363 research outputs found
Text_S1 – Supplemental material for Healthcare utilization, psychiatric medication and risk of rehospitalization in suicide-attempting patients with common mental disorders
No full textSupplemental material, Text_S1 for Healthcare utilization, psychiatric medication and risk of rehospitalization in suicide-attempting patients with common mental disorders by Thomas Niederkrotenthaler, Ellenor Mittendorfer-Rutz, Stefan Thurner, Gottfried Endel and Peter Klimek in Australian & New Zealand Journal of Psychiatry</p
sj-docx-1-sjp-10.1177_14034948221079060 – Supplemental material for Differences in labour market marginalisation between refugees, non-refugee immigrants and Swedish-born youth: Role of age at arrival and residency duration
No full textSupplemental material, sj-docx-1-sjp-10.1177_14034948221079060 for Differences in labour market marginalisation between refugees, non-refugee immigrants and Swedish-born youth: Role of age at arrival and residency duration by Gerdur Geirsdottir, Ellenor Mittendorfer-Rutz, Emma Björkenstam, Lingjing Chen, Thomas E. Dorner and Ridwanul Amin in Scandinavian Journal of Public Health</p
Perinatal and familial risk factors of youth suicidal behaviour
No full textCompleted suicide constitutes one of the leading causes of death in adolescents and young adults. Youth suicide attempt often precedes completed suicide and represents in itself a considerable public health problem in Sweden and in other European countries.The aims of this study were to 1) scrutinise trends in suicide mortality in adolescents compared to trends in an older age group and in relation to changes in reporting practices in European countries, 2) investigate the relation of maternal, pre- and perinatal factors with subsequent suicidal behaviour in young adults, 3) analyse the association of foetal and childhood growth and their interaction with subsequent suicide attempt by violent and nonviolent means, and finally 4) analyse the independent and interacting effects of familial and individual psychopathology as well as familial suicidal behaviour on suicide attempt in young adults.For this purpose, the WHO mortality database has been used for the analysis of European suicide trends from 1979 to 1996 in Study I. For the investigation of pre-and perinatal, childhood and familial factors in relation to subsequent suicidal behaviour up to seven Swedish registers were linked: the Medical Birth register, the 1990 Population and Housing Census, the Inpatient Care Register, the Cause of Death Register, the Multi Generation Register, the Military Service Conscription Register and the Register of the Total Population. The birth cohort 1973-80 was followed up to 1999 using a cohort study design in Study II and III, including 713,370 individuals in Study II and 318,953 males in Study III. In paper IV all individuals, who were born 1968-80 and who had attempted suicide (14,440 cases) until 1999 were matched for gender, county and month of birth with 144,400 controls.Suicide rates in adolescents increased for males in twenty-one and for females in eighteen of the thirty European countries during the 1980s and mid-1990s. These increases were generally accompanied by stable or decreasing trends in suicide rates of males and females of 20 years and over. In several countries changes in reporting practices affected to different degrees the temporal variations in adolescent suicide rates, primarily in males.Results from Study II revealed that teenage motherhood increased the risk of both suicide attempt and completion in adolescents and young adults. Multiparity and low maternal education predicted suicide attempt in young offspring. Preterm birth was a strong predictor for violent suicide attempt. Restricted foetal growth was associated with both suicide completion and attempt. The inverse association of foetal growth and suicide attempt did not seem to be modified by childhood growth (Study III). Decline in postnatal linear growth potential entailed an additional risk.Familial suicidal behaviour, primarily suicide attempt, and familial psychopathology, mainly substance abuse and personality disorders, were significantly associated with an increased risk of suicide attempt in young adults. There seemed to be an effect of familial suicidal behaviour as well as familial psychopathology on youth suicide attempt beyond the transmission of mental illness. Familial suicidal behaviour had a stronger effect on suicide attempt of early onset and on boys. Individual psychopathology, primarily substance abuse, affective and personality disorders, emerged as the strongest risk factor for suicide attempt in young adults. Significant interactions were also observed between psychopathology in index subjects and familial suicidal behaviour.List of scientific papersI. Mittendorfer Rutz E, Wasserman D (2004). Trends in adolescent suicide mortality in the WHO European region. European Child and Adolescent Psychiatry. 13(5): 321-31.II. Mittendorfer-Rutz E, Rasmussen F, Wasserman D (2004). Restricted fetal growth and adverse maternal psychosocial and socioeconomic conditions as risk factors for suicidal behaviour of offspring: a cohort study. Lancet. 364(9440): 1135-40. https://pubmed.ncbi.nlm.nih.gov/15451220III. Mittendorfer Rutz E, Rasmussen F, Wasserman D (2005). Foetal and childhood growth and the risk of suicide attempt - a cohort study of 318,953 young men. [Submitted]IV. Mittendorfer Rutz E, Rasmussen F, Wasserman D (2005). Familial clustering of suicidal behaviour and psychopathology in young suicide attempters - a register-based nested case control study. [Manuscript]</p
Efficacy and effectiveness of antipsychotics in schizophrenia: network meta-analyses combining evidence from randomised controlled trials and real-world data
No full textBackground: There is debate about the generalisability of results from randomised clinical trials (RCTs) to real-world settings. Studying outcomes of treatments for schizophrenia can shed light on this issue and inform treatment guidelines. We therefore compared the efficacy and effectiveness of antipsychotics for relapse prevention in schizophrenia and estimated overall treatment effects using all available RCT and real-world evidence. Methods: We conducted network meta-analyses using individual participant data from Swedish and Finnish national registries and aggregate data from RCTs. The target population was adults (age >18 and 1 means superior effectiveness in real-world to RCTs), except for LAI versus oral comparisons (HR ratio 0·73 [0·53-0·99], indicating superior effectiveness in real-world data relative to RCTs). The real-world network meta-analysis showed clozapine was most effective, followed by olanzapine LAI. The RCT network meta-analysis exhibited heterogeneity and inconsistency. The joint real-world and RCT network meta-analysis identified olanzapine as the most efficacious antipsychotic amongst those present in both RCTs and the real world registries. Interpretation: LAI antipsychotics perform slightly better in the real world than according to RCTs. Otherwise, RCT evidence was in line with real-world evidence for most between-drug comparisons, but RCTs might overestimate effectiveness of antipsychotics observed in routine care settings. Our results further the understanding of the generalisability of RCT findings to clinical practice and can inform preferential prescribing guidelines. Funding: None
The WHO European monitoring surveys on national suicide preventive programmes and strategies
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Childhood adversity and common mental disorders in young employees in Sweden : is the association affected by early adulthood occupational class?
No full textBackground: Childhood adversities are associated with an elevated risk for common mental disorders (CMDs). Whether the strength of the association also holds for young employees is unclear. Given the increase in CMD rates in young adults over the past decade, identification of risk factors has important implications for future public health interventions. The current study aimed to investigate the effects of childhood adversities on CMDs. Additionally, the role of occupational class (non-manual/manual workers) in the relationship was examined. Methods: This population-based longitudinal cohort study included 544,003 employees, 19-29 years, residing in Sweden in 2009. Adversities included parental death, parental mental and somatic disorders, parental separation or single-parent household, household public assistance and residential instability. Estimates of risk of CMDs, measured as prescription of antidepressants and/or psychiatric care with a clinical diagnosis of CMDs, between 2010 and 2016 were calculated as relative risks (RR) with 95% confidence intervals (CI), using a modified Poisson regression analysis. Occupational class (non-manual/manual workers) was explored as a potential moderator. Results: In both manual and non-manual workers, childhood adversities were associated with an elevated risk of subsequent CMDs. The risk was moderated by occupational class, i.e., especially pronounced risk was found in manual workers who had experienced cumulative adversity (adjusted RR 1.76, 95% CI 1.70-1.83) when compared to non-manual workers with no adversity. Among the adversities examined, having had a parent treated for a mental disorder, having grown up in a household living on public assistance or having experienced residential instability were the strongest predictors of CMDs. Conclusion: Our findings suggest that, among young employees, manual workers with a history of multiple childhood adversities are especially vulnerable to subsequent CMDs
Prevalence and predictors of healthcare use for psychiatric disorders at 9 years after a first episode of psychosis : a Swedish national cohort study
No full textBACKGROUND: Psychotic disorders are known to exhibit heterogeneity with regards to illness course and prognosis, yet few studies have examined long-term healthcare use. OBJECTIVE: To determine the prevalence and predictors of healthcare use for psychiatric disorders at 9 years after the first episode of psychosis (FEP). METHODS: National registers were used to identify all Swedish residents aged 18-35 years with FEP between 2006 and 2013. The 12-month period-prevalence of secondary healthcare use was determined at each year of the 9-year follow-up, categorised according to main diagnosis (psychotic disorder vs other psychiatric disorder vs none vs censored). Multinomial logistic regression models were used to examine associations between baseline characteristics and healthcare use at 9 years and derive predicted probabilities and 95% CIs for the four outcome groups, for each predictor variable. FINDINGS: Among 7733 individuals with FEP, 31.7% were treated in secondary healthcare for psychotic disorders at the 9-year follow-up, 24.1% were treated for other psychiatric disorders, 35.7% did not use healthcare services for psychiatric disorders and 8.5% were censored due to death/emigration. Having an initial diagnosis of schizophrenia was associated with the highest probability of secondary healthcare use for psychotic disorder at 9 years (0.50, 95% CI (0.46 to 0.54)] followed by inpatient treatment at first diagnosis (0.37, 95% CI (0.35 to 0.38)). CONCLUSION: Although 56% of individuals with FEP were treated for psychiatric disorders in secondary healthcare 9 years later, a substantial proportion were treated for non-psychotic disorders. CLINICAL IMPLICATIONS: Individuals with an initial diagnosis of schizophrenia, who received their first diagnosis in inpatient settings, may need more intensive treatment to facilitate remission and recovery
Socioeconomic inequalities in treatment of individuals with common mental disorders regarding subsequent development of mental illness
No full textPurpose
Socioeconomic differences appear to be reflected in both, the development and the treatment of common mental disorders (CMDs, i.e. depressive, anxiety and stress-related disorders). Underlying mechanisms of these inequalities are to date not fully understood. This study aimed to investigate if (1) there are socioeconomic differences with regard to type of treatment and (2) if the socioeconomic status modifies the association between treatment and subsequent inpatient care or suicide attempt, respectively, in individuals with CMDs.
Methods
The study population comprised 66,097 individuals aged 18–59 on sick-leave due to a CMD during 2006 in Sweden. Cox regression with a follow-up from 2007 through 2010 estimated crude and multivariate hazard ratios (HR) with 95% confidence intervals (CI).
Results
Individuals with sickness absence due to CMDs and a higher educational level were had a lower proportions of specialised health care and combined psychiatric medication than their counterparts with lower education. However, if high educated CMD patients received more combined medication, associations with subsequent mental inpatient care (p < 0.01) and suicide attempt (p < 0.05) were stronger than for their counterparts with low education. Moreover, previous inpatient care due to mental disorders was associated with higher HRs of subsequent suicide attempt in CMD patients with high education (HR 5.88; CI 3.02–11.45) compared to those with low education (1.96; 1.06–3.60).
Conclusion
Findings suggest that socioeconomic inequalities shape differences in treatment measures and mental health development in individuals with CMDs. These differences might signal discrepancies in treatment per se or reflect morbidity differences requiring different treatment regimens, or may be due to the fact that different diagnoses are given in different educational strata due to differential role of stigma
Prevention of depression and suicide in Primary Health Care settings: a systematic review of the evidence
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