| 1. |
- Dobrosavljevic, Maja, 1986-
(författare)
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Attention-Deficit/Hyperactivity Disorder (ADHD) Beyond the Young Age : Investigation of the Prevalence of ADHD in Older Adults and the Risk of Age-related Disorders
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder characterized by impairing levels of inattention and/or hyperactivity-impulsivity. Symptoms of ADHD, which typically emerge in childhood, may persist until older age with a substantial adverse impact on health and functionality. Yet there is a notable knowledge gap in research on ADHD in older age and the potential associations of adult ADHD with disorders that are common in older age (i.e., age-related disorders). Thus, this thesis aimed to investigate the prevalence rates of ADHD in older age and whether ADHD in adulthood is associated with an increased risk of age-related disorders. Study I, a systematic review and meta-analysis, suggests that a considerable number of older adults report elevated levels of ADHD symptoms, while the prevalence of treated ADHD is less than half of the prevalence of clinically diagnosed ADHD. In Studies II, III, and IV, we used data from Swedish population registers. We found that ADHD is associated with an increased risk of dementia and mild cognitive impairment (Study II), which substantially attenuates after controlling for psychiatric comorbidity. Further, ADHD symptoms in adulthood are associated with an increased risk of subsequent cardiometabolic disorders (Study III). The associations attenuate after controlling for educational attainment, psychiatric comorbidity, and lifestyle factors, and they are confounded by genetic factors. Finally, the prediction of cardiovascular risk in adults initiating pharmacological treatment for ADHD may improve by considering novel risk factors (i.e., psychiatric comorbidity and use of other psychotropic medications) in addition to traditional predictors (Study IV). Overall, the findings indicate that a substantial number of older adults have increased levels of ADHD symptoms and that ADHD in adults is associated with an increased risk of age-related disorders. Further longitudinal studies, based on both community samples and epidemiological data, are needed to explore the risk of age-related disorders in ADHD, and the underlying mechanisms, until a more advanced older age.
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| 2. |
- Solares Canal, Carmen, 1987-
(författare)
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The impact of criminal and externalizing behaviors on aging : Long-term associations with health and dementia
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Previous studies have shown that criminal and other externalizing behaviors are associated with several adverse outcomes, but very little is known about the impact of these behaviors beyond middle adulthood. Few studies have explored how a life-course background of criminal and externalizing behaviors influence aging and more specifically, whether it is associated with the onset and development of different neurodegenerative, mental, and physical health disorders when aging. The overarching aim of this dissertation is to advance the knowledge about the long-term influence that criminal and other externalizing behaviors along the lifespan may have on health and neurodegeneration while individuals age. This aim was explored throughout three studies: Study I, a systematic review and meta-analysis performed to investigate the prevalence of several mental and physical health problems of older offenders; Study II, a Swedish population-based register study which examined how the severity of the criminal background associated with dementia and mild cognitive impairment (MCI), and how several life-course factors influenced these associations and; Study III, a multi-generation cohort study investigating whether externalizing behaviors and dementia co-aggregate in families. The main findings suggest that older adults with criminal and externalizing behavioral backgrounds, and overall, those with a severe criminal history, exhibit an increased liability to develop physical and mental health problems as well as MCI and dementia when aging. This increased risk is influenced by life-course health and psychosocial problems as well as genetic and familial environmental factors. In general, findings from this thesis point towards a better understanding of the aging process of individuals with this background, and to further the scientific knowledge about the influence of life-course adverse behaviors on aging. This knowledge may promote the development of preventive and interventive strategies for individuals with a criminal and externalizing behavioral background.
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| 3. |
- Sundelin, Heléne E.K. 1965-
(författare)
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Comorbidity and complications in neurological diseases
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Neurological diseases are complex and many share etiology as well as comorbidities. Epilepsy, a brain disorder characterized by an enduring predisposition to generate epileptic seizures and autism spectrum disorder (ASD), are considered to be associated, but the connection is still not fully uncovered. Cerebral palsy (CP), a lifelong, nonspecific, non-progressive disorder of posture and movement control, and Ehlers-Danlos Syndrome (EDS), a connective tissue disorder, both have many consequences for health and wellbeing throughout life.Aims: The aim of this thesis was to explore the impact of comorbidity and complications in neurological diseases and EDS. The objective was to gain information on the nature of the connection between epilepsy and ASD, if EDS, ASD and CP have consequences for pregnancy outcome, and the risk of traffic accidents in individuals with epilepsy.Materials and methods: The studies are all historical observational population- based cohort studies with prospectively collected data from national registers. The risk of ASD was analysed in 85,201 individuals with epilepsy and compared with 425,760 controls as well as for their firstdegree relatives. In a cohort of 1,248,178 singleton births, 314 births to women with EDS, 2,072 births to women with ASD, and 770 births to women with CP, pregnancy outcome was explored. The risk of traffic accidents was estimated in 29,220 individuals with epilepsy and 267,637 matched controls.Results: There is an increased risk of; ASD in individuals with epilepsy and their relatives, moderately preterm birth and pre-eclampsia in maternal ASD, of preterm birth in maternal CP and transport accidents in individuals with epilepsy. There is no increased risk of adverse pregnancy outcome in women with EDS.Conclusions: This thesis found proofs of a bidirectional association between epilepsy and ASD, that ASD and CP have consequences for pregnancy outcome and epilepsy is a risk factor for traffic accidents.
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| 4. |
- Andersson, Anneli, 1992-
(författare)
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How is ADHD associated with comorbidities and health related outcomes? : The role of familial factors and ADHD during pregnancy
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder characterized by impaired attention and hyperactivity/impulsivity. ADHD is associated with several comorbidities and health-related outcomes. However, it is uncertain whether ADHD is more strongly associated with certain disorder domains, and whether ADHD-related comorbidities and health-related outcomes is important to consider during pregnancy. Aims: To expand the knowledge regarding the genetic overlap between ADHD and other psychiatric disorder symptoms, and to increase the awareness and understanding related to ADHD in women, with a focus on adverse health behaviors, mental health problems, and pregnancy outcomes. Methods: The present thesis includes one systematic review and metaanalysis (Study I), and three studies based on population-based register data from Sweden (Study II, III, and IV), and Norway (Study II).Results: Individuals with ADHD have an increased liability to meet criteria for externalizing, internalizing and neurodevelopmental disordersymptoms, and these co-occurrences are partly due to shared genetic risks. Further, ADHD is an important risk factor to consider before, during and after pregnancy, as ADHD increases the risk of smoking during pregnancy, mental health problems postpartum, and adverse pregnancy outcomes.Conclusions: The genetic overlaps between ADHD and other psychiatric disorder symptoms were similar across disorder dimensions. Further, results demonstrated that ADHD is an important risk factor to consider in women surrounding pregnancy. These findings point towards the importance of recognizing that women diagnosed with ADHD need to be prioritized and allowed more attention and support by the healthcare system, specifically during their fertile years.
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| 5. |
- Li, Lin, 1989-
(författare)
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Somatic and occupational outcomes in adult ADHD : epidemiology studies based on real-world data
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders, characterized by inattention or hyperactivity–impulsivity, or both. ADHD is a multifactorial disorder influenced by the complex interplay between genetic and environmental risk factors, but a detailed understanding of the causal status of these factors is lacking. ADHD is associated with many psychiatric disorders, but somatic comorbidity in ADHD has received less attention in the research literature. Pharmacological treatment is effective in reducing the core symptoms of ADHD, but the effects on occupational outcomes remain unclear. The overarching aim of this thesis is to extend previous knowledge on the early risk factors of ADHD, and to increase the awareness and the understanding on somatic and occupational outcomes of ADHD in adults.In Study I, we combined a systematic review and mate-analysis with a population based cohort of 971,501 individuals born between 1992 and 2004 in Sweden. The meta-analysis revealed a positive association between maternal pre-pregnancy overweight/obesity and risk of ADHD in offspring. However, these associations gradually attenuated toward the null when adjusted for measured confounders,unmeasured factors shared by cousins and unmeasured factors shared by siblings. In Study II, by using a Swedish population-based twin study with 17,999 individuals aged 20–47 years, we found both inattention and hyperactivity/impulsivity was associated with higher consumption of high-sugar food and unhealthy dietary habits, although these associations were generally weak. Further, the observed associations was explained by both genetic and non-shared environmental factors.In Study III, we explored the prospective associations between ADHD and a broad range of cardiovascular diseases in 5,389,519 adults from Sweden, and found that ADHD may be a novel and independent risk factor for cardiovascular diseases. In Study IV, based on the longitudinal cohort of 12,875 middle-aged adults with ADHD, we found the use of ADHD medications during the previous two years was associated with a 10% reduction in the risk of long-term unemployment in the following year.Taken together, findings from the thesis highlight the need of future studies with various study designs, to fully understand the aetiology and long-term health outcomes of ADHD across the lifespan.
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| 6. |
- Oskarsson, Sofi, 1989-
(författare)
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Biological risk factors for crime : Adverse perinatal events and psychophysiology
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Biological risk factors for crime have been largely neglected within main-stream criminology. However, a large body of research has over the past few decades converged on the conclusion that it is important to consider biological risk factors for crime, as they may help to inform theory and etiology. We are gaining more knowledge about the biological underpinnings of crime in a rapidly evolving research field, but many questions remain to be answered.The overarching goal with the present dissertation was to expand the knowledge about biological risk factors, including adverse perinatal events and psychophysiology, for crime. Specifically, Study I aimed to examine the associations between adverse perinatal events and offspring crime in men and women respectively. Study II aimed to examine associations for resting heart rate and systolic blood pressure with reoffending in men. Study III aimed to examine associations for resting heart rate with crime in women. Lastly, Study IV aimed to synthesize existing evidence on the relationship between psychopathic personality and aversive startle potentiation. These aims were pursued through three studies utilizing Swedish population-based registers (Study I, Study II, and Study III), as well as one systematic review (Study IV).Taken together, the overall findings of the present dissertation suggest that biological risk factors are important for crime in various ways. Biological risk factors represent an important step forward to broaden our understanding of crime and may have the potential to inform theory and etiology as well as to ultimately improve prediction, prevention, and intervention strategies.
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| 7. |
- Fine, Kimberly L., et al.
(författare)
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Association Between Early Prescribed Opioid Initiation and Risk of Suicidal Behavior
- 2020
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Prescription opioid use has been linked to increased risk of suicidal behavior in adults. However, little research exists examining the role of prescription opioid use on risk of suicidal behavior in children and adolescents. This population is at high risk for suicidal behavior, as suicide is the second leading cause of death for people ages 10 to 34. Using healthcare data from Swedish population registers, we aimed to characterize the extent to which exposure to opioids at a young age leads to an increased risk of new onset suicidal behavior, for those with no history of suicidal behavior. Compared to demographically matched non-recipients, young people who initiated prescription opioids had just under three times the rate of subsequent suicidal behavior (HR = 2.64, 95% CI, 2.47-2.81). Compared to their unexposed siblings, young people who initiated prescription opioids had roughly two times the rate of subsequent suicidal behavior (HR = 1.83, 95% CI, 1.67-2.01). Finally, compared to young people initiating prescription NSAIDs, young people who initiated prescription opioids had only 19% relatively greater rates of suicidal behavior (HR, 1.19, 95% CI, 1.11-1.27). These results suggest the association between prescription opioids and suicidal behavior may be driven by the underlying pain indication.
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| 8. |
- Fine, Kimberly L., et al.
(författare)
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Initiation of Opioid Prescription and Risk of Suicidal Behavior Among Youth and Young Adults
- 2022
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Ingår i: Pediatrics. - : American Academy of Pediatrics. - 0031-4005 .- 1098-4275. ; 149:3
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND OBJECTIVES: Opioids are involved in an increasing proportion of suicide deaths. This study examined the association between opioid analgesic prescription initiation and suicidal behavior among young people.METHODS: We analyzed Swedish population-register data on 1 895 984 individuals ages 9 to 29 years without prior recorded opioid prescriptions. We identified prescriptions dispensed from January 2007 onward and diagnosed self-injurious behavior and death by suicide through December 2013. We first compared initiators with demographically matched noninitiators. To account for confounding, we applied an active comparator design, which examined suicidal behavior among opioid initiators relative to prescription nonsteroidal antiinflammatory drug (NSAID) initiators while inverse-probability-of-treatment weighting with individual and familial covariates.RESULTS: Among the cohort, 201 433 individuals initiated opioid prescription. Relative to demographically matched noninitiators, initiators (N = 180 808) had more than doubled risk of incident suicidal behavior (hazard ratio = 2.64; 95% confidence interval [CI], 2.47-2.81). However, in the active comparator design, opioid initiators (N = 86 635) had only 19% relatively greater risk of suicidal behavior compared with NSAID initiators (N = 255 096; hazard ratio = 1.19; 95% CI,: 1.11-1.28), corresponding to a weighted 5-year cumulative incidence of 2.2% (95% CI, 2.1-2.4) for opioid and 1.9% (95% CI, 1.9-2.0) for NSAID initiators. Most sensitivity analyses produced comparable results.CONCLUSIONS: Opioid initiation may make only a small contribution to the elevated risk of suicidal behavior among young people receiving pharmacologic pain management. In weighing benefits and harms of opioid initiation, our results suggest that increased risk of suicidal behavior may not be a major concern.
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| 9. |
- Quinn, Patrick D., et al.
(författare)
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Association of Opioid Prescription Initiation during Adolescence and Young Adulthood with Subsequent Substance-Related Morbidity
- 2020
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Ingår i: JAMA pediatrics. - : American Medical Association. - 2168-6203 .- 2168-6211. ; 174:11, s. 1048-1055
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Tidskriftsartikel (refereegranskat)abstract
- Importance: Concerns about adverse outcomes associated with opioid analgesic prescription have led to major guideline and policy changes. Substantial uncertainty remains, however, regarding the association between opioid prescription initiation and increased risk of subsequent substance-related morbidity.Objective: To examine the association of opioid initiation among adolescents and young adults with subsequent broadly defined substance-related morbidity.Design, setting, and participants: This cohort study analyzed population-register data from January 1, 2007, to December 31, 2013, on Swedish individuals aged 13 to 29 years by January 1, 2013, who were naive to opioid prescription. To account for confounding, the analysis compared opioid prescription recipients with recipients of nonsteroidal anti-inflammatory drugs as an active comparator, compared opioid-recipient twins and other multiple birth individuals with their nonrecipient co-multiple birth offspring (co-twin control), examined dental prescription as a specific indication, and included individual, parental, and socioeconomic covariates. Data were analyzed from March 30, 2019, to January 22, 2020.Exposures: Opioid prescription initiation, defined as first dispensed opioid analgesic prescription.Main outcomes and measures: Substance-related morbidity, assessed as clinically diagnosed substance use disorder or overdose identified from inpatient or outpatient specialist records, substance use disorder or overdose cause of death, dispensed pharmacotherapy for alcohol use disorder, or conviction for substance-related crime.Results: Among the included cohort (n = 1 541 862; 793 933 male [51.5%]), 193 922 individuals initiated opioid therapy by December 31, 2013 (median age at initiation, 20.9 years [interquartile range, 18.2-23.6 years]). The active comparator design included 77 143 opioid recipients without preexisting substance-related morbidity and 229 461 nonsteroidal anti-inflammatory drug recipients. The adjusted cumulative incidence of substance-related morbidity within 5 years was 6.2% (95% CI, 5.9%-6.5%) for opioid recipients and 4.9% (95% CI, 4.8%-5.1%) for nonsteroidal anti-inflammatory drug recipients (hazard ratio, 1.29; 95% CI, 1.23-1.35). The co-twin control design produced comparable results (3013 opioid recipients and 3107 nonrecipients; adjusted hazard ratio, 1.43; 95% CI, 1.02-2.01), as did restriction to analgesics prescribed for dental indications and additional sensitivity analyses.Conclusions and relevance: Among adolescents and young adults analyzed in this study, initial opioid prescription receipt was associated with an approximately 30% to 40% relative increase in risk of subsequent substance-related morbidity in multiple designs that adjusted for confounding. These findings suggest that this increase may be smaller than previously estimated in some other studies.
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| 10. |
- Quinn, Patrick D., et al.
(författare)
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Associations of mental health and family background with opioid analgesic therapy : a nationwide Swedish register-based study
- 2019
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Ingår i: Pain. - : Elsevier. - 0304-3959 .- 1872-6623. ; 160:11, s. 2464-2472
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Tidskriftsartikel (refereegranskat)abstract
- There is evidence of greater opioid prescription to individuals in the United States with mental health conditions. Whether these associations generalize beyond the US prescription environment and to familial mental health and socioeconomic status (SES) has not been examined comprehensively. This study estimated associations of diverse preexisting mental health diagnoses, parental mental health history, and SES in childhood with opioid analgesic prescription patterns nationwide in Sweden. Using register-based data, we identified 5,071,193 (48.4% female) adolescents and adults who were naive to prescription opioid analgesics and followed them from 2007 to 2014. The cumulative incidence of any dispensed opioid analgesic within 3 years was 11.4% (95% CI, 11.3%-11.4%). Individuals with preexisting self-injurious behavior, as well as opioid and other substance use, attention-deficit/hyperactivity, depressive, anxiety, and bipolar disorders had greater opioid therapy initiation rates than did individuals without the respective conditions (hazard ratios from 1.24 [1.20-1.27] for bipolar disorder to 2.12 [2.04-2.21] for opioid use disorder). Among 1,298,083 opioid recipients, the cumulative incidence of long-term opioid therapy (LTOT) was 7.6% (7.6%-7.7%) within 3 years of initiation. All mental health conditions were associated with greater LTOT rates (hazard ratios from 1.66 [1.56-1.77] for bipolar disorder to 3.82 [3.51-4.15] for opioid use disorder) and were similarly associated with concurrent benzodiazepine-opioid therapy. Among 1,482,462 adolescents and young adults, initiation and LTOT rates were greater for those with parental mental health history or lower childhood SES. Efforts to understand and ameliorate potential adverse effects of opioid analgesics must account for these patterns.
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