Aims: With advancements in cancer treatments, the survival rates of patients with their first primary cancer (FPC) have increased, resulting in a rise in the number of patients with second primary cancer (SPC). However, there has been no assessment on the incidence of suicide among patients with SPC. This study assessed the occurrence of suicide among patients with SPC and compared them with that in patients with FPC.
Methods: This was a retrospective, population-based cohort study that followed patients with FPC and SPC diagnosed from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) 17 registries database between 1 January 2000 and 31 December 2019.
Results: For patients with SPC, an age of 85+ years at diagnosis was associated with a higher incidence of suicide death (HR, 1.727; 95% CI, 1.075-2.774), while the suicide death was not considerably different in the chemotherapy group (P > 0.05). Female genital system cancers (HR, 3.042; 95% CI, 1.819-6.361) accounted for the highest suicide death among patients with SPC. The suicide death distribution of patients with SPC over time indicated that suicide events mainly occurred within 5 to 15 years of diagnosis. Compared with patients with FPC, patients with SPC in general had a lower risk of suicide, but increased year by year.
Conclusion: The risk of suicide was reduced in patients with SPC compared with patients with FPC, but increased year by year. Therefore, oncologists and related health professionals need to provide continuous psychological support to reduce the incidence of suicide. The highest suicide death was found among patients with female genital system cancer.
{"title":"Suicide rates among patients with first and second primary cancer.","authors":"Yanting Jiang, Yiqi Wang, Xiaofei Cheng, Ziyang Zhou, Jili Wang, Haogang Yu, Guorong Yao, Zhongjie Lu, Xin Chen, Senxiang Yan, Feng Zhao","doi":"10.1017/S2045796023000690","DOIUrl":"10.1017/S2045796023000690","url":null,"abstract":"<p><strong>Aims: </strong>With advancements in cancer treatments, the survival rates of patients with their first primary cancer (FPC) have increased, resulting in a rise in the number of patients with second primary cancer (SPC). However, there has been no assessment on the incidence of suicide among patients with SPC. This study assessed the occurrence of suicide among patients with SPC and compared them with that in patients with FPC.</p><p><strong>Methods: </strong>This was a retrospective, population-based cohort study that followed patients with FPC and SPC diagnosed from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) 17 registries database between 1 January 2000 and 31 December 2019.</p><p><strong>Results: </strong>For patients with SPC, an age of 85+ years at diagnosis was associated with a higher incidence of suicide death (HR, 1.727; 95% CI, 1.075-2.774), while the suicide death was not considerably different in the chemotherapy group (<i>P</i> > 0.05). Female genital system cancers (HR, 3.042; 95% CI, 1.819-6.361) accounted for the highest suicide death among patients with SPC. The suicide death distribution of patients with SPC over time indicated that suicide events mainly occurred within 5 to 15 years of diagnosis. Compared with patients with FPC, patients with SPC in general had a lower risk of suicide, but increased year by year.</p><p><strong>Conclusion: </strong>The risk of suicide was reduced in patients with SPC compared with patients with FPC, but increased year by year. Therefore, oncologists and related health professionals need to provide continuous psychological support to reduce the incidence of suicide. The highest suicide death was found among patients with female genital system cancer.</p>","PeriodicalId":11787,"journal":{"name":"Epidemiology and Psychiatric Sciences","volume":null,"pages":null},"PeriodicalIF":8.1,"publicationDate":"2023-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10539740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10283961","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}
Pub Date : 2023-09-08DOI: 10.1017/S2045796023000689
Antonio Lasalvia, Stefano Pillan, Giulia Marzocco, Anna Ambrosini, Franco Veltro, Tecla Pozzan, Camilla D'Astore, Doriana Cristofalo, Mirella Ruggeri, Chiara Bonetto
Aims: People with mental disorders frequently report experiences of discrimination within mental health services, which can have significant detrimental effects on individuals' well-being and recovery. This study aimed to develop and validate a new standardized measure aiming to assess experiences of stigmatization among people with mental disorders within mental health services.
Methods: The scale was developed in Italian and tested for ease of use, comprehension, acceptability, relevance of items and response options within focus group session. A cross-sectional validation survey was conducted among mental health service users in Italy. Exploratory factor analysis with Promax oblique rotation, the Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy and the Bartlett's test of sphericity were used to assess the suitability of the sample for factor analysis. Reliability was assessed as internal consistency using Cronbach's alpha and as test-retest reliability using weighted kappa and intraclass correlation coefficient (ICC). Precision was examined by Kendall's tau-b coefficient.
Results: Overall, 240 people with mental disorders participated in the study; 56 also completed the retest evaluation after 2 weeks. The 18 items of the scale converged over a two-factor solution ('Dignity violation and personhood devaluation' and 'Perceived life restrictions and social exclusion'), accounting for 56.4% of the variance (KMO 0.903; Bartlett's test p < 0.001). Cronbach's alpha for the total score was 0.934. The scale showed one item with kappa above 0.81, four items between 0.61 and 0.80, ten items between 0.41 and 0.60, two items between 0.21 and 0.40 and only one item below 0.20. ICC was 0.928 (95% CI 0.877-0.958). Kendall's tau-b ranged from 0.450 to 0.617 (p < 0.001).
Conclusions: The newly developed scale represents a valid and reliable measure for assessing experiences of stigma among patients receiving care within mental health services. The scale has provided initial evidence of being specifically tailored for individuals with psychotic and bipolar disorders. However, the factorial structure of the scale should be replicated through a confirmatory factor analysis on a larger sample of individuals with these conditions.
{"title":"Development and validation of a new standardized measure for assessing experiences of discrimination within mental health services. A participatory research project.","authors":"Antonio Lasalvia, Stefano Pillan, Giulia Marzocco, Anna Ambrosini, Franco Veltro, Tecla Pozzan, Camilla D'Astore, Doriana Cristofalo, Mirella Ruggeri, Chiara Bonetto","doi":"10.1017/S2045796023000689","DOIUrl":"10.1017/S2045796023000689","url":null,"abstract":"<p><strong>Aims: </strong>People with mental disorders frequently report experiences of discrimination within mental health services, which can have significant detrimental effects on individuals' well-being and recovery. This study aimed to develop and validate a new standardized measure aiming to assess experiences of stigmatization among people with mental disorders within mental health services.</p><p><strong>Methods: </strong>The scale was developed in Italian and tested for ease of use, comprehension, acceptability, relevance of items and response options within focus group session. A cross-sectional validation survey was conducted among mental health service users in Italy. Exploratory factor analysis with Promax oblique rotation, the Kaiser<b>-</b>Meyer<b>-</b>Olkin (KMO) measure of sampling adequacy and the Bartlett's test of sphericity were used to assess the suitability of the sample for factor analysis. Reliability was assessed as internal consistency using Cronbach's alpha and as test-retest reliability using weighted kappa and intraclass correlation coefficient (ICC). Precision was examined by Kendall's tau-b coefficient.</p><p><strong>Results: </strong>Overall, 240 people with mental disorders participated in the study; 56 also completed the retest evaluation after 2 weeks. The 18 items of the scale converged over a two-factor solution ('Dignity violation and personhood devaluation' and 'Perceived life restrictions and social exclusion'), accounting for 56.4% of the variance (KMO 0.903; Bartlett's test <i>p</i> < 0.001). Cronbach's alpha for the total score was 0.934. The scale showed one item with kappa above 0.81, four items between 0.61 and 0.80, ten items between 0.41 and 0.60, two items between 0.21 and 0.40 and only one item below 0.20. ICC was 0.928 (95% CI 0.877-0.958). Kendall's tau-b ranged from 0.450 to 0.617 (<i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>The newly developed scale represents a valid and reliable measure for assessing experiences of stigma among patients receiving care within mental health services. The scale has provided initial evidence of being specifically tailored for individuals with psychotic and bipolar disorders. However, the factorial structure of the scale should be replicated through a confirmatory factor analysis on a larger sample of individuals with these conditions.</p>","PeriodicalId":11787,"journal":{"name":"Epidemiology and Psychiatric Sciences","volume":null,"pages":null},"PeriodicalIF":8.1,"publicationDate":"2023-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10539746/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10252915","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}
Pub Date : 2023-09-08DOI: 10.1017/S2045796023000616
Frank Iorfino, Mathew Varidel, Roman Marchant, Sally Cripps, Jacob Crouse, Ante Prodan, Rafael Oliveria, Joanne S Carpenter, Daniel F Hermens, Adam Guastella, Elizabeth Scott, Jai Shah, Kathleen Merikangas, Jan Scott, Ian B Hickie
Aims: The needs of young people attending mental healthcare can be complex and often span multiple domains (e.g., social, emotional and physical health factors). These factors often complicate treatment approaches and contribute to poorer outcomes in youth mental health. We aimed to identify how these factors interact over time by modelling the temporal dependencies between these transdiagnostic social, emotional and physical health factors among young people presenting for youth mental healthcare.
Methods: Dynamic Bayesian networks were used to examine the relationship between mental health factors across multiple domains (social and occupational function, self-harm and suicidality, alcohol and substance use, physical health and psychiatric syndromes) in a longitudinal cohort of 2663 young people accessing youth mental health services. Two networks were developed: (1) 'initial network', that shows the conditional dependencies between factors at first presentation, and a (2) 'transition network', how factors are dependent longitudinally.
Results: The 'initial network' identified that childhood disorders tend to precede adolescent depression which itself was associated with three distinct pathways or illness trajectories; (1) anxiety disorder; (2) bipolar disorder, manic-like experiences, circadian disturbances and psychosis-like experiences; (3) self-harm and suicidality to alcohol and substance use or functioning. The 'transition network' identified that over time social and occupational function had the largest effect on self-harm and suicidality, with direct effects on ideation (relative risk [RR], 1.79; CI, 1.59-1.99) and self-harm (RR, 1.32; CI, 1.22-1.41), and an indirect effect on attempts (RR, 2.10; CI, 1.69-2.50). Suicide ideation had a direct effect on future suicide attempts (RR, 4.37; CI, 3.28-5.43) and self-harm (RR, 2.78; CI, 2.55-3.01). Alcohol and substance use, physical health and psychiatric syndromes (e.g., depression and anxiety, at-risk mental states) were independent domains whereby all direct effects remained within each domain over time.
Conclusions: This study identified probable temporal dependencies between domains, which has causal interpretations, and therefore can provide insight into their differential role over the course of illness. This work identified social, emotional and physical health factors that may be important early intervention and prevention targets. Improving social and occupational function may be a critical target due to its impacts longitudinally on self-harm and suicidality. The conditional independence of alcohol and substance use supports the need for specific interventions to target these comorbidities.
{"title":"The temporal dependencies between social, emotional and physical health factors in young people receiving mental healthcare: a dynamic Bayesian network analysis.","authors":"Frank Iorfino, Mathew Varidel, Roman Marchant, Sally Cripps, Jacob Crouse, Ante Prodan, Rafael Oliveria, Joanne S Carpenter, Daniel F Hermens, Adam Guastella, Elizabeth Scott, Jai Shah, Kathleen Merikangas, Jan Scott, Ian B Hickie","doi":"10.1017/S2045796023000616","DOIUrl":"10.1017/S2045796023000616","url":null,"abstract":"<p><strong>Aims: </strong>The needs of young people attending mental healthcare can be complex and often span multiple domains (e.g., social, emotional and physical health factors). These factors often complicate treatment approaches and contribute to poorer outcomes in youth mental health. We aimed to identify how these factors interact over time by modelling the temporal dependencies between these transdiagnostic social, emotional and physical health factors among young people presenting for youth mental healthcare.</p><p><strong>Methods: </strong>Dynamic Bayesian networks were used to examine the relationship between mental health factors across multiple domains (social and occupational function, self-harm and suicidality, alcohol and substance use, physical health and psychiatric syndromes) in a longitudinal cohort of 2663 young people accessing youth mental health services. Two networks were developed: (1) 'initial network', that shows the conditional dependencies between factors at first presentation, and a (2) 'transition network', how factors are dependent longitudinally.</p><p><strong>Results: </strong>The 'initial network' identified that childhood disorders tend to precede adolescent depression which itself was associated with three distinct pathways or illness trajectories; (1) anxiety disorder; (2) bipolar disorder, manic-like experiences, circadian disturbances and psychosis-like experiences; (3) self-harm and suicidality to alcohol and substance use or functioning. The 'transition network' identified that over time social and occupational function had the largest effect on self-harm and suicidality, with direct effects on ideation (relative risk [RR], 1.79; CI, 1.59-1.99) and self-harm (RR, 1.32; CI, 1.22-1.41), and an indirect effect on attempts (RR, 2.10; CI, 1.69-2.50). Suicide ideation had a direct effect on future suicide attempts (RR, 4.37; CI, 3.28-5.43) and self-harm (RR, 2.78; CI, 2.55-3.01). Alcohol and substance use, physical health and psychiatric syndromes (e.g., depression and anxiety, at-risk mental states) were independent domains whereby all direct effects remained within each domain over time.</p><p><strong>Conclusions: </strong>This study identified probable temporal dependencies between domains, which has causal interpretations, and therefore can provide insight into their differential role over the course of illness. This work identified social, emotional and physical health factors that may be important early intervention and prevention targets. Improving social and occupational function may be a critical target due to its impacts longitudinally on self-harm and suicidality. The conditional independence of alcohol and substance use supports the need for specific interventions to target these comorbidities.</p>","PeriodicalId":11787,"journal":{"name":"Epidemiology and Psychiatric Sciences","volume":null,"pages":null},"PeriodicalIF":5.9,"publicationDate":"2023-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10539737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10197010","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}
Pub Date : 2023-09-01DOI: 10.1017/S2045796023000677
J L Ayuso-Mateos, D Morillo, J M Haro, B Olaya, E Lara, M Miret
Aims: To assess whether there is a change in the prevalence of depression and suicidal ideation after the strict lockdown measures due to the first wave of the COVID-19 pandemic in Spain, and to assess which are the factors associated with the incidence of a depressive episode or suicidal ideation during the lockdown.
Methods: Data from a longitudinal adult population-based cohort from Madrid and Barcelona were analysed (n = 1103). Face-to-face home-based (pre-pandemic) and telephone interviews were performed. Depression and suicidal ideation were assessed through an adaptation of the Composite International Diagnostic Interview (CIDI 3.0). Population prevalence estimates and multivariable logistic regressions were computed.
Results: Prevalence rates of depression changed significantly from before to after the COVID-19 outbreak (from 3.06% to 12.00%; p = 0.01) and per sex and age groups. Individuals reporting COVID-19 concerns (odds ratio [OR] = 3.11; 95% confidence interval [CI] = 1.45-6.69) and those feeling loneliness (OR = 1.99; 95% CI = 1.52-2.61) during the lockdown were at increased risk of developing depression during the confinement. Resilience showed a protective effect against the risk of depression (OR = 0.57; 95% CI = 0.39-0.83), while individuals perceiving social support during the confinement were at lower risk of developing suicidal thoughts (OR = 0.21; 95% CI = 0.09-0.46). Greater disability during the lockdown was also associated with the risk of suicidal ideation (OR = 2.77; 95% CI = 1.53-5.03).
Conclusions: Continuous reinforcement of mental health preventive and intervening measures is of global importance, particularly among vulnerable groups who are experiencing the most distress. Future research should strive to evaluate the long-term effects of the COVID-19 crisis on mental health.
{"title":"Changes on depression and suicidal ideation under severe lockdown restrictions during the first wave of the COVID-19 pandemic in Spain: a longitudinal study in the general population.","authors":"J L Ayuso-Mateos, D Morillo, J M Haro, B Olaya, E Lara, M Miret","doi":"10.1017/S2045796023000677","DOIUrl":"10.1017/S2045796023000677","url":null,"abstract":"<p><strong>Aims: </strong>To assess whether there is a change in the prevalence of depression and suicidal ideation after the strict lockdown measures due to the first wave of the COVID-19 pandemic in Spain, and to assess which are the factors associated with the incidence of a depressive episode or suicidal ideation during the lockdown.</p><p><strong>Methods: </strong>Data from a longitudinal adult population-based cohort from Madrid and Barcelona were analysed (<i>n</i> = 1103). Face-to-face home-based (pre-pandemic) and telephone interviews were performed. Depression and suicidal ideation were assessed through an adaptation of the Composite International Diagnostic Interview (CIDI 3.0). Population prevalence estimates and multivariable logistic regressions were computed.</p><p><strong>Results: </strong>Prevalence rates of depression changed significantly from before to after the COVID-19 outbreak (from 3.06% to 12.00%; <i>p</i> = 0.01) and per sex and age groups. Individuals reporting COVID-19 concerns (odds ratio [OR] = 3.11; 95% confidence interval [CI] = 1.45-6.69) and those feeling loneliness (OR = 1.99; 95% CI = 1.52-2.61) during the lockdown were at increased risk of developing depression during the confinement. Resilience showed a protective effect against the risk of depression (OR = 0.57; 95% CI = 0.39-0.83), while individuals perceiving social support during the confinement were at lower risk of developing suicidal thoughts (OR = 0.21; 95% CI = 0.09-0.46). Greater disability during the lockdown was also associated with the risk of suicidal ideation (OR = 2.77; 95% CI = 1.53-5.03).</p><p><strong>Conclusions: </strong>Continuous reinforcement of mental health preventive and intervening measures is of global importance, particularly among vulnerable groups who are experiencing the most distress. Future research should strive to evaluate the long-term effects of the COVID-19 crisis on mental health.</p>","PeriodicalId":11787,"journal":{"name":"Epidemiology and Psychiatric Sciences","volume":null,"pages":null},"PeriodicalIF":5.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10539734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10144911","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}
Aims: Previous cross-sectional and case-control studies have proposed that decreased vitamin D levels are positively correlated with the risk of suicidality in adults. However, limited studies have examined the association between vitamin D and suicidality in adolescents. This study aimed to investigate the relationship between serum vitamin D and suicidality risk among early adolescents.
Methods: Data were obtained from a Chinese early adolescent cohort. In this cohort, seventh-grade students from a middle school in Anhui Province were invited to voluntarily participate in the baseline assessments and provide peripheral blood samples (in September 2019). The participants were followed up annually (in September 2020 and September 2021). Serum 25-hydroxyvitamin D [25(OH)D] and vitamin D-related single-nucleotide polymorphisms at baseline were measured in November 2021. Traditional observational and Mendelian randomization (MR) analyses were performed to examine the relationship between serum 25(OH)D at baseline and the risk of baseline and incident suicidality (i.e., suicidal ideation [SI], plans and attempts).
Results: Traditional observational analysis did not reveal a significant linear or non-linear association of serum 25(OH)D concentration with the risks of baseline and 2-year incident suicidality in the total sample (P > .05 for all). Sex-stratified analysis revealed a non-linear association between the 25(OH)D concentration and the risk of baseline SI in women (Poverall = .002; Pnon-linear = .001). Moreover, the risk of baseline SI in the 25(OH) insufficiency group was lower than that in the 25(OH) deficiency group in the total sample (odds ratio [OR] = 0.69, 95% confidence interval [CI] = 0.51-0.92, P = .012). This difference remained significant in women (OR = 0.59, 95% CI = 0.40-0.87, P = .008) but not in men (OR = 0.78, 95% CI = 0.53-1.15, P = .205). Additionally, both linear and non-linear MR analyses did not support the causal effect of serum 25(OH)D concentration on the risk of baseline, 1-year and 2-year incident suicidality (P > .05 for all).
Conclusions: This study could not confirm the causal effect of vitamin D on suicidality risk among Chinese early adolescents. Future studies must confirm these findings with a large sample size.
目的:以往的横断面研究和病例对照研究认为,维生素 D 水平的降低与成年人的自杀风险呈正相关。然而,有关青少年维生素 D 与自杀之间关系的研究却十分有限。本研究旨在调查早期青少年血清维生素D与自杀风险之间的关系:方法:数据来自中国青少年队列。在该队列中,安徽省一所中学的七年级学生受邀自愿参加基线评估并提供外周血样本(2019年9月)。参与者每年接受一次随访(2020 年 9 月和 2021 年 9 月)。2021年11月测量基线时的血清25-羟维生素D [25(OH)D]和维生素D相关单核苷酸多态性。研究人员进行了传统的观察分析和孟德尔随机化(MR)分析,以检验基线时的血清25(OH)D与基线和事件自杀风险(即自杀意念[SI]、计划和企图)之间的关系:结果:传统的观察分析表明,在所有样本中,血清 25(OH)D 浓度与基线和 2 年内发生自杀行为的风险之间不存在显著的线性或非线性关系(P > .05)。性别分层分析显示,女性的 25(OH)D 浓度与基线 SI 风险之间存在非线性关系(Poverall = .002; Pnon-linear = .001)。此外,在所有样本中,25(OH)D 不足组的基线 SI 风险低于 25(OH)D 缺乏组(几率比 [OR] = 0.69,95% 置信区间 [CI] = 0.51-0.92,P = .012)。这一差异在女性(OR = 0.59,95% CI = 0.40-0.87,P = .008)中仍然显著,但在男性(OR = 0.78,95% CI = 0.53-1.15,P = .205)中则不显著。此外,线性和非线性MR分析均不支持血清25(OH)D浓度对基线、1年和2年自杀事件风险的因果效应(P > .05):本研究无法证实维生素D对中国青少年自杀风险的因果关系。今后的研究必须通过大量样本来证实这些发现。
{"title":"Vitamin D and suicidality: a Chinese early adolescent cohort and Mendelian randomization study.","authors":"Mengyuan Yuan, Yonghan Li, Junjie Chang, Xueying Zhang, Shaojie Wang, Leilei Cao, Yuan Li, Gengfu Wang, Puyu Su","doi":"10.1017/S2045796023000665","DOIUrl":"10.1017/S2045796023000665","url":null,"abstract":"<p><strong>Aims: </strong>Previous cross-sectional and case-control studies have proposed that decreased vitamin D levels are positively correlated with the risk of suicidality in adults. However, limited studies have examined the association between vitamin D and suicidality in adolescents. This study aimed to investigate the relationship between serum vitamin D and suicidality risk among early adolescents.</p><p><strong>Methods: </strong>Data were obtained from a Chinese early adolescent cohort. In this cohort, seventh-grade students from a middle school in Anhui Province were invited to voluntarily participate in the baseline assessments and provide peripheral blood samples (in September 2019). The participants were followed up annually (in September 2020 and September 2021). Serum 25-hydroxyvitamin D [25(OH)D] and vitamin D-related single-nucleotide polymorphisms at baseline were measured in November 2021. Traditional observational and Mendelian randomization (MR) analyses were performed to examine the relationship between serum 25(OH)D at baseline and the risk of baseline and incident suicidality (i.e., suicidal ideation [SI], plans and attempts).</p><p><strong>Results: </strong>Traditional observational analysis did not reveal a significant linear or non-linear association of serum 25(OH)D concentration with the risks of baseline and 2-year incident suicidality in the total sample (<i>P</i> > .05 for all). Sex-stratified analysis revealed a non-linear association between the 25(OH)D concentration and the risk of baseline SI in women (<i>P</i><sub>overall</sub> = .002; <i>P</i><sub>non-linear</sub> = .001). Moreover, the risk of baseline SI in the 25(OH) insufficiency group was lower than that in the 25(OH) deficiency group in the total sample (odds ratio [OR] = 0.69, 95% confidence interval [CI] = 0.51-0.92, <i>P</i> = .012). This difference remained significant in women (OR = 0.59, 95% CI = 0.40-0.87, <i>P =</i> .008) but not in men (OR = 0.78, 95% CI = 0.53-1.15, <i>P =</i> .205). Additionally, both linear and non-linear MR analyses did not support the causal effect of serum 25(OH)D concentration on the risk of baseline, 1-year and 2-year incident suicidality (<i>P</i> > .05 for all).</p><p><strong>Conclusions: </strong>This study could not confirm the causal effect of vitamin D on suicidality risk among Chinese early adolescents. Future studies must confirm these findings with a large sample size.</p>","PeriodicalId":11787,"journal":{"name":"Epidemiology and Psychiatric Sciences","volume":null,"pages":null},"PeriodicalIF":5.9,"publicationDate":"2023-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10465318/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10125947","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}
Pub Date : 2023-08-09DOI: 10.1017/S2045796023000628
Ana Portillo-Van Diest, Gemma Vilagut, Itxaso Alayo, Montse Ferrer, Franco Amigo, Benedikt L Amann, Andrés Aragón-Peña, Enric Aragonès, Ángel Asúnsolo Del Barco, Mireia Campos, Isabel Del Cura-González, Meritxell Espuga, Ana González-Pinto, Josep M Haro, Amparo Larrauri, Nieves López-Fresneña, Alma Martínez de Salázar, Juan D Molina, Rafael M Ortí-Lucas, Mara Parellada, José M Pelayo-Terán, Aurora Pérez-Zapata, José I Pijoan, Nieves Plana, Teresa Puig, Cristina Rius, Carmen Rodríguez-Blázquez, Ferran Sanz, Consol Serra, Iratxe Urreta-Barallobre, Ronald C Kessler, Ronny Bruffaerts, Eduard Vieta, Víctor Pérez-Solá, Jordi Alonso, Philippe Mortier
Aim: To investigate the occurrence of traumatic stress symptoms (TSS) among healthcare workers active during the COVID-19 pandemic and to obtain insight as to which pandemic-related stressful experiences are associated with onset and persistence of traumatic stress.
Methods: This is a multicenter prospective cohort study. Spanish healthcare workers (N = 4,809) participated at an initial assessment (i.e., just after the first wave of the Spain COVID-19 pandemic) and at a 4-month follow-up assessment using web-based surveys. Logistic regression investigated associations of 19 pandemic-related stressful experiences across four domains (infection-related, work-related, health-related and financial) with TSS prevalence, incidence and persistence, including simulations of population attributable risk proportions (PARP).
Results: Thirty-day TSS prevalence at T1 was 22.1%. Four-month incidence and persistence were 11.6% and 54.2%, respectively. Auxiliary nurses had highest rates of TSS prevalence (35.1%) and incidence (16.1%). All 19 pandemic-related stressful experiences under study were associated with TSS prevalence or incidence, especially experiences from the domains of health-related (PARP range 88.4-95.6%) and work-related stressful experiences (PARP range 76.8-86.5%). Nine stressful experiences were also associated with TSS persistence, of which having patient(s) in care who died from COVID-19 had the strongest association. This association remained significant after adjusting for co-occurring depression and anxiety.
Conclusions: TSSs among Spanish healthcare workers active during the COVID-19 pandemic are common and associated with various pandemic-related stressful experiences. Future research should investigate if these stressful experiences represent truly traumatic experiences and carry risk for the development of post-traumatic stress disorder.
{"title":"Traumatic stress symptoms among Spanish healthcare workers during the COVID-19 pandemic: a prospective study.","authors":"Ana Portillo-Van Diest, Gemma Vilagut, Itxaso Alayo, Montse Ferrer, Franco Amigo, Benedikt L Amann, Andrés Aragón-Peña, Enric Aragonès, Ángel Asúnsolo Del Barco, Mireia Campos, Isabel Del Cura-González, Meritxell Espuga, Ana González-Pinto, Josep M Haro, Amparo Larrauri, Nieves López-Fresneña, Alma Martínez de Salázar, Juan D Molina, Rafael M Ortí-Lucas, Mara Parellada, José M Pelayo-Terán, Aurora Pérez-Zapata, José I Pijoan, Nieves Plana, Teresa Puig, Cristina Rius, Carmen Rodríguez-Blázquez, Ferran Sanz, Consol Serra, Iratxe Urreta-Barallobre, Ronald C Kessler, Ronny Bruffaerts, Eduard Vieta, Víctor Pérez-Solá, Jordi Alonso, Philippe Mortier","doi":"10.1017/S2045796023000628","DOIUrl":"https://doi.org/10.1017/S2045796023000628","url":null,"abstract":"<p><strong>Aim: </strong>To investigate the occurrence of traumatic stress symptoms (TSS) among healthcare workers active during the COVID-19 pandemic and to obtain insight as to which pandemic-related stressful experiences are associated with onset and persistence of traumatic stress.</p><p><strong>Methods: </strong>This is a multicenter prospective cohort study. Spanish healthcare workers (<i>N</i> = 4,809) participated at an initial assessment (i.e., just after the first wave of the Spain COVID-19 pandemic) and at a 4-month follow-up assessment using web-based surveys. Logistic regression investigated associations of 19 pandemic-related stressful experiences across four domains (infection-related, work-related, health-related and financial) with TSS prevalence, incidence and persistence, including simulations of population attributable risk proportions (PARP).</p><p><strong>Results: </strong>Thirty-day TSS prevalence at T1 was 22.1%. Four-month incidence and persistence were 11.6% and 54.2%, respectively. Auxiliary nurses had highest rates of TSS prevalence (35.1%) and incidence (16.1%). All 19 pandemic-related stressful experiences under study were associated with TSS prevalence or incidence, especially experiences from the domains of health-related (PARP range 88.4-95.6%) and work-related stressful experiences (PARP range 76.8-86.5%). Nine stressful experiences were also associated with TSS persistence, of which having patient(s) in care who died from COVID-19 had the strongest association. This association remained significant after adjusting for co-occurring depression and anxiety.</p><p><strong>Conclusions: </strong>TSSs among Spanish healthcare workers active during the COVID-19 pandemic are common and associated with various pandemic-related stressful experiences. Future research should investigate if these stressful experiences represent truly traumatic experiences and carry risk for the development of post-traumatic stress disorder.</p>","PeriodicalId":11787,"journal":{"name":"Epidemiology and Psychiatric Sciences","volume":null,"pages":null},"PeriodicalIF":8.1,"publicationDate":"2023-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10465320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10125943","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}
Aims: To investigate mechanisms of suicide risk in people bereaved by suicide, prompted by observations that bereaved people experience higher levels of distress around dates of emotional significance. We hypothesised that suicide-bereaved first-degree relatives and partners experience an increased risk of self-harm and suicide around dates of (i) anniversaries of the death and (ii) the deceased's birthday, compared with intervening periods.
Methods: We conducted a self-controlled case series study using national register data on all individuals living in Denmark from 1 January 1980 to 31 December 2016 and who were bereaved by the suicide of a first-degree relative or partner (spouse or cohabitee) during that period, and who had the outcome (any episode of self-harm or suicide) within 5 years and 6 weeks of the bereavement. We compared relative incidence of suicidal behaviour in (i) the first 30 days after bereavement and (ii) in the aggregated exposed periods (6 weeks either side of death anniversaries; 6 weeks either side of the deceased's birthdays) to the reference (aggregated unexposed intervening periods). As an indirect comparison, we repeated these models in people bereaved by other causes.
Results: We found no evidence of an elevated risk of suicidal behaviour during periods around anniversaries of a death or the deceased's birthdays in people bereaved by suicide (adjusted incidence rate ratio [IRRadj] = 1.00; 95% confidence interval [CI] = 0.87-1.16) or other causes (IRRadj = 1.04; 95% CI = 1.00-1.08) compared with intervening periods. Rates were elevated in the 30 days immediately after bereavement by other causes (IRRadj: 1.95, 95% CI: 1.77-2.22).
Conclusions: Although people bereaved by suicide are at elevated risk of self-harm and suicide, our findings do not suggest that this risk is heightened around emotionally significant anniversaries. Bereavement care should be accessible at all points after a traumatic loss as needs will differ over the grief trajectory.
{"title":"Investigating risk of self-harm and suicide on anniversaries after bereavement by suicide and other causes: a Danish population-based self-controlled case series study.","authors":"Alexandra Pitman, Yanakan Logeswaran, Keltie McDonald, Julie Cerel, Gemma Lewis, Annette Erlangsen","doi":"10.1017/S2045796023000653","DOIUrl":"10.1017/S2045796023000653","url":null,"abstract":"<p><strong>Aims: </strong>To investigate mechanisms of suicide risk in people bereaved by suicide, prompted by observations that bereaved people experience higher levels of distress around dates of emotional significance. We hypothesised that suicide-bereaved first-degree relatives and partners experience an increased risk of self-harm and suicide around dates of (i) anniversaries of the death and (ii) the deceased's birthday, compared with intervening periods.</p><p><strong>Methods: </strong>We conducted a self-controlled case series study using national register data on all individuals living in Denmark from 1 January 1980 to 31 December 2016 and who were bereaved by the suicide of a first-degree relative or partner (spouse or cohabitee) during that period, and who had the outcome (any episode of self-harm or suicide) within 5 years and 6 weeks of the bereavement. We compared relative incidence of suicidal behaviour in (i) the first 30 days after bereavement and (ii) in the aggregated exposed periods (6 weeks either side of death anniversaries; 6 weeks either side of the deceased's birthdays) to the reference (aggregated unexposed intervening periods). As an indirect comparison, we repeated these models in people bereaved by other causes.</p><p><strong>Results: </strong>We found no evidence of an elevated risk of suicidal behaviour during periods around anniversaries of a death or the deceased's birthdays in people bereaved by suicide (adjusted incidence rate ratio [IRR<sub>adj</sub>] = 1.00; 95% confidence interval [CI] = 0.87-1.16) or other causes (IRR<sub>adj</sub> = 1.04; 95% CI = 1.00-1.08) compared with intervening periods. Rates were elevated in the 30 days immediately after bereavement by other causes (IRR<sub>adj</sub>: 1.95, 95% CI: 1.77-2.22).</p><p><strong>Conclusions: </strong>Although people bereaved by suicide are at elevated risk of self-harm and suicide, our findings do not suggest that this risk is heightened around emotionally significant anniversaries. Bereavement care should be accessible at all points after a traumatic loss as needs will differ over the grief trajectory.</p>","PeriodicalId":11787,"journal":{"name":"Epidemiology and Psychiatric Sciences","volume":null,"pages":null},"PeriodicalIF":8.1,"publicationDate":"2023-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10465319/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10128807","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}
Pub Date : 2023-08-04DOI: 10.1017/S2045796023000641
J Spahlholz, E Baumann, R Müller-Hilmer, R Hilmer, C Sander, S Schindler, S Speerforck, M C Angermeyer, G Schomerus
Aims: Help-seeking for mental health problems is facilitated and hindered by several factors at the individual, interpersonal and community level. The most frequently researched factors contributing to differences in help-seeking behaviour are based on classical socio-demographic variables, such as age, gender and education, but explanations for the observed differences are often absent or remain vague. The present study complements traditional approaches in help-seeking research by introducing a milieu approach, focusing on values and political attitudes as a possible explanation for differences in help-seeking for emotional mental health problems.
Methods: A representative cross-sectional survey of N = 3,042 respondents in Germany was conducted through face-to-face interviews about past help-seeking for mental health problems, socio-demographic characteristics and values and political attitudes.
Results: Multivariate logistic regression analyses indicated that belonging to a cosmopolitan intellectual milieu group was significantly associated with an increased likelihood of past help-seeking for mental health issues (psychotherapeutic/psychological help-seeking [OR = 2.09, 95% CI: 1.11-3.93, p < 0.05) and primary care (OR = 2.21, 95% CI: 1.15-4.24, p < 0.05]), whereas members of individualist and conservative milieu groups were less likely to report having sought help from a psychotherapist, but not from a general practitioner. Increased odds ratios were also found for a number of socio-demographic variables, such as being aged 26 years and over, a female gender and more than 12 years of formal education. Associations between socio-demographic variables remained significant, and the explained variance of the used models improved considerably when milieu variables were added.
Conclusions: We discuss how milieu-specific patterns were relevant for explaining differences in mental health service use in addition to socio-demographic factors. It seems promising to consider help-seeking from a milieu perspective to improve disparities in access to and the use of psychotherapy as well as to resource allocation.
目的:在个人、人际和社区层面,寻求精神健康问题的帮助受到若干因素的促进和阻碍。最常被研究的导致求助行为差异的因素是基于经典的社会人口变量,如年龄、性别和教育程度,但对观察到的差异的解释往往不存在或仍然模糊。本研究补充了传统的求助研究方法,引入了一种环境方法,关注价值观和政治态度作为对情感心理健康问题求助差异的可能解释。方法:采用面对面访谈的方法,对3042名德国受访者进行代表性横断面调查,调查内容包括过去的心理健康问题求助情况、社会人口学特征以及价值观和政治态度。结果:多因素logistic回归分析表明,属于国际化知识分子环境群体与过去寻求心理健康问题(心理治疗/心理帮助)的可能性增加显著相关[OR = 2.09, 95% CI: 1.11-3.93, p p]。结论:除了社会人口统计学因素外,我们讨论了环境特定模式如何与解释心理健康服务使用差异相关。从环境的角度来考虑寻求帮助,以改善心理治疗的获取和使用以及资源分配方面的差距,似乎很有希望。
{"title":"Do values and political attitudes affect help-seeking? Exploring reported help-seeking for mental health problems in a general population sample using a milieu framework.","authors":"J Spahlholz, E Baumann, R Müller-Hilmer, R Hilmer, C Sander, S Schindler, S Speerforck, M C Angermeyer, G Schomerus","doi":"10.1017/S2045796023000641","DOIUrl":"https://doi.org/10.1017/S2045796023000641","url":null,"abstract":"<p><strong>Aims: </strong>Help-seeking for mental health problems is facilitated and hindered by several factors at the individual, interpersonal and community level. The most frequently researched factors contributing to differences in help-seeking behaviour are based on classical socio-demographic variables, such as age, gender and education, but explanations for the observed differences are often absent or remain vague. The present study complements traditional approaches in help-seeking research by introducing a milieu approach, focusing on values and political attitudes as a possible explanation for differences in help-seeking for emotional mental health problems.</p><p><strong>Methods: </strong>A representative cross-sectional survey of <i>N</i> = 3,042 respondents in Germany was conducted through face-to-face interviews about past help-seeking for mental health problems, socio-demographic characteristics and values and political attitudes.</p><p><strong>Results: </strong>Multivariate logistic regression analyses indicated that belonging to a cosmopolitan intellectual milieu group was significantly associated with an increased likelihood of past help-seeking for mental health issues (psychotherapeutic/psychological help-seeking [OR = 2.09, 95% CI: 1.11-3.93, <i>p</i> < 0.05) and primary care (OR = 2.21, 95% CI: 1.15-4.24, <i>p</i> < 0.05]), whereas members of individualist and conservative milieu groups were less likely to report having sought help from a psychotherapist, but not from a general practitioner. Increased odds ratios were also found for a number of socio-demographic variables, such as being aged 26 years and over, a female gender and more than 12 years of formal education. Associations between socio-demographic variables remained significant, and the explained variance of the used models improved considerably when milieu variables were added.</p><p><strong>Conclusions: </strong>We discuss how milieu-specific patterns were relevant for explaining differences in mental health service use in addition to socio-demographic factors. It seems promising to consider help-seeking from a milieu perspective to improve disparities in access to and the use of psychotherapy as well as to resource allocation.</p>","PeriodicalId":11787,"journal":{"name":"Epidemiology and Psychiatric Sciences","volume":null,"pages":null},"PeriodicalIF":8.1,"publicationDate":"2023-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10465317/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10126737","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}
Aims: Socio-cultural integration of refugees has received scant attention in the academic literature. Türkiye hosts the largest number of refugees, including Afghans, as the second largest asylum-seeking group in Türkiye. There is a dearth of research into the mental health and integration of Afghan refugees in Türkiye. The aim of the present study was to investigate socio-cultural integration outcomes among Afghan refugees in Türkiye by considering the role of traumatic events and post-displacement stressors. The role of mental health in integration outcomes was further examined.
Methods: A cross-sectional, web-based survey study with 785 Afghan refugees in Türkiye was conducted between April and June 2021. Data were collected on socio-demographic characteristics, potentially traumatic events (PTEs) (Harvard Trauma Questionnaire), post-displacement stressors (Post-Migration Living Difficulties Checklist), mental health symptoms (Hopkins Symptoms Checklist-25), social integration- social bonds (contact with co-ethnic group members) and social bridges (contact with the host community)- and cultural integration (Vancouver Index of Acculturation). Structural equation modelling was conducted to test the hypothesized relationship between conflict and displacement-related stressors, mental health and socio-cultural integration.
Results: Findings showed that conflict-related traumatic events and post-displacement stressors significantly predicted higher mental health symptoms. Experiencing traumatic events significantly predicted higher levels of social bridges, adopting destination culture and lower level of maintaining heritage culture. Mental health problems predicted the relationship between stressors related to forced displacement and integration outcomes-social bridges and adopting destination culture. These findings highlight the role of mental health as an indispensable resource for socio-cultural integration. Further, conflict and displacement-related stressors are important determinants of socio-cultural integration among Afghan refugees in Türkiye.
Conclusion: Exposure to PTEs and post-displacement stressors were significant risk factors for the mental health and socio-cultural integration of Afghan refugees in Türkiye. These stressful experiences deteriorate refugees' mental health, which hinders their integration into the host society.
{"title":"Socio-cultural integration of Afghan refugees in Türkiye: the role of traumatic events, post-displacement stressors and mental health.","authors":"Gülşah Kurt, Maryam Ekhtiari, Peter Ventevogel, Merve Ersahin, Zeynep Ilkkursun, Nuriye Akbiyik, Ceren Acarturk","doi":"10.1017/S204579602300063X","DOIUrl":"https://doi.org/10.1017/S204579602300063X","url":null,"abstract":"<p><strong>Aims: </strong>Socio-cultural integration of refugees has received scant attention in the academic literature. Türkiye hosts the largest number of refugees, including Afghans, as the second largest asylum-seeking group in Türkiye. There is a dearth of research into the mental health and integration of Afghan refugees in Türkiye. The aim of the present study was to investigate socio-cultural integration outcomes among Afghan refugees in Türkiye by considering the role of traumatic events and post-displacement stressors. The role of mental health in integration outcomes was further examined.</p><p><strong>Methods: </strong>A cross-sectional, web-based survey study with 785 Afghan refugees in Türkiye was conducted between April and June 2021. Data were collected on socio-demographic characteristics, potentially traumatic events (PTEs) (Harvard Trauma Questionnaire), post-displacement stressors (Post-Migration Living Difficulties Checklist), mental health symptoms (Hopkins Symptoms Checklist-25), social integration- <i>social bonds</i> (contact with co-ethnic group members) and <i>social bridges</i> (contact with the host community)- and cultural integration (Vancouver Index of Acculturation). Structural equation modelling was conducted to test the hypothesized relationship between conflict and displacement-related stressors, mental health and socio-cultural integration.</p><p><strong>Results: </strong>Findings showed that conflict-related traumatic events and post-displacement stressors significantly predicted higher mental health symptoms. Experiencing traumatic events significantly predicted higher levels of social bridges, adopting destination culture and lower level of maintaining heritage culture. Mental health problems predicted the relationship between stressors related to forced displacement and integration outcomes-social bridges and adopting destination culture. These findings highlight the role of mental health as an indispensable resource for socio-cultural integration. Further, conflict and displacement-related stressors are important determinants of socio-cultural integration among Afghan refugees in Türkiye.</p><p><strong>Conclusion: </strong>Exposure to PTEs and post-displacement stressors were significant risk factors for the mental health and socio-cultural integration of Afghan refugees in Türkiye. These stressful experiences deteriorate refugees' mental health, which hinders their integration into the host society.</p>","PeriodicalId":11787,"journal":{"name":"Epidemiology and Psychiatric Sciences","volume":null,"pages":null},"PeriodicalIF":8.1,"publicationDate":"2023-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10465316/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10126735","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}
Pub Date : 2023-07-20DOI: 10.1017/S2045796023000574
Heeyeon Kim, Jae Han Kim, Junghwan Kim, Jong Yeob Kim, Samuele Cortese, Lee Smith, Ai Koyanagi, Joaquim Radua, Paolo Fusar-Poli, Andre F Carvalho, Gonzalo Salazar de Pablo, Jae Il Shin, Keun-Ah Cheon, Marco Solmi
Aims: This study aimed to summarize the evidence on sleep alterations in medication-naïve children and adolescents with autism spectrum disorder (ASD).
Methods: We systematically searched PubMed/Medline, Embase and Web of Science databases from inception through March 22, 2021. This study was registered with PROSPERO (CRD42021243881). Any observational study was included that enrolled medication-naïve children and adolescents with ASD and compared objective (actigraphy and polysomnography) or subjective sleep parameters with typically developing (TD) counterparts. We extracted relevant data such as the study design and outcome measures. The methodological quality was assessed through the Newcastle-Ottawa Scale (NOS). A meta-analysis was carried out using the random-effects model by pooling effect sizes as Hedges' g. To assess publication bias, Egger's test and p-curve analysis were done. A priori planned meta-regression and subgroup analysis were also performed to identify potential moderators.
Results: Out of 4277 retrieved references, 16 studies were eligible with 981 ASD patients and 1220 TD individuals. The analysis of objective measures showed that medication-naïve ASD patients had significantly longer sleep latency (Hedges' g 0.59; 95% confidence interval [95% CI] 0.26 to 0.92), reduced sleep efficiency (Hedges' g -0.58; 95% CI -0.87 to -0.28), time in bed (Hedges' g -0.64; 95% CI -1.02 to -0.26) and total sleep time (Hedges' g -0.64; 95% CI -1.01 to -0.27). The analysis of subjective measures showed that they had more problems in daytime sleepiness (Hedges' g 0.48; 95% CI 0.26 to 0.71), sleep latency (Hedges' g 1.15; 95% CI 0.72 to 1.58), initiating and maintaining sleep (Hedges' g 0.86; 95% CI 0.39 to 1.33) and sleep hyperhidrosis (Hedges' g 0.48; 95% CI 0.29 to 0.66). Potential publication bias was detected for sleep latency, sleep period time and total sleep time measured by polysomnography. Some sleep alterations were moderated by age, sex and concurrent intellectual disability. The median NOS score was 8 (interquartile range 7.25-8.75).
Conclusion: We found that medication-naïve children and adolescents with ASD presented significantly more subjective and objective sleep alterations compared to TD and identified possible moderators of these differences. Future research requires an analysis of how these sleep alterations are linked to core symptom severity and comorbid behavioural problems, which would provide an integrated therapeutic intervention for ASD. However, our results should be interpreted in light of the potential publication bias.
目的:本研究旨在总结medication-naïve自闭症谱系障碍(ASD)儿童和青少年睡眠改变的证据。方法:我们系统地检索了PubMed/Medline、Embase和Web of Science数据库,检索时间从成立到2021年3月22日。本研究已在PROSPERO注册(CRD42021243881)。任何观察性研究都包括medication-naïve自闭症儿童和青少年,并将客观睡眠参数(活动图和多导睡眠图)或主观睡眠参数与典型发育(TD)相比较。我们提取了相关数据,如研究设计和结果测量。通过纽卡斯尔-渥太华量表(NOS)评估方法学质量。采用随机效应模型进行荟萃分析,将效应大小池化为Hedges’g。为了评估发表偏倚,采用Egger’s检验和p曲线分析。还进行了先验计划元回归和亚组分析以确定潜在的调节因子。结果:在4277篇检索文献中,16项研究纳入981名ASD患者和1220名TD患者。客观测量分析显示medication-naïve ASD患者的睡眠潜伏期明显更长(Hedges' g 0.59;95%可信区间[95% CI] 0.26至0.92),睡眠效率降低(Hedges' g -0.58;95% CI -0.87至-0.28),卧床时间(Hedges的g -0.64;95% CI -1.02至-0.26)和总睡眠时间(Hedges' g -0.64;95% CI为-1.01 ~ -0.27)。主观测量的分析表明,他们在白天困倦方面有更多的问题(赫奇斯的g值为0.48;95% CI 0.26 - 0.71),睡眠潜伏期(Hedges' g 1.15;95% CI 0.72至1.58),启动和维持睡眠(Hedges g 0.86;95% CI 0.39 - 1.33)和睡眠多汗症(Hedges' g 0.48;95% CI 0.29 ~ 0.66)。通过多导睡眠描记术检测睡眠潜伏期、睡眠时间和总睡眠时间的潜在发表偏倚。一些睡眠改变受到年龄、性别和并发智力残疾的影响。NOS评分中位数为8分(四分位数范围7.25 ~ 8.75)。结论:我们发现medication-naïve患有ASD的儿童和青少年与TD相比表现出更多的主观和客观睡眠改变,并确定了这些差异的可能调节因素。未来的研究需要分析这些睡眠改变如何与核心症状严重程度和共病行为问题联系起来,这将为ASD提供综合治疗干预。然而,我们的结果应该根据潜在的发表偏倚来解释。
{"title":"Subjective and objective sleep alterations in medication-naïve children and adolescents with autism spectrum disorder: a systematic review and meta-analysis.","authors":"Heeyeon Kim, Jae Han Kim, Junghwan Kim, Jong Yeob Kim, Samuele Cortese, Lee Smith, Ai Koyanagi, Joaquim Radua, Paolo Fusar-Poli, Andre F Carvalho, Gonzalo Salazar de Pablo, Jae Il Shin, Keun-Ah Cheon, Marco Solmi","doi":"10.1017/S2045796023000574","DOIUrl":"https://doi.org/10.1017/S2045796023000574","url":null,"abstract":"<p><strong>Aims: </strong>This study aimed to summarize the evidence on sleep alterations in medication-naïve children and adolescents with autism spectrum disorder (ASD).</p><p><strong>Methods: </strong>We systematically searched PubMed/Medline, Embase and Web of Science databases from inception through March 22, 2021. This study was registered with PROSPERO (CRD42021243881). Any observational study was included that enrolled medication-naïve children and adolescents with ASD and compared objective (actigraphy and polysomnography) or subjective sleep parameters with typically developing (TD) counterparts. We extracted relevant data such as the study design and outcome measures. The methodological quality was assessed through the Newcastle-Ottawa Scale (NOS). A meta-analysis was carried out using the random-effects model by pooling effect sizes as Hedges' <i>g</i>. To assess publication bias, Egger's test and <i>p</i>-curve analysis were done. A priori planned meta-regression and subgroup analysis were also performed to identify potential moderators.</p><p><strong>Results: </strong>Out of 4277 retrieved references, 16 studies were eligible with 981 ASD patients and 1220 TD individuals. The analysis of objective measures showed that medication-naïve ASD patients had significantly longer sleep latency (Hedges' <i>g</i> 0.59; 95% confidence interval [95% CI] 0.26 to 0.92), reduced sleep efficiency (Hedges' <i>g</i> -0.58; 95% CI -0.87 to -0.28), time in bed (Hedges' <i>g</i> -0.64; 95% CI -1.02 to -0.26) and total sleep time (Hedges' <i>g</i> -0.64; 95% CI -1.01 to -0.27). The analysis of subjective measures showed that they had more problems in daytime sleepiness (Hedges' <i>g</i> 0.48; 95% CI 0.26 to 0.71), sleep latency (Hedges' <i>g</i> 1.15; 95% CI 0.72 to 1.58), initiating and maintaining sleep (Hedges' <i>g</i> 0.86; 95% CI 0.39 to 1.33) and sleep hyperhidrosis (Hedges' <i>g</i> 0.48; 95% CI 0.29 to 0.66). Potential publication bias was detected for sleep latency, sleep period time and total sleep time measured by polysomnography. Some sleep alterations were moderated by age, sex and concurrent intellectual disability. The median NOS score was 8 (interquartile range 7.25-8.75).</p><p><strong>Conclusion: </strong>We found that medication-naïve children and adolescents with ASD presented significantly more subjective and objective sleep alterations compared to TD and identified possible moderators of these differences. Future research requires an analysis of how these sleep alterations are linked to core symptom severity and comorbid behavioural problems, which would provide an integrated therapeutic intervention for ASD. However, our results should be interpreted in light of the potential publication bias.</p>","PeriodicalId":11787,"journal":{"name":"Epidemiology and Psychiatric Sciences","volume":null,"pages":null},"PeriodicalIF":8.1,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10387490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10293635","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}