Whether younger age at diagnosis of coronary heart disease (CHD) is associated with a higher risk of incident depression and anxiety or not remains unexamined. This study aimed to explore the association between age at diagnosis of CHD and incident depression and anxiety.
Data were from the UK Biobank. Information on the diagnosis of CHD, depression, and anxiety was collected at baseline and follow-ups. Cox proportional hazards models and the propensity score matching method were applied.
A total of 438,376 adults were included, of which 49,620 had CHD (median follow-up: 13.8 years). Compared with participants without CHD, participants with CHD were at an increased risk of incident depression and anxiety. Younger age at diagnosis of CHD (per 10-year decrement) was associated with a higher risk of depression (HR = 1.73, 95% CI: 1.65–1.82, p < 0.001) and anxiety (HR = 1.66, 95% CI: 1.57–1.74, p < 0.001). In propensity score matching analysis, CHD patients were at a higher risk of depression and anxiety than matched controls without CHD among all diagnosis age groups, and the HRs gradually elevated with descending age at CHD diagnosis.
Individuals diagnosed with CHD at a younger age were at an elevated risk of incident depression and anxiety than individuals diagnosed at an older age, underscoring the necessity to pay attention to their mental health and conduct timely interventions to attenuate the subsequent risk of depression and anxiety.
Introduction: Residual cognitive deficits are commonly reported by individuals in remission from depression, often affecting daily life functioning and mental health. To provide tailored and personalized cognitive enhancement interventions for this population, there is a need for a better understanding of the characteristics of those who benefit from such interventions. Therefore, this study aimed to identify predictors of changes in subjective executive functioning following an internet-delivered cognitive enhancement intervention for adults in remission from depression.
Methods: Data were collected from a randomized controlled trial investigating the efficacy of an internet-delivered cognitive enhancement intervention. Changes in subjective executive functioning from pre-treatment to the six-month follow-up were assessed in 44 participants in remission from depression, using the Behavior Rating Inventory of Executive Function Adult Global Executive Composite. Linear mixed model analyses were conducted to investigate the impact of demographic, clinical, and treatment credibility variables on change in subjective cognitive functioning over time.
Results: The results showed that shorter lifetime depression duration predicted greater improvements in subjective executive functioning (p = 0.031). Higher levels of treatment expectancy and credibility were related to greater improvements in subjective cognitive functioning (p = 0.024). Participants with a partner showed better treatment response than those without a partner (p < 0.001).
Conclusion: This study builds on previous research on cognitive enhancement interventions in remitted depression, highlighting the impact of depression duration, treatment expectancy, and credibility on treatment response. Interventions targeting cognitive deficits appear most effective for those with a shorter lifetime duration of depression. Therefore, efforts should be made to enhance outcomes in those with a chronic course. To maximize engagement and outcomes, these interventions should be delivered in a way that individuals in remission from depression view them as credible and capable of reducing their deficits. Previous research has not found partner status to predict change in subjective executive functioning. The effect of partner status on treatment response should be investigated further.
Many studies have examined physicians' risk of suicide, but studies of other healthcare occupations have been fewer. Suicide attempts have also rarely been studied. We aimed to determine the risks of suicide and suicide attempts among healthcare workers in comparison with non-healthcare workers, according to occupational qualification level.
This population-based cohort study linking Swedish national registers included 243,183 healthcare workers in high-qualified occupations (e.g., physicians); 1,789,076 workers in other high-qualified occupations; 514,726 healthcare workers in low-qualified occupations (e.g., assistant nurses); and 2,026,890 workers in low-qualified occupations residing in Sweden in 2005 and followed them until the latest December 31, 2020. We estimated adjusted hazard ratios (aHR) for suicide and first suicide attempt.
Compared to non-healthcare workers, higher risks for suicide were observed for several healthcare occupations, primarily those working with patient care (e.g., aHR physicians 1.57, 95% CI: 1.23–2.00, registered nurses 1.61, 95% CI: 1.37–1.88, assistant nurses 1.25, 95% CI: 1.17–1.34), rather than those in administrative roles (aHR high-qualified healthcare administrators 1.01 95% CI: 0.76–1.35). Among physicians, the risk was most apparent for psychiatrists (aHR 2.70, 95% CI: 1.21–6.03). For suicide attempts, the risks were primarily observed among registered nurses (aHR 1.22, 95% CI: 1.15–1.29) and assistant nurses (aHR 1.15, 95% CI: 1.12–1.18). Among healthcare workers, assistant nurses had the highest incidence rates for suicide (18.7/100,000 person-years) and suicide attempts (175.1/100,000 person-years).
Workers in several healthcare occupations showed a higher risk of suicide relative to non-healthcare workers with a similar occupational qualification level. Interventions may need to be developed to reduce the risk of suicidal behavior in these groups.
Individuals with bipolar disorder face an elevated risk of premature death, often due to external causes such as accidental injuries, self-harm, and substance-related deaths. This study aimed to investigate the incidence of severe poisonings among individuals with bipolar disorder and to examine associated demographic and clinical factors.
We conducted a cohort study using data from national registers in Finland, measuring hospitalizations and deaths due to poisoning by medicines or illegal substances in 1996–2018. Cox proportional hazards regression models were used to assess associations between predictor variables and poisoning outcomes.
The study population comprised 60,045 individuals aged 15–65 diagnosed with bipolar disorder in 1987–2018. During the study period, 13.1% (N = 7872) of the population experienced at least one poisoning resulting in hospitalization or death. The age-standardized rate of hospitalizations was 50.6 (95% CI, 49.5–51.7) per 1000 person-years and of deaths 1.8 (95% CI, 1.6–2.0) per 1000 person-years. The majority of poisonings leading to hospitalization (59.1%) or death (56.6%) were intentional and caused by pharmaceuticals (hospitalizations, 76.9%; deaths, 63.6%). Additionally, psychoactive narcotics and stimulants were the cause of 26.8% of the poisoning deaths. The strongest risk factors for hospitalization were substance use disorder (adjusted hazard ratio, aHR, 2.75, 95% CI, 2.61–2.90) and a history of suicide attempt (2.70, 2.52–2.88). The risk of poisoning death was most strongly associated with substance use disorder (3.02, 2.60–3.52) and a history of suicide attempt (2.38, 1.94–2.91). Female sex was associated with a higher risk of hospitalization (1.19, 1.14–1.25), but a lower risk of death (0.72, 0.62–0.82).
Individuals with bipolar disorder face a substantial risk of poisoning by medicines or illegal substances, with notable sex differences in hospitalization and death rates. Key risk factors include substance use disorder and a history of suicide attempt.
Bipolar disorder (BD) significantly affects life expectancy (LE), results in substantial loss of LE, and contributes to high medical costs, with these impacts varying by age at onset and gender. Previous studies have often overlooked the significance of age at the onset when estimating LE in individuals with BD. This study aimed to address this limitation and assess the impacts of BD on LE, loss of LE, and medical costs for BD patients categorized by age and gender in Taiwan using a new semiparametric extrapolation method over an 11-year duration.
A rolling-over algorithm estimated the survival function, with lifetime risk extrapolated. LE and loss of LE were calculated by comparing BD patients to matched non-BD referents by sex, age, and diagnosis year. Lifetime medical costs were determined by multiplying average monthly expenses by survival rates. Data from Taiwan's National Health Insurance (2009–2019) identified BD patients aged 5–84 with ≥ 2 outpatient or ≥ 1 inpatient BD diagnosis. The semiparametric survival extrapolation method was validated by comparing it with the Kaplan–Meier analysis.
The results indicate that following a BD diagnosis, patients have an LE of 26.79 years, reflecting a loss of 15.08 years compared to matched referents. On average, patients with BD incurred annual medical expenses of around $2516, with costs rising with age for both sexes. The mean estimated lifetime cost for the study population was about $55,015. The extrapolation method demonstrated high accuracy, with a less than 5% relative bias.
Semiparametric extrapolation is an effective method for estimating LE, loss of LE, and lifetime costs in BD. Future work could refine semiparametric extrapolation and assess factors influencing LE loss and lifetime costs in BD.
To replicate a previous study addressing differences and similarities of older adults with bipolar disorder (OABD) treated with lithium as compared to those treated with other drugs.
Cross-sectional analysis of a harmonized dataset of the GAGE-BD Project, with over 2 thousand participants enrolled from two recruitment waves, with worldwide representation. Participants were allocated in two treatment groups according to the availability of information about current lithium use (Lithium, n = 754; Non-lithium, n = 1,161). We used linear regression, linear mixed and generalized linear mixed models to examine the associations between treatment groups and other variables, with emphasis on the distribution of socio-demographical and clinical variables, controlling for age, gender, and study site.
We found statistical associations between lithium use and higher education level, as well as with bipolar-1 subtype, and a negative association with comorbid anxiety disorder. OABD patients treated with lithium had lower scores on depression rating scales, and better overall global cognitive and functional state. Lithium users also reported having fewer cardiovascular comorbidities.
We found several potentially relevant differences in the clinical profile of OABD treated with lithium; nonetheless, the interpretation of the present results must take into account the methodological limitations inherent to the cross-sectional approach and data harmonization.
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