Trends in levels of self-reported psychological distress among individuals who seek psychiatric services over eight years: a comparison between age groups in three population surveys in Stockholm County

BACKGROUND: Psychiatric service use has increased in Sweden and in other developed countries, particularly among young people. Possible explanations include lower threshold for help-seeking among young people, but evidence is scarce. METHODS: We analysed the 2002, 2006 and 2010 Stockholm public health surveys for changes in the mean level of psychological distress among adult users of psychiatric in- and outpatient services in four age groups: 18-24, 25-44, 45-64 and ≥65 years. Psychological distress was measured via the 12-item General Health Questionnaire (GHQ-12), using the Likert scoring method 0-1-2-3. In- and out-patient psychiatric service use within 6 months from the surveys was obtained from registers. RESULTS: The mean level of distress among young adults 18-24 years who utilize psychiatric services decreased between 2002 (mean GHQ-12 score, 95% confidence interval 20.5, 18.1-23.0) and 2010 (16.2, 14.6-17.7), while it remained fairly stable in older age groups. Results were similar in sex-stratified analyses, although the decrease was statistically significant only among young women 18-24 years. At the end of the follow-up, the level of distress among patients was similar for all age-groups. CONCLUSIONS: There were no differences between age groups in the level of distress when seeking care at the end of the follow-up period, supporting that there is no age-specific over- or under-consumption of psychiatric care in later years. However, the lowered threshold for help-seeking among young adults over time might have contributed to increases in psychiatric service use in the young age group. Public health policy and service delivery planning should consider the needs of the widening group of young users of psychiatric services

Parenthood and lower risk of suicide in women and men: the total Swedish population followed across adulthood

Background: Previous studies suggest a protective effect of parenthood on suicide, but little is known about how the association may change across the lifespan, or in relation to sex, marital status or occurrence of psychiatric disorders. Methods: We followed a cohort of over 5 million Swedish women and men, from 1991 to 2011, up to max. age 75, for death by suicide using national registers. Information on childbirths/adoptions, potential confounders and modifying factors were obtained from national registers. We assessed the associations between parenthood and suicide across adulthood using within time-stratified Cox regression models, with parenthood as a time-dependent exposure. Results: Parents had a lower risk of suicide than non-parents across the lifespan, after adjusting for sociodemographic factors. The association was most pronounced in young adults, especially young women, but attenuated with increasing age and converged between sexes in older age groups. The lower risk of suicide over the life course was similar whether parents were married, unmarried or divorced, apart from married men; among them, parents only had a lower risk above age 55. The lower risk in parents was also evident in people with a history of psychiatric hospitalizations, but disappeared from age 55 in this population. Conclusion: The lower risk of suicide was present in both parents, was most pronounced in young adulthood and weakened with increasing age. Our results are consistent with a plausible mechanism where feelings of responsibility and connectedness are protective against suicide in parents

Maternal vitamin D deficiency and the risk of autism spectrum disorders:population-based study

BACKGROUND: Maternal vitamin D deficiency may increase risk of autism spectrum disorder (ASD), but direct evidence is lacking. AIMS: To clarify the relationship between maternal vitamin D deficiency and offspring risk of ASD with and without intellectual disability. METHOD: Using a register-based total population study (N=509 639), we calculated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) of ASD with and without intellectual disability in relation to lifetime diagnoses of maternal vitamin D deficiency. Although rare, such deficiency was associated with offspring risk of ASD with, but not without, intellectual disability (aORs 2.51, 95% CI 1.22–5.16 and 1.28, 0.68–2.42). Relationships were stronger in non-immigrant children. CONCLUSIONS: If reflecting associations for prenatal hypovitaminosis, these findings imply gestational vitamin D substitution as a means of ASD prevention. DECLARATION OF INTEREST: None. COPYRIGHT AND USAGE: © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence

Maternal bereavement shortly before or during pregnancy and risk of postpartum psychotic illness: a population-based study from Denmark and Sweden

Pauline Warselius,1 Sven Cnattingius,1 Jiong Li,2 Dang Wei,3 Unnur Anna Valdimarsdottir,4,5 Kyriaki Kosidou,3,6 Johan Reutfors,1 Jørn Olsen,2,7 Mogens Vestergaard,8,9 Carsten Obel,8,9 Krisztina D László31Department of Medicine Solna, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden; 2Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark; 3Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; 4Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; 5Faculty of Medicine, University of Iceland, Reykjavik, Iceland; 6Centre for Epidemiology and Community Medicine, Stockholm County’s Health Care District, Stockholm, Sweden; 7Department of Epidemiology, School of Public Health, University of California, Los Angeles, CA, USA; 8Department of Public Health, Aarhus University, Aarhus, Denmark; 9Research Unit and Section for General Practice, Department of Public Health, University of Aarhus, Aarhus, DenmarkPurpose: Postpartum psychosis is a rare but severe complication following childbirth, with unknown etiology. This study investigated whether the death of a close family member — a source of severe stress — the year before or during pregnancy was associated with an increased risk of psychotic illness in the postpartum period among women without and with a history of psychiatric disorder.Methods: We studied live births in Denmark during 1978–2008 and births in Sweden during 1973–2006 (n=5,246,978). Information on death of women’s relatives and partners and sociodemographic, health-, and pregnancy-related factors was obtained through linkage with nationwide registries.Results: The death of a close relative the year before or during pregnancy was not associated with psychotic illness during the first 90 days postpartum among women without (adjusted HR 1.02, 95% CI 0.76–1.37) or with a history of psychiatric disorder (HR 0.96, 95% CI 0.74–1.25). Similarly, there was no association between bereavement and risk of postpartum psychosis according to the timing of the loss (the year before or during pregnancy), the relative’s cause of death (natural or unnatural), or the woman’s relationship to the deceased (parent/sibling or partner/older child).Conclusions: Death of a close relative, one of the most severe sources of stress, before or during pregnancy was not associated with postpartum psychosis. Therefore, these data do not support the hypothesis that severely stressful life events, such as bereavement around the time of pregnancy, are associated with postpartum psychosis.Keywords: postpartum, psychosis, bereavement, stress, pregnancy, cohort stud