Mette Reilev, Jacob Harbo Andersen, Mikkel Højlund, Elsebeth Stenager, Lotte Rasmussen, Erik Christiansen
Introduction
Changes in psychotropic drug use relative to suicidal behavior could potentially inform the timing of preventive efforts. We aimed to describe the initiation and discontinuation of psychotropic drugs relative to suicide and suicide attempts.
Methods
The Danish registries were used to describe incidents and prevalent use of psychotropic drugs 2 years before and after a suicide attempt and before suicide. Discontinuation of psychotropic drugs in the 6-month period prior to suicide and suicide attempts was estimated. Analyses were stratified by drug groups, sex, and age.
Results
Among 5.8 million Danish citizens(2021), 6374 died by suicide, and 29,332 had a first-ever suicide attempt from 2010 to 2021. Use of psychotropic drugs increased markedly in the 6 months prior to suicide and suicide attempt, e.g., up to 18 incident drug redemptions and 92 prevalent drug redemptions per 100 persons in the month before suicide. The highest rates of both incident and prevalent drug redemptions were observed immediately after the suicide attempt. Psychotropic drug use was generally lower among men. Immediately after the suicide attempt, however, men exhibited a slightly higher level of incident use than women. Ten percent discontinued psychotropic drugs completely in the 6-month period before suicide, while 48% discontinued drugs used in alcohol abuse.
Conclusion
We found a marked increase in psychotropic drug use before suicide and before and after attempted suicide. Complete pre-attempt discontinuation of psychotropic drugs was low, though approximately half discontinued drugs used for alcohol abuse. The process of prescribing psychotropic drugs may represent an opportunity for prevention.
{"title":"Initiation and Discontinuation of Psychotropic Drugs Relative to Suicidal Behavior: A Danish Registry-Based Study","authors":"Mette Reilev, Jacob Harbo Andersen, Mikkel Højlund, Elsebeth Stenager, Lotte Rasmussen, Erik Christiansen","doi":"10.1111/acps.13792","DOIUrl":"10.1111/acps.13792","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Changes in psychotropic drug use relative to suicidal behavior could potentially inform the timing of preventive efforts. We aimed to describe the initiation and discontinuation of psychotropic drugs relative to suicide and suicide attempts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The Danish registries were used to describe incidents and prevalent use of psychotropic drugs 2 years before and after a suicide attempt and before suicide. Discontinuation of psychotropic drugs in the 6-month period prior to suicide and suicide attempts was estimated. Analyses were stratified by drug groups, sex, and age.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 5.8 million Danish citizens(2021), 6374 died by suicide, and 29,332 had a first-ever suicide attempt from 2010 to 2021. Use of psychotropic drugs increased markedly in the 6 months prior to suicide and suicide attempt, e.g., up to 18 incident drug redemptions and 92 prevalent drug redemptions per 100 persons in the month before suicide. The highest rates of both incident and prevalent drug redemptions were observed immediately after the suicide attempt. Psychotropic drug use was generally lower among men. Immediately after the suicide attempt, however, men exhibited a slightly higher level of incident use than women. Ten percent discontinued psychotropic drugs completely in the 6-month period before suicide, while 48% discontinued drugs used in alcohol abuse.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We found a marked increase in psychotropic drug use before suicide and before and after attempted suicide. Complete pre-attempt discontinuation of psychotropic drugs was low, though approximately half discontinued drugs used for alcohol abuse. The process of prescribing psychotropic drugs may represent an opportunity for prevention.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 6","pages":"698-708"},"PeriodicalIF":5.3,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13792","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143497731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kamilla W. Miskowiak, Julian Macoveanu, Brice Ozenne, Emily E. Beaman, Vibeke H. Dam, Patrick M. Fisher, Gitte M. Knudsen, Lars V. Kessing, Martin B. Jørgensen, Vibe G. Frokjaer, Anjali Sankar
Introduction
Patients with mood disorders, especially, major depressive disorder (MDD) and bipolar disorder (BD), are at heightened risk of relapse and psychiatric rehospitalizations. Therefore, there is an urgent need to identify modifiable biomarkers to inform personalized and intensified prevention strategies for those at the greatest risk of relapse and hospital readmissions. Brain structural measures subserving cognitive function hold particular promise among potential predictive biomarkers.
Methods
In the present study, structural magnetic resonance imaging scans were obtained from 319 patients with BD (n = 241) or MDD (n = 78). [Correction added on 7 March 2025, after first online publication: In the preceding sentence, ‘MDD (n=241) or BD (n=78)’ has been changed to ‘BD (n=241) or MDD (n=78)’.] Longitudinal data on psychiatric hospitalization for up to 10 years were available from the Danish National population-based registers. Interhemispheric hippocampal asymmetry, a putative marker of cognitive function and brain reserve, was calculated for each patient. The association between hippocampal asymmetry and future psychiatric hospitalization was assessed using a cause-specific Cox regression model. Exploratory analyses, also using a cause-specific Cox model, assessed the association of prefrontal and hippocampal gray matter volume and whole-brain white matter volume with hospitalizations.
Results
The results indicated a negative association between rightward hippocampal asymmetry (i.e., left<right) and risk of future hospitalizations (HR = 0.90, corresponding to a 10-year risk reduction of 0.018 for a 1% increase in asymmetry, p = 0.040). Exploratory analysis indicated that a larger right hippocampus volume was associated with a reduced risk of hospitalization (HR = 0.18, p = 0.004) while a larger bilateral dorsolateral prefrontal volume (HR = 1.06, p = 0.01) was associated with an increased risk of hospitalization.
Conclusion
The findings suggest a role for hippocampal and, additionally, prefrontal morphological features in the risk of future psychiatric hospitalizations in mood disorders.
{"title":"Relation Between Brain Morphological Features and Psychiatric Hospitalization Risk in Major Depressive and Bipolar Disorders","authors":"Kamilla W. Miskowiak, Julian Macoveanu, Brice Ozenne, Emily E. Beaman, Vibeke H. Dam, Patrick M. Fisher, Gitte M. Knudsen, Lars V. Kessing, Martin B. Jørgensen, Vibe G. Frokjaer, Anjali Sankar","doi":"10.1111/acps.13790","DOIUrl":"10.1111/acps.13790","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Patients with mood disorders, especially, major depressive disorder (MDD) and bipolar disorder (BD), are at heightened risk of relapse and psychiatric rehospitalizations. Therefore, there is an urgent need to identify modifiable biomarkers to inform personalized and intensified prevention strategies for those at the greatest risk of relapse and hospital readmissions. Brain structural measures subserving cognitive function hold particular promise among potential predictive biomarkers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In the present study, structural magnetic resonance imaging scans were obtained from 319 patients with BD (<i>n</i> = 241) or MDD (<i>n</i> = 78). [Correction added on 7 March 2025, after first online publication: In the preceding sentence, ‘MDD (n=241) or BD (n=78)’ has been changed to ‘BD (n=241) or MDD (n=78)’.] Longitudinal data on psychiatric hospitalization for up to 10 years were available from the Danish National population-based registers. Interhemispheric hippocampal asymmetry, a putative marker of cognitive function and brain reserve, was calculated for each patient. The association between hippocampal asymmetry and future psychiatric hospitalization was assessed using a cause-specific Cox regression model. Exploratory analyses, also using a cause-specific Cox model, assessed the association of prefrontal and hippocampal gray matter volume and whole-brain white matter volume with hospitalizations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The results indicated a negative association between rightward hippocampal asymmetry (i.e., left<right) and risk of future hospitalizations (HR = 0.90, corresponding to a 10-year risk reduction of 0.018 for a 1% increase in asymmetry, <i>p</i> = 0.040). Exploratory analysis indicated that a larger right hippocampus volume was associated with a reduced risk of hospitalization (HR = 0.18, <i>p</i> = 0.004) while a larger bilateral dorsolateral prefrontal volume (HR = 1.06, <i>p</i> = 0.01) was associated with an increased risk of hospitalization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The findings suggest a role for hippocampal and, additionally, prefrontal morphological features in the risk of future psychiatric hospitalizations in mood disorders.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 6","pages":"689-697"},"PeriodicalIF":5.3,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13790","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143466470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Erik Perfalk, Martin Bernstorff, Andreas Aalkjær Danielsen, Søren Dinesen Østergaard
Background
Clinical decision support systems based on machine learning (ML) models are emerging within psychiatry. To ensure their successful implementation, healthcare staff needs to trust these systems. Here, we investigated if providing staff with basic information about ML-based clinical decision support systems enhances their trust in them.
Methods
We conducted a randomised survey experiment among staff in the Psychiatric Services of the Central Denmark Region. The participants were allocated to one of three arms, receiving different types of information: An intervention arm (receiving information on clinical decision-making supported by an ML model); an active control arm (receiving information on standard clinical decision process without ML support); and a blank control arm (no information). Subsequently, participants responded to various questions regarding their trust/distrust in ML-based clinical decision support systems. The effect of the intervention was assessed by pairwise comparisons between all randomization arms on sum scores of trust and distrust.
Results
Among 2838 invitees, 780 completed the survey experiment. The intervention enhanced trust and diminished distrust in ML-based clinical decision support systems compared with the active control arm (Trust: mean difference = 5% [95% confidence interval (CI): 2%; 9%], p value < 0.001; Distrust: mean difference = −4% [−7%; −1%], p value = 0.042) and the blank control arm (Trust: mean difference = 5% [2%; 11%], p value = 0.003; Distrust: mean difference = −3% [−6%; −1%], p value = 0.021).
Conclusion
Providing information on ML-based clinical decision support systems in hospital psychiatry may increase healthcare staff trust in such systems.
{"title":"Receiving Information on Machine Learning-Based Clinical Decision Support Systems in Psychiatric Services Increases Staff Trust in These Systems: A Randomized Survey Experiment","authors":"Erik Perfalk, Martin Bernstorff, Andreas Aalkjær Danielsen, Søren Dinesen Østergaard","doi":"10.1111/acps.13791","DOIUrl":"10.1111/acps.13791","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Clinical decision support systems based on machine learning (ML) models are emerging within psychiatry. To ensure their successful implementation, healthcare staff needs to trust these systems. Here, we investigated if providing staff with basic information about ML-based clinical decision support systems enhances their trust in them.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a randomised survey experiment among staff in the Psychiatric Services of the Central Denmark Region. The participants were allocated to one of three arms, receiving different types of information: An intervention arm (receiving information on clinical decision-making supported by an ML model); an active control arm (receiving information on standard clinical decision process without ML support); and a blank control arm (no information). Subsequently, participants responded to various questions regarding their trust/distrust in ML-based clinical decision support systems. The effect of the intervention was assessed by pairwise comparisons between all randomization arms on sum scores of trust and distrust.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 2838 invitees, 780 completed the survey experiment. The intervention enhanced trust and diminished distrust in ML-based clinical decision support systems compared with the active control arm (Trust: mean difference = 5% [95% confidence interval (CI): 2%; 9%], <i>p</i> value < 0.001; Distrust: mean difference = −4% [−7%; −1%], <i>p</i> value = 0.042) and the blank control arm (Trust: mean difference = 5% [2%; 11%], <i>p</i> value = 0.003; Distrust: mean difference = −3% [−6%; −1%], <i>p</i> value = 0.021).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Providing information on ML-based clinical decision support systems in hospital psychiatry may increase healthcare staff trust in such systems.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 1","pages":"39-48"},"PeriodicalIF":5.3,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13791","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Commentary on “Recovery and Recurrence From Major Depression in Adolescence and Adulthood”","authors":"Amogh Verma, Shubham Kumar, Rachana Mehta, Ranjana Sah","doi":"10.1111/acps.13789","DOIUrl":"10.1111/acps.13789","url":null,"abstract":"","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 5","pages":"646-648"},"PeriodicalIF":5.3,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143187566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Gomes-da-Costa, I. Fernandéz-Pérez, R. Borras, et al., “Is a Vegetarian Diet Beneficial for Bipolar Disorder? Relationship Between Dietary Patterns, Exercise and Pharmacological Treatments With Metabolic Syndrome and Course of Disease in Bipolar Disorder,” Acta Psychiatrica Scandinavica 150, no. 4 (2024): 209–222.
The correct ones are highlighted in the following table, the values in yellow in the article's table refer to the p-value, of each value with statistical significance *.
The correct ones are highlighted in the following table, the values in yellow in the article's table refer to the p-value, of each value with statistical significance *.
The correct ones are highlighted in the following table, the values in yellow in the article's table refer to the p-value, of each value with statistical significance *.
We apologize for this error.
S. Gomes-da-Costa， I. fernandsamz - psamez， R. Borras等，“素食对双相情感障碍有益吗？”饮食模式、运动和药物治疗与双相情感障碍代谢综合征和疾病进程的关系，《斯堪的纳维亚精神病学学报》150期。[4](2024): 209-222。正确的在下表中突出显示，文中表格中黄色的值为各值的p值，具有统计学显著性*。正确的在下表中突出显示，文中表格中黄色的值为各值的p值，具有统计学显著性*。正确的在下表中突出显示，文中表格中黄色的值为各值的p值，具有统计学显著性*。我们为这个错误道歉。
{"title":"Correction to “Is a Vegetarian Diet Beneficial for Bipolar Disorder? Relationship Between Dietary Patterns, Exercise and Pharmacological Treatments With Metabolic Syndrome and Course of Disease in Bipolar Disorder”","authors":"","doi":"10.1111/acps.13788","DOIUrl":"10.1111/acps.13788","url":null,"abstract":"<p>S. Gomes-da-Costa, I. Fernandéz-Pérez, R. Borras, et al., “Is a Vegetarian Diet Beneficial for Bipolar Disorder? Relationship Between Dietary Patterns, Exercise and Pharmacological Treatments With Metabolic Syndrome and Course of Disease in Bipolar Disorder,” <i>Acta Psychiatrica Scandinavica</i> 150, no. 4 (2024): 209–222.</p><p>The correct ones are highlighted in the following table, the values in yellow in the article's table refer to the <i>p</i>-value, of each value with statistical significance *.</p><p>The correct ones are highlighted in the following table, the values in yellow in the article's table refer to the <i>p</i>-value, of each value with statistical significance *.</p><p>The correct ones are highlighted in the following table, the values in yellow in the article's table refer to the <i>p</i>-value, of each value with statistical significance *.</p><p>We apologize for this error.</p>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 4","pages":"550-553"},"PeriodicalIF":5.3,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13788","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143187570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mao-Hsuan Huang, Yi-Hsuan Kuan, Pei-Chi Tu, Wan-Chen Chang, Yee-Lam E. Chan, Tung-Ping Su
Background
The neurobiological basis of impulsivity and its role in suicide attempt (SA) in BD remains underexplored. This study aimed to examine the functional connectivity (FC) within the prefrontal cortex (PFC) in BD patients with and without a history of SA, focusing on the role of trait impulsivity.
Methods
Seventy-two euthymic BD patients (34 with a history of SA, BDSA; and 38 without, BDNS) and 55 age- and sex-matched healthy controls underwent resting-state functional MRI. FC analyses were conducted on four PFC regions: superior frontal gyrus (SFG), middle frontal gyrus (MFG), inferior frontal gyrus (IFG), and orbitofrontal cortex (OFC). Trait impulsivity was assessed using the Barratt Impulsiveness Scale (BIS-11), and its association with FC was analyzed using a general linear model, adjusting for demographic and clinical variables.
Results
BDSA had higher trait impulsivity than BDNS and the controls. BDSA exhibited reduced FC between the PFC and sensorimotor (postcentral and precentral gyri) and thalamic regions compared to BDNS. These reductions in FC of the fronto-thalamic and fronto-sensorimotor circuits were significantly associated with higher trait impulsivity scores.
Conclusion
The findings highlight specific PFC-based FC alterations associated with suicide attempts and trait impulsivity in BD, offering potential neurobiological markers for suicide risk in this population.
{"title":"Altered Functional Connectivity of Prefrontal Cortex-Related Circuitry and Trait Impulsivity in Patients With Bipolar Disorder and History of Suicide Attempts","authors":"Mao-Hsuan Huang, Yi-Hsuan Kuan, Pei-Chi Tu, Wan-Chen Chang, Yee-Lam E. Chan, Tung-Ping Su","doi":"10.1111/acps.13786","DOIUrl":"10.1111/acps.13786","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The neurobiological basis of impulsivity and its role in suicide attempt (SA) in BD remains underexplored. This study aimed to examine the functional connectivity (FC) within the prefrontal cortex (PFC) in BD patients with and without a history of SA, focusing on the role of trait impulsivity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Seventy-two euthymic BD patients (34 with a history of SA, BDSA; and 38 without, BDNS) and 55 age- and sex-matched healthy controls underwent resting-state functional MRI. FC analyses were conducted on four PFC regions: superior frontal gyrus (SFG), middle frontal gyrus (MFG), inferior frontal gyrus (IFG), and orbitofrontal cortex (OFC). Trait impulsivity was assessed using the Barratt Impulsiveness Scale (BIS-11), and its association with FC was analyzed using a general linear model, adjusting for demographic and clinical variables.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>BDSA had higher trait impulsivity than BDNS and the controls. BDSA exhibited reduced FC between the PFC and sensorimotor (postcentral and precentral gyri) and thalamic regions compared to BDNS. These reductions in FC of the fronto-thalamic and fronto-sensorimotor circuits were significantly associated with higher trait impulsivity scores.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The findings highlight specific PFC-based FC alterations associated with suicide attempts and trait impulsivity in BD, offering potential neurobiological markers for suicide risk in this population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 5","pages":"634-643"},"PeriodicalIF":5.3,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Adrian E. Desai Boström, Thomas Cars, Clara Hellner, Johan Lundberg
Objective
The study aimed to estimate 5-year recurrence rates of first-episode major depressive disorder (MDD) and assess the impact of adolescence on recurrence likelihood after the first episode, compared to adults.
Methods
A pre-registered retrospective cohort study that utilized epidemiological data from the Stockholm MDD Cohort (1997–2018), including all individuals registered with a depression diagnosis in Region Stockholm from 2010 to 2018. This dataset combines longitudinal information from primary and secondary care, socioeconomic data, drug dispensations, psychotherapy sessions, brain stimulation treatments, and inpatient treatment. The study included 9124 individuals (1727 adolescents aged 13–17 and 7397 adults aged 18–40) who experienced their first MDD episode between 2011 and 2012, with at least three months of remission. Propensity score weighting balanced cohorts for biological sex, socioeconomic status, depression severity, psychiatric comorbidities, and treatments.
Results
The 5-year recurrence rates were 46.1% for adolescents and 49.0% for adults. The study had over 80% power to detect a minimum absolute difference in recurrence rates of approximately 5.5 percentage points. No significant difference in recurrence likelihood (p = 0.364) or time from remission to recurrence (median 379 days for adolescents, 326 days for adults, p = 0.836) was found between groups. Findings were consistent across bootstrap replicates and sensitivity analyses with extended remission periods.
Conclusions
Approximately half of individuals with a first MDD episode experience recurrence within five years. Recurrence rates were higher than expected for adults but consistent with expectations for adolescents. The study underscores the need for relapse prevention from adolescence through adulthood and indicates a similar clinical course of MDD across age groups.
{"title":"Recovery and Recurrence From Major Depression in Adolescence and Adulthood","authors":"Adrian E. Desai Boström, Thomas Cars, Clara Hellner, Johan Lundberg","doi":"10.1111/acps.13785","DOIUrl":"10.1111/acps.13785","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The study aimed to estimate 5-year recurrence rates of first-episode major depressive disorder (MDD) and assess the impact of adolescence on recurrence likelihood after the first episode, compared to adults.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A pre-registered retrospective cohort study that utilized epidemiological data from the Stockholm MDD Cohort (1997–2018), including all individuals registered with a depression diagnosis in Region Stockholm from 2010 to 2018. This dataset combines longitudinal information from primary and secondary care, socioeconomic data, drug dispensations, psychotherapy sessions, brain stimulation treatments, and inpatient treatment. The study included 9124 individuals (1727 adolescents aged 13–17 and 7397 adults aged 18–40) who experienced their first MDD episode between 2011 and 2012, with at least three months of remission. Propensity score weighting balanced cohorts for biological sex, socioeconomic status, depression severity, psychiatric comorbidities, and treatments.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The 5-year recurrence rates were 46.1% for adolescents and 49.0% for adults. The study had over 80% power to detect a minimum absolute difference in recurrence rates of approximately 5.5 percentage points. No significant difference in recurrence likelihood (<i>p</i> = 0.364) or time from remission to recurrence (median 379 days for adolescents, 326 days for adults, <i>p</i> = 0.836) was found between groups. Findings were consistent across bootstrap replicates and sensitivity analyses with extended remission periods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Approximately half of individuals with a first MDD episode experience recurrence within five years. Recurrence rates were higher than expected for adults but consistent with expectations for adolescents. The study underscores the need for relapse prevention from adolescence through adulthood and indicates a similar clinical course of MDD across age groups.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 5","pages":"625-633"},"PeriodicalIF":5.3,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13785","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jessica Mundy, Alisha S. M. Hall, Esben Agerbo, Clara Albiñana, Jette Steinbach, Bjarni J. Vilhjálmsson, Søren D. Østergaard, Katherine L. Musliner
Background
Previous research has shown that females who use hormonal contraception are at increased risk of developing depression, and that the risk is highest among adolescents. While this finding could reflect age-specific effects of exogenous hormones on mental health, genetic liability for mental disorders could be confounding the association. Our goal was to test the plausibility of this hypothesis by determining whether polygenic liabilities for major depressive disorder (MDD), bipolar disorder (BD), schizophrenia (SCZ), and attention deficit hyperactivity disorder (ADHD) are associated with younger age at hormonal contraception initiation.
Methods
We conducted a cohort study using data from the Danish iPSYCH2015 sub-cohort, a representative sample of people born in Denmark between May 1981 and December 2008. Polygenic scores (PGSs) for MDD, BD, SCZ, and ADHD were created using the most recent genome-wide association study meta-analyses from the Psychiatric Genomics Consortium. Associations between PGSs and hormonal contraception initiation in the following age categories: 10–14, 15–19, 20–24, and 25+ were examined via Cox regression. We examined any hormonal contraception, oral contraception, and non-oral contraception.
Results
PGS-MDD and PGS-ADHD showed the strongest associations with hormonal contraception initiation at age 10–14 (PGS-ADHD: HR = 1.21 [95% CI = 1.16–1.27], p = 6.16 x 10−18; PGS-MDD: 1.21 [1.16–1.27], p = 1.22 x 10−17). The associations then steadily decreased as age at hormonal contraception initiation increased. Both PGS-MDD and PGS-ADHD were also associated with initiation at ages 15–19, but not at 20–24 or 25+. PGS-BD and PGS-SCZ were also associated, albeit not as strongly, with initiation at age 10–14 only (PGS-BD: 1.07 [1.02–1.13], p = 6.87 × 10−3; PGS-SCZ: 1.09 [1.04–1.14], p = 8.61 × 10−4).
Conclusions and Relevance
These results suggest that genetic confounding could explain some of the association between early hormonal contraception use and depression. Where possible, researchers studying this important topic should account for possible confounding by genetic liability for mental disorders.
{"title":"Genetic Confounding of the Association Between Age at First Hormonal Contraception and Depression","authors":"Jessica Mundy, Alisha S. M. Hall, Esben Agerbo, Clara Albiñana, Jette Steinbach, Bjarni J. Vilhjálmsson, Søren D. Østergaard, Katherine L. Musliner","doi":"10.1111/acps.13774","DOIUrl":"10.1111/acps.13774","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Previous research has shown that females who use hormonal contraception are at increased risk of developing depression, and that the risk is highest among adolescents. While this finding could reflect age-specific effects of exogenous hormones on mental health, genetic liability for mental disorders could be confounding the association. Our goal was to test the plausibility of this hypothesis by determining whether polygenic liabilities for major depressive disorder (MDD), bipolar disorder (BD), schizophrenia (SCZ), and attention deficit hyperactivity disorder (ADHD) are associated with younger age at hormonal contraception initiation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a cohort study using data from the Danish iPSYCH2015 sub-cohort, a representative sample of people born in Denmark between May 1981 and December 2008. Polygenic scores (PGSs) for MDD, BD, SCZ, and ADHD were created using the most recent genome-wide association study meta-analyses from the Psychiatric Genomics Consortium. Associations between PGSs and hormonal contraception initiation in the following age categories: 10–14, 15–19, 20–24, and 25+ were examined via Cox regression. We examined any hormonal contraception, oral contraception, and non-oral contraception.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>PGS-MDD and PGS-ADHD showed the strongest associations with hormonal contraception initiation at age 10–14 (PGS-ADHD: HR = 1.21 [95% CI = 1.16–1.27], <i>p</i> = 6.16 x 10<sup>−18</sup>; PGS-MDD: 1.21 [1.16–1.27], <i>p</i> = 1.22 x 10<sup>−17</sup>). The associations then steadily decreased as age at hormonal contraception initiation increased. Both PGS-MDD and PGS-ADHD were also associated with initiation at ages 15–19, but not at 20–24 or 25+. PGS-BD and PGS-SCZ were also associated, albeit not as strongly, with initiation at age 10–14 only (PGS-BD: 1.07 [1.02–1.13], <i>p</i> = 6.87 × 10<sup>−3</sup>; PGS-SCZ: 1.09 [1.04–1.14], <i>p</i> = 8.61 × 10<sup>−4</sup>).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions and Relevance</h3>\u0000 \u0000 <p>These results suggest that genetic confounding could explain some of the association between early hormonal contraception use and depression. Where possible, researchers studying this important topic should account for possible confounding by genetic liability for mental disorders.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 4","pages":"529-536"},"PeriodicalIF":5.3,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13774","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142918647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Florencia Forte, Derek Clougher, Àlex G. Segura, Gisela Mezquida, Ana Maria Sánchez-Torres, Eduard Vieta, Marina Garriga, Antonio Lobo, Ana M González-Pinto, Covadonga M. Diaz-Caneja, Alexandra Roldan, Anabel Martínez-Arán, Elena de la Serna, Anna Mané, Sergi Mas, Carla Torrent, Kelly Allot, Miquel Bernardo, Silvia Amoretti, PEPs Group
Background
Studies have shown associations between polygenic risk scores for educational attainment (PRSEA), cognitive reserve (CR), cognition, negative symptoms (NS), and psychosocial functioning in first-episode psychosis (FEP). However, their specific interactions remain unclear. This study aimed to investigate the mediating roles of CR, cognition, and NS in the relationship between PRSEA and psychosocial functioning one year after a FEP. Additionally, we sought to explore the impact of two NS subtypes on this relationship: diminished Expression (EXP-NS) and Motivation and Pleasure (MAP-NS).
Methods
A total of 138 FEP participants, predominantly male (70%), with a mean age of 24.77 years (SD = 5.29), underwent genetic, clinical, and cognitive assessments two months after study enrollment. Functioning evaluation followed at one-year follow-up. To investigate the mediating role of CR, cognition, and NS in the relationship between PRSEA and functioning, a serial mediation model was employed. Two further mediation models were tested to explore the differential impact of EXP-NS and MAP-NS. Mediation analysis was performed using the PROCESS macro version 4.1 within SPSS version 26.
Results
The serial mediation model revealed a causal chain for PRSEA > CR > cognition > NS > Functioning (β = −3.08, 95%CI [−5.73, −0.43], p = 0.023). When differentiating by type of NS, only EXP-NS were significantly associated in the casual chain (β = −0.17, 95% CI [−0.39, −0.01], p < 0.05).
Conclusions
CR, cognition and NS -specifically EXP-NS- mediate the association between PRSEA and psychosocial functioning at one-year follow-up in FEP patients. These results highlight the potential for personalized interventions based on genetic predisposition.
{"title":"From Genetics to Psychosocial Functioning: Unraveling the Mediating Roles of Cognitive Reserve, Cognition, and Negative Symptoms in First-Episode Psychosis","authors":"M. Florencia Forte, Derek Clougher, Àlex G. Segura, Gisela Mezquida, Ana Maria Sánchez-Torres, Eduard Vieta, Marina Garriga, Antonio Lobo, Ana M González-Pinto, Covadonga M. Diaz-Caneja, Alexandra Roldan, Anabel Martínez-Arán, Elena de la Serna, Anna Mané, Sergi Mas, Carla Torrent, Kelly Allot, Miquel Bernardo, Silvia Amoretti, PEPs Group","doi":"10.1111/acps.13779","DOIUrl":"10.1111/acps.13779","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Studies have shown associations between polygenic risk scores for educational attainment (PRS<sub>EA</sub>), cognitive reserve (CR), cognition, negative symptoms (NS), and psychosocial functioning in first-episode psychosis (FEP). However, their specific interactions remain unclear. This study aimed to investigate the mediating roles of CR, cognition, and NS in the relationship between PRS<sub>EA</sub> and psychosocial functioning one year after a FEP. Additionally, we sought to explore the impact of two NS subtypes on this relationship: diminished Expression (EXP-NS) and Motivation and Pleasure (MAP-NS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 138 FEP participants, predominantly male (70%), with a mean age of 24.77 years (SD = 5.29), underwent genetic, clinical, and cognitive assessments two months after study enrollment. Functioning evaluation followed at one-year follow-up. To investigate the mediating role of CR, cognition, and NS in the relationship between PRS<sub>EA</sub> and functioning, a serial mediation model was employed. Two further mediation models were tested to explore the differential impact of EXP-NS and MAP-NS. Mediation analysis was performed using the PROCESS macro version 4.1 within SPSS version 26.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The serial mediation model revealed a causal chain for PRS<sub>EA</sub> > CR > cognition > NS > Functioning (<i>β</i> = −3.08, 95%CI [−5.73, −0.43], <i>p</i> = 0.023). When differentiating by type of NS, only EXP-NS were significantly associated in the casual chain (<i>β</i> = −0.17, 95% CI [−0.39, −0.01], <i>p</i> < 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>CR, cognition and NS -specifically EXP-NS- mediate the association between PRS<sub>EA</sub> and psychosocial functioning at one-year follow-up in FEP patients. These results highlight the potential for personalized interventions based on genetic predisposition.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 5","pages":"600-612"},"PeriodicalIF":5.3,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13779","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142890602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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