Does it make sense to do repeated surveys?--the Lundby Study, 1947-1997

OBJECTIVE

To describe the Lundby Study and the difficulties in doing repeated surveys.

METHOD

Best-estimate consensus diagnoses have been used since 1957 together with DSM-IV and ICD-10 in 1997.

RESULTS

The Lundby population consisting of 3563 probands was investigated in 1947, 1957 and 1972. Sufficient information was available for 98-99%. In 1997-2000 a fourth field investigation was carried out. Attrition rate for the interviews was 13% (238/1797). About 36% (1030/2827) had died between 1972 and 1997, but data from registers, case notes and key-informants for the period 1972 and 1997 completed the information for 94% (2659/2827). The population has followed the same pattern of development as many rural populations in Sweden since the 1940s. Multiple sources of information are preferable in longitudinal studies in order to tackle the problem of changing diagnostic systems.

CONCLUSION

Low attrition rates over 50 years and reasonable diagnostic uniformity make comparisons over time justifiable.

The course of alcoholism among men in the Lundby Longitudinal Study, Sweden

OBJECTIVE

The purpose of this study is to describe the course of alcoholism among men in the Lundby community cohort.

METHOD

A subset (N = 41) of initially nonalcoholic male subjects were diagnosed by a psychiatrist as first incidence alcoholics (alcohol abuse and/or dependence) during the period 1957-72, all of whom have been followed through four waves of investigation between 1947 and 1993.

RESULTS

The proportion of remission of the entire 41 former alcoholic subjects was 39%. Of the 23 survivors, 52% were remitted. The recovery started at age 30-39 and culminated at age 40-49.

CONCLUSIONS

In this 40-year follow-up of former alcoholics, stable remissions were shown to occur at a rate of approximately 40% (50% in survivors). Critical variables were severity and the subjects' age at the time of recovery. The results are tentative because of the small number of individuals.

First-incidence anxiety in the Lundby Study: course and predictors of outcome

The aim of the present study was to analyse first-incidence anxiety in the Lundby Study with regard to course and predictors of outcome between 1947 and 1972. The Lundby concept of anxiety corresponds broadly to that of anxiety disorders in DSM-III-R. The Lundby Study is a prospective, psychiatric study of a geographically defined total population. The present study includes 124 subjects (46 men and 78 women) who between 1947 and 1972 developed anxiety as their first mental illness in life. The median total duration of illness was 1.6 years in men and 1.4 years in women. In both sexes episodes of mild impairment dominated. In total, 54% of the men and 71% of the women were mentally healthy at the follow-up in 1972. A minority of the probands (27%) received psychiatric treatment. They significantly more often suffered from panic disorder with agoraphobia during their first episode, and from comorbidity of other mental illnesses, than did untreated subjects. They also had a significantly longer total duration of illness, a variable with a negative predictive influence on the probability of being mentally healthy in 1972. Men with anxiety showed a 55% increase in alcoholism compared to standard values. They also displayed an increased risk of relapsing into mental illness compared to female cases, a result which, in the light of earlier findings of increased mortality rates, suggests that further investigations of men with anxiety syndromes in the general population are warranted.

A 50-year perspective of a family with chromosome-14-linked Alzheimer's disease

A Swedish family with two generations suffering from presenile dementia with an unusually severe Alzheimer encephalopathy was first reported in 1946. The hypothesis that the disease was inherited through a dominant gene is strongly supported by the follow-up 50 years later of three additional generations and molecular genetic findings of a novel presenilin-1 gene mutation in the family. The pedigree contains six cases with well-documented dementia in four consecutive generations. The Alzheimer encephalopathy was unusually severe in the three cases studied post-mortem, with a pronounced involvement of the central grey structures, such as the claustrum, the nuclei around the third ventricle, the central thalamic nuclei and the brain stem. There were no vascular lesions and little amyloid angiopathy. All six affected cases showed the typical temporoparietal symptom pattern and other core symptoms of Alzheimer's disease, such as logoclonia, myoclonic twitchings and major motor seizures. Other predominant features were psychomotor slowness, increased muscular tension, a stiff stooped gait and a rapid loss of weight. The symptom pattern is convincingly explained by the consistent and severe involvement of cortical and central grey structures and is probably linked to the presenilin-1 gene mutation.

Mortality in alcoholism among men in the Lundby Community Cohort, Sweden: a forty-year follow-up

OBJECTIVE

The Lundby Community Cohort has been studied at multiple points in time for more than four decades. The purpose of the present study was to estimate various aspects of mortality among alcoholic men in the cohort.

METHOD

The mortality rate was calculated for a defined subset of 41 originally nonalcoholic men, who were diagnosed as first incidence alcoholics during the period 1957-1972, all of whom were followed-up through four waves of investigation between 1947 and 1993. Certified causes of death were obtained from the Swedish National Bureau of Statistics and complemented with information from relatives and hospital records.

RESULTS

Of the 41 men, 18 (44%) had died by 1993; 27% before age 60. The average age at death was 56.6 years, (age range 25-86 years). The mortality risk for the group calculated as odds ratio was estimated to be 5.6. The most common causes of death were diseases of the circulatory system (9/18 or 50%). Accidents and suicides were also significant causes (8/18 or 44%), especially in age groups 20-59. The results were compared with those of an earlier published 15-year follow-up of another sample of alcoholics in the Lundby population.

CONCLUSIONS

In accordance with the international literature, the study shows a significant reduction in life expectancy for men with alcohol-related disorders compared with matched controls. The data will be used as a basis for forthcoming qualitative analyses of how individual life courses are correlated with alcoholism and heavy drinking.

Mortality of anxiety syndromes in a normal population. The Lundby Study

The mortality of anxiety syndromes between 1972 and 1992 was investigated in a prospective study of a normal population, the 1947 Lundby cohort. 121 persons with anxiety according to the Lundby definition (Anx), and 74 persons with panic disorder with/without agoraphobia (PD-Ag) according to the DSM-III-R, all of them developing their first episode between 1947 and 1972, were analyzed with regard to general mortality and special cause of death. Sex- and age-specific mortality rates for these groups were calculated and compared with the corresponding rates of the cohort's 1,877 remaining subjects without first episodes of Anx/PD-Ag. In contrast to the females, the annual rates of general mortality in males with Anx/PD-Ag were 1.9/2.2 times higher in the age group 65-84 years, compared with the rates of the non-Anx/PD-Ag groups. They also had an increase in death due to circulatory disorders, most pronounced in males with PD-Ag before the age of 65. There were no suicides in any of the Anx/PD-Ag groups during the observation period.

Coping with life span crises in a group at risk of mental and behavioral disorders: from the Lundby study

The subjects belong to a prospective, longitudinal population study on mental health, the Lundby study, performed in 1947, 1957 and 1972. In 1988-1989, 148 individuals, then 42-56 years of age, raised in families with at least 3 risk factors for mental or behavioral disorders, were interviewed about their life span coping style. Twenty-two coping mechanisms were rated; optimism, substitution, wishful thinking, problem-solving, planning, self-reliance, humor, acceptance, resignation, social support, comparison with others, religion, catharsis, self-criticism, value reinforcement, alcohol and drug consumption, professional help, endurance, information-seeking, isolating activity, magic and minimizing. Together they contributed statistically significantly to mental health (explained variance 24%) and quality of life (explained variance 28%). Problem-solving, social support and optimism were frequently used and were statistically associated with positive mental health and lower frequencies of some mental disorders. Sense of coherence, a personal disposition factor, was also statistically associated (explained variance 22%) with the combined coping mechanisms.

Predictors of anxiety in the Lundby study: a prospective study of a normal population during 1947-1972

The aim of the present study was to search for specific premorbid background factors of 'anxiety' in a normal population, the 1947 Lundby cohort. 2,550 probands were repeatedly examined by psychiatrists during a 25-year period, regardless of medical care. The semi-structured examinations included items referring to the proband's mental and physical health, personality, behaviour and socio-economic background. In the present study, only assessments made before the first onset of anxiety were considered. Very strict criteria of 'healthiness' and anxiety regarding the comparison groups were used. Five out of 50 items considered were significantly predictive. The male features share certain similarities with those observed in earlier predictor studies on anxiety and depressive disorders, while the traits found in women seem to predispose for other mental illness as well.

Intelligence and temperament as protective factors for mental health. A cross-sectional and prospective epidemiological study

The Sjöbring system of personality dimensions measuring intellectual capacity, activity, impulsivity and sociability was used to study possible "salutogenic" (i.e. causes of health) effects. The study comprised 590 subjects investigated in 1947, 1957, 1972 and 1988-1989 in the Lundby project, an epidemiological study in Sweden. Psychiatric diagnoses were made in 1947, 1957 and 1972. Mental health was estimated in 1988-1989 using the concept "love well, work well, play well and expect well". The Sjöbring dimensions were clinically assessed in 1972. Both in the concurrent study in 1972 and in the prospective study in 1988-1989 "super capacity" (high intellectual function), "super validity" (high activity level) and "super solidity" (low impulsivity) were statistically associated with lower frequencies of certain psychiatric diagnoses and a higher frequency of positive mental health. These variables are proposed to increase coping capacity, and therefore increase stress resilience.

Salutogenic childhood factors reported by middle-aged individuals. Follow-up of the children from the Lundby study grown up in families experiencing three or more childhood psychiatric risk factors

This study is salutogenic (= causes of health), focusing on factors which corresponded to good mental health in subjects who had been exposed to at least three child psychiatric risk factors when growing up. The material was drawn from a prospective, longitudinal population study on mental health, the Lundby Study, which was performed in three waves in 1947, 1957 and 1972. In 1988/89, 148 individuals then 42-56 years of age, were re-visited and interviewed about their life span experiences. Factors previously found to increase stress resilience in children and adolescents were identified. The personal dispositions during childhood found to be associated with adult positive mental health were childhood positive self-esteem, successful coping, internal locus of control and intellectual capacity. Childhood family factors, such as trusting relations with a parent and shared values, were also important. Antonovsky's sense of coherence model can be used to explain the mechanisms by which the different variables can lead to health through increasing an individual's capacity for comprehensibility, manageability and meaningfulness, the three concepts of sense of coherence.

Mental tiredness in the Lundby study: incidence and course over 25 years

The Lundby study is a prospective, epidemiological survey of mental health in a total population. When evaluating the material of 2550 individuals followed from 1947 to 1972, we found a large group with mental tiredness as the dominating symptom. Next to depression this was the most frequent diagnosis in the population. According to our concept of Tiredness, one third of the women ran a lifetime risk of developing a first-ever episode of Tiredness, while the risk for men was one fifth. The incidence of Tiredness is described together with the total frequency of episodes. The course of mental illness starting with a first episode of Tiredness within the 25-year investigation period shows that about one third of the men and half of the women relapsed into Tiredness or other mental illnesses, not infrequently with a serious outcome. However, most of the episodes of Tiredness lasted less than 2 years and were of milder impairment. We emphasize the importance of further investigations by means of epidemiological, clinical and neurochemical methods as regards the heterogeneous syndrome of mental fatigue.

Anxiety in the Lundby Study: re-evaluation according to DSM-III-R, incidence and risk

This study presents the incidence and risk of Anxiety Disorders according to DSM-III-R in the 1947 Lundby cohort. The figures are based on a re-evaluation of 124 first-ever episodes of 'Anxiety' according to the Lundby definition. Panic Disorders without/with Agoraphobia constituted the largest groups, while a proportionally low rate of Generalized Anxiety Disorder was obtained. The incidence rates per 100 person years in Panic Disorders without Agoraphobia were 0.07 for men and 0.20 for women, the female dominance being statistically significant. Corresponding figures in Panic Disorders with Agoraphobia were 0.04 and 0.07. About 20% fell into other diagnostic categories, the most dominating being Mood and Adjustment Disorders and Hypochondriasis. Comparisons with incidence rates from the ECA and Stirling County studies are made and outlines for further research presented.

Vascular dementia in the Lundby study. 2. An attempt to identify possible risk factors

Vascular dementia represents a group of diseases of great medical and social impact. Its etiology is largely unknown but is most likely multifactorial. Factors related to the brain circulation are involved. The aim of the present study was to find out if personality and social background factors might have a clear precipitating or protective value. This study comprises a total population of 2,612 individuals from a geographically delimited area, Lundby, in southern Sweden. In 1957, Hagnell personally examined 99% of the population. A follow-up study of the same individuals, irrespective of domicile, was performed 15 years later. No social background factors proved to be relevant in this study. Personality factors, including psychosomatic reactions, did, however, demonstrate a highly predictive influence on the risk of developing vascular dementia.

Premorbid personality traits and psychosomatic background factors in depression: the Lundby Study 1957-1972

The search for specific predepressive personality factors has a long tradition in psychiatry. Studies in which assessments were made prospectively, before the onset of a first-ever episode of the illness, are, however, rare. In the present report from the Lundby Study we have investigated premorbid, mainly personality-related background factors for first incidences of depressive disorder, diagnosed according to the Lundby criteria for 'Depression proper' and 'Depression plus other psychiatric symptoms'. The items found to be of a predictive value differed between the two diagnostic subgroups and also between men and women. The findings are discussed and compared with earlier predictor studies on depression.

Vascular dementia in the Lundby study. 1. A prospective, epidemiological study of incidence and risk from 1957 to 1972

In this study, a total population, the 1957 Lundby cohort, was investigated with regard to the incidence of vascular dementia over a 15-year period, and to provide a succeeding study with basic data concerning the background factors for vascular dementia. The 1957 cohort comprises 2,612 persons who were registered in the geographically delimited Lundby area on July 1, 1957. The lifetime risk of developing vascular dementia was found to be 34.5% in men and 19.4% in women when all degrees of impairment were taken into account, the preponderance for the male sex being very obvious.

Incidence of dementia in the Lundby Study

The incidences of senile dementia of Alzheimer type (SDAT) and multi-infarction dementia (MID) were studied in a total Swedish population, the Lundby project. The study is prospective and covers a 25-year period. The incidence rates per year of contracting SDAT or MID and the probability in each 10-year age interval of contracting dementia in the elderly were calculated, as well as the cumulative risk up to a certain age. The lifetime risk of contracting SDAT was for men 25.5% and for women 31.9%. The corresponding figures for MID were 29.8 and 25.1%.

Senile dementia of the Alzheimer type in the Lundby Study. II. An attempt to identify possible risk factors

In recent years research on senile dementia of the Alzheimer type (SDAT) has made progress within the field of pathology and to a certain extent in that of heredity. Within epidemiology, the search for risk factors is intensifying but the findings are still inconclusive. The present study of possible risk factors concentrates on environmental and personality factors. The total population of 2612 persons from a geographically delimited area, Lundby, two neighbouring parishes in southern Sweden, was examined in 1957 by one psychiatrist (Hagnell). A follow-up study of the same population, irrespective of domicile, was performed 15 years later, in 1972. Various precipitating as well as protective personality background factors were found to be significant for the outcome of SDAT, but no environmental factors appeared to be statistically significant in this cohort.

The prevalence of vascular dementia in Europe: facts and fragments from 1980-1990 studies. EURODEM-Prevalence Research Group

We selected, reanalyzed, and compared data from current prevalence studies of vascular dementia in Europe. Inclusion criteria were: dementia defined by the Diagnostic and Statistical Manual for Mental Disorders, edition 3, or equivalent criteria; case finding through direct individual examination; appropriate sample size; and inclusion of institutionalized persons. Mixed dementia was combined with vascular dementia. Of the 23 surveys of dementia considered, five fulfilled the inclusion criteria. Age-specific prevalence varied more widely for men than for women; differences were greater in older ages. The prevalence increased steeply with advancing age in all countries, and was generally higher in men; it declined over 15 years in the age class of 80 to 89 years in one Swedish population. Within populations, Alzheimer's disease was generally more common than vascular dementia. Unfortunately, prevalence studies of vascular dementia are limited in Europe and worldwide, and their comparison is impeded by the lack of common diagnostic criteria.

Frequency and distribution of Alzheimer's disease in Europe: a collaborative study of 1980-1990 prevalence findings. The EURODEM-Prevalence Research Group

We reanalyzed and compared current prevalence estimates of Alzheimer's disease in Europe. Studies characterized as follows qualified for comparison: dementia defined by the Diagnostic and Statistical Manual for Mental Disorders, 3rd edition, or equivalent criteria; Alzheimer's disease diagnosed by the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association or equivalent criteria; case-finding through direct individual examination; appropriate sample size; and inclusion of institutionalized persons. Of the 23 European surveys of dementia considered, six fulfilled the inclusion criteria. When age and sex were considered, there were no major geographic differences in the prevalence of Alzheimer's disease across Europe. Overall European prevalence (per 100 population) for the age groups 30 to 59, 60 to 69, 70 to 79, and 80 to 89 years was, respectively, 0.02, 0.3, 3.2, and 10.8. Prevalence increased exponentially with advancing age and, in some populations, was consistently higher in women. Prevalence remained stable over 15 years in one study.

The prevalence of dementia in Europe: a collaborative study of 1980-1990 findings. Eurodem Prevalence Research Group

To obtain age- and gender-specific estimates of the prevalence of dementia in Europe and to study differences in prevalence across countries, we pooled and re-analysed original data of prevalence studies of dementia carried out in some European countries between 1980 and 1990. The study followed these steps: census of existing datasets, collection of data in a standardized format, selection of datasets suitable for comparison, comparison of age and gender patterns. From the 23 datasets of European surveys considered, 12 were selected for comparison. Only population-based studies in which dementia was defined by DSM-III or equivalent criteria and in which all subjects were examined personally were included. Studies in which institutionalized subjects were not investigated were excluded. Age- and gender-specific prevalences were compared within and across studies and overall prevalences were computed. Although prevalence estimates differed across studies, the general age- and gender-distribution was similar for all studies. The overall European prevalences for the five-year age groups from 60 to 94 years, were 1.0, 1.4, 4.1, 5.7, 13.0, 21.6 and 32.2%, respectively. In subjects under 75 years the prevalence of dementia was slightly higher in men than in women; in those aged 75 years or over the prevalence was higher in women. The prevalence figures nearly doubled with every five years of increase in age.

Senile dementia of the Alzheimer type in the Lundby Study. I. A prospective, epidemiological study of incidence and risk during the 15 years 1957-1972

In spite of the great impact of senile dementia of the Alzheimer type (SDAT) on society, far too little is known about its epidemiology. In this study of a total, normal population from a geographically delimited area in Sweden, Lundby, 2612 persons were examined in 1957 by one psychiatrist (Hagnell). In 1972 the same population was reexamined irrespective of domicile. The incidence and risk of contracting SDAT during the 15 years were calculated. No cases of SDAT were diagnosed before the age of 60 years. The lifetime risk was for men 25.7% and for women 26.2%. When only the very severely impaired were taken into account, the figures were 14.5% in men and 14.6% in women.

Childhood vulnerability and adult invincibility

This study is salutogenic, focusing on the people who cope successfully with the handicapping background of a high-risk childhood. Of those aged 0-15 in 1947 in a total population survey of 2 Swedish parishes, 221 persons with 3 or more childhood psychiatric risk factors were identified. Personal interviews were conducted with 148 of them in 1988-1989. Four measures were used: the Sense of Coherence Scale, the Symptom Distress Checklist, the Quality of Life Scale, and a qualitative overall measure of health status using all interview material. Data analysis focuses on stressing the considerable proportion who managed to overcome their handicapped backgrounds. The sense of coherence is proposed as a powerful explanatory variable in such success.

A prospective study of first-incidence depression. The Lundby study, 1957-72

The present study is based on the so-called 1957 Lundby cohort, a geographically defined normal Swedish population of 2612 individuals who were evaluated for mental disorders in 1957 and 1972. The annual age-standardised first incidence of depression, with or without other psychiatric symptoms, all degrees of impairment included, was found to be 4.3 per 1000 person years in men and 7.6 per 1000 person years in women. Up until 70 years of age, the cumulative probability of suffering a first episode of depression was 27% in men and 45% in women.

Epidemiology of cycloid psychosis

The incidence and risk of cycloid psychosis were investigated in the 1947 cohort of the Lundby Study. No male cases were found. For women the incidence rate (per 100 observation years) was 0.016%. The cumulative probability, i.e. risk up to 60 years of age, was 0.7%. These figures are about half of those for schizophrenia in women in the same population. It is concluded that cycloid psychosis constitutes a substantial part of psychotic disorders among women.

Incidence of anxiety in the Lundby Study: changes over time during a quarter of a century

2,550 persons from a geographically delimited area in Sweden were examined and described by a team of 4 psychiatrists in 1947. Mental disorders, personality traits, social factors etc. were recorded for all but 1% of the population. Irrespective of domicile the same persons were examined in the same way first 10, then another 15 years later. The incidence of 'Anxiety' up to 60 years of age was 9.9% in men and 19.7% in women. The majority of both sexes had their first episode as young adults or in the younger middle age (30-39 years). Among men with a 'severe and medium' impairment, the cumulative probability of disease was higher in the 15-year period 1957-1972 than in the 10-year period 1947-1957.

Epidemiology of cycloid psychosis. A prospective longitudinal study of incidence and risk in the 1947 cohort of the Lundby Study

The objective of the present study on cycloid psychosis was to describe the incidence and risk in a defined population sample. We therefore re-evaluated specific diagnostic groups in the 1947 cohort of the Lundby Study. Three female cases were identified as cycloid psychosis according to the diagnostic criteria of Leonhard, Perris and Brockington. No men were found. The incidence rate (per 100 observation years) was found to be 0.016% for women. The cumulative probability i.e. risk, up to 60 years of age was calculated to be 0.7%. Incidence rate and risk for cycloid psychosis in women was thus about half of the corresponding values for schizophrenia as described for the same population in a parallel study. We conclude that cases of cycloid psychosis constitute a substantial proportion of female psychotic patients.

Predictors of alcoholism in the Lundby Study. II. Personality traits as risk factors for alcoholism

In 1957 all inhabitants (2,612) in a delimited geographical area, Lundby, were examined by a psychiatrist. Personality traits were scored for each individual. During the following 15 years 58 men became alcoholics (44 who had been 15 years or over in 1957). Among the men who in 1957 were scored 'subsolid in combination with symptom neurosis' the risk of becoming an alcoholic was increased 13.5 to 15.8 times. Protective against alcoholism was 'subvalidity in combination with psychosomatic symptoms'. The men with this combination had their risk decreased 12 times. The prediction of alcoholism depended on which factors and which combinations were used. With a sensitivity of 50% a specificity of almost 90% was reached; with a sensitivity of 60% specificities between 70% and 80% were reached.

Predictors of alcoholism in the Lundby Study. I. Material and methods

In this prospective longitudinal study over 15 years (1957 to 1972) the background factors for those who became alcoholics and those who did not were registered before anybody knew what the outcome would be. The population (2,612 inhabitants) lived in 1957 in a delimited area in the South of Sweden, Lundby. In 1957 nearby everyone (98%) was examined by a single psychiatrist, and again in 1972, irrespective of domicile, by two psychiatrists. Among the men who at the outset did not misuse alcohol, 58 became alcoholics. These alcoholics were compared with the non-alcoholics regarding e.g. personality traits, social factors and interactions between factors.

Predictors of alcoholism in the Lundby Study. III. Social risk factors for alcoholism

In 1957 all inhabitants (2,612) in a delimited geographical area, Lundby, were examined by a psychiatrist, and social factors were evaluated for each individual. During the following 15 years 58 men became alcoholics. Among the men who in 1957 were in the age group 0-14 years and belonged to a 'gang', the risk of becoming an alcoholic was 100-fold increased. 'Gang' was also an important factor in the age group 15-24 years. 'Crisis' was an important factor among those over 14, and 'disintegrated environment' in the age group 25-59 years. In the latter age group occupations such as 'entrepreneur', became important as a precipitating factor. 'Married' was the only protective factor found.

Prevalence and incidence of senile and multi-infarct dementia in the Lundby Study: a comparison between the time periods 1947-1957 and 1957-1972

In a recent Lundby paper, based on the original 1947 Lundby cohort [Hagnell et al., 1983], we reported a diminishing trend in the incidence of both senile and multi-infarct dementia from the first period of study 1947-1957 to the second, 1957-1972. In the present study we use the total Lundby population, including those who entered the Lundby project in 1957, as a basis for our calculations. The findings indicate no statistically significant changes in the prevalence and incidence of senile and multi-infarct dementia during the observation period 1947-1972.

Mortality and age psychosis in the Lundby Study: death risk of senile and multi-infarct dementia. Changes over time in a prospective study of a total population followed over 25 or 15 years

Persons suffering from age psychosis are known to have a high mortality rate. During the last decades there has been a general improvement in the standard of living and the availability of medical resources for the elderly in most western countries. It has been suggested that persons with a diagnosis of age psychosis have benefited from these changes and live longer with their illness than they did before. The Lundby cohort comprises 3,563 persons from a total population followed concerning mental disorders (psychiatrically treated as well as untreated) for 15 or 25 years. In the present Lundby Study we have calculated the changes over time concerning death risk among persons with senile and multi-infarct dementia and overmortality associated with these two main subgroups of age psychosis. We found that the prognosis in terms of mortality had not undergone any statistically significant change during the 25-year period 1947-1972 among persons in the Lundby cohort with a diagnosis of senile and multi-infarct dementia.

Prevalence of age psychosis and mortality among age psychotics in the Lundby Study. Changes over time during a 25-year observation period

It has been suggested that persons suffering from age psychosis have benefited from social and medical improvement in the society so that they live longer with their illness than they did before. The Lundby cohort comprises 3,563 persons from a total population, followed concerning mental disorders for 15 or 25 years. In the present study we have investigated the changes over time concerning prevalence of age psychosis and mortality among age psychotics in the Lundby Study during the 25-year observation period. When the first 10-year period was compared with the second 15-year period, the figures for average prevalence of age psychosis and death risk associated with a diagnosis of age psychosis had generally decreased in both sexes, but the differences found between the two time periods did not reach statistical significance. A significantly lower mortality during the second time period was found among mentally healthy women.

Current trends in the incidence of senile and multi-infarct dementia. A prospective study of a total population followed over 25 years; the Lundby Study

Organic brain syndromes among the elderly have been studied prospectively in a total population during the 25-year period 1947-1972. The population (2,550 persons) originates from a geographically delimited area in southern Sweden (Lundby). The original population has been followed for 25 years irrespective of domicile. A comparison of incidences for the first 10-year period (1947-1957) and the second 15-year period (1957-1972) shows a decrease in organic brain syndromes in the population concerning multi-infarct as well as senile dementias.

Mortality and hidden mental disorder in the Lundby Study. Age-standardized death rates among mentally ill 'non-patients' in a total population observed during a 25-year period

In the Lundby Study, all mental illnesses, treated as well as untreated, that occurred during a 25-year period in a geographically defined Swedish general population sample were evaluated. All forms of psychiatric services used by the population during the same period were registered. The present study investigates the mortality pattern of mentally ill persons who did not receive psychiatric specialist treatment. Men with a 'hidden' mental disorder showed a significantly increased mortality from non-violet causes (p less than 0.001). The relative somatic death risk in this group was even slightly higher than that found among mentally ill men who had received psychiatric specialist care. The somatic overmortality found among women with a hidden mental disorder did not reach statistical significance, while mentally ill women who had been treated showed a significant excess mortality from natural causes (p less than 0.05). The total number of violet deaths was small and calculations on violet death risks were performed only for men. Among men with a hidden mental disorder the age-standardized violent death risk was twice that of the total male population, but the increase did not reach statistical significance. Men with a treated mental disorder showed a significant over-mortality from violent causes (p less than 0.001).

Mortality psychiatric specialist care in the Lundby study. Age-standardized death rates in different forms of psychiatric services in a total population investigated during a 25-year period

In the present study a general population cohort of 3,563 persons has been observed concerning psychiatric attendance during a 25-year period, and the mortality experience among patients of different levels of psychiatric care has been studied. The relative overall death risk compared with that of the total Lundby population was found to be 1.9 in men and 1.5 in women with a background of any kind of psychiatric contact. Among former or present inpatients at mental hospitals the overall mortality rate in both sexes was about twice as high as that found in the total population. In men who had been inpatients at psychiatric departments the relative death risk from all causes of death was 4.8, whereas the corresponding risks among men and women who had only come into contact with psychiatric services as outpatients were 1.3 and 1.1, respectively. The relative violent death risk in men with a psychiatric contact was 4.6 compared with the total male population.

Incidence of alcoholism among men in the Lundby community cohort Sweden, 1957-1972. Probabilistic baseline calculations

The annual age-standardized incidence rate of alcohol dependence among men in the Lundby community cohort prospectively observed during 1957-1972 (N = 2550) was 130 per 100,000 (including "alcohol abuse," 300 per 100,000). The individual expectancy of developing alcohol dependence in a lifetime was 8.6% (including "alcohol abuse," 19.3%). Of the cumulative probability, 78% was manifested by those under 40 years of age.

Are we entering an age of melancholy? Depressive illnesses in a prospective epidemiological study over 25 years: the Lundby Study, Sweden

The Lundby cohort consists of all inhabitants in a delimited area in Sweden studied in 1947 by Essen-Möller, then by Hagnell in 1957, and by Hagnell & Ojesjö in 1975. It has been claimed that depressive disorders have increased during the sixties and seventies. In order to examine this hypothesis on a normal population (the Lundby Study), comparisons were made of the incidence figures for depression during the periods 1947-57 and 1957-72, and during the five 5-year intervals within the period.

Mortality in the Lundby study. Natural death in different forms of mental disorder in a total population investigated during a 25-year period

There is an increased mortality among persons who are or who have been under psychiatric care. In any normal population many individuals suffer from mental disorders without coming into contact with psychiatric services, and our knowledge of the mortality pattern of these groups is limited. The Lundby cohort comprises 3,563 persons from a total population, followed concerning mental disorders during 15 and 25 years. In the present study we have investigated the mortality from nonviolent, natural causes among persons in the Lundby cohort with a history of mental disorders, irrespective of contact with psychiatrists or other physicians. The relative death rate from natural causes compared with the standard population was found to be 1.5 among men and 1.2 among women with backgrounds of mental disorders. Neurotics had no excess mortality in this study.

Violent death and mental disorders in the Lundby Study. Accidents and suicides in a total population during a 25-year period

The purpose of the present study was to investigate the association between mental disorders and death from suicide and accident. The violent death group was drawn from a prospective psychiatric cohort study of 3,563 persons followed during 25 years (the Lundby Study). The deceased persons in the cohort had all been examined by psychiatrists on one or two occasions during their lives. Among men with a background of mental disorders, the age-standardized suicide rate was found to be about 4 times higher and the age-standardized accident rate about 2 1/2 times higher than that of the standard male population. When the immediate circumstances around the unnatural deaths were studied, mental as well as somatic disorders were found to have been present at the time of death in a high proportion of the cases. Neoplasms were found in 3 of the 28 suicide persons.

Suicide and depression in the male part of the Lundby study. Changes over time during a 25-year observation period

In the Lundby study, 3,563 persons from a geographically delimited area in Sweden have been examined by psychiatrists on repeated occasions during a 25-year period. Mental disorders, personality traits, social factors, etc., have been recorded. Great efforts have been made to get sufficient outside information about the living as well as the deceased. During the observation period 28 persons, 23 men and 5 women, committed suicide. More than half of the suicide individuals had had a depressive disorder. The male part of the cohort has been studied concerning changes over time of prevalence of depression and age standardized rates of completed suicide. When the first 10-year period 1947-1957 was compared with the last 15-year period 1957-1972, the prevalence of depression was found to have increased over time, while the suicide rates had decreased among men in the Lundby cohort.

Does the incidence of age psychosis decrease? A prospective, longitudinal study of a complete population investigated during the 25-year period 1947-1972: the Lundby study

2,550 persons from a geographically delimited area in Sweden were examined and described by a team of 4 psychiatrists in 1947. Mental disorders, personality traits, social factors, etc. were recorded for all but 1% of the population. 10 and 25 years later the same persons were examined in the same way irrespective of domicile. Great efforts were made to get sufficient outside information about the living as well as the deceased persons. The incidence of age psychoses was lower in the 15-year period 1957-1972 than in the 10-year period 1947-1957.

Suicide rates in the Lundby study: mental illness as a risk factor for suicide

In the present investigation we have used a longitudinal psychiatric-epidemiological study of 3,563 persons who, at a certain date 1947 or 1957, were registered in a geographically well-defined area in Sweden, "Lundby". This population has been observed and psychiatrically evaluated for 25 and 15 years, respectively. During the observation period 23 men and 5 women committed suicide. In the total Lundby cohort the age-standardized male suicide rate was 51 per 100,000 person years. The corresponding rate in men without a psychiatric diagnosis was 8.3, among men who had suffered some kind of psychiatric disorder other than depression 83, and among men with depression 650. The study thus indicates that mental illness, especially depressive disorder, implies a considerably increased risk.

Prevalence of male alcoholism in a cohort observed for 25 years

The purpose of this work was to establish the age-specific prevalence rates of alcoholism syndromes in a cohort defined 25 years ago. Information has been collected by psychiatrists through free, exploratory field interviews subsequently checked against documentary records. Alcoholism was medically defined in three categories (abusers, addicts, and chronics). Drinking symptomatology active within the last year was estimated for 97.6% of the 952 men alive at the cross-section date July 1, 1972. Only three women were diagnosed as current alcoholics (0.3%) and women were excluded from the analyses. The prevalence of alcoholism among men was 9.5% (abuse 3.3%, addiction 2.8%, chronic alcoholism 3.4%). Type and severity of alcoholism were found to have different patterns for different age groups. The number of persons with the more severe forms had increased between 1957 and 1972, most apparent chronic alcoholism in age group 50-59 (from 1.1% to 6.8%). The longitudinal dynamic will be the object of special analyses.

Suicide in the Lundby study: a controlled prospective investigation of stressful life events

The purpose of the present study was to investigate the role played by stressful life events in completed suicide and to find out to what extent similar experiences occur at corresponding periods of life among persons, who do not commit suicide. The suicide group was drawn from a prospective psychiatric cohort study of 3,563 persons, followed during 25 years (The Lundby Study). The suicide persons had all been examined by psychiatrists on one or two occasions at a 'normal' period of their lives. Two control groups from the same population were used: one age- and sex-matched normal group, one sex-matched group of deceased persons, who had died of nonviolent causes at the same ages as the corresponding suicide persons. Acute psychiatric illness was the most prominent factor immediately preceding the suicide. 26 out of the total of 28 suicide persons were considered psychiatrically ill at time of suicide. More suicide persons that controls had experienced undesirable events such as: blow to the self-esteem; object loss; problems at work; sickness reporting, and moving of house. The findings suggest that persons, who finally commit suicide have received more than their due share of the hardships of life. Medical prophylactic measures such as crises intervention and awareness of the diagnosis of depression are discussed.

Suicide in the Lundby study: a comparative investigation of clinical aspects

28 cases of suicide committed in a Swedish population subjected to repeated psychiatric investigations are described. Two groups of controls were selected from the same population: sex- and age-matched living persons (normal group) and sex-matched persons who had died from organic disease at ages corresponding to those at which the individuals in the suicide group had taken their lives (deceased group). The three groups were compared concerning clinical circumstances regarded to have been of importance for the final suicidal act. Interest was focused on events that had occurred during the year prior to suicide. Psychiatric disorders were diagnosed in 93% of the suicide group, in 60% of the deceased group, and in 32% of the normal group. Depression was the main diagnosis (50%) in the suicide group, organic brain syndrome in decreased and normals. Medical advice was sought more often (75%) by the suicide group than by normal controls (34%) and about equally often as by the deceased control (84%). 10 of the suicide persons with depressive illness had never seen a psychiatrist.

Suicide and endogenous depression with somatic symptoms in the Lundby study

The purpose of the study was to elucidate the role played by the so-called masked or somatic depressions in suicide. The records of 28 suicide persons were analyzed concerning depressive symptoms at time of death. The suicide group was drawn from a prospective longitudinal cohort study of 3,563 persons which began in 1947 (the Lunbdy Project) and was followed up during 25 years. All persons had been examined once or twice before the suicide. 14 were considered to have suffered from depression. Irrespective of any reactive factor, most of the depressive persons had symptoms of endogenous type. In 19 out of the 14 persons with depression the clinical picture included also somatic symptoms. The persons with depression had often sought medical advice, though mostly not psychiatrists'. Many of them had been difficult to treat and had shown negativism to medical care. An important suicide prophylactic measure would be to enhance the awareness of hospital clinicians and practitioners of the existence, diagnosis and treatment of endogenous depression.