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Brikell, I., Yao, H., Li, L., Astrup, A., Gao, L., Gillies, M. B., . . . Chang, Z. (2024). ADHD medication discontinuation and persistence across the lifespan: a retrospective observational study using population-based databases. Lancet psychiatry, 11(1), 16-26
Open this publication in new window or tab >>ADHD medication discontinuation and persistence across the lifespan: a retrospective observational study using population-based databases
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2024 (English)In: Lancet psychiatry, ISSN 2215-0374, E-ISSN 2215-0366, Vol. 11, no 1, p. 16-26Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Although often intended for long-term treatment, discontinuation of medication for ADHD is common. However, cross-national estimates of discontinuation are missing due to the absence of standardised measures. The aim of this study was to determine the rate of ADHD treatment discontinuation across the lifespan and to describe similarities and differences across countries to guide clinical practice.

METHODS: We did a retrospective, observational study using population-based databases from eight countries and one Special Administrative Region (Australia, Denmark, Hong Kong, Iceland, the Netherlands, Norway, Sweden, the UK, and the USA). We used a common analytical protocol approach and extracted prescription data to identify new users of ADHD medication. Eligible individuals were aged 3 years or older who had initiated ADHD medication between 2010 and 2020. We estimated treatment discontinuation and persistence in the 5 years after treatment initiation, stratified by age at initiation (children [age 4-11 years], adolescents [age 12-17 years], young adults [age 18-24 years], and adults [age ≥25 years]) and sex. Ethnicity data were not available.

FINDINGS: 1 229 972 individuals (735 503 [60%] males, 494 469 females [40%]; median age 8-21 years) were included in the study. Across countries, treatment discontinuation 1-5 years after initiation was lowest in children, and highest in young adults and adolescents. Within 1 year of initiation, 65% (95% CI 60-70) of children, 47% (43-51) of adolescents, 39% (36-42) of young adults, and 48% (44-52) of adults remained on treatment. The proportion of patients discontinuing was highest between age 18 and 19 years. Treatment persistence for up to 5 years was higher across countries when accounting for reinitiation of medication; at 5 years of follow-up, 50-60% of children and 30-40% of adolescents and adults were covered by treatment in most countries. Patterns were similar across sex.

INTERPRETATION: Early medication discontinuation is prevalent in ADHD treatment, particularly among young adults. Although reinitiation of medication is common, treatment persistence in adolescents and young adults is lower than expected based on previous estimates of ADHD symptom persistence in these age groups. This study highlights the scope of medication treatment discontinuation and persistence in ADHD across the lifespan and provides new knowledge about long-term ADHD medication use.

FUNDING: European Union Horizon 2020 Research and Innovation Programme.

Place, publisher, year, edition, pages
Elsevier, 2024
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-110005 (URN)10.1016/S2215-0366(23)00332-2 (DOI)38035876 (PubMedID)2-s2.0-85178365504 (Scopus ID)
Funder
EU, Horizon 2020
Available from: 2023-12-01 Created: 2023-12-01 Last updated: 2024-01-12Bibliographically approved
Martini, M. I., Butwicka, A., Du Rietz, E., Kanina, A., Rosenqvist, M. A., Larsson, H., . . . Taylor, M. J. (2024). Age effects on autism heritability and etiological stability of autistic traits. Journal of Child Psychology and Psychiatry
Open this publication in new window or tab >>Age effects on autism heritability and etiological stability of autistic traits
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2024 (English)In: Journal of Child Psychology and Psychiatry, ISSN 0021-9630, E-ISSN 1469-7610Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: Autism and autistic traits onset in childhood but persist into adulthood. Little is known about how genetic and environmental factors influence autism and autistic traits into adulthood. We aimed to determine age effects on the heritability of clinically diagnosed autism and the etiological stability of autistic traits from childhood to adulthood using twin methods.

METHODS: From 23,849 twin pairs in the Swedish Twin Register born between 1959 and 2010, we identified 485 individuals (1.01%, 31.5% female) with a clinical autism diagnosis. We estimated and compared the relative contribution of genetic, shared, and nonshared environmental influences to autism in childhood and adulthood. We further used multivariate twin analysis with four measurement points among 1,348 twin pairs in the longitudinal Twin Study of Child and Adolescent Development to assess the phenotypic and etiological stability of autistic traits - measured with three scales from the Child Behavior Checklist - from childhood to adulthood.

RESULTS: Autism heritability was comparable from childhood, (96% [95% CI, 76-99%]) to adulthood (87% [67-96%]). Autistic traits were moderately stable (phenotypic correlation = 0.35-0.61) from childhood to adulthood, and their heritability varied between 52 and 71%. We observed stable as well as newly emerging genetic influences on autistic traits from ages 8-9 to 19-20, and unique nonshared environmental influences at each age.

CONCLUSIONS: Genetic factors are important for autism and autistic traits in adulthood and separate genetic studies in adults are warranted.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
Keywords
Autism spectrum disorder, autistic traits, genetics, longitudinal studies, twin study
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-111018 (URN)10.1111/jcpp.13949 (DOI)001144427500001 ()38239074 (PubMedID)2-s2.0-85182438977 (Scopus ID)
Available from: 2024-01-30 Created: 2024-01-30 Last updated: 2024-02-05Bibliographically approved
Fernández de la Cruz, L., Isomura, K., Lichtenstein, P., Larsson, H., Kuja-Halkola, R., Chang, Z., . . . Mataix-Cols, D. (2024). All cause and cause specific mortality in obsessive-compulsive disorder: nationwide matched cohort and sibling cohort study. BMJ (Clinical Research Edition), 384, Article ID e077564.
Open this publication in new window or tab >>All cause and cause specific mortality in obsessive-compulsive disorder: nationwide matched cohort and sibling cohort study
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2024 (English)In: BMJ (Clinical Research Edition), ISSN 0959-8138, Vol. 384, article id e077564Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To estimate the risk of all cause and cause specific mortality in people with obsessive-compulsive disorder (OCD) compared with matched unaffected people from the general population and with their unaffected siblings. DESIGN: Population based matched cohort and sibling cohort study. SETTING: Register linkage in Sweden.

PARTICIPANTS: Population based cohort including 61 378 people with OCD and 613 780 unaffected people matched (1:10) on sex, birth year, and county of residence; sibling cohort consisting of 34 085 people with OCD and 47 874 unaffected full siblings. Cohorts were followed up for a median time of 8.1 years during the period from 1 January 1973 to 31 December 2020. MAIN OUTCOME MEASURES: All cause and cause specific mortality.

RESULTS: 4787 people with OCD and 30 619 unaffected people died during the study period (crude mortality rate 8.1 and 5.1 per 1000 person years, respectively). In stratified Cox proportional hazards models adjusted for birth year, sex, county, migrant status (born in Sweden versus abroad), and sociodemographic variables (latest recorded education, civil status, and family income), people with OCD had an increased risk of all cause mortality (hazard ratio 1.82, 95% confidence interval 1.76 to 1.89) and mortality due to natural causes (1.31, 1.27 to 1.37) and unnatural causes (3.30, 3.05 to 3.57). Among the natural causes of death, those due to endocrine, nutritional, and metabolic diseases, mental and behavioural disorders, and diseases of the nervous, circulatory, respiratory, digestive, and genitourinary systems were higher in the OCD cohort. Conversely, the risk of death due to neoplasms was lower in the OCD cohort compared with the unaffected cohort. Among the unnatural causes, suicide showed the highest hazard ratio, followed by accidents. The results were robust to adjustment for psychiatric comorbidities and familial confounding.

CONCLUSIONS: Non-communicable diseases and external causes of death, including suicides and accidents, were major contributors to the risk of mortality in people with OCD. Better surveillance, prevention, and early intervention strategies should be implemented to reduce the risk of fatal outcomes in people with OCD.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2024
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-111022 (URN)10.1136/bmj-2023-077564 (DOI)38233033 (PubMedID)2-s2.0-85182795484 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2015-00569Region Stockholm, 20160143; 20180078Swedish Society of Medicine, SLS-879801Karolinska Institute, FS-2018:0007
Available from: 2024-01-30 Created: 2024-01-30 Last updated: 2024-01-30Bibliographically approved
Mataix-Cols, D., Isomura, K., Sidorchuk, A., Rautio, D., Ivanov, V. Z., Rück, C., . . . Fernández de la Cruz, L. (2024). All-Cause and Cause-Specific Mortality Among Individuals With Hypochondriasis. JAMA psychiatry, Article ID e234744.
Open this publication in new window or tab >>All-Cause and Cause-Specific Mortality Among Individuals With Hypochondriasis
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2024 (English)In: JAMA psychiatry, ISSN 2168-6238, E-ISSN 2168-622X, article id e234744Article in journal (Refereed) Epub ahead of print
Abstract [en]

IMPORTANCE: Hypochondriasis, also known as health anxiety disorder, is a prevalent, yet underdiagnosed psychiatric disorder characterized by persistent preoccupation about having serious and progressive physical disorders. The risk of mortality among individuals with hypochondriasis is unknown.

OBJECTIVE: To investigate all-cause and cause-specific mortality among a large cohort of individuals with hypochondriasis.

DESIGN, SETTING, AND PARTICIPANTS: This Swedish nationwide matched-cohort study included 4129 individuals with a validated International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnosis of hypochondriasis assigned between January 1, 1997, and December 31, 2020, and 41 290 demographically matched individuals without hypochondriasis. Individuals with diagnoses of dysmorphophobia (body dysmorphic disorder) assigned during the same period were excluded from the cohort. Statistical analyses were conducted between May 5 and September 27, 2023. EXPOSURE: Validated ICD-10 diagnoses of hypochondriasis in the National Patient Register.

MAIN OUTCOME AND MEASURES: All-cause and cause-specific mortality in the Cause of Death Register. Covariates included birth year, sex, county of residence, country of birth (Sweden vs abroad), latest recorded education, civil status, family income, and lifetime psychiatric comorbidities. Stratified Cox proportional hazards regression models were used to estimate the hazard ratios (HRs) and 95% CIs of all-cause and cause-specific mortality.

RESULTS: Of the 4129 individuals with hypochondriasis (2342 women [56.7%]; median age at first diagnosis, 34.5 years [IQR, 26.3-46.1 years]) and 41 290 demographically matched individuals without hypochondriasis (23 420 women [56.7%]; median age at matching, 34.5 years [IQR, 26.4-46.2 years]) in the study, 268 individuals with hypochondriasis and 1761 individuals without hypochondriasis died during the study period, corresponding to crude mortality rates of 8.5 and 5.5 per 1000 person-years, respectively. In models adjusted for sociodemographic variables, an increased rate of all-cause mortality was observed among individuals with hypochondriasis compared with individuals without hypochondriasis (HR, 1.69; 95% CI, 1.47-1.93). An increased rate was observed for both natural (HR, 1.60; 95% CI, 1.38-1.85) and unnatural (HR, 2.43; 95% CI, 1.61-3.68) causes of death. Most deaths from unnatural causes were attributed to suicide (HR, 4.14; 95% CI, 2.44-7.03). The results were generally robust to additional adjustment for lifetime psychiatric disorders.

CONCLUSIONS AND RELEVANCE: This cohort study suggests that individuals with hypochondriasis have an increased risk of death from both natural and unnatural causes, particularly suicide, compared with individuals from the general population without hypochondriasis. Improved detection and access to evidence-based care should be prioritized.

Place, publisher, year, edition, pages
American Medical Association (AMA), 2024
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:oru:diva-110362 (URN)10.1001/jamapsychiatry.2023.4744 (DOI)001125352600001 ()38091000 (PubMedID)2-s2.0-85181006109 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2015-00569; 2021-00132Stockholm County Council, 20160143; 20180078; 963608)Swedish Society of Medicine, SLS-879801Karolinska Institute, FS-2018:0007
Available from: 2023-12-18 Created: 2023-12-18 Last updated: 2024-02-05Bibliographically approved
Chen, C., Chang, Z., Kuja-Halkola, R., D'Onofrio, B. M., Larsson, H., Andell, P., . . . Pettersson, E. (2024). Associations Between General and Specific Mental Health Conditions in Young Adulthood and Cardiometabolic Complications in Middle Adulthood: A 40-Year Longitudinal Familial Coaggregation Study of 672,823 Swedish Individuals. American Journal of Psychiatry, Article ID appiajp20220951.
Open this publication in new window or tab >>Associations Between General and Specific Mental Health Conditions in Young Adulthood and Cardiometabolic Complications in Middle Adulthood: A 40-Year Longitudinal Familial Coaggregation Study of 672,823 Swedish Individuals
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2024 (English)In: American Journal of Psychiatry, ISSN 0002-953X, E-ISSN 1535-7228, article id appiajp20220951Article in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVE: Most mental disorders, when examined individually, are associated with an increased risk of cardiometabolic complications. However, these associations might be attributed to a general liability to psychopathology or confounded by unmeasured familial factors. The authors investigated the association between psychiatric conditions in young adulthood and the risk of cardiometabolic complications in middle adulthood, up to 40 years later.

METHODS: This cohort study (N=672,823) identified all individuals and their siblings born in Sweden between 1955 and 1962 and followed the cohort through 2013. Logistic regression models were used to estimate the bivariate associations between 10 psychiatric conditions or criminal convictions and five cardiometabolic complications in individuals. A general factor model was used to identify general, internalizing, externalizing, and psychotic factors based on the comorbidity among psychiatric conditions and criminal convictions. The cardiometabolic complications were then regressed on the latent general factor and three uncorrelated specific factors within a structural equation modeling framework in individuals and across sibling pairs.

RESULTS: Each psychiatric condition significantly increased the risk of cardiometabolic complications. These associations appeared nonspecific, as multivariate models indicated that most were attributable to the general factor of psychopathology, rather than to specific psychiatric conditions. There were no or only small associations between individuals' general psychopathology and their siblings' cardiometabolic complications. The same pattern was evident for the specific internalizing and psychotic factors.

CONCLUSIONS: Associations between mental disorders in early life and later long-term risk of cardiometabolic complications appeared to be attributable to a general liability to psychopathology. Familial coaggregation analyses suggested that the elevated risk could not be attributed to confounders shared within families. One possibility is that lifestyle-based interventions may reduce the risk of later cardiometabolic complications for patients with several mental disorders.

Place, publisher, year, edition, pages
HighWire Press, 2024
Keywords
Cardiovascular Disease, Comorbidity, Familial Coaggregation, General Psychopathology Model, Mental Disorders, Metabolic Syndrome
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-111033 (URN)10.1176/appi.ajp.20220951 (DOI)38263878 (PubMedID)
Available from: 2024-02-01 Created: 2024-02-01 Last updated: 2024-02-01Bibliographically approved
Zhang, L., Li, L., Andell, P., Garcia-Argibay, M., Quinn, P. D., D'Onofrio, B. M., . . . Chang, Z. (2024). Attention-Deficit/Hyperactivity Disorder Medications and Long-Term Risk of Cardiovascular Diseases. JAMA psychiatry, 81(2), 178-187
Open this publication in new window or tab >>Attention-Deficit/Hyperactivity Disorder Medications and Long-Term Risk of Cardiovascular Diseases
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2024 (English)In: JAMA psychiatry, ISSN 2168-6238, E-ISSN 2168-622X, Vol. 81, no 2, p. 178-187Article in journal (Refereed) Published
Abstract [en]

IMPORTANCE: Use of attention-deficit/hyperactivity disorder (ADHD) medications has increased substantially over the past decades. However, the potential risk of cardiovascular disease (CVD) associated with long-term ADHD medication use remains unclear.

OBJECTIVE: To assess the association between long-term use of ADHD medication and the risk of CVD.

DESIGN, SETTING, AND PARTICIPANTS: This case-control study included individuals in Sweden aged 6 to 64 years who received an incident diagnosis of ADHD or ADHD medication dispensation between January 1, 2007, and December 31, 2020. Data on ADHD and CVD diagnoses and ADHD medication dispensation were obtained from the Swedish National Inpatient Register and the Swedish Prescribed Drug Register, respectively. Cases included individuals with ADHD and an incident CVD diagnosis (ischemic heart diseases, cerebrovascular diseases, hypertension, heart failure, arrhythmias, thromboembolic disease, arterial disease, and other forms of heart disease). Incidence density sampling was used to match cases with up to 5 controls without CVD based on age, sex, and calendar time. Cases and controls had the same duration of follow-up.

EXPOSURE: Cumulative duration of ADHD medication use up to 14 years.

MAIN OUTCOMES AND MEASURES: The primary outcome was incident CVD. The association between CVD and cumulative duration of ADHD medication use was measured using adjusted odds ratios (AORs) with 95% CIs.

RESULTS: Of 278 027 individuals with ADHD aged 6 to 64 years, 10 388 with CVD were identified (median [IQR] age, 34.6 [20.0-45.7] years; 6154 males [59.2%]) and matched with 51 672 control participants without CVD (median [IQR] age, 34.6 [19.8-45.6] years; 30 601 males [59.2%]). Median (IQR) follow-up time in both groups was 4.1 (1.9-6.8) years. Longer cumulative duration of ADHD medication use was associated with an increased risk of CVD compared with nonuse (0 to ≤1 year: AOR, 0.99 [95% CI, 0.93-1.06]; 1 to ≤2 years: AOR, 1.09 [95% CI, 1.01-1.18]; 2 to ≤3 years: AOR, 1.15 [95% CI, 1.05-1.25]; 3 to ≤5 years: AOR, 1.27 [95% CI, 1.17-1.39]; and >5 years: AOR, 1.23 [95% CI, 1.12-1.36]). Longer cumulative ADHD medication use was associated with an increased risk of hypertension (eg, 3 to ≤5 years: AOR, 1.72 [95% CI, 1.51-1.97] and >5 years: AOR, 1.80 [95% CI, 1.55-2.08]) and arterial disease (eg, 3 to ≤5 years: AOR, 1.65 [95% CI, 1.11-2.45] and >5 years: AOR, 1.49 [95% CI, 0.96-2.32]). Across the 14-year follow-up, each 1-year increase of ADHD medication use was associated with a 4% increased risk of CVD (AOR, 1.04 [95% CI, 1.03-1.05]), with a larger increase in risk in the first 3 years of cumulative use (AOR, 1.08 [95% CI, 1.04-1.11]) and stable risk over the remaining follow-up. Similar patterns were observed in children and youth (aged <25 years) and adults (aged ≥25 years).

CONCLUSIONS AND RELEVANCE: This case-control study found that long-term exposure to ADHD medications was associated with an increased risk of CVDs, especially hypertension and arterial disease. These findings highlight the importance of carefully weighing potential benefits and risks when making treatment decisions about long-term ADHD medication use. Clinicians should regularly and consistently monitor cardiovascular signs and symptoms throughout the course of treatment.

Place, publisher, year, edition, pages
American Medical Association (AMA), 2024
National Category
Public Health, Global Health, Social Medicine and Epidemiology Psychiatry
Research subject
Psychiatry
Identifiers
urn:nbn:se:oru:diva-109838 (URN)10.1001/jamapsychiatry.2023.4294 (DOI)001160796100013 ()37991787 (PubMedID)2-s2.0-84906321904 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2019-01172; 2022-01111EU, Horizon 2020, 965381
Available from: 2023-11-22 Created: 2023-11-22 Last updated: 2024-02-26Bibliographically approved
Bränn, E., Chen, Y., Song, H., László, K. D., D'Onofrio, B. M., Hysaj, E., . . . Lu, D. (2024). Bidirectional association between autoimmune disease and perinatal depression: a nationwide study with sibling comparison. Molecular Psychiatry
Open this publication in new window or tab >>Bidirectional association between autoimmune disease and perinatal depression: a nationwide study with sibling comparison
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2024 (English)In: Molecular Psychiatry, ISSN 1359-4184, E-ISSN 1476-5578Article in journal (Refereed) Epub ahead of print
Abstract [en]

Although major depression, characterized by a pro-inflammatory profile, genetically overlap with autoimmune disease (AD) and the perinatal period involve immune system adaptations and AD symptom alterations, the bidirectional link between perinatal depression (PND) and AD is largely unexplored. Hence, the objective of this study was to investigate the bidirectional association between PND and AD. Using nationwide Swedish population and health registers, we conducted a nested case-control study and a matched cohort study. From 1,347,901 pregnancies during 2001-2013, we included 55,299 incident PND, their unaffected full sisters, and 10 unaffected matched women per PND case. We identified 41 subtypes of AD diagnoses recorded in the registers and compared PND with unaffected population-matched women and full sisters, using multivariable regressions. Women with an AD had a 30% higher risk of subsequent PND (95% CI 1.2-1.5) and women exposed to PND had a 30% higher risk of a subsequent AD (95% CI 1.3-1.4). Comparable associations were found when comparing exposed women with their unaffected sisters (nested case-control OR: 1.3, 95% CI 1.2-1.5, matched cohort HR: 1.3, 95% CI 1.1-1.6), and when studying antepartum and postpartum depression. The bidirectional association was more pronounced among women without psychiatric comorbidities (nested case-control OR: 1.5, 95% CI 1.4-1.6, matched cohort HR: 1.4, 95% CI 1.4-1.5) and strongest for multiple sclerosis (nested case-control OR: 2.0, 95% CI 1.6-2.3, matched cohort HR: 1.8, 95% CI 1.0-3.1). These findings demonstrate a bidirectional association between AD and PND independent of psychiatric comorbidities, suggesting possibly shared biological mechanisms. If future translational science confirms the underlying mechanisms, healthcare providers need to be aware of the increased risk of PND among women with ADs and vice versa.

Place, publisher, year, edition, pages
Springer Nature, 2024
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:oru:diva-110634 (URN)10.1038/s41380-023-02351-1 (DOI)001138135800001 ()38191927 (PubMedID)2-s2.0-85181726077 (Scopus ID)
Funder
Karolinska Institute
Note

This study was funded by Karolinska Institutet's Research Foundation Grants (2022-01548) to EB, Forte (2020-00971), the Karolinska Institutet Strategic Research Area in Epidemiology and Biostatistics to DL, the Swedish research council (2020-01003) to DL, and the Icelandic Research Fund (ReMood, grant no: 218274) to UAV. We would like to send our appreciation to Anna Hildenbrand Michelman and Anna Udden for grammatical editing suggestions. Open access funding provided by Karolinska Institute.

Correction: Bidirectional association between autoimmune disease and perinatal depression: a nationwide study with sibling comparison. Mol Psychiatry. Bränn, E., Chen, Y., Song, H. et al. Mol Psychiatry (2024). https://doi.org/10.1038/s41380-024-02438-3

Available from: 2024-01-09 Created: 2024-01-09 Last updated: 2024-02-06Bibliographically approved
Ångström, A.-K., Andersson, A., Garcia-Argibay, M., Chang, Z., Lichtenstein, P., D’Onofrio, B. M., . . . Larsson, H. (2024). Criminal convictions in males and females diagnosed with attention deficit hyperactivity disorder: A Swedish national registry study. Paper presented at 2024/01/26. JCPP Advances
Open this publication in new window or tab >>Criminal convictions in males and females diagnosed with attention deficit hyperactivity disorder: A Swedish national registry study
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2024 (English)In: JCPP Advances, E-ISSN 2692-9384Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background: Individuals with Attention-Deficit/Hyperactivity Disorder (ADHD) face an elevated risk of criminal convictions compared to those without ADHD. However, understanding this link involves considering sex differences, coexisting psychiatric conditions, and unmeasured familial factors. This study aimed to explore the connection between ADHD and criminal convictions (both violent and non-violent) in males and females, while also assessing the impact of comorbid psychiatric disorders and familial factors.

Methods: Using Swedish national registers, we identified individuals born between 1986 and 1997 (635,391 males and 600,548 females). ADHD was defined through clinical diagnosis and prescribed medications, while criminal convictions were determined based on Swedish lower court records. Unmeasured familial factors were accounted for using a sibling design approach.

Results: Findings revealed that individuals with ADHD had a notably higher absolute and relative risk of both violent and non-violent criminal convictions compared to those without ADHD. While criminal convictions were more frequent among males with ADHD, females with ADHD exhibited higher relative risks (HR violent 10.50, non-violent 4.04) than their male counterparts (HR violent 6.03, non-violent 3.57). Additionally, lower socioeconomic status (SES) in individuals with ADHD was associated with increased relative risks for criminal convictions compared to individuals with ADHD who had higher SES. Adjusting for childhood and internalizing psychiatric disorders partially attenuated these associations, while substance use disorders (SUD) substantially attenuated them. SUD also contributed to an elevated absolute risk of criminal convictions in both male and female individuals with ADHD. Accounting for unmeasured shared familial factors slightly reduced the estimates, but the association between ADHD and criminal convictions persisted.

Conclusion: In conclusion, ADHD remains a potent independent risk factor for criminal convictions, with varying effects based on gender. This underscores the importance of tailored crime prevention strategies and early interventions for individuals with ADHD, especially when comorbid SUD is present.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
Keywords
ADHD, non-violent crime, violent crime
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-111054 (URN)10.1002/jcv2.12217 (DOI)
Conference
2024/01/26
Funder
Swedish Research Council, 2018-02599
Available from: 2024-01-26 Created: 2024-01-26 Last updated: 2024-02-12Bibliographically approved
Chen, Y., Shen, Q., Lichtenstein, P., Gradus, J. L., Arnberg, F. K., Larsson, H., . . . Valdimarsdottir, U. A. (2024). Incidence Trajectories of Psychiatric Disorders After Assault, Injury, and Bereavement. JAMA psychiatry, Article ID e235156.
Open this publication in new window or tab >>Incidence Trajectories of Psychiatric Disorders After Assault, Injury, and Bereavement
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2024 (English)In: JAMA psychiatry, ISSN 2168-6238, E-ISSN 2168-622X, article id e235156Article in journal (Refereed) Epub ahead of print
Abstract [en]

IMPORTANCE: Traumatic events have been associated with elevated risks of psychiatric disorders, while the contributions of familial factors to these associations remain less clear.

OBJECTIVE: To determine the contribution of familial factors to long-term incidence trajectories of psychiatric disorders following potentially traumatic events.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study evaluated 3 separate cohorts of individuals residing in Sweden who were free of previous diagnosed psychiatric disorders when first exposed to assault (n = 49 957), injury (n = 555 314), or bereavement (n = 321 263) from January 1987 to December 2013, together with their unexposed full siblings, and 10 age-, sex-, and birthplace-matched unexposed individuals (per exposed individual). Cohorts were created from the Swedish Total Population Register linked to health and population registers. Data were analyzed from March 2022 to April 2023.

EXPOSURES: Potentially traumatic events, including various types of assault, injuries, and bereavement (death of a child or of a spouse or partner), were ascertained from the Swedish national registers.

MAIN OUTCOMES AND MEASURES: Incident psychiatric disorders were ascertained from the Swedish Patient Register. Flexible parametric and Cox models were used to estimate associations of potentially traumatic events with incident psychiatric disorders after multivariable adjustment.

RESULTS: The median (IQR) age at exposure to assault, injury, and bereavement was 22 (18-31), 19 (8-40), and 60 (51-68) years, respectively. During a median (IQR) follow-up of 4.9 (2.2-8.2), 9.1 (4.1-15.6), and 8.1 (3.4-14.8) years, the incidence rates of any psychiatric disorder were 38.1, 13.9, and 9.0 per 1000 person-years for the exposed groups of the 3 cohorts, respectively. Elevated risk of any psychiatric disorder was observed during the first year after exposure to any assault (hazard ratio [HR], 4.55; 95% CI, 4.34-4.77), injury (HR, 3.31; 95% CI,3.23-3.38), or bereavement (HR, 2.81; 95% CI, 2.72-2.91) and thereafter (assault HR, 2.50; 95% CI, 2.43-2.56; injury HR, 1.69; 95% CI, 1.68-1.70; bereavement HR, 1.42; 95% CI, 1.40-1.44). Comparable associations were obtained in sibling comparison (first year: assault HR, 3.70; 95% CI, 3.37-4.05; injury HR, 2.98; 95% CI, 2.85-3.12; bereavement HR, 2.72; 95% CI, 2.54-2.91; thereafter: assault HR, 1.93; 95% CI, 1.84-2.02; injury HR, 1.51; 95% CI, 1.48-1.53; bereavement HR, 1.35; 95% CI, 1.31-1.38). The risk elevation varied somewhat by type of traumatic events and psychiatric disorders, with the greatest HR noted for posttraumatic stress disorder after sexual assault (sibling comparison HR, 4.52; 95% CI, 3.56-5.73 during entire follow-up period).

CONCLUSIONS AND RELEVANCE: In this study, the long-term risk elevation of psychiatric disorders after potentially traumatic events was largely independent of familial factors. The risk elevation observed immediately after these events motivates early clinical surveillance and mental health services for these vulnerable populations.

Place, publisher, year, edition, pages
American Medical Association (AMA), 2024
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-111023 (URN)10.1001/jamapsychiatry.2023.5156 (DOI)001145581300002 ()38231519 (PubMedID)2-s2.0-85181006109 (Scopus ID)
Funder
EU, Horizon 2020, 847776EU, European Research Council, 726413
Note

This work was supported by EU Horizon 2020 Research and Innovation Action grant 847776 (Valdimarsdóttir), Grant of Excellence, Icelandic Research Fund grant 163362-051 (Valdimarsdóttir), European Research Council Consolidator grant 726413 (Valdimarsdóttir), the Project for Disciplines of Excellence, West China Hospital, Sichuan University grant ZYYC21005 (Song), the Outstanding Clinical Discipline Project of Shanghai Pudong grant PWYgy2021-02, and the Fundamental Research Funds for the Central Universities (Shen).

Available from: 2024-01-30 Created: 2024-01-30 Last updated: 2024-02-05Bibliographically approved
Martin, C., Jebril, W., Larsson, H., Curman, P., Bachar-Wikström, E. & Wikström, J. D. (2024). Individuals with Darier disease have an increased risk of suicide and self-injurious behaviours [Letter to the editor]. British Journal of Dermatology, 190(2), 284-285
Open this publication in new window or tab >>Individuals with Darier disease have an increased risk of suicide and self-injurious behaviours
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2024 (English)In: British Journal of Dermatology, ISSN 0007-0963, E-ISSN 1365-2133, Vol. 190, no 2, p. 284-285Article in journal, Letter (Refereed) Published
Abstract [en]

In a large population-based registry study of 935 patients in Sweden with Darier disease, we show that patients with the disease display significantly increased risks of suicide and self-injurious behaviours.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2024
National Category
Neurosciences
Identifiers
urn:nbn:se:oru:diva-109502 (URN)10.1093/bjd/ljad424 (DOI)001114021500001 ()37890021 (PubMedID)2-s2.0-85183501931 (Scopus ID)
Funder
Insamlingsstiftelsen HudFondenSwedish Research CouncilSwedish Society for Medical Research (SSMF)Harald Jeanssons stiftelseWallenberg FoundationsÅke Wiberg FoundationSwedish Society of MedicineMagnus Bergvall Foundation
Note

Funding Agencies:

Hudfonden, Swedish Research Council, Swedish Society for Medical Research, Leo foundation, ALF medicin Stockholm, Jeanssons stiftelse, Wallenberg foundation, Åke Wibergs stiftelse, The Swedish Society of Medicine, Magnus Bergvalls stiftelse and Tore Nilssons stiftelse.

Available from: 2023-10-31 Created: 2023-10-31 Last updated: 2024-02-05Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-6851-3297

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