the 131 415 participants (mean [SD] age, 43.0 [10.4] years; 80 344 [61.1%] women), 1081 individuals (0.8%) developed dementia. After adjustment for potential confounders, the hazard ratio (HR) was 1.16 (95% CI, 0.98-1.37) for consuming greater than 14 vs 1 to 14 U of alcohol per week and 1.22 (95% CI, 1.01-1.48) for greater than 21 vs 1 to 21 U/wk. Of the 96 591 participants with data on loss of consciousness, 10 004 individuals (10.4%) reported having lost consciousness due to alcohol consumption in the past 12 months. The association between loss of consciousness and dementia was observed in men (HR, 2.86; 95% CI, 1.77-4.63) and women (HR, 2.09; 95% CI, 1.34-3.25) during the first 10 years of follow-up (HR, 2.72; 95% CI, 1.78-4.15), after excluding the first 10 years of follow-up (HR, 1.86; 95% CI, 1.16-2.99), and for early-onset (<65 y: HR, 2.21; 95% CI, 1.46-3.34) and late-onset (≥65 y: HR, 2.25; 95% CI, 1.38-3.66) dementia, Alzheimer disease (HR, 1.98; 95% CI, 1.28-3.07), and dementia with features of atherosclerotic cardiovascular disease (HR, 4.18; 95% CI, 1.86-9.37). The association with dementia was not explained by 14 other alcohol-related conditions. With moderate drinkers (1-14 U/wk) who had not lost consciousness as the reference group, the HR for dementia was twice as high in participants who reported having lost consciousness, whether their mean weekly consumption was moderate (HR, 2.19; 95% CI, 1.42-3.37) or heavy (HR, 2.36; 95% CI, 1.57-3.54).

CONCLUSIONS AND RELEVANCE

The findings of this study suggest that alcohol-induced loss of consciousness, irrespective of overall alcohol consumption, is associated with a subsequent increase in the risk of dementia.

Why stop at two opinions? Reply to McCrae (2020)

McCrae (2020) argues that it is premature to explore interventions focused on personality change. In his commentary, he suggests that interventions should be promoted only if their effects in self-report data are confirmed by the additional opinion of informants. We agree with the essence of his position and would go further by envisioning a new framework for rigorous collaborative research on personality change (Bleidorn et al., 2020). We nevertheless maintain that policymakers would benefit from considering the additional opinion of personality scientists. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

General psychopathology factor and borderline personality disorder: Evidence for substantial overlap from two nationally representative surveys of U.S. adults

A general psychopathology factor reflects an underlying liability for a wide range of mental disorders. There is suggestive evidence that borderline personality disorder (BPD) may be strongly associated with the general psychopathology factor, but there are no detailed data on the degree of overlap between the general psychopathology factor and BPD or its individual symptoms. This study examined the overlap between the general psychopathology factor and BPD using cross-sectional survey data from two nationally representative samples of U.S. adults, the National Comorbidity Survey Replication (N = 5,692) and the National Comorbidity Survey follow-up (N = 5,001). Structural equation modeling was used to fit a bifactor general psychopathology model and to examine the general psychopathology factor's associations with (a) a series of Clusters A, B, and C personality disorder symptoms including BPD symptoms and (b) a latent BPD. Results showed that the shared variance between the general psychopathology factor and a latent BPD was 56% in the National Comorbidity Survey Replication and 71% in the National Comorbidity Survey follow-up. The correlation between the general factor and BPD could be set to unity without worsening model fit, suggesting that BPD closely reflects a general liability to psychopathology. The affective features of BPD were particularly strongly associated with the general psychopathology factor. Findings are discussed with respect to the nosology of BPD and the treatment of mental disorders. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Personality, disability-free life years, and life expectancy: Individual participant meta-analysis of 131,195 individuals from 10 cohort studies

OBJECTIVE

We examined how personality traits of the Five Factor Model were related to years of healthy life years lost (mortality and disability) for individuals and the population.

METHOD

Participants were 131,195 individuals from 10 cohort studies from Australia, Germany, the United Kingdom, and the United States (n = 43,935 from seven cohort studies for the longitudinal analysis of disability, assessed using scales of Activities of Daily Living).

RESULTS

Lower Conscientiousness was associated with higher mortality and disability risk, but only when Conscientiousness was below its median level. If the excess risk associated with low Conscientiousness had been absent, population life expectancy would have been 1.3 years longer and disability-free life 1.0 years longer. Lower emotional stability was related to shorter life expectancy, but only among those in the lowest 15% of the distribution, and disability throughout the distribution: if the excess risk associated with low emotional stability had been absent, population life expectancy would have been 0.4 years longer and disability-free life 2.4 years longer.

CONCLUSIONS

Personality traits of low Conscientiousness and low emotional stability are associated with reduced healthy life expectancy of individuals and population.

Long working hours and change in body weight: analysis of individual-participant data from 19 cohort studies

OBJECTIVE

To examine the relation between long working hours and change in body mass index (BMI).

METHODS

We performed random effects meta-analyses using individual-participant data from 19 cohort studies from Europe, US and Australia (n = 122,078), with a mean of 4.4-year follow-up. Working hours were measured at baseline and categorised as part time (<35 h/week), standard weekly hours (35-40 h, reference), 41-48 h, 49-54 h and ≥55 h/week (long working hours). There were four outcomes at follow-up: (1) overweight/obesity (BMI ≥ 25 kg/m2) or (2) overweight (BMI 25-29.9 kg/m2) among participants without overweight/obesity at baseline; (3) obesity (BMI ≥ 30 kg/m2) among participants with overweight at baseline, and (4) weight loss among participants with obesity at baseline.

RESULTS

Of the 61,143 participants without overweight/obesity at baseline, 20.2% had overweight/obesity at follow-up. Compared with standard weekly working hours, the age-, sex- and socioeconomic status-adjusted relative risk (RR) of overweight/obesity was 0.95 (95% CI 0.90-1.00) for part-time work, 1.07 (1.02-1.12) for 41-48 weekly working hours, 1.09 (1.03-1.16) for 49-54 h and 1.17 (1.08-1.27) for long working hours (P for trend <0.0001). The findings were similar after multivariable adjustment and in subgroup analyses. Long working hours were associated with an excess risk of shift from normal weight to overweight rather than from overweight to obesity. Long working hours were not associated with weight loss among participants with obesity.

CONCLUSIONS

This analysis of large individual-participant data suggests a small excess risk of overweight among the healthy-weight people who work long hours.

Homophily in Personality Enhances Group Success Among Real-Life Friends

Personality affects dyadic relations and teamwork, yet its role among groups of friends has been little explored. We examine for the first time whether similarity in personality enhances the effectiveness of real-life friendship groups. Using data from a longitudinal study of a European fraternity (10 male and 15 female groups), we investigate how individual Big Five personality traits were associated with group formation and whether personality homophily related to how successful the groups were over 1 year (N = 147-196). Group success was measured as group performance/identification (adoption of group markers) and as group bonding (using the inclusion-of-other-in-self scale). Results show that individuals' similarity in neuroticism and conscientiousness predicted group formation. Furthermore, personality similarity was associated with group success, even after controlling for individual's own personality. Especially higher group-level similarity in conscientiousness was associated with group performance, and with bonding in male groups.

Longitudinal Experience–Wide Association Studies—A Framework for Studying Personality Change

The importance of personality for predicting life outcomes in the domains of love, work, and health is well established, as is evidence that personality traits, while relatively stable, can change. However, little is known about the sources and processes that drive changes in personality traits and how such changes might impact important life outcomes. In this paper, we make the case that the research paradigms and methodological approaches commonly used in personality psychology need to be revised to advance our understanding of the sources and processes of personality change. We propose Longitudinal Experience–Wide Association Studies as a framework for studying personality change that can address the limitations of current methods, and we discuss strategies for overcoming some of the challenges associated with Longitudinal Experience–Wide Association Studies. © 2020 European Association of Personality Psychology

Association of Healthy Lifestyle With Years Lived Without Major Chronic Diseases

IMPORTANCE

It is well established that selected lifestyle factors are individually associated with lower risk of chronic diseases, but how combinations of these factors are associated with disease-free life-years is unknown.

OBJECTIVE

To estimate the association between healthy lifestyle and the number of disease-free life-years.

DESIGN, SETTING, AND PARTICIPANTS

A prospective multicohort study, including 12 European studies as part of the Individual-Participant-Data Meta-analysis in Working Populations Consortium, was performed. Participants included 116 043 people free of major noncommunicable disease at baseline from August 7, 1991, to May 31, 2006. Data analysis was conducted from May 22, 2018, to January 21, 2020.

EXPOSURES

Four baseline lifestyle factors (smoking, body mass index, physical activity, and alcohol consumption) were each allocated a score based on risk status: optimal (2 points), intermediate (1 point), or poor (0 points) resulting in an aggregated lifestyle score ranging from 0 (worst) to 8 (best). Sixteen lifestyle profiles were constructed from combinations of these risk factors.

MAIN OUTCOMES AND MEASURES

The number of years between ages 40 and 75 years without chronic disease, including type 2 diabetes, coronary heart disease, stroke, cancer, asthma, and chronic obstructive pulmonary disease.

RESULTS

Of the 116 043 people included in the analysis, the mean (SD) age was 43.7 (10.1) years and 70 911 were women (61.1%). During 1.45 million person-years at risk (mean follow-up, 12.5 years; range, 4.9-18.6 years), 17 383 participants developed at least 1 chronic disease. There was a linear association between overall healthy lifestyle score and the number of disease-free years, such that a 1-point improvement in the score was associated with an increase of 0.96 (95% CI, 0.83-1.08) disease-free years in men and 0.89 (95% CI, 0.75-1.02) years in women. Comparing the best lifestyle score with the worst lifestyle score was associated with 9.9 (95% CI 6.7-13.1) additional years without chronic diseases in men and 9.4 (95% CI 5.4-13.3) additional years in women (P < .001 for dose-response). All of the 4 lifestyle profiles that were associated with the highest number of disease-free years included a body-mass index less than 25 (calculated as weight in kilograms divided by height in meters squared) and at least 2 of the following factors: never smoking, physical activity, and moderate alcohol consumption. Participants with 1 of these lifestyle profiles reached age 70.3 (95% CI, 69.9-70.8) to 71.4 (95% CI, 70.9-72.0) years disease free depending on the profile and sex.

CONCLUSIONS AND RELEVANCE

In this multicohort analysis, various healthy lifestyle profiles appeared to be associated with gains in life-years without major chronic diseases.

Immigrants' mental health service use compared to that of native Finns: a register study

PURPOSE

Many aspects related to migration might predispose immigrants to mental health problems. Yet immigrants have been shown to underuse mental health services. The aim of this study was to compare the intensity of psychiatric care, as an indicator of treatment adequacy, between natives and immigrants living in Finland.

METHODS

We used nationwide register data that included all the immigrants living in Finland at the end of 2010 (n = 185,605) and their matched controls. Only those who had used mental health services were included in the analyses (n = 14,285). We used multinomial logistic regression to predict the categorized treatment intensity by immigrant status, region and country of origin, length of residence, and other background variables.

RESULTS

Immigrants used mental health services less than Finnish controls and with lower intensity. The length of residence in Finland increased the probability of higher treatment intensity. Immigrants from Eastern Europe, sub-Saharan Africa, the Middle East, and Northern Africa were at the highest risk of receiving low-intensity treatment.

CONCLUSIONS

Some immigrant groups seem to persistently receive less psychiatric treatment than Finnish-born controls. Identification of these groups is important and future research is needed to determine the mechanisms behind these patterns.

Connectivity of depression symptoms before and after diagnosis of a chronic disease: A network analysis in the U.S. Health and Retirement Study

BACKGROUND

Many chronic diseases increase the risk of depressive symptoms, but few studies have examined whether these diseases also affect the composition of symptoms a person is likely to experience. As the risk and progression of depression may vary between chronic diseases, we used network analysis to examine how depression symptoms are connected before and after the diagnosis of diabetes, heart disease, stroke, and cancer.

METHODS

Participants (N = 7779) were from the longitudinal survey of the Health and Retirement Study. Participants were eligible if they had information on depression symptoms two and/or four years before and after the diagnosis of either diabetes, heart disease, cancer or stroke. We formed a control group with no chronic disease that was matched on age, sex and ethnic background to those with a disease. We constructed depression symptom networks and compared the overall connectivity of those networks, and depression symptom sum scores, for before and after the diagnosis of each disease.

RESULTS

Depression symptom sum scores increased with the diagnosis of each disease. The connectivity of depression symptoms remained unchanged for all the diseases, except for stroke, for which the connectivity decreased with the diagnosis.

LIMITATIONS

Comorbidity with other chronic diseases was not controlled for as we focused on the onset of specific diseases.

CONCLUSIONS

Our results suggest that although the mean level of depression symptoms increases after the diagnosis of chronic disease, with most chronic diseases, these changes are not reflected in the network structure of depression symptoms.

Health behaviors and psychological distress: changing associations between 1997 and 2016 in the United States

OBJECTIVES

Smoking rates have declined with a slower pace among those with psychological distress compared to those without. We examined whether other health behaviors (heavy alcohol consumption, physical inactivity, short sleep duration) showed similar trends associated with psychological distress. We also examined differences by age and birth cohort.

METHODS

Data were from the annually repeated cross-sectional U.S. National Health Interview Surveys (NHIS) of 1997-2016 (total n = 603,518). Psychological distress was assessed with the 6-item Kessler Psychological Distress Scale (K6).

RESULTS

Psychological distress became more strongly associated with smoking (OR 1.09 per 10 years; 95% CI 1.07, 1.12), physical inactivity (OR 1.08; 1.05, 1.11), and short sleep (OR 1.12; 1.06, 1.18), but less strongly associated with heavy alcohol consumption (OR 0.93; 0.89, 0.98). The associations of smoking and alcohol consumption attenuated with age, whereas the association with physical inactivity strengthened with age. Compared to older birth cohorts, smoking became more strongly associated with psychological distress among younger birth cohorts up to those born in the 1980s.

CONCLUSIONS

The strength of associations between psychological distress and health behaviors may vary by time period, age, and birth cohort.

Shorter birth intervals between siblings are associated with increased risk of parental divorce

Birth intervals are a crucial component of fertility behaviour and family planning. Short birth intervals are associated—although not necessarily causally—with negative health-related outcomes, but less is known about their associations with family functioning. Here, the associations between birth intervals and marital stability were investigated by Cox regression using a nationally representative, register-based sample of individuals with two (N = 42,481) or three (N = 22,514) children from contemporary Finland (observation period 1972–2009). Shorter interbirth intervals were associated with an increased risk of parental divorce over a ten-year follow-up. Individuals with birth intervals of up to 1.5 years had 24–49 per cent higher divorce risk compared to individuals whose children were born more than 4 years apart. The pattern was similar in all socioeconomic groups and among individuals with earlier and later entry to parenthood. Our results add to the growing body of research showing associations between short birth intervals and negative outcomes in health and family functioning.

Childhood Psychosocial Environment and Adult Cardiac Health: A Causal Mediation Approach

INTRODUCTION

This study used causal mediation analysis to assess the life-course associations of a favorable childhood psychosocial environment with left ventricular mass and diastolic function in adulthood and the extent to which adult health behaviors mediate these associations.

METHODS

The sample included 880 participants (56% women) from the Young Finns Study with data on the childhood environment from 1980, adult health behaviors (smoking, physical activity, diet, and BMI) from 2001 and an echocardiographic assessment of the left ventricular mass (g/m^2.7) and diastolic function (E/e' ratio; higher values indicating a lower diastolic function) from 2011. The associations of the childhood environment with the left ventricular mass and E/e' ratio and mediation pathways through health behaviors were assessed using marginal structural models that were controlled for age, sex, and time-dependent confounding by adult socioeconomic position (measured as educational attainment) via inverse probability weighting. The data were analyzed in 2018-2019.

RESULTS

The mean age in 2011 was 41 (range 34-49) years. Those above versus below the median childhood score had a 1.28 g/m^2.7 lower left ventricular mass (95% CI= -2.63, 0.07) and a 0.18 lower E/e' ratio (95% CI= -0.39, 0.03). There was no evidence for indirect effects from childhood environments to left ventricular outcomes through adult health behaviors after controlling for time-dependent confounding by the adult socioeconomic position (indirect effect β= -0.30, 95% CI= -1.22, 0.63 for left ventricular mass; β= -0.04, 95% CI= -0.18, 0.11 for E/e' ratio). The results after multiple imputation were similar.

CONCLUSIONS

A favorable childhood environment is associated with more optimal cardiac structure and function in adulthood. After accounting for socioeconomic positions, adult health behaviors explain little of the associations.