Epidemiology and Psychiatric Sciences最新文献

Aims: To estimate the self-reported and parent-reported mental well-being of adolescents (aged 14 and 17) with/without intellectual disability in a sample of young people representative of the UK population.

Methods: Secondary analysis of data collected in Waves 6 and 7 of the UK's Millennium Cohort Study. The analytic sample consisted of 10,838 adolescent respondents at age 14 (361 with intellectual disability and 10,477 without) and 9,408 adolescent respondents at age 17 (292 with intellectual disability and 9,116 without).

Results: Parental reports of adolescent problems on the Strengths and Difficulties Questionnaire (SDQ) indicated that adolescents with intellectual disability at ages 14 and 17 were more likely to have problems than those without intellectual disability across all SDQ domains. Adolescent self-report data at age 17 indicated that adolescents with intellectual disability were more likely to (self)-report that they had problems than those without intellectual disability on all but one SDQ domain. The magnitude of relative inequality between those with and without intellectual disability was consistently lower for self-report than parental report. On indicators of depression, mental well-being, self-harm, positive mental health, happiness and general psychological distress at ages 14 and 17, we found no self-reported group differences between adolescents with and without intellectual disability.

Conclusions: Further research is needed to understand: (1) why the magnitude of mental health inequalities between those with and without intellectual disability on the SDQ may be dependent on the identity of the informant; and (2) whether such differences are also apparent for other measures of mental health or well-being.

Aims: Mental health related stigma and discrimination is a universal phenomenon and a contributor to the adversity experienced by people with schizophrenia. Research has produced inconsistent findings on how discrimination differs across settings and the contextual factors that underpin these differences. This study investigates the association between country-level Human Development Index (HDI) and experienced and anticipated discrimination reported by people with schizophrenia.

Methods: This study is a secondary data analysis of a global cross-sectional survey completed by people living with schizophrenia across 29 countries, between 2005 and 2008. Experienced and anticipated discrimination were assessed using the Discrimination and Stigma Scale (DISC-10). Countries were classified according to their 2006 HDI. Negative binomial and Poisson regression analyses with a robust standard errors approach were conducted to investigate associations between country-level HDI and discrimination.

Results: In the regression analyses, no evidence was found for a linear association between HDI and experienced or anticipated discrimination. Further exploratory analyses showed a significant non-linear association between HDI ratings and experienced discrimination. Participants in "high" and "very high" HDI countries reported more experienced discrimination compared to those in "medium" HDI countries.

Conclusions: HDI does, to some extent, appear to be associated with how far discrimination is experienced across different contexts. More high-quality cross-national research, including research focused on "medium" and "low" countries, is needed to substantiate these findings and identify underlying factors that may explain the pattern observed for experienced discrimination, including generating new datasets that would enable for these analyses to be repeated and contrasted with more recent data. An in-depth understanding of these factors will further aid the adaptation of cross-cultural and context specific anti-stigma interventions in future.

Aims: Three factors converge to underscore the heightened importance of evaluating the potential health/well-being effects of friendships in older adulthood. First, policymakers, scientists, and the public alike are recognizing the importance of social relationships for health/well-being and creating national policies to promote social connection. Second, many populations are rapidly aging throughout the world. Third, we currently face what some call a 'friendship recession'. Although, growing research documents associations between friendship with better health and well-being, friendship can also have a 'dark side' and can potentially promote negative outcomes. To better capture friendship's potential heterogeneous effects, we took an outcome-wide analytic approach.

Methods: We analysed data from 12,998 participants in the Health and Retirement Study (HRS) - a prospective and nationally representative cohort of U.S. adults aged >50, and, evaluated if increases in friendship strength (between t₀; 2006/2008 and t₁; 2010/2012) were associated with better health/well-being across 35 outcomes (in t₂; 2014/2016). To assess friendship strength, we leveraged all available friendship items in HRS and created a composite 'friendship score' that assessed the following three domains: (1) friendship network size, (2) friendship network contact frequency and (3) friendship network quality.

Results: Stronger friendships were associated with better outcomes on some indicators of physical health (e.g. reduced risk of mortality), health behaviours (e.g. increased physical activity) and nearly all psychosocial indicators (e.g. higher positive affect and mastery, as well as lower negative affect and risk of depression). Friendship was also associated with increased likelihood of smoking and heavy drinking (although the latter association with heavy drinking did not reach conventional levels of statistical significance).

Conclusions: Our findings indicate that stronger friendships can have a dual impact on health and well-being. While stronger friendships appear to mainly promote a range of health and well-being outcomes, stronger friendships might also promote negative outcomes. Additional research is needed, and any future friendship interventions and policies that aim to enhance outcomes should focus on how to amplify positive outcomes while mitigating harmful ones.

Aims: Although seasonality has been documented for mental disorders, it is unknown whether similar patterns can be observed in employee sickness absence from work due to a wide range of mental disorders with different severity level, and to what extent the rate of change in light exposure plays a role. To address these limitations, we used daily based sickness absence records to examine seasonal patterns in employee sickness absence due to mental disorders.

Methods: We used nationwide diagnosis-specific psychiatric sickness absence claims data from 2006 to 2017 for adult individuals aged 16-67 (n = 636,543 sickness absence episodes) in Finland, a high-latitude country with a profound variation in daylength. The smoothed time-series of the ratio of observed and expected (O/E) daily counts of episodes were estimated, adjusted for variation in all-cause sickness absence rates during the year.

Results: Unipolar depressive disorders peaked in October-November and dipped in July, with similar associations in all forms of depression. Also, anxiety and non-organic sleep disorders peaked in October-November. Anxiety disorders dipped in January-February and in July-August, while non-organic sleep disorders dipped in April-August. Manic episodes reached a peak from March to July and dipped in September-November and in January-February. Seasonality was not dependent on the severity of the depressive disorder.

Conclusions: These results suggest a seasonal variation in sickness absence due to common mental disorders and bipolar disorder, with high peaks in depressive, anxiety and sleep disorders towards the end of the year and a peak in manic episodes starting in spring. Rapid changes in light exposure may contribute to sickness absence due to bipolar disorder. The findings can help clinicians and workplaces prepare for seasonal variations in healthcare needs.

Aims: The burden of mental disorders is increasing worldwide, thus, affecting society and healthcare systems. This study investigated the independent influences of age, period and cohort on the global prevalence of mental disorders from 1990 to 2019; compared them by sex; and predicted the future burden of mental disorders in the next 25 years.

Methods: The age-specific and sex-specific incidence of mental disorders worldwide was analysed according to the general analysis strategy used in the Global Burden of Disease Study in 2019. The incidence and mortality trends of mental disorders from 1990 to 2019 were evaluated through joinpoint regression analysis. The influences of age, period and cohort on the incidence of mental disorders were evaluated with an age-period-cohort model.

Results: From 1990 to 2019, the sex-specific age-standardized incidence and disability-adjusted life years (DALY) rate decreased slightly. Joinpoint regression analysis from 1990 to 2019 indicated four turning points in the male DALY rate and five turning points in the female DALY rate. In analysis of age effects, the relative risk (RR) of incidence and the DALY rate in mental disorders in men and women generally showed an inverted U-shaped pattern with increasing age. In analysis of period effects, the incidence of mental disorders increased gradually over time, and showed a sub-peak in 2004 (RR, 1.006 for males; 95% CI, 1.000-1.012; 1.002 for women, 0.997-1.008). Analysis of cohort effects showed that the incidence and DALY rate decreased in successive birth cohorts. The incidence of mental disorders is expected to decline slightly over the next 25 years, but the number of cases is expected to increase.

Conclusions: Although the age-standardized burden of mental disorders has declined in the past 30 years, the number of new cases and deaths of mental disorders worldwide has increased, and will continue to increase in the near future. Therefore, relevant policies should be used to promote the prevention and management of known risk factors and strengthen the understanding of risk profiles and incidence modes of mental disorders, to help guide future research on control and prevention strategies.

Aims: It has been suggested that people with mental disorders have an elevated risk to acquire severe acute respiratory syndrome coronavirus 2 and to be disproportionally affected by coronavirus disease 19 (COVID-19) once infected. We aimed to analyse the COVID-19 infection rate, course and outcome, including mortality and long COVID, in people with anxiety, depressive, neurodevelopmental, schizophrenia spectrum and substance use disorders relative to control subjects without these disorders.

Methods: This study constitutes a preregistered systematic review and random-effects frequentist and Bayesian meta-analyses. Major databases were searched up until 27 June 2023.

Results: Eighty-one original articles were included reporting 304 cross-sectional and prospective effect size estimates (median n per effect-size = 114837) regarding associations of interest. Infection risk was not significantly increased for any mental disorder that we investigated relative to samples of people without these disorders. The course of COVID-19, however, is relatively severe, and long COVID and COVID-19-related hospitalization are more likely in all patient samples that we investigated. The odds of dying from COVID-19 were high in people with most types of mental disorders, except for those with anxiety and neurodevelopmental disorders relative to non-patient samples (pooled ORs range, 1.26-2.57). Bayesian analyses confirmed the findings from the frequentist approach and complemented them with estimates of the strength of evidence.

Conclusions: Once infected, people with pre-existing mental disorders are at an elevated risk for a severe COVID-19 course and outcome, including long COVID and mortality, relative to people without pre-existing mental disorders, despite an infection risk not significantly increased.

Aims: Schizophrenia is associated with cardiovascular disease (CVD) risk, and patients with schizophrenia are more likely to receive suboptimal care for CVD. However, there is limited knowledge regarding in-hospital prognosis and quality of care for patients with schizophrenia hospitalized for heart failure (HF). This study sought to elucidate the association between schizophrenia and in-hospital mortality, as well as cardiovascular treatment in patients hospitalized with HF.

Methods: Using the nationwide cardiovascular registry data in Japan, a total of 704,193 patients hospitalized with HF from 2012 to 2019 were included and stratified by age: young age, > 18 to 45 years (n = 20,289); middle age, >45 to 65 years (n = 114,947); and old age, >65 to 85 years (n = 568,957). All and 30-day in-hospital mortality as well as prescription of cardiovascular medications were assessed. After multiple imputation for missing values, mixed-effect multivariable logistic regression analysis was performed using patient and hospital characteristics with hospital identifier as a variable with random effects.

Results: Patients with schizophrenia were more likely to experience prolonged hospital stays, and incur higher hospitalization costs. In-hospital mortality for non-elderly patients with schizophrenia was significantly worse than for those without schizophrenia: the mortality rate was 7.6% vs 3.5% and the adjusted odds ratio (OR) was 1.96 (95% confidence interval (CI): 1.24-3.10, P = 0.0037) in young adult patients; 6.2% vs 4.0% and 1.49 (95% CI: 1.17-1.88, P < 0.001) in middle-aged patients. Thirty-day in-hospital mortality was significantly worse in middle-aged patients: the mortality rate was 4.7% vs 3.0% and an adjusted OR was 1.40 (95% CI: 1.07-1.83, P = 0.012). In-hospital mortality in elderly patients did not differ between those with and without schizophrenia. Prescriptions of beta-blockers and angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers were significantly lower in patients with schizophrenia across all age groups.

Conclusion: Schizophrenia was identified as a risk factor for in-hospital mortality and reduced prescription of cardioprotective medications in non-elderly patients hospitalized with HF. These findings highlight the necessity for differentiated care and management of HF in patients with severe mental illnesses.

Aims: Girls who experience an earlier onset of menarche than their peers are at increased risk of depressive symptoms in mid-adolescence, but it is unclear if this association persists into adulthood. This study examines whether longitudinal patterns of depressive symptoms from adolescence to adulthood vary according to timing of menarche.

Methods: About 4,864 female participants in the UK Avon Longitudinal Study of Parents and Children provided data on age at onset of menarche (assessed in repeated questionnaires from 8 to 17 years) and depressive symptoms across nine time points (13 to 26 years) using the Short Mood and Feelings Questionnaire. We compared patterns of depressive symptoms in girls with 'early' (<11.5 years), 'normative' (11.5 to 13.5 years) and 'late' (≥13.5 years) menarche using a linear spline multilevel growth curve model adjusted for indicators of socioeconomic position, father absence and body mass index.

Results: Early, compared with normative, menarche was associated with higher levels of depressive symptoms at age 14 (imputed adjusted estimated difference = 0.94, 95% confidence interval [CI] = 0.44, 1.45), but the association attenuated at 24 years (0.24 [-0.72, 1.19]). Late menarche, compared with normative, was associated with a lower level of depressive symptoms at age 14 (-0.69 [-1.10, -0.29]), but this association also attenuated at 24 years (-0.15 [-0.92, 0.62]).

Conclusions: This study did not find a persistent effect of early menarche, compared to normative, on depressive symptoms. However, our findings are consistent with the level of depressive symptoms increasing at the onset of menarche irrespective of timing. The late onset girls 'catch up' with their peers who experience menarche earlier in terms of depressive symptoms. Future studies should continue to assess the impact of timing of menarche further into adulthood.

Aims: Despite recommendations to initiate clozapine after two unsuccessful trials of antipsychotics, clozapine is underprescribed and initiated too late. The aim of this study was to describe different antipsychotic treatment sequences in the 36 months before the initiation of clozapine and to characterize clusters of treatment trajectories.

Methods: Using the French National Health Insurance database, a historical cohort study of the population in an area in western France was performed. The data from all new users of clozapine with a diagnosis of schizophrenia or schizoaffective disorder in the period of 2017-2018 were evaluated. All outpatient reimbursements for antipsychotics during the 36 months before clozapine initiation were analysed. Successive reimbursements for identical treatments were grouped into treatment trials (TTs), and different trajectories were clustered using a state sequence analysis.

Results: The results showed 1191 TTs for 287 individuals. The mean number of TTs per individual was 3.2. Risperidone, aripiprazole and haloperidol were the main treatments delivered. The frequencies of antipsychotics used differed between monotherapies and combination therapies. A three-cluster typology was identified: one cluster (n = 133) of 'less treated' younger individuals with fewer TTs and shorter TT durations; a second cluster (n = 53) of 'more treated' individuals with higher numbers of TTs and combinations of antipsychotics; and a third cluster (n = 103) of 'treatment-stable' older individuals with longer TT durations.

Conclusions: The results indicate that the median number of TTs during the 36 months before clozapine prescription was higher than the two recommended. The different trajectories were associated with individual characteristics and treatment differences, suggesting that additional studies of clinical parameters are needed to understand barriers to clozapine prescription.

Aims: There is clear evidence that installing safety barriers is effective in preventing jumping suicides from high-risk bridges with only moderate displacement to other nearby bridges. However, the impact of barriers on jumping suicides across broader geographical areas is not well understood. We examined patterns in jumping suicides across the state of Victoria, Australia, after a safety barrier was installed at the West Gate Bridge which, before the installation of the barrier, was the site of approximately 40% of Victoria's jumping suicides.

Methods: We used negative binomial regression analyses on Victorian data from 2000 to 2019 to compare rates of jumping suicides at the West Gate Bridge, other bridges and non-bridge jumping locations before, during and after the West Gate Bridge barrier installation. We conducted linear regression analyses to examine whether the distance travelled from the deceased's usual residence to the location of their jumping suicide changed between the before, during and after barrier installation periods.

Results: After installation of the barrier, there were no jumping suicides at the West Gate Bridge (rate ratio [RR] = 0.00, 95% credible intervals [95% Cr] = 0.00-0.0001) and there was strong evidence that the rate of jumping suicides at all locations declined by 65% (RR = 0.35, 95% Cr = 0.22-0.54). At other bridges, there was also evidence of a reduction (RR = 0.31, 95% Cr = 0.11-0.70), but there was no evidence of a change at non-bridge locations (RR = 0.74, 95% Cr = 0.39-1.30).

Conclusion: After installation of the safety barrier at the West Gate Bridge, jumping suicide in Victoria decreased overall and at other bridges, and did not appear to change at non-bridge locations. Our findings show that when barriers are installed at a site responsible for a disproportionately high number of jumping suicides, they are not only highly effective at the site where the barriers are installed but can also have a prevention impact beyond the immediate locale at similar sites.