| 1. |
- Brander, Gustaf, et al.
(författare)
-
Association of Perinatal Risk Factors With Obsessive-Compulsive Disorder : A Population-Based Birth Cohort, Sibling Control Study
- 2016
-
Ingår i: JAMA psychiatry. - Chicago, USA : American Medical Association. - 2168-6238 .- 2168-622X. ; 73:11, s. 1135-1144
-
Tidskriftsartikel (refereegranskat)abstract
- Importance: Perinatal complications may increase the risk of obsessive-compulsive disorder (OCD). Previous reports were based on small, retrospective, specialist clinic-based studies that were unable to rigorously control for unmeasured environmental and genetic confounding.Objective: To prospectively investigate a wide range of potential perinatal risk factors for OCD, controlling for unmeasured factors shared between siblings in the analyses.Design, Setting, and Participants: This population-based birth cohort study included all 2 421 284 children from singleton births in Sweden from January 1, 1973, to December 31, 1996, who were followed up through December 31, 2013. From the 1 403 651 families in the cohort, differentially exposed siblings from the 743 885 families with siblings were evaluated; of these, 11 592 families included clusters of full siblings that were discordant for OCD. Analysis of the data was conducted from January, 26, 2015, to September, 5, 2016.Exposures: Perinatal data were collected from the Swedish Medical Birth Register and included maternal smoking during pregnancy, labor presentation, obstetric delivery, gestational age (for preterm birth), birth weight, birth weight in relation to gestational age, 5-minute Apgar score, and head circumference.Main Outcomes and Measures: Previously validated OCD codes (International Statistical Classification of Diseases and Health Related Problems, Tenth Revision, code F42) in the Swedish National Patient Register.Results: Of 2 421 284 individuals included in the cohort, 17 305 persons were diagnosed with OCD. Of these, 7111 were men (41.1%). The mean (SD) age of individuals at first diagnosis of OCD was 23.4 (6.5) years. An increased risk for OCD remained after controlling for shared familial confounders and measured covariates (including sex, year of birth, maternal and paternal age at birth, and parity), for smoking 10 or more cigarettes per day during pregnancy (hazard ratio [HR], 1.27; 95% CI, 1.02-1.58), breech presentation (HR, 1.35; 95% CI, 1.06-1.71), delivery by cesarean section (HR, 1.17; 95% CI, 1.01-1.34), preterm birth (HR, 1.24; 95% CI, 1.07-1.43), birth weight 1501 to 2500 g (HR, 1.30; 95% CI, 1.05-1.62) and 2501 to 3500 g (HR, 1.08; 95% CI, 1.01-1.16), being large for gestational age (HR, 1.23; 95% CI, 1.05-1.45), and Apgar distress scores at 5 minutes (HR, 1.50; 95% CI, 1.07-2.09). Gestational age and birth weight followed inverse dose-response associations, whereby an increasingly higher risk for OCD was noted in children with a shorter gestational age and lower birth weight. We also observed a dose-response association between the number of perinatal events and increased OCD risk, with HRs ranging from 1.11 (95% CI, 1.07-1.15) for 1 event to 1.51 (95% CI, 1.18-1.94) for 5 or more events.Conclusions and Relevance: A range of perinatal risk factors is associated with a higher risk for OCD independent of shared familial confounders, suggesting that perinatal risk factors may be in the causal pathway to OCD.
|
|
| 2. |
- Brander, Gustaf, et al.
(författare)
-
Perinatal risk factors in Tourette's and chronic tic disorders : a total population sibling comparison study
- 2018
-
Ingår i: Molecular Psychiatry. - : Nature Publishing Group. - 1359-4184 .- 1476-5578. ; 23:5, s. 1189-1197
-
Tidskriftsartikel (refereegranskat)abstract
- Adverse perinatal events may increase the risk of Tourette's and chronic tic disorders (TD/CTD), but previous studies have been unable to control for unmeasured environmental and genetic confounding. We aimed to prospectively investigate potential perinatal risk factors for TD/CTD, taking unmeasured factors shared between full siblings into account. A population-based birth cohort, consisting of all singletons born in Sweden in 1973-2003, was followed until December 2013. A total of 3 026 861 individuals were identified, 5597 of which had a registered TD/CTD diagnosis. We then studied differentially exposed full siblings from 947 942 families; of these, 3563 families included siblings that were discordant for TD/CTD. Perinatal data were collected from the Medical Birth Register and TD/CTD diagnoses were collected from the National Patient Register, using a previously validated algorithm. In the fully adjusted models, impaired fetal growth, preterm birth, breech presentation and cesarean section were associated with a higher risk of TD/CTD, largely independent from shared family confounders and measured covariates. Maternal smoking during pregnancy was associated with risk of TD/CTD in a dose-response manner but the association was no longer statistically significant in the sibling comparison models or after the exclusion of comorbid attention-deficit/hyperactivity disorder. A dose-response relationship between the number of adverse perinatal events and increased risk for TD/CTD was also observed, with hazard ratios ranging from 1.41 (95% confidence interval (CI): 1.33-1.50) for one event to 2.42 (95% CI: 1.65-3.53) for five or more events. These results pave the way for future gene by environment interaction and epigenetic studies in TD/CTD.
|
|
| 3. |
- Fernández de la Cruz, Lorena, et al.
(författare)
-
Suicide in obsessive-compulsive disorder : a population-based study of 36 788 Swedish patients
- 2017
-
Ingår i: Molecular Psychiatry. - : Nature Publishing Group. - 1359-4184 .- 1476-5578. ; 22:11, s. 1626-1632
-
Tidskriftsartikel (refereegranskat)abstract
- The risk of death by suicide in individuals with obsessive-compulsive disorder (OCD) is largely unknown. Previous studies have been small and methodologically flawed. We analyzed data from the Swedish national registers to estimate the risk of suicide in OCD and identify the risk and protective factors associated with suicidal behavior in this group. We used a matched case-cohort design to estimate the risk of deaths by suicide and attempted suicide in individuals diagnosed with OCD, compared with matched general population controls (1:10). Cox regression models were used to study predictors of suicidal behavior. We identified 36 788 OCD patients in the Swedish National Patient Register between 1969 and 2013. Of these, 545 had died by suicide and 4297 had attempted suicide. In unadjusted models, individuals with OCD had an increased risk of both dying by suicide (odds ratio (OR)=9.83 (95% confidence interval (CI), 8.72-11.08)) and attempting suicide (OR=5.45 (95% CI, 5.24-5.67)), compared with matched controls. After adjusting for psychiatric comorbidities, the risk was reduced but remained substantial for both death by suicide and attempted suicide. Within the OCD cohort, a previous suicide attempt was the strongest predictor of death by suicide. Having a comorbid personality or substance use disorder also increased the risk of suicide. Being a woman, higher parental education and having a comorbid anxiety disorder were protective factors. We conclude that patients with OCD are at a substantial risk of suicide. Importantly, this risk remains substantial after adjusting for psychiatric comorbidities. Suicide risk should be carefully monitored in patients with OCD.
|
|
| 4. |
- Fernández de la Cruz, Lorena, et al.
(författare)
-
Suicide in Tourette's and Chronic Tic Disorders
- 2017
-
Ingår i: Biological Psychiatry. - : Elsevier. - 0006-3223 .- 1873-2402. ; 82:2, s. 111-118
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Persons with neuropsychiatric disorders are at increased risk of suicide, but there is little data concerning Tourette's and chronic tic disorders (TD/CTD). We aimed to quantify the risk of suicidal behavior in a large nationwide cohort of patients with TD/CTD, establish the contribution of psychiatric comorbidity to this risk, and identify predictors of suicide.Methods: Using a validated algorithm, we identified 7736 TD/CTD cases in the Swedish National Patient Register during a 44-year period (1969-2013). Using a matched case-cohort design, patients were compared with general population control subjects (1:10 ratio). Risk of suicidal behavior was estimated using conditional logistic regressions. Predictors of suicidal behavior in the TD/CTD cohort were studied using Cox regression models.Results: In unadjusted models, TD/CTD patients, compared with control subjects, had an increased risk of both dying by suicide (odds ratio: 4.39; 95% confidence interval [CI]: 2.89-6.67) and attempting suicide (odds ratio: 3.86; 95% CI: 3.50-4.26). After adjusting for psychiatric comorbidities, the risk was reduced but remained substantial. Persistence of tics beyond young adulthood and a previous suicide attempt were the strongest predictors of death by suicide in TD/CTD patients (hazard ratio: 11.39; 95% CI: 3.71-35.02, and hazard ratio: 5.65; 95% CI: 2.21-14.42, respectively).Conclusions: TD/CTD are associated with substantial risk of suicide. Suicidal behavior should be monitored in these patients, particularly in those with persistent tics, history of suicide attempts, and psychiatric comorbidities. Preventive and intervention strategies aimed to reduce the suicidal risk in this group are warranted.
|
|
| 5. |
- Rommel, Anna-Sophie, et al.
(författare)
-
Is Physical Activity Causally Associated With Symptoms of Attention-Deficit/Hyperactivity Disorder?
- 2015
-
Ingår i: Journal of the American Academy of Child and Adolescent Psychiatry. - Amsterdam, Netherlands : Elsevier. - 0890-8567 .- 1527-5418. ; 54:7, s. 565-570
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: Emerging evidence suggests that physical activity (PA) enhances cognition and may be a protective factor for attention-deficit/hyperactivity disorder (ADHD). Yet the impact of PA on ADHD symptoms has been investigated only in a few undersized, nonrandomized, and retrospective studies. We examined the effect of PA during late adolescence on ADHD symptoms in early adulthood while controlling for unmeasured genetic and shared environmental confounding.Method: The effect of PA at age 16 to 17 years (baseline) on ADHD symptoms at age 19 to 20 years (follow-up) was examined using a within-monozygotic (MZ) twins fixed-effects model in 232 MZ twin pairs born in Sweden between May 1985 and December 1986. Parents rated their children's DSM ADHD symptoms at baseline and follow-up. Participants' weekly energy expenditure (in metabolic equivalent task minutes per week) was based on self-reports at baseline of PA frequency, intensity, and duration.Results: Greater weekly energy expenditure in adolescence was significantly associated with reduced ADHD symptom levels in early adulthood, even when controlling for unmeasured confounding (all genetic and environmental factors shared within MZ twin pairs) as well as ADHD symptoms and body mass index (BMI) at baseline, β = -0.21, p = .013 (95% CI = -0.38 to -0.05). Similar results were observed for the 2 ADHD subcomponents: hyperactivity/impulsivity, β = -0.21, p = .022 (95% CI = -0.39 to -0.03), and inattention, β = -0.19, p = .049 (95% CI = -0.36 to -0.0005).Conclusion: In line with a causal hypothesis, PA was inversely associated with ADHD symptoms, even after adjusting for unmeasured confounding. These findings suggest that PA in adolescence might decrease ADHD symptoms in early adulthood. However, given the size of the effect, the clinical value of this intervention needs to be explored further.
|
|
| 6. |
- Rydell, Mina, et al.
(författare)
-
Genetic and environmental contributions to the association between ADHD and affective problems in early childhood : A Swedish population-based twin study
- 2017
-
Ingår i: American Journal of Medical Genetics Part B. - Stockholm : John Wiley & Sons. - 1552-4841 .- 1552-485X. ; 174:5, s. 538-546
-
Tidskriftsartikel (refereegranskat)abstract
- Few twin studies have explored the relative contribution of genetic and environmental factors to the association between attention deficit hyperactivity disorder (ADHD) and affective problems, and no study has focused on preschool children. We used the classical twin design to explore the genetic and environmental overlap between ADHD symptoms and affective problems in preschool children, based on 879 five-year-old twin pairs born in Sweden 2004-2005. Questionnaire-based parent-ratings were used to measure ADHD symptoms and affective problems. A bivariate twin design was used to decompose variance in ADHD and affective problems into genetic and environmental components, and to test the degree to which these components overlapped across the two traits. Our results showed that there was a significant correlation of 0.34 (95% Confidence Interval [CI] 0.29-0.38) between ADHD and affective problems. This correlation was mostly explained by additive genetic factors (64%, 95%CI 37-93%), and to a lesser extent by shared environmental factors (35%, 95%CI 10-59%). Nonshared environmental factors did not contribute to the correlation between ADHD and affective problems (0%, 95%CI -9 to 10%). These findings show that there is a significant association between ADHD and affective problems in preschool children that is mostly explained by genetic influences. This adds important knowledge about the etiology of both ADHD and affective problems by indicating that these phenotypes are linked from as early as preschool years. This also needs to be taken into consideration when diagnosing young children and clinicians should consider assessing both affective problems and ADHD if one is present.
|
|
| 7. |
- Rydell, Mina, et al.
(författare)
-
Has the attention deficit hyperactivity disorder phenotype become more common in children between 2004 and 2014? : Trends over 10 years from a Swedish general population sample
- 2018
-
Ingår i: Journal of Child Psychology and Psychiatry. - Stockholm : Blackwell Publishing. - 0021-9630 .- 1469-7610. ; 59:8, s. 863-871
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Studies have reported increases in clinically diagnosed and treated attention deficit hyperactivity disorder (ADHD) during the last decade, but it is unclear if this reflects an increase in the underlying ADHD phenotype. We aimed to clarify if there has been an increase in the prevalence of ADHD-like traits in the general population from 2004 to 2014.METHOD: Data were collected from 9-year-old twins (19,271), participating in the population-based Child and Adolescent Twin Study in Sweden between 2004 and 2014. We assessed lifetime ADHD symptoms using the Autism-Tics, ADHD and other Comorbidities inventory. Research proxies for diagnostic-level ADHD and subthreshold ADHD were derived from this scale. We modeled the lifetime prevalence of diagnostic-level and subthreshold ADHD with logistic regression, and assessed mean ADHD scores each year with linear regression. Lifetime prevalence of clinically diagnosed ADHD was retrieved from the National Patient Register and modeled with logistic regression.RESULTS: The prevalence of diagnostic-level ADHD based on parent ratings did not differ significantly over time from 2004 to 2014 (OR 1.37; 95% CI: 0.77-2.45; p-value .233). Both subthreshold ADHD and mean ADHD scores increased significantly over time (both p-values <.001). Clinically diagnosed ADHD increased more than fivefold from 2004 to 2014 (OR 5.27, 95% CI: 1.85-14.96).CONCLUSIONS: We found no evidence of an increase in ADHD-like traits at the extreme end of the distribution from 2004 to 2014, but small increases in normal and subthreshold variations of ADHD-like traits were observed. This suggests that the increased rates of clinically diagnosed ADHD might reflect changes in diagnostic and treatment practices of ADHD, administrative changes in reporting diagnoses, greater awareness of ADHD, better access to healthcare, or current overdiagnosis, rather than an increase in the ADHD phenotype.
|
|
| 8. |
- Rydell, Mina
(författare)
-
Tobacco use and dependence : does it originate in utero?
- 2014
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Prenatal nicotine exposure (such as from maternal smoking during pregnancy) has been hypothesized to cause a so called programming effect, where epigenetic changes might result in a long-lasting vulnerability to tobacco use and dependence, manifesting during adolescence or young adulthood. However, previous observational studies show mixed results, perhaps because the association could be influenced by a common genetic predisposition to tobacco use as well as by social factors influencing both parental tobacco use during pregnancy and tobacco use in the offspring. The aim of this thesis was to enhance knowledge about the association between prenatal exposure to nicotine and tobacco use and tobacco dependence later in life. Study I assessed the association between parental tobacco use during pregnancy and tobacco use and dependence in adolescent offspring, based on 3,020 youths living in Stockholm County, who were followed from age 11 to 18. Study II investigated the influence of maternal smoking during pregnancy on tobacco use in adult offspring, based on 1,124 young adults, participating in the Stockholm Public Health Survey in 2006 and 2010. The Swedish Sibling Health Cohort, which consists of 1,538 sibling pairs, 19-27 years old and discordant for maternal smoking during pregnancy, constituted the study population for Study III and IV. These studies assessed the influence of prenatal exposure to maternal smoking on tobacco use (Study III) and dependence (Study IV) in young adults, while taking genetic and environmental factors into account. Study IV was based on two subsamples where both siblings were lifetime daily smokers (193 pairs) or snus users (173 pairs). Results from this thesis showed that prenatal exposure to parental tobacco use was linked with a higher risk of heavy tobacco use and dependence in adolescent girls (Study I). Maternal smoking during pregnancy was associated with an increased risk of established and heavy snus use in young adults (Study II). However, there was no association between maternal smoking during pregnancy and tobacco use (Study III) or dependence (Study IV) when exposure-discordant siblings were compared. In this thesis, prenatal nicotine exposure from parental tobacco use was not associated with tobacco use or dependence in young adults. An association with heavy use and dependence in adolescent girls cannot be excluded, but is more likely caused by residual confounding. These findings do not support the hypothesis of an important programming effect caused by prenatal nicotine exposure. If such an effect exists it is most likely weaker than the influence of genetic and early-environmental factors. Instead, this thesis emphasizes the utmost importance of genetic and early-environmental influences on the development of tobacco use and dependence.
|
|
| 9. |
- Sahlin, Hanna, et al.
(författare)
-
Association Between Deliberate Self-harm and Violent Criminality
- 2017
-
Ingår i: JAMA psychiatry. - : AMER MEDICAL ASSOC. - 2168-6238 .- 2168-622X. ; 74:6, s. 615-621
-
Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE Individuals who self-harm may have an increased risk of aggression toward others, but this association has been insufficiently investigated. More conclusive evidence may affect assessment, treatment interventions, and clinical guidelines. OBJECTIVE To investigate the association between nonfatal self-harm and violent crime. DESIGN, SETTING, AND PARTICIPANTS This population-based longitudinal cohort study, conducted from January 1, 1997, through December 31, 2013, studied all Swedish citizens born between 1982 and 1998 who were 15 years and older (N = 1 850 252). Individuals who emigrated from Sweden before the age of 15 years (n = 104 051) or immigrated to Sweden after the age of 13 years (ie, <2 years before the beginning of the follow-up; n = 22 009) were excluded. Data analysis was performed from April 21, 2016, to June 4, 2016. EXPOSURES Receipt of self-harm-associated clinical care. MAIN OUTCOMES AND MEASURES Conviction of a violent crime according to the Swedish penal code. RESULTS The study cohort consisted of 1 850 525 individuals (950 382 males and 900 143 females), and the mean (SD) follow-up time was 8.1 (4.7) years (range, 0-17.0 years; minimum age, 15 years; maximum age, 32 years). During a mean follow-up period of 8.1 years, 55 185 individuals (3.0%) received clinical care for self-harm. The crude hazard ratio was 4.9 (95% CI, 4.8-5.0) for violent crime conviction in exposed individuals compared with the unexposed group. Women who self-harm were at particularly high risk for expressing violent behaviors. After adjustment for relevant psychiatric comorbidities and socioeconomic status, an almost doubled hazard of violent offense remained (hazard ratio, 1.8; 95% CI, 1.8-1.9). CONCLUSIONS AND RELEVANCE Self-harm is associated with an increased risk of conviction for a violent offense in both sexes. The risk of violence, as well as the risk of suicide and self-harm, should be assessed among offending and self-harming individuals.
|
|
| 10. |
- Tornstam, Lars, 1943-, et al.
(författare)
-
Ensamheten i Sverige 1985-2008
- 2010
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Ensamheten inte mer utbredd 2008 jämför med 1985 År 2008 upprepades vid sociologiska institutionen, Uppsala universitet en ensamhetsstudie som tidigare gjorts år 1985. År 1985 var det 49 procent av den vuxna befolkningen i åldrarna 25-79 år som ofta eller ibland kände ensamhet. År 2008 hade den siffran sjunkit till 42 procent. Oftast och starkast ensamhet känner man då som nu bland de unga, inte bland de äldre som vi ofta är benägna att tro. Kvinnor kände 1985 också aningen mer ensamhet jämfört med männen, vilket också gäller den nya undersökningen 2008, som innefattar 1 742 svenskar i åldrarna 20-90 år. Ensamhet är en mix av olika känslor I studien skiljs mellan olika sorters ensamhet, varav också en är självvald och positiv. Den negativa känslan av ensamheten är egentligen mix av delkänslor där bl.a. sådant som nedvärdering, alienation, självömkan och desperation utgör ingredienser. Känslomixen ser olika ut för olika kategorier människor, där kvinnor under 50 avviker genom att i sin ensamhetskänsla ha hög inblandning av just de nämnda känsloingredienserna. Män 50+ har å andra sidan en låg inblandning av dessa känsloingredienser, men istället mer av det som kallas ”skamset undflyende”. Många olika orsaker till ensamhet Åtta distinkt åtskilda grupper av självupplevda orsaker till ensamhet kan särskiljas: man är utan närrelation, är alienerad, är avvikande, har otillräckliga vänskapsband, befinner sig där man inte vill vara, inte är intresserad av andra, saknar transportmedel, har påtvingat umgänge. De yngre respondenterna tenderar att framhäva orsaker som att vara alienerad, avvikande och ha otillräckliga vänskapsband, medan de äldre respondenterna istället framhåller att vara utan närrelation, att inte vara intresserad av andra, samt att sakna transportmedel. Otrygg barndom sammanhänger med ensamhet i vuxen ålder – hela livet De respondenter som beskriver att barndomen var mindre trygg, eller att man hade svårt att få vänner som barn, eller att man hade svårt etablera kontakt med det motsatta könet, rapporterar också mer och intensivare ensamhetskänslor i vuxen ålder. Åtgärderna mot ensamhet ofta mindre funktionella Det allra vanligaste är att man tittar på TV – som inte hjälper. Det finns dock en hel repertoar av åtgärder som klassificerats i sju olika kategorier. Hit hör fokuserad aktivitet, som bl.a. innebär att man ringer eller besöker någon; tröstkonsumtion, inåtvändhet, förströelse, bedövning, eskapism och arbete. Den fokuserade aktiviteten, som också är mest effektiv mot ensamhetskänslorna, används i högre grad av kvinnor, som dock samtidigt mer än männen ägnar sig åt tröstkonsumtion och inåtvändhet. Män, å andra sidan, ägnar sig i högre grad åt eskapism (musicerande, drickande), som inte hjälper, samt och åt arbete.
|
|
