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Wang Y, Unnarsdóttir AB, Magnúsdóttir I, Fang F, Thordardottir EB, Rúnarsdóttir H, Love TJ, Kristinsson SY, Pálsson R, Jakobsdóttir J, Zoega H, Ásbjörnsdóttir KH, Song H, Hauksdóttir A, Aspelund T, Valdimarsdóttir UA. Trends of perceived disruption in healthcare services during the pandemic: findings from the COVID-19 National Resilience Cohort in Iceland. Eur J Public Health 2024; 34:394-401. [PMID: 38129962 PMCID: PMC10990518 DOI: 10.1093/eurpub/ckad220] [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] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) caused major disruptions in healthcare services worldwide. Yet, little is known about the association between perceived disruption in healthcare services and socio-demographic factors, pre-existing health conditions as well as concurrent physical and psychological symptoms. METHODS Leveraging data from the Icelandic COVID-19 National Resilience Cohort, we performed a repeated measure analysis among 15 754 participants who responded to the question on perceived disruption in healthcare services from December 2020 to July 2021, to explore its association with socio-demographic factors, health indicators and conditions. Furthermore, we performed a longitudinal analysis among 7848 participants with two repeated measures to explore the association between timing and duration of perceived disruption in healthcare services and changes in depression, anxiety, sleep quality and somatic symptoms. RESULTS The prevalence of perceived disruption in healthcare services slightly decreased over time (P < 0.01). Perceived disruption in healthcare services was more prevalent among individuals with pre-existing health conditions, i.e. history of psychiatric disorders (prevalence ratio = 1.59, 95% confidence interval 1.48-1.72) and chronic somatic conditions [1.40 (1.30-1.52)]. However, no increase in the prevalence of perceived disruption in healthcare services was observed among individuals diagnosed with COVID-19 [0.99 (0.84-1.18)]. Moreover, we found that emerging perceived disruption in healthcare services was associated with an increase in symptoms of mental illness during the pandemic (βs 0.06-0.68). CONCLUSIONS A disruption in healthcare services during the COVID-19 pandemic was reported by vulnerable groups, while the Icelandic healthcare system managed to maintain accessible services to individuals with COVID-19.
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Affiliation(s)
- Yue Wang
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Anna Bára Unnarsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Ingibjörg Magnúsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Fang Fang
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Edda Bjork Thordardottir
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland
- Mental Health Services, Landspitali—The National University Hospital of Iceland, Reykjavik, Iceland
| | - Harpa Rúnarsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Thorvardur Jon Love
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Internal Medicine Services, Landspitali—The National University Hospital of Iceland, Reykjavik, Iceland
| | - Sigurður Yngvi Kristinsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Division of Hematology, Landspitali—The National University Hospital of Iceland, Reykjavik, Iceland
| | - Runólfur Pálsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Internal Medicine Services, Landspitali—The National University Hospital of Iceland, Reykjavik, Iceland
| | - Jóhanna Jakobsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Helga Zoega
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - Kristjana Hrönn Ásbjörnsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Huan Song
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Arna Hauksdóttir
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Thor Aspelund
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Unnur Anna Valdimarsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, 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
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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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3
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Köhler-Forsberg O, Ge F, Hauksdóttir A, Thordardottir EB, Ásbjörnsdóttir K, Rúnarsdóttir H, Tómasson G, Jakobsdóttir J, Guðmundsdóttir B, Björnsson AS, Sigurðsson E, Aspelund T, Valdimarsdottir UA. Adverse childhood experiences and psychological functioning among women with schizophrenia or bipolar disorder: population-based study. Br J Psychiatry 2024; 224:6-12. [PMID: 37850429 PMCID: PMC10751941 DOI: 10.1192/bjp.2023.128] [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: 05/06/2023] [Revised: 07/07/2023] [Accepted: 08/30/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) are well-known risk factors for schizophrenia and bipolar disorder. AIMS The aim was to study the associations between specific ACEs and psychological functioning in women with schizophrenia or bipolar disorder. METHOD Among 29 367 women (mean age 44 years) from the Icelandic Stress-And-Gene-Analysis (SAGA) study, 534 (1.8%, mean age 40) reported having been diagnosed with schizophrenia or bipolar disorder, which were combined to 'severe mental disorders'. Participants reported on 13 types of ACEs, childhood deprivation and psychological functioning (defined as coping ability and current symptoms of depression, anxiety and sleep disturbances). Adjusted Poisson regression calculated prevalence ratios (PRs) between ACEs and severe mental disorders. Linear regression assessed the association between ACEs and psychological functioning among women with a severe mental disorder. RESULTS Women with a severe mental disorder reported more ACEs (mean 4.57, s.d. = 2.82) than women without (mean 2.51, s.d. = 2.34) in a dose-dependent manner (fully-adjusted PR = 1.23 per ACE, 95% CI 1.20-1.27). After mutual adjustment for other ACEs, emotional abuse, sexual abuse, mental illness of a household member, emotional neglect, bullying and collective violence were associated with severe mental disorders. Among women with severe mental disorders, a higher number of ACEs was associated with increased symptom burden of depression (β = 2.79, 95% CI = 1.19-4.38) and anxiety (β = 2.04, 95% CI = 0.99-3.09) including poorer sleep quality (β = 0.83, 95% CI = 0.07-1.59). Findings were similar for schizophrenia and bipolar disorder separately. CONCLUSION Women with schizophrenia or bipolar disorder show a strong history of ACEs, which may interfere with their psychological functioning and, therefore, need to be addressed as part of their treatment, for example, with trauma-focused psychotherapy.
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Affiliation(s)
- Ole Köhler-Forsberg
- Psychosis Research Unit, Aarhus University Hospital – Psychiatry, Denmark; and Department of Clinical Medicine, Aarhus University, Denmark
| | - Fenfen Ge
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Iceland
| | - Arna Hauksdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Iceland
| | - Edda Bjork Thordardottir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Iceland; and Mental Health Services, Landspitali, The National University Hospital of Iceland, Iceland
| | | | - Harpa Rúnarsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Iceland
| | - Gunnar Tómasson
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Iceland
| | - Jóhanna Jakobsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Iceland
| | - Berglind Guðmundsdóttir
- Faculty of Medicine, University of Iceland, Iceland; and Mental Health Services, Landspitali, The National University Hospital of Iceland, Iceland
| | | | | | - Thor Aspelund
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Iceland
| | - Unnur A. Valdimarsdottir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Iceland; Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Sweden; and Harvard T.H. Chan School of Public Health, USA
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4
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Shen Q, Joyce EE, Ebrahimi OV, Didriksen M, Lovik A, Sævarsdóttir KS, Magnúsdóttir I, Mikkelsen DH, Unnarsdóttir AB, Hauksdóttir A, Hoffart A, Kähler AK, Thórdardóttir EB, Eythórsson E, Frans EM, Tómasson G, Ask H, Hardardóttir H, Jakobsdóttir J, Lehto K, Lu L, Andreassen OA, Sullivan PF, Pálsson R, Erikstrup C, Ostrowski SR, Werge T, Aspelund T, Pedersen OB, Johnson SU, Fang F, Valdimarsdóttir UA. COVID-19 illness severity and 2-year prevalence of physical symptoms: an observational study in Iceland, Sweden, Norway and Denmark. Lancet Reg Health Eur 2023; 35:100756. [PMID: 38115966 PMCID: PMC10730314 DOI: 10.1016/j.lanepe.2023.100756] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/20/2023] [Accepted: 10/03/2023] [Indexed: 12/21/2023]
Abstract
Background Although the persistence of physical symptoms after SARS-CoV-2 infection is a major public health concern, evidence from large observational studies beyond one year post diagnosis remain scarce. We aimed to assess the prevalence of physical symptoms in relation to acute illness severity up to more than 2-years after diagnosis of COVID-19. Methods This multinational study included 64,880 adult participants from Iceland, Sweden, Denmark, and Norway with self-reported data on COVID-19 and physical symptoms from April 2020 to August 2022. We compared the prevalence of 15 physical symptoms, measured by the Patient Health Questionnaire (PHQ-15), among individuals with or without a confirmed COVID-19 diagnosis, by acute illness severity, and by time since diagnosis. We additionally assessed the change in symptoms in a subset of Swedish adults with repeated measures, before and after COVID-19 diagnosis. Findings During up to 27 months of follow-up, 34.5% participants (22,382/64,880) were diagnosed with COVID-19. Individuals who were diagnosed with COVID-19, compared to those not diagnosed, had an overall 37% higher prevalence of severe physical symptom burden (PHQ-15 score ≥15, adjusted prevalence ratio [PR] 1.37 [95% confidence interval [CI] 1.23-1.52]). The prevalence was associated with acute COVID-19 severity: individuals bedridden for seven days or longer presented with the highest prevalence (PR 2.25 [1.85-2.74]), while individuals never bedridden presented with similar prevalence as individuals not diagnosed with COVID-19 (PR 0.92 [0.68-1.24]). The prevalence was statistically significantly elevated among individuals diagnosed with COVID-19 for eight of the fifteen measured symptoms: shortness of breath, chest pain, dizziness, heart racing, headaches, low energy/fatigue, trouble sleeping, and back pain. The analysis of repeated measurements rendered similar results as the main analysis. Interpretation These data suggest an elevated prevalence of some, but not all, physical symptoms during up to more than 2 years after diagnosis of COVID-19, particularly among individuals suffering a severe acute illness, highlighting the importance of continued monitoring and alleviation of these targeted core symptoms. Funding This work was mainly supported by grants from NordForsk (COVIDMENT, grant number 105668 and 138929) and Horizon 2020 (CoMorMent, 847776). See Acknowledgements for further details on funding.
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Affiliation(s)
- 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
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Emily E. Joyce
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Omid V. Ebrahimi
- Department of Psychology, University of Oslo, Oslo, Norway
- Modum Bad Psychiatric Hospital and Research Center, Vikersund, Norway
| | - Maria Didriksen
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Anikó Lovik
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Methodology and Statistics Unit, Institute of Psychology, Leiden University, Leiden, the Netherlands
| | - Karen Sól Sævarsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Ingibjörg Magnúsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Dorte Helenius Mikkelsen
- Institute of Biological Psychiatry, Mental Health Services, Copenhagen University Hospital, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Copenhagen and Aarhus, Denmark
| | - Anna Bára Unnarsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Arna Hauksdóttir
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Asle Hoffart
- Modum Bad Psychiatric Hospital and Research Center, Vikersund, Norway
| | - Anna K. Kähler
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Edda Björk Thórdardóttir
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Mental Health Services, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
| | - Elías Eythórsson
- Internal Medicine and Emergency Services, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
| | - Emma M. Frans
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Gunnar Tómasson
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Internal Medicine and Emergency Services, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
| | - Helga Ask
- Department of Psychology, University of Oslo, Oslo, Norway
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
| | - Hrönn Hardardóttir
- Internal Medicine and Emergency Services, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
| | - Jóhanna Jakobsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Kelli Lehto
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Estonia
| | - Li Lu
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
- Institute of Health Management and Policy, School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ole A. Andreassen
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Patrick F. Sullivan
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Departments of Genetics and Psychiatry, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Runólfur Pálsson
- Internal Medicine and Emergency Services, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Christian Erikstrup
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Sisse Rye Ostrowski
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Werge
- Institute of Biological Psychiatry, Mental Health Services, Copenhagen University Hospital, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Copenhagen and Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Lundbeck Foundation Center for GeoGenetics, GLOBE Institute, University of Copenhagen, Copenhagen, Denmark
| | - Thor Aspelund
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- The Icelandic Heart Association, Kopavogur, Iceland
| | - Ole B.V. Pedersen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Immunology, Zealand University Hospital, Denmark
| | - Sverre Urnes Johnson
- Department of Psychology, University of Oslo, Oslo, Norway
- Modum Bad Psychiatric Hospital and Research Center, Vikersund, Norway
| | - Fang Fang
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Unnur Anna Valdimarsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, 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, Massachusetts, USA
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5
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Bränn E, Vaina A, Daníelsdóttir HB, Thordardottir EB, Yang Q, Jakobsdóttir J, Aspelund T, Hauksdóttir A, Valdimarsdóttir UA, Lu D. Association between adverse childhood experiences and perinatal depressive symptoms: a cross-sectional analysis of 16,831 women in Iceland. Arch Womens Ment Health 2023; 26:839-849. [PMID: 37726573 PMCID: PMC10632282 DOI: 10.1007/s00737-023-01369-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/05/2023] [Indexed: 09/21/2023]
Abstract
Emerging data suggest that certain adverse childhood experiences (ACEs) are associated with perinatal depression (PND). However, few studies have comprehensively assessed the cumulative number and types of ACEs and their association to PND. We conducted a cross-sectional analysis among 16,831 female participants from the Stress-And-Gene-Analysis (SAGA) cohort in Iceland, 2018. ACEs were surveyed with the World Health Organization ACE-International questionnaire, while PND symptoms were assessed using the Edinburgh Postnatal Depression Scale (lifetime version). We, while adjusting for confounding factors, estimated the prevalence ratio (PR) of PND in relation to total number of ACEs using the Poisson quasi-likelihood model and further performed analyses for type-specific ACEs. At a mean age of 44 years (SD ± 11.1), 6,201 (36.8%) participants had experienced probable PND. Total number of ACEs was positively associated with PND (PR 1.11 per ACE, 95% CI: 1.10-1.11), also among women without any psychiatric comorbidities (PR 1.13, 95% CI: 1.11-1.14). PRs increased in a dose-response manner with the number of ACEs (P for trend < 0.001); women that endorsed 5 or more ACEs were twice as likely to have experienced PND (PR 2.24, 95% CI: 2.09-2.41). All ACE types (n = 13) were associated with PND, with most pronounced association for emotional neglect by a guardian (PR 1.53, 95% CI: 1.47-1.59). Our findings suggest a positive association between number of ACEs and PND symptoms. If our results are confirmed with prospective data, healthcare providers need to be alert of the risk of PND among expecting mothers with history of ACEs.
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Affiliation(s)
- Emma Bränn
- Institute of Environmental Medicine, Unit of Integrative Epidemiology, Karolinska Institutet, Stockholm, Sweden.
| | - Alexandra Vaina
- Institute of Environmental Medicine, Unit of Integrative Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | | | - Edda Bjork Thordardottir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Mental Health Services, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | - Qian Yang
- Department of Medicine, Unit of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Jóhanna Jakobsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Thor Aspelund
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Arna Hauksdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Unnur A Valdimarsdóttir
- Institute of Environmental Medicine, Unit of Integrative Epidemiology, Karolinska Institutet, Stockholm, Sweden
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Donghao Lu
- Institute of Environmental Medicine, Unit of Integrative Epidemiology, Karolinska Institutet, Stockholm, Sweden
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6
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Lovik A, González-Hijón J, Hoffart A, Fawns-Ritchie C, Magnúsdóttir I, Lu L, Unnarsdóttir AB, Kähler AK, Campbell A, Hauksdóttir A, Chourpiliadis C, McCartney DL, Thordardóttir EB, Joyce EE, Frans EM, Jakobsdóttir J, Trogstad L, Andreassen OA, Magnus P, Johnson SU, Sullivan PF, Aspelund T, Porteous DJ, Ask H, Ebrahimi OV, Valdimarsdóttir UA, Fang F. Elevated symptoms of depression and anxiety among family members and friends of critically ill COVID-19 patients - an observational study of five cohorts across four countries. Lancet Reg Health Eur 2023; 33:100733. [PMID: 37953992 PMCID: PMC10636287 DOI: 10.1016/j.lanepe.2023.100733] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/04/2023] [Accepted: 08/23/2023] [Indexed: 11/14/2023]
Abstract
Background Little is known regarding the mental health impact of having a significant person (family member and/or close friend) with COVID-19 of different severity. Methods The study included five prospective cohorts from four countries (Iceland, Norway, Sweden, and the UK) with self-reported data on COVID-19 and symptoms of depression and anxiety during March 2020-March 2022. We calculated prevalence ratios (PR) of depression and anxiety in relation to having a significant person with COVID-19 and performed a longitudinal analysis in the Swedish cohort to describe temporal patterns. Findings 162,237 and 168,783 individuals were included in the analysis of depression and anxiety, respectively, of whom 24,718 and 27,003 reported a significant person with COVID-19. Overall, the PR was 1.07 (95% CI: 1.05-1.10) for depression and 1.08 (95% CI: 1.03-1.13) for anxiety in relation to having a significant person with COVID-19. The respective PRs for depression and anxiety were 1.15 (95% CI: 1.08-1.23) and 1.24 (95% CI: 1.14-1.34) if the patient was hospitalized, 1.42 (95% CI: 1.27-1.57) and 1.45 (95% CI: 1.31-1.60) if the patient was ICU-admitted, and 1.34 (95% CI: 1.22-1.46) and 1.36 (95% CI: 1.22-1.51) if the patient died. Individuals with a significant person with hospitalized, ICU-admitted, or fatal COVID-19 showed elevated prevalence of depression and anxiety during the entire year after the COVID-19 diagnosis. Interpretation Family members and close friends of critically ill COVID-19 patients show persistently elevated prevalence of depressive and anxiety symptoms. Funding This study was primarily supported by NordForsk (COVIDMENT, 105668) and Horizon 2020 (CoMorMent, 847776).
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Affiliation(s)
- Anikó Lovik
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Methodology and Statistics Unit, Institute of Psychology, Leiden University, Leiden, the Netherlands
| | - Juan González-Hijón
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Asle Hoffart
- Department of Psychology, University of Oslo, Oslo, Norway
- Research Institute, Modum Bad Psychiatric Hospital, Vikersund, Norway
| | - Chloe Fawns-Ritchie
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, Scotland
- Division of Psychology, University of Dundee, Dundee, Scotland
| | - Ingibjörg Magnúsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Li Lu
- Health Management and Policy Institute, School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
| | - Anna Bára Unnarsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Anna K. Kähler
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Archie Campbell
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, Scotland
| | - Arna Hauksdóttir
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Charilaos Chourpiliadis
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Daniel L. McCartney
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, Scotland
| | - Edda Björk Thordardóttir
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Mental Health Services, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | - Emily E. Joyce
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Emma M. Frans
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Jóhanna Jakobsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Lill Trogstad
- Division of Infection Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Ole A. Andreassen
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Per Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Sverre Urnes Johnson
- Department of Psychology, University of Oslo, Oslo, Norway
- Research Institute, Modum Bad Psychiatric Hospital, Vikersund, Norway
| | - Patrick F. Sullivan
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
- Departments of Genetics and Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Thor Aspelund
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- The Icelandic Heart Association, Kopavogur, Iceland
| | - David J. Porteous
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, Scotland
| | - Helga Ask
- Department of Psychology, University of Oslo, Oslo, Norway
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
| | - Omid V. Ebrahimi
- Department of Psychology, University of Oslo, Oslo, Norway
- Research Institute, Modum Bad Psychiatric Hospital, Vikersund, Norway
| | - Unnur Anna Valdimarsdóttir
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Fang Fang
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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7
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Shen Q, Song H, Aspelund T, Yu J, Lu D, Jakobsdóttir J, Bergstedt J, Yi L, Sullivan P, Sjölander A, Ye W, Fall K, Fang F, Valdimarsdóttir U. Cardiovascular disease and subsequent risk of psychiatric disorders: a nationwide sibling-controlled study. eLife 2022; 11:e80143. [PMID: 36269046 PMCID: PMC9718522 DOI: 10.7554/elife.80143] [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: 05/10/2022] [Accepted: 10/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background The association between cardiovascular disease (CVD) and selected psychiatric disorders has frequently been suggested while the potential role of familial factors and comorbidities in such association has rarely been investigated. Methods We identified 869,056 patients newly diagnosed with CVD from 1987 to 2016 in Sweden with no history of psychiatric disorders, and 910,178 full siblings of these patients as well as 10 individually age- and sex-matched unrelated population controls (N = 8,690,560). Adjusting for multiple comorbid conditions, we used flexible parametric models and Cox models to estimate the association of CVD with risk of all subsequent psychiatric disorders, comparing rates of first incident psychiatric disorder among CVD patients with rates among unaffected full siblings and population controls. Results The median age at diagnosis was 60 years for patients with CVD and 59.2% were male. During up to 30 years of follow-up, the crude incidence rates of psychiatric disorder were 7.1, 4.6, and 4.0 per 1000 person-years for patients with CVD, their siblings and population controls. In the sibling comparison, we observed an increased risk of psychiatric disorder during the first year after CVD diagnosis (hazard ratio [HR], 2.74; 95% confidence interval [CI], 2.62-2.87) and thereafter (1.45; 95% CI, 1.42-1.48). Increased risks were observed for all types of psychiatric disorders and among all diagnoses of CVD. We observed similar associations in the population comparison. CVD patients who developed a comorbid psychiatric disorder during the first year after diagnosis were at elevated risk of subsequent CVD death compared to patients without such comorbidity (HR, 1.55; 95% CI, 1.44-1.67). Conclusions Patients diagnosed with CVD are at an elevated risk for subsequent psychiatric disorders independent of shared familial factors and comorbid conditions. Comorbid psychiatric disorders in patients with CVD are associated with higher risk of cardiovascular mortality suggesting that surveillance and treatment of psychiatric comorbidities should be considered as an integral part of clinical management of newly diagnosed CVD patients. Funding This work was supported by the EU Horizon 2020 Research and Innovation Action Grant (CoMorMent, grant no. 847776 to UV, PFS, and FF), Grant of Excellence, Icelandic Research Fund (grant no. 163362-051 to UV), ERC Consolidator Grant (StressGene, grant no. 726413 to UV), Swedish Research Council (grant no. D0886501 to PFS), and US NIMH R01 MH123724 (to PFS).
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Affiliation(s)
- Qing Shen
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska InstitutetStockholmSweden
- Centre of Public Health Sciences, Faculty of Medicine, University of IcelandReykjavíkIceland
| | - Huan Song
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska InstitutetStockholmSweden
- Centre of Public Health Sciences, Faculty of Medicine, University of IcelandReykjavíkIceland
- West China Biomedical Big Data Center, West China Hospital, Sichuan UniversityChengduChina
- Medical Big Data Center, Sichuan UniversityChengduChina
| | - Thor Aspelund
- Centre of Public Health Sciences, Faculty of Medicine, University of IcelandReykjavíkIceland
| | - Jingru Yu
- Department of Medical Epidemiology and Biostatistics, Karolinska InstitutetStockholmSweden
| | - Donghao Lu
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska InstitutetStockholmSweden
- West China Biomedical Big Data Center, West China Hospital, Sichuan UniversityChengduChina
- Department of Epidemiology, Harvard T.H. Chan School of Public HealthBostonUnited States
| | - Jóhanna Jakobsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of IcelandReykjavíkIceland
| | - Jacob Bergstedt
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska InstitutetStockholmSweden
| | - Lu Yi
- Department of Medical Epidemiology and Biostatistics, Karolinska InstitutetStockholmSweden
| | - Patrick Sullivan
- Department of Medical Epidemiology and Biostatistics, Karolinska InstitutetStockholmSweden
- Departments of Genetics and Psychiatry, University of North CarolinaChapel HillUnited States
| | - Arvid Sjölander
- Department of Medical Epidemiology and Biostatistics, Karolinska InstitutetStockholmSweden
| | - Weimin Ye
- Department of Medical Epidemiology and Biostatistics, Karolinska InstitutetStockholmSweden
| | - Katja Fall
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska InstitutetStockholmSweden
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro UniversityÖrebroSweden
| | - Fang Fang
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska InstitutetStockholmSweden
| | - Unnur Valdimarsdóttir
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska InstitutetStockholmSweden
- Centre of Public Health Sciences, Faculty of Medicine, University of IcelandReykjavíkIceland
- Department of Epidemiology, Harvard T.H. Chan School of Public HealthBostonUnited States
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8
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Unnarsdóttir AB, Lovik A, Fawns-Ritchie C, Ask H, Kõiv K, Hagen K, Didriksen M, Christoffersen LAN, Garðarsson AB, McIntosh A, Kähler AK, Campbell A, Hauksdóttir A, Erikstrup C, Mikkelsen DH, Altschul D, Thordardottir EB, Frans EM, Kvale G, Tómasson G, Kariis HM, Jónsdóttir HL, Rúnarsdóttir H, Magnúsdóttir I, Eid J, Jakobsdóttir J, Nielsen KR, Kaspersen KA, Milani L, Trogstad LIS, Yi L, Bruun MT, Sullivan PF, Magnus PM, Shen Q, Nesvåg R, Brandlistuen RE, Mägi R, Ostrowski SR, Løkhammer S, Solem S, Reichborn-Kjennerud T, Hansen TF, Werge T, Aspelund T, Porteous DJ, Fang F, Lehto K, Andreassen OA, Pedersen OBV, Hellard SL, Valdimarsdóttir UA. Cohort Profile: COVIDMENT: COVID-19 cohorts on mental health across six nations. Int J Epidemiol 2022; 51:e108-e122. [PMID: 35020900 PMCID: PMC8690101 DOI: 10.1093/ije/dyab234] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/21/2021] [Indexed: 12/30/2022] Open
Affiliation(s)
- Anna Bára Unnarsdóttir
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Anikó Lovik
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Chloe Fawns-Ritchie
- Department of Psychology, University of Edinburgh, Edinburgh, UK
- Centre for Genomic and Experimental Medicine, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Helga Ask
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
| | - Kadri Kõiv
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Estonia
| | - Kristen Hagen
- Department of Psychiatry, Molde Hospital, Møre og Romsdal Hospital Trust, Molde, Norway
| | - Maria Didriksen
- Department of Clinical Immunology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | | | | | - Andrew McIntosh
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK
| | - Anna K Kähler
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Archie Campbell
- Centre for Genomic and Experimental Medicine, University of Edinburgh, Western General Hospital, Edinburgh, UK
- Centre for Medical Informatics, Usher Institute, Edinburgh, UK
| | - Arna Hauksdóttir
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus N, Denmark
| | - Dorte Helenius Mikkelsen
- Institute of Biological Psychiatry, Mental Health Services Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Drew Altschul
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Edda Bjork Thordardottir
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Emma Maria Frans
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Gerd Kvale
- BCBP, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Gunnar Tómasson
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department of Rheumatology, University Hospital, Iceland
| | - Hanna Maria Kariis
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Estonia
| | - Harpa Lind Jónsdóttir
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Faculty of Psychology, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Harpa Rúnarsdóttir
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Ingibjörg Magnúsdóttir
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Jarle Eid
- Faculty of Psychology, Center for Crisis Psychology, University of Bergen, Bergen, Norway
| | - Jóhanna Jakobsdóttir
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Kaspar René Nielsen
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
| | - Kathrine Agergård Kaspersen
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus N, Denmark
- Danish Big Data Centre for Environment and Health (BERTHA), Aarhus University, Roskilde, Denmark
| | - Lili Milani
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Estonia
| | - Lill-Iren Schou Trogstad
- Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Lu Yi
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mie Topholm Bruun
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Patrick F Sullivan
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Departments of Genetics and Psychiatry, University of North Carolina, NC, USA
| | - Per Minor Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Qing Shen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ragnar Nesvåg
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
| | - Ragnhild E Brandlistuen
- Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
- Norwegian Mother, Father and Child Cohort Study (MoBa), Norwegian Institute of Public Health, Oslo, Norway
| | - Reedik Mägi
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Estonia
| | - Sisse Rye Ostrowski
- Department of Clinical Immunology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Solveig Løkhammer
- NORMENT, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Stian Solem
- BCBP, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ted Reichborn-Kjennerud
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Thomas Folkmann Hansen
- Danish Headache Center, Department of Neurology, Copenhagen University Hospital Rigshopitalet, Glostrup, Denmark
- NovoNordisk Foundation Center for Protein Research, Copenhagen University, Copenhagen, Denmark
| | - Thomas Werge
- Institute of Biological Psychiatry, Mental Health Services Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Thor Aspelund
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Icelandic Heart Association, Kopavogur, Iceland
| | - David J Porteous
- Centre for Genomic and Experimental Medicine, University of Edinburgh, Western General Hospital, Edinburgh, UK
- Centre for Medical Informatics, Usher Institute, Edinburgh, UK
| | - Fang Fang
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kelli Lehto
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Estonia
| | - Ole A Andreassen
- Faculty of Medicine, NORMENT Centre, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Faculty of Medicine, NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | | | - Stephanie Le Hellard
- BCBP, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- NORMENT, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Unnur A Valdimarsdóttir
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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9
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Unnarsdóttir AB, Hauksdóttir A, Aspelund T, Gunnarsdóttir V, Tómasson G, Jakobsdóttir J, Valdimarsdóttir UA, Thordardottir EB. Sleep disturbances among women in a Subarctic region: a nationwide study. Sleep 2022; 45:6582689. [PMID: 35532192 PMCID: PMC9366651 DOI: 10.1093/sleep/zsac100] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/31/2022] [Indexed: 01/10/2023] Open
Abstract
STUDY OBJECTIVES To date, few studies have assessed sleep problems among women residing in Subarctic regions. Therefore, the aim of this large-scale population-based study was to assess the prevalence of severe sleep problems and associated factors among Icelandic women, living at 63-66°N. METHODS Participants were 29 681 women (18-69 years old) who took part in the Icelandic Stress-And-Gene-Analysis study in 2018-2019. Background information, health-related behavior, and mental health symptoms were assessed with an online questionnaire. The Pittsburgh Sleep Quality Index (PSQI) was used to assess severe sleep problems during the past month. Adjusting for age, marital status, number of children, education, personal income, work schedule, region, and response period, we used modified Poisson log-linear models to obtain prevalence ratios (PRs) with 95% confidence intervals (CIs). RESULTS Overall, 24.2% of women reported severe sleep problems (PSQI >10). Women responding in the winter presented with an overall higher prevalence of severe sleep problems, compared to those responding in the summer (PR 1.21; 95% CI, 1.15 to 1.28). Severe sleep problems were more prevalent among young and late-midlife women, those who were single, had children, socio-economic challenges, worked shifts, and flexible hours. Furthermore, obesity, suboptimal health behaviors, excessive screen time, and mental health problems were associated with severe sleep problems. CONCLUSION Severe sleep problems are more common among women in Subarctic regions than elsewhere, particularly during winter. These findings motivate the development of preventive strategies and interventions for women in the Subarctic who suffer from sleep problems.
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Affiliation(s)
- Anna Bára Unnarsdóttir
- Corresponding author. Anna Bára Unnarsdóttir, Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Sturlugata 8, 101 Reykjavik, Iceland.
| | - Arna Hauksdóttir
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Thor Aspelund
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Vigdís Gunnarsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Gunnar Tómasson
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland,Department of Rheumatology, University Hospital, Reykjavik, Iceland
| | - Jóhanna Jakobsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Unnur Anna Valdimarsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Edda Bjork Thordardottir
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
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10
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Magnúsdóttir I, Lovik A, Unnarsdóttir AB, McCartney D, Ask H, Kõiv K, Christoffersen LAN, Johnson SU, Hauksdóttir A, Fawns-Ritchie C, Helenius D, González-Hijón J, Lu L, Ebrahimi OV, Hoffart A, Porteous DJ, Fang F, Jakobsdóttir J, Lehto K, Andreassen OA, Pedersen OBV, Aspelund T, Valdimarsdóttir UA. Acute COVID-19 severity and mental health morbidity trajectories in patient populations of six nations: an observational study. Lancet Public Health 2022; 7:e406-e416. [PMID: 35298894 PMCID: PMC8920517 DOI: 10.1016/s2468-2667(22)00042-1] [Citation(s) in RCA: 74] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/09/2022] [Accepted: 02/11/2022] [Indexed: 02/07/2023]
Abstract
Background Methods Findings Interpretation Funding
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Affiliation(s)
- Ingibjörg Magnúsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Anikó Lovik
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anna Bára Unnarsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Daniel McCartney
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Helga Ask
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
| | - Kadri Kõiv
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Estonia
| | | | - Sverre Urnes Johnson
- Department of Psychology, University of Oslo, Oslo, Norway; Modum Bad Psychiatric Center, Vikersund, Norway
| | - Arna Hauksdóttir
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Chloe Fawns-Ritchie
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital, Edinburgh, UK; Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Dorte Helenius
- Institute of Biological Psychiatry, Mental Health Services Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Juan González-Hijón
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Li Lu
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway; NORMENT Centre, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Omid V Ebrahimi
- Department of Psychology, University of Oslo, Oslo, Norway; Modum Bad Psychiatric Center, Vikersund, Norway
| | - Asle Hoffart
- Department of Psychology, University of Oslo, Oslo, Norway; Modum Bad Psychiatric Center, Vikersund, Norway
| | - David J Porteous
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Fang Fang
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jóhanna Jakobsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Kelli Lehto
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Estonia
| | - Ole A Andreassen
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ole B V Pedersen
- Department of Clinical Immunology, Zealand University Hospital, Koege, Denmark
| | - Thor Aspelund
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland; The Icelandic Heart Association, Kopavogur, Iceland
| | - Unnur Anna Valdimarsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, 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.
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11
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Yang Q, Þórðardóttir EB, Hauksdóttir A, Aspelund T, Jakobsdóttir J, Halldorsdottir T, Tomasson G, Rúnarsdóttir H, Danielsdottir HB, Bertone-Johnson ER, Sjölander A, Fang F, Lu D, Valdimarsdóttir UA. Association between adverse childhood experiences and premenstrual disorders: a cross-sectional analysis of 11,973 women. BMC Med 2022; 20:60. [PMID: 35184745 PMCID: PMC8859885 DOI: 10.1186/s12916-022-02275-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 01/24/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Childhood abuse and neglect have been associated with premenstrual disorders (PMDs), including premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). However, the associations of other adverse childhood experiences (ACEs) and the cumulative number of ACEs with PMDs remain to be explored. METHODS To evaluate the associations of the cumulative number and types of ACEs with PMDs, we conducted a cross-sectional analysis with a subsample of menstruating women within the Stress-And-Gene-Analysis (SAGA) cohort, assessed for PMDs and ACEs (N=11,973). The cumulative and individual exposure of 13 types of ACEs was evaluated by a modified ACE-International Questionnaire. A modified version of the Premenstrual Symptom Screening Tool was used to identify probable cases of PMDs, further sub-grouped into PMS and PMDD. Prevalence ratios (PRs) of PMDs in relation to varying ACEs were estimated using Poisson regression. RESULTS At a mean age of 34.0 years (standard deviation (SD) 9.1), 3235 (27%) met the criteria of probable PMDs, including 2501 (21%) for PMS and 734 (6%) for PMDD. The number of ACEs was linearly associated with PMDs (fully-adjusted PR 1.12 per ACE, 95% CI 1.11-1.13). Specifically, the PR for PMDs was 2.46 (95% CI 2.21-2.74) for women with 4 or more ACEs compared with women with no ACEs. A stronger association was observed for probable PMDD compared to PMS (p for difference <0.001). The associations between ACEs and PMDs were stronger among women without PTSD, anxiety, or depression, and without childhood deprivation and were stronger among women a lower level of social support (p for interaction<0.001). All types of ACEs were positively associated with PMDs (PRs ranged from 1.11 to 1.51); the associations of sexual abuse, emotional neglect, family violence, mental illness of a household member, and peer and collective violence were independent of other ACEs. CONCLUSIONS Our findings suggest that childhood adverse experiences are associated with PMDs in a dose-dependent manner. If confirmed by prospective data, our findings support the importance of early intervention for girls exposed to ACEs to minimize risks of PMDs and other morbidities in adulthood.
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Affiliation(s)
- Qian Yang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, SE-171 77, Stockholm, Sweden. .,Institute of Environmental Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden.
| | - Edda Björk Þórðardóttir
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, IS-101, Reykjavík, Iceland
| | - Arna Hauksdóttir
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, IS-101, Reykjavík, Iceland
| | - Thor Aspelund
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, IS-101, Reykjavík, Iceland
| | - Jóhanna Jakobsdóttir
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, IS-101, Reykjavík, Iceland
| | - Thorhildur Halldorsdottir
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, IS-101, Reykjavík, Iceland.,Department of Psychology, Reykjavik University, IS-101, Reykjavik, Iceland
| | - Gunnar Tomasson
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, IS-101, Reykjavík, Iceland
| | - Harpa Rúnarsdóttir
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, IS-101, Reykjavík, Iceland
| | - Hilda Björk Danielsdottir
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, SE-171 77, Stockholm, Sweden.,Center of Public Health Sciences, Faculty of Medicine, University of Iceland, IS-101, Reykjavík, Iceland
| | - Elizabeth R Bertone-Johnson
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA-01003, USA.,Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA-01003, USA
| | - Arvid Sjölander
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Donghao Lu
- Institute of Environmental Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden. .,Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA-02115, USA.
| | - Unnur Anna Valdimarsdóttir
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, SE-171 77, Stockholm, Sweden.,Center of Public Health Sciences, Faculty of Medicine, University of Iceland, IS-101, Reykjavík, Iceland.,Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA-02115, USA
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12
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Daníelsdóttir HB, Aspelund T, Thordardottir EB, Fall K, Fang F, Tómasson G, Rúnarsdóttir H, Yang Q, Choi KW, Kennedy B, Halldorsdottir T, Lu D, Song H, Jakobsdóttir J, Hauksdóttir A, Valdimarsdóttir UA. Adverse childhood experiences and resilience among adult women: A population-based study. eLife 2022; 11:e71770. [PMID: 35101173 PMCID: PMC8806181 DOI: 10.7554/elife.71770] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 01/18/2022] [Indexed: 02/05/2023] Open
Abstract
Background Adverse childhood experiences (ACEs) have consistently been associated with elevated risk of multiple adverse health outcomes, yet their contribution to coping ability and psychiatric resilience in adulthood is unclear. Methods Cross-sectional data were derived from the ongoing Stress-And-Gene-Analysis cohort, representing 30% of the Icelandic nationwide female population, 18-69 years. Participants in the current study were 26,198 women with data on 13 ACEs measured with the ACE-International Questionnaire. Self-reported coping ability was measured with the Connor-Davidson Resilience Scale and psychiatric resilience was operationalized as absence of psychiatric morbidity. Generalized linear regression assuming normal or Poisson distribution were used to assess the associations of ACEs with coping ability and psychiatric resilience controlling for multiple confounders. Results Number of ACEs was inversely associated with adult resilience in a dose-dependent manner; every 1SD unit increase in ACE scores was associated with both lower levels of coping ability (β = -0.14; 95% CI-0.15,-0.13) and lower psychiatric resilience (β = -0.28; 95% CI-0.29,-0.27) in adulthood. Compared to women with 0 ACEs, women with ≥5 ACEs had 36% lower prevalence of high coping ability (PR = 0.64, 95% CI 0.59,0.70) and 58% lower prevalence of high psychiatric resilience (PR = 0.42; 95% CI 0.39,0.45). Specific ACEs including emotional neglect, bullying, sexual abuse and mental illness of household member were consistently associated with reduced adult resilience. We observed only slightly attenuated associations after controlling for adult socioeconomic factors and social support in adulthood. Conclusions Cumulative ACE exposure is associated with lower adult resilience among women, independent of adult socioeconomic factors and social support, indicating that adult resilience may be largely determined in childhood. Funding This work was supported by the European Research Council (Consolidator grant; UAV, grant number 726413), and the Icelandic Center for Research (Grant of excellence; UAV, grant number 163362-051). HBD was supported by a doctoral grant from the University of Iceland Research Fund.
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Affiliation(s)
- Hilda Björk Daníelsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of IcelandReykjavíkIceland
- Department of Medical Epidemiology & Biostatistics, Karolinska InstitutetStockholmSweden
| | - Thor Aspelund
- Centre of Public Health Sciences, Faculty of Medicine, University of IcelandReykjavíkIceland
| | | | - Katja Fall
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro UniversityÖrebroSweden
- Institute of Environmental Medicine, Karolinska InstitutetStockholmSweden
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska InstitutetStockholmSweden
| | - Gunnar Tómasson
- Centre of Public Health Sciences, Faculty of Medicine, University of IcelandReykjavíkIceland
| | - Harpa Rúnarsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of IcelandReykjavíkIceland
| | - Qian Yang
- Department of Medical Epidemiology & Biostatistics, Karolinska InstitutetStockholmSweden
| | - Karmel W Choi
- Department of Psychiatry, Massachusetts General HospitalBostonUnited States
- Harvard T.H. Chan School of Public HealthBostonUnited States
| | - Beatrice Kennedy
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala UniversityUppsalaSweden
| | - Thorhildur Halldorsdottir
- Centre of Public Health Sciences, Faculty of Medicine, University of IcelandReykjavíkIceland
- Department of Psychology, Reykjavík UniversityReykjavikIceland
| | - Donghao Lu
- Institute of Environmental Medicine, Karolinska InstitutetStockholmSweden
- Harvard T.H. Chan School of Public HealthBostonUnited States
| | - Huan Song
- West China Biomedical Big Data Center, West China Hospital, Sichuan UniversityChengduChina
| | - Jóhanna Jakobsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of IcelandReykjavíkIceland
| | - Arna Hauksdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of IcelandReykjavíkIceland
| | - Unnur Anna Valdimarsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of IcelandReykjavíkIceland
- Department of Medical Epidemiology & Biostatistics, Karolinska InstitutetStockholmSweden
- Harvard T.H. Chan School of Public HealthBostonUnited States
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13
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Gunnarsdóttir J, Swift EM, Jakobsdóttir J, Smárason A, Thorkelsson T, Einarsdóttir K. Cesarean birth, obstetric emergencies, and adverse neonatal outcomes in Iceland during a period of increasing labor induction. Birth 2021; 48:493-500. [PMID: 34132423 DOI: 10.1111/birt.12564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/14/2020] [Accepted: 06/02/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The rate of labor induction has risen steeply throughout the world. This project aimed to estimate changes in the rates of adverse maternal and neonatal outcomes in Iceland between 1997 and 2018, and to assess whether the changes can be explained by an increased rate of labor induction. METHODS Singleton live births, occurring between 1997 and 2018, that did not start by prelabor cesarean, were identified from the Icelandic Medical Birth Register (n = 85 971). Rates of intrapartum cesarean birth (CB), obstetric emergencies, and neonatal outcomes were calculated, and adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) were estimated with log-binomial regression (reference: 1997-2001). Adjustments were made for: (a) maternal characteristics, and (b) labor induction and gestational age. RESULTS The rate of labor induction increased from 13.6% in the period 1997-2001 to 28.1% in the period 2014-2018. The rate of intrapartum CB decreased between the periods of 1997-2001 and 2014-2018 for both primiparous (aRR 0.76, 95% CI: 0.69 to 0.84) and multiparous women (aRR 0.55, 95% CI: 0.49 to 0.63). The rate of obstetric emergencies and adverse neonatal outcomes also decreased between these time periods. Adjusting for labor induction did not attenuate these associations. CONCLUSIONS The rates of adverse maternal outcomes and adverse neonatal outcomes decreased over the study period. However, there was no evidence that this decrease could be explained by the increased rate of labor induction.
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Affiliation(s)
- Jóhanna Gunnarsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Obstetrics and Gynecology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Emma M Swift
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Faculty of Nursing - Department of Midwifery, University of Iceland, Reykjavik, Iceland
| | - Jóhanna Jakobsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Alexander Smárason
- Institution of Health Science Research, University of Akureyri and Akureyri Hospital, Akureyri, Iceland
| | - Thordur Thorkelsson
- Division of Neonatal Intensive Care, Children's Medical Center, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Kristjana Einarsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
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14
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Saevarsdóttir KS, Hilmarsdóttir HÝ, Magnúsdóttir I, Hauksdóttir A, Thordardottir EB, Gudjónsdóttir ÁB, Tomasson G, Rúnarsdóttir H, Jónsdóttir HL, Gudmundsdóttir B, Pétursdóttir G, Petersen PH, Kristinsson SY, Love TJ, Hansdóttir S, Hardardóttir H, Gudmundsson G, Eythorsson E, Gudmundsdóttir DG, Sigbjörnsdóttir H, Haraldsdóttir S, Möller AD, Palsson R, Jakobsdóttir J, Aspelund T, Valdimarsdottir U. Illness severity and risk of mental morbidities among patients recovering from COVID-19: a cross-sectional study in the Icelandic population. BMJ Open 2021; 11:e049967. [PMID: 34301663 PMCID: PMC8313306 DOI: 10.1136/bmjopen-2021-049967] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To test if patients recovering from COVID-19 are at increased risk of mental morbidities and to what extent such risk is exacerbated by illness severity. DESIGN Population-based cross-sectional study. SETTING Iceland. PARTICIPANTS A total of 22 861 individuals were recruited through invitations to existing nationwide cohorts and a social media campaign from 24 April to 22 July 2020, of which 373 were patients recovering from COVID-19. MAIN OUTCOME MEASURES Symptoms of depression (Patient Health Questionnaire), anxiety (General Anxiety Disorder Scale) and posttraumatic stress disorder (PTSD; modified Primary Care PTSD Screen for DSM-5) above screening thresholds. Adjusting for multiple covariates and comorbidities, multivariable Poisson regression was used to assess the association between COVID-19 severity and mental morbidities. RESULTS Compared with individuals without a diagnosis of COVID-19, patients recovering from COVID-19 had increased risk of depression (22.1% vs 16.2%; adjusted relative risk (aRR) 1.48, 95% CI 1.20 to 1.82) and PTSD (19.5% vs 15.6%; aRR 1.38, 95% CI 1.09 to 1.75) but not anxiety (13.1% vs 11.3%; aRR 1.24, 95% CI 0.93 to 1.64). Elevated relative risks were limited to patients recovering from COVID-19 that were 40 years or older and were particularly high among individuals with university education. Among patients recovering from COVID-19, symptoms of depression were particularly common among those in the highest, compared with the lowest tertile of influenza-like symptom burden (47.1% vs 5.8%; aRR 6.42, 95% CI 2.77 to 14.87), among patients confined to bed for 7 days or longer compared with those never confined to bed (33.3% vs 10.9%; aRR 3.67, 95% CI 1.97 to 6.86) and among patients hospitalised for COVID-19 compared with those never admitted to hospital (48.1% vs 19.9%; aRR 2.72, 95% CI 1.67 to 4.44). CONCLUSIONS Severe disease course is associated with increased risk of depression and PTSD among patients recovering from COVID-19.
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Affiliation(s)
- Karen Sól Saevarsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, School of Health Sciences, Reykjavik, Iceland
| | - Hildur Ýr Hilmarsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, School of Health Sciences, Reykjavik, Iceland
| | - Ingibjörg Magnúsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, School of Health Sciences, Reykjavik, Iceland
| | - Arna Hauksdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, School of Health Sciences, Reykjavik, Iceland
| | - Edda Bjork Thordardottir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, School of Health Sciences, Reykjavik, Iceland
| | - Ásdís Braga Gudjónsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, School of Health Sciences, Reykjavik, Iceland
| | - Gunnar Tomasson
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, School of Health Sciences, Reykjavik, Iceland
- Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
| | - Harpa Rúnarsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, School of Health Sciences, Reykjavik, Iceland
| | - Harpa Lind Jónsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, School of Health Sciences, Reykjavik, Iceland
- Faculty of Psychology, University of Iceland School of Health Sciences, Reykjavik, Iceland
| | | | - Gudrún Pétursdóttir
- Institute for Sustainability Studies, University of Iceland, Reykjavik, Iceland
| | - Pétur Henry Petersen
- Faculty of Medicine, University of Iceland School of Health Sciences, Reykjavik, Iceland
| | - Sigurdur Yngvi Kristinsson
- Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland School of Health Sciences, Reykjavik, Iceland
| | - Thorvardur Jon Love
- Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland School of Health Sciences, Reykjavik, Iceland
| | - Sif Hansdóttir
- Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
| | - Hrönn Hardardóttir
- Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
| | - Gunnar Gudmundsson
- Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland School of Health Sciences, Reykjavik, Iceland
| | - Elias Eythorsson
- Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
| | | | | | | | | | - Runolfur Palsson
- Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland School of Health Sciences, Reykjavik, Iceland
| | - Jóhanna Jakobsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, School of Health Sciences, Reykjavik, Iceland
| | - Thor Aspelund
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, School of Health Sciences, Reykjavik, Iceland
- Icelandic Heart Association, Kopavogur, Iceland
| | - Unnur Valdimarsdottir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, School of Health Sciences, Reykjavik, Iceland
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
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15
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Jensen RA, Sim X, Smith AV, Li X, Jakobsdóttir J, Cheng CY, Brody JA, Cotch MF, Mcknight B, Klein R, Wang JJ, Kifley A, Harris TB, Launer LJ, Taylor KD, Klein BEK, Raffel LJ, Li X, Ikram MA, Klaver CC, van der Lee SJ, Mutlu U, Hofman A, Uitterlinden AG, Liu C, Kraja AT, Mitchell P, Gudnason V, Rotter JI, Boerwinkle E, van Duijn CM, Psaty BM, Wong TY. Novel Genetic Loci Associated With Retinal Microvascular Diameter. ACTA ACUST UNITED AC 2015; 9:45-54. [PMID: 26567291 DOI: 10.1161/circgenetics.115.001142] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 11/11/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND There is increasing evidence that retinal microvascular diameters are associated with cardiovascular and cerebrovascular conditions. The shared genetic effects of these associations are currently unknown. The aim of this study was to increase our understanding of the genetic factors that mediate retinal vessel size. METHODS AND RESULTS This study extends previous genome-wide association study results using 24 000+ multiethnic participants from 7 discovery cohorts and 5000+ subjects of European ancestry from 2 replication cohorts. Using the Illumina HumanExome BeadChip, we investigate the association of single-nucleotide polymorphisms and variants collectively across genes with summary measures of retinal vessel diameters, referred to as the central retinal venule equivalent and the central retinal arteriole equivalent. We report 4 new loci associated with central retinal venule equivalent, one of which is also associated with central retinal arteriole equivalent. The 4 single-nucleotide polymorphisms are rs7926971 in TEAD1 (P=3.1×10(-) (11); minor allele frequency=0.43), rs201259422 in TSPAN10 (P=4.4×10(-9); minor allele frequency=0.27), rs5442 in GNB3 (P=7.0×10(-10); minor allele frequency=0.05), and rs1800407 in OCA2 (P=3.4×10(-8); minor allele frequency=0.05). The latter single-nucleotide polymorphism, rs1800407, was also associated with central retinal arteriole equivalent (P=6.5×10(-12)). Results from the gene-based burden tests were null. In phenotype look-ups, single-nucleotide polymorphism rs201255422 was associated with both systolic (P=0.001) and diastolic blood pressures (P=8.3×10(-04)). CONCLUSIONS Our study expands the understanding of genetic factors influencing the size of the retinal microvasculature. These findings may also provide insight into the relationship between retinal and systemic microvascular disease.
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