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Sökning: WFRF:(Päären Aivar 1965 )

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  • Bohman, H, et al. (författare)
  • Somatic symptoms in adolescence as a predictor of in-patient care for mental disorders in adulthood
  • 2016
  • Ingår i: European Journal of Public Health. - 1101-1262 .- 1464-360X. ; 26:1
  • Tidskriftsartikel (övrigt vetenskapligt)abstract
    • BackgroundSomatic symptoms such as headache, abdominal pain and dizziness, are common among young people and often associated with poor everyday functioning and concurrent mental disorders. Yet, relatively few studies have examined the long-term consequences of such symptoms. The aim of the study was to investigate if somatic symptoms in adolescence predict adulthood hospital based care for mental disorders.MethodsThe total school population of 16-17-year olds, in the city of Uppsala, Sweden, was screened for depression in 1991-1993. Adolescents with positive screening and the same number of healthy controls took part in a semi-structured diagnostic interview of mental disorders. In addition, 21 different self-rated functional somatic symptoms were assessed. The participants were followed up in the national patients register about 20 years later (n = 337). The associations between somatic symptoms in adolescence and in-patient care and out-patient hospital based mental health care in adulthood were analysed using binary logistic regression analysis.ResultsAdolescents with somatic symptoms had an excess risk of later psychiatric hospital based health care. The presence of multiple somatic symptoms (≥5) in adolescence was associated with psychiatric hospital based care in adulthood also when controlling for depression and anxiety in adolescence as well as sex and potential psychosocial confounders (OR 3.29, p = 0.046). The presence of just any somatic symptom (≥1) in adolescence predicted later hospital based mental health care for mood disorders (OR 8.49, p = 0.041) whereas adolescent depression, anxiety and sex did not, when mutually adjusted for.ConclusionsSomatic symptoms in adolescence are a strong independent predictor of severe mental health problems in adulthood. The link between adolescent somatic symptoms and adult mood disorders are particularly strong even when somatic symptoms are compared head to head with concurrent depression and anxiety.
  • Alaie, Iman, et al. (författare)
  • Uppsala Longitudinal Adolescent Depression Study (ULADS)
  • 2019
  • Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055 .- 2044-6055. ; 9:3
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: To present the Uppsala Longitudinal Adolescent Depression Study, initiated in Uppsala, Sweden, in the early 1990s. The initial aim of this epidemiological investigation was to study the prevalence, characteristics and correlates of adolescent depression, and has subsequently expanded to include a broad range of social, economic and health-related long-term outcomes and cost-of-illness analyses.Participants: The source population was first-year students (aged 16-17) in upper-secondary schools in Uppsala during 1991-1992, of which 2300 (93%) were screened for depression. Adolescents with positive screening and sex/age-matched peers were invited to a comprehensive assessment. A total of 631 adolescents (78% females) completed this assessment, and 409 subsequently completed a 15year follow-up assessment. At both occasions, extensive information was collected on mental disorders, personality and psychosocial situation. Detailed social, economic and health-related data from 1993 onwards have recently been obtained from the Swedish national registries for 576 of the original participants and an age-matched reference population (N=200 000).Findings to date: The adolescent lifetime prevalence of a major depressive episode was estimated to be 11.4%. Recurrence in young adulthood was reported by the majority, with a particularly poor prognosis for those with a persistent depressive disorder or multiple somatic symptoms. Adolescent depression was also associated with an increased risk of other adversities in adulthood, including additional mental health conditions, low educational attainment and problems related to intimate relationships.Future plans: Longitudinal studies of adolescent depression are rare and must be responsibly managed and utilised. We therefore intend to follow the cohort continuously by means of registries. Currently, the participants are approaching mid-adulthood. At this stage, we are focusing on the overall long-term burden of adolescent depression. For this purpose, the research group has incorporated expertise in health economics. We would also welcome extended collaboration with researchers managing similar datasets.
  • Jonsson, Ulf, 1974-, et al. (författare)
  • Mental health outcome of long-term and episodic adolescent depression : 15-year follow-up of a community  sample
  • 2011
  • Ingår i: Journal of Affective Disorders. - 0165-0327 .- 1573-2517. ; 130:3, s. 395-404
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Recent studies have highlighted the unfavourable natural course of chronic/long-term depression. We investigated the adult mental health outcome of adolescent depression, with specific focus on long-term and episodic adolescent major depression (MD). METHODS: A community sample of depressed adolescents and non-depressed peers was followed-up with a structured diagnostic interview after 15years. The participants (n=382) were divided into five groups depending on their status in adolescence: no depression (n=155); long-term MD (n=91); episodic MD (n=63); dysthymia (n=33); and subthreshold symptoms (n=40). Outcomes (age 19-31) included mood disorders, other mental disorders, suicidality, and treatment for mental disorders. RESULTS: The long-term group overall had a poorer outcome than the non-depressed group, with the episodic group in an intermediate position. The outcome of the dysthymic group was similar to that of the long-term group, while the subsyndromal group did not differ markedly from the non-depressed group. The long-term group was more likely than the episodic group to report adult anxiety disorders, multiple mental disorders, suicide attempts, and treatment; they also seemed to develop more persistent adult depressions, with a higher number of recurrent episodes and longer duration of antidepressant treatment. Even after adjustment for adolescent factors of clinical and etiological importance, the long-term group had a markedly less favourable outcome than the episodic group. LIMITATION: The participation rate at follow-up was 64.6%. CONCLUSION: Longstanding depression in adolescence is a powerful predictor of continued mental health problems in adulthood. It is now important to evaluate if early interventions can alter this severe course.
  • Bohman, Hannes, 1965-, et al. (författare)
  • Long term follow up of adolescent depression : a population based study
  • 2010
  • Ingår i: Upsala Journal of Medical Sciences. - 0300-9734 .- 2000-1967. ; 115:1, s. 21-29
  • Tidskriftsartikel (refereegranskat)abstract
    • Adolescent depression is common. Earlier studies indicate that relapses and recurrences are common. But many questions are still unanswered. The aim of the present study has been to follow subjects with adolescent depressions, identified in a population-based study, over a 15-year period. Subjects with adolescent depression (n = 362) and a comparison group (n = 250) were followed in the National Swedish registers.The formerly depressed females had significantly more out-patient visits, and a significantly higher proportion (78.4% versus 69.6%) had at least one out-patient visit. Among the males, no significant differences were found as concerns out-patient visits. The formerly depressed females had significantly more in-patient stays (3.6 versus 2.4) and a significantly higher total number of in-patient days (27.4 versus 10.1). A significantly higher proportion had in-patient days due to mental disorders (9.5% versus 4.6%), in particular anxiety disorders (4.9% versus 1.0%). As concerns the males, a significantly higher proportion had in-patient days due to mental disorders (16.5% versus 1.8%), in particular alcohol and drug abuse (7.6% versus 0%).Among the formerly depressed females there were no significant differences against the comparison group as concerns the proportion of being a mother, number of children per woman, or age at first child. However, a significantly higher proportion of the formerly depressed females had had different, usually mild, disorders related to pregnancy (8.6% versus 0.6%). The children of the women with adolescent depressions were not affected.
  • Bohman, Hannes, 1965-, et al. (författare)
  • Prognostic significance of functional somatic symptoms in adolescence : a 15-year community-based follow-up study of adolescents with depression compared with healthy peers
  • 2012
  • Ingår i: BMC Psychiatry. - 1471-244X .- 1471-244X. ; 12, s. 90-
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundThere is a lack of population-based long-term longitudinal research on mental health status and functional physical/somatic symptoms. Little is known about the long-term mental health outcomes associated with somatic symptoms or the temporal relationship between depression and such symptoms. This 15-year study followed up adolescents with depression and matched controls, screened from a population-based sample, who reported different numbers of somatic symptoms.MethodsThe total population of 16–17-year-olds in Uppsala, Sweden, was screened for depression in 1991–1993. Adolescents who screened positive and an equal number of healthy controls took part in a semi-structured diagnostic interview. In addition, 21 different self-rated somatic symptoms were assessed. Sixty-four percent of those adolescents participated in a follow-up structured interview 15 years later.ResultsSomatic symptoms in adolescence predicted depression and other adult mental disorders regardless of the presence of adolescent depression. In adolescents with depression, the number of functional somatic symptoms predicted, in a dose response relationship, suicidal behavior, bipolar episodes, and psychotic episodes as well as chronic and recurrent depression. Contrary to expectations, the somatic symptoms of abdominal pain and perspiration without exertion better predicted depression than all DSM-IV depressive symptoms. Abdominal pain persisted as an independent strong predictor of depression and anxiety, even after controlling for other important confounders.ConclusionsSomatic symptoms in adolescence can predict severe adult mental health disorders. The number of somatic symptoms concurrent with adolescent depression is, in a stepwise manner, linked to suicidal attempts, bipolar disorders, psychotic disorders, and recurrent and chronic depression. These findings can be useful in developing treatment guidelines for patients with somatic symptoms.
  • Bohman, Hannes, 1965-, et al. (författare)
  • Thicker carotid intima layer, thinner media layer and higher intima/media ratio in women with recurrent depressive disorders : a pilot study using non-invasive high frequency ultrasound
  • 2010
  • Ingår i: World Journal of Biological Psychiatry. - : Informa Healthcare. - 1562-2975 .- 1814-1412. ; 11:1, s. 71-75
  • Tidskriftsartikel (refereegranskat)abstract
    • Background. Growing evidence indicates that depression is an important risk factor for coronary heart disease. Thus, the aim of the present study has been to investigate if young women with adolescent onset and recurrent depressive disorders have signs of carotid intima and media changes already at the age of 30. Methods. Fifteen subjects with adolescent onset recurrent depressive disorders, mean age 31.5 years, were compared to 20 healthy women with a mean age of 39.6 years. The thickness of carotid artery intima and media was assessed, using non-invasive high-frequency ultrasound (25MHz). Results. The subjects with recurrent depressive disorders had significantly thicker carotid intima, significantly thinner carotid media and significantly higher intima/media ratio despite the fact that they were about 10 years younger than the healthy women. Hypertension, obesity or smoking could not explain the results. Conclusion. Already at the age of 30, subjects with recurrent depressive disorders with adolescent onset do have early signs of carotid intima and media changes, indicating a less healthy artery wall, despite otherwise no clinical signs of cardiovascular disease.
  • Päären, Aivar, 1965-, et al. (författare)
  • Early risk factors for adult bipolar disorder in adolescents with mood disorders : A 15-year follow-up of a community sample
  • 2014
  • Ingår i: BMC Psychiatry. - 1471-244X .- 1471-244X. ; 14:1, s. 363-
  • Tidskriftsartikel (refereegranskat)abstract
    • Background:  We aimed to outline the early risk factors for adult bipolar disorder (BPD) in adolescents with mood disorders.Methods: Adolescents (16-17 years old) with mood disorders (n=287; 90 participants with hypomania spectrum episodes and 197 with major depressive disorder [MDD]) were identified from a community sample. Fifteen years later (at 30-33 years of age), mood episodes were assessed (n=194). The risk of developing BPD (n=22), compared with MDD (n=104) or no mood episodes in adulthood (n=68), was estimated via logistic regression. Adolescent mood symptoms, non-mood disorders, and family characteristics were assessed as potential risk factors.Results: Among the adolescents with mood disorders, a family history of BPD was the strongest predictor of developing BPD compared with having no mood episodes in adulthood (OR=5.94; 95% CI=1.11-31.73), whereas disruptive disorders significantly increased the risk of developing BPD compared with developing MDD (OR=2.94; CI=1.06-8.12). The risk that adolescents with MDD would develop adult BPD, versus having no mood episodes in adulthood, was elevated among those with an early disruptive disorder (OR=3.62; CI=1.09-12.07) or multiple somatic symptoms (OR=6.60; CI=1.70-25.67). Only disruptive disorders significantly predicted adult BPD among adolescents with MDD versus continued MDD in adulthood (OR=3.59; CI=1.17-10.97). Only a few adolescents with hypomania spectrum episodes continued to have BPD as adults, and anxiety disorders appeared to increase this risk.Conclusions: Although most of the identified potential risk factors are likely general predictors of continued mood disorders, disruptive disorders emerged as specific predictors of developing adult BPD among adolescents with MDD.
  • Päären, Aivar, 1965- (författare)
  • Long-Term Health Outcome of Adolescent  Mood Disorders : Focus on Bipolar Disorder
  • 2015
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • There has recently been an intense debate about the increased rate of bipolar disorders (BPD) in children and adolescents observed in clinical settings. Thus, there is great interest in child and adolescent symptoms of hypomania and whether these symptoms subsequently will develop into BPD. More knowledge about early signs could give insight into the development of the disorder. There are also concerns that hypomanic symptoms in adolescence indicate excess risk of other health conditions. It has been reported that patients with mood disorders have a high consumption of prescription drugs in different ATC classes.The primary objective of this thesis was to better understand the mental health outcome of adolescents with hypomania spectrum symptoms and to identify early risk factors for adult bipolar disorder among adolescents with mood disorders. In order to widen the scope and investigate health outcome of mood disorder in general psychopharmacological outcomes were included.A community sample of adolescents (N=2 300) in the town of Uppsala, Sweden, was screened for depressive symptoms. Both participants with positive screening and matched controls (in total 631) were diagnostically interviewed. Ninety participants reported hypomania spectrum episodes, while another 197 fulfilled the criteria for major depressive disorder (MDD) without a history of a hypomania spectrum episode. A follow-up after 15 years included a blinded diagnostic interview, a self-assessment of personality disorders, and national register data on prescription drugs and health services use. Adolescent mood symptoms, non-mood disorders, and family characteristics were assessed. Univariate and multivariate analyses were used.The results indicate that the phenomenology of the hypomania spectrum episodes during childhood and adolescence per se does not predict adult bipolar disorder. However, having both affective symptoms during adolescence and a family history of bipolar disorder increases the risk of developing bipolar disorders in adulthood. Disruptive disorder in childhood or adolescence as well as family histories of BPD emerged as significant risk factors that differentiated between the future development of BPD and MDD.Adolescents with hypomania spectrum episodes and adolescents with MDD do not differ substantially in health outcomes in adulthood. Both groups are at increased risk for subsequent mental health problems, high consumption of prescription drugs, and high health care use, compared with the control group. The high rates of prescription drugs in many ATC classes found among the former depressed females seem to indicate a series of co-morbid somatic illnesses.Thus, it is important to identify and treat children and adolescents with mood disorders, and carefully follow the continuing course. Characteristics such as disruptive disorders and family history warrant particular attention.
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