Mental ill-health in contemporary young adults

Young adulthood is the peak age for the onset of most mental disorders and is a period of crucial importance for the establishment of emotional well-being in adult life. Mental health problems, including psychological distress and depressive symptoms, as well as suicide attempts, are reported to be increasing among young people, especially females, in many Western countries. Thus, the overall purpose of this thesis is to examine trends and causes of mental ill-health in contemporary young adults, with a focus on gender differences. In Study I, we investigated recent time trends in several indicators of mental ill-health, and the patterning of these indicators between genders and younger vs. older individuals in Stockholm County, Sweden during 1997-2006. Self-reported anxiety and psychiatric service use increased among young individuals of both genders, while attempted suicides increased only among young women. By contrast, these indicators decreased or remained stable in the older age group from year 2001 and onwards. In Study II, we studied the association between social position and the risk for different severity levels of psychological distress, as well as depression in the Stockholm Public Health cohort. We found that the socioeconomic gradient for clinical depression is more pronounced than that for distress. Low income is associated with the risk of distress and the association is stronger for severe distress. Depression is markedly linked with occupational class in men and with family income in women, and this is especially true among younger individuals. In Study III, we explored the relationships between a number of possible causes and subsequent psychological distress as well as suicide attempts, immigrant status, age at transition into adult life (as reflected by employment status, age at becoming a parent and housing tenure), social adversity (including unemployment and financial strain), in a large population-based sample of young adults, with a focus on possible gender differences. We found that immigration from outside Europe and social adversity are associated with mental health problems in young adults, especially females. Postponed transition into adulthood furthermore appears to be associated with poor mental health in young women. In Study IV, we examined the relationship between poor school performance and selfreported suicide attempts in a large sample of young adults, and the extent to which this is explained by adult health behaviours or social conditions. We also examined the potential modifying role of previous suicidal thoughts. We found that poor school performance is a strong predictor of future suicide attempts in young adults, and that this relationship appears to be strongest in individuals without a history of suicidal thoughts. Furthermore, adult socioeconomic factors and health behaviours do not seem to explain the association. Instead, other factors linked with poor school performance, such as poor coping, may explain the relationship. In conclusion, our findings indicate a rising, and highly prevalent, mental ill-health among the young in Stockholm and underscore the importance of social factors, such as social position, social adversity, immigration, age at transition to adulthood, and school performance in the causation of mental ill-health in contemporary young adults

Association of Childhood Infection With IQ and Adult Nonaffective Psychosis in Swedish Men: A Population-Based Longitudinal Cohort and Co-relative Study.

Importance: Associations between childhood infection, IQ, and adult nonaffective psychosis (NAP) are well established. However, examination of sensitive periods for exposure, effect of familial confounding, and whether IQ provides a link between childhood infection and adult NAP may elucidate pathogenesis of psychosis further. Objectives: To test the association of childhood infection with IQ and adult NAP, to find whether shared familial confounding explains the infection-NAP and IQ-NAP associations, and to examine whether IQ mediates and/or moderates the childhood infection-NAP association. Design, Setting, and Participants: Population-based longitudinal cohort study using linkage of Swedish national registers. The risk set included all Swedish men born between 1973 and 1992 and conscripted into the military until the end of 2010 (n = 771 698). We included 647 515 participants in the analysis. Measurement of Exposures: Hospitalization with any infection from birth to age 13 years. Main Outcomes and Measures: Hospitalization with an International Classification of Diseases diagnosis of NAP until the end of 2011. At conscription around age 18 years, IQ was assessed for all participants. Results: At the end of follow-up, the mean (SD) age of participants was 30.73 (5.3) years. Exposure to infections, particularly in early childhood, was associated with lower IQ (adjusted mean difference for infection at birth to age 1 year: -1.61; 95% CI, -1.74 to -1.47) and with increased risk of adult NAP (adjusted hazard ratio for infection at birth to age 1 year: 1.19; 95% CI, 1.06 to 1.33). There was a linear association between lower premorbid IQ and adult NAP, which persisted after excluding prodromal cases (adjusted hazard ratio per 1-point increase in IQ: 0.976; 95% CI, 0.974 to 0.978). The infection-NAP and IQ-NAP associations were similar in the general population and in full-sibling pairs discordant for exposure. The association between infection and NAP was both moderated (multiplicative, β = .006; SE = 0.002; P = .02 and additive, β = .008; SE = 0.002; P = .001) and mediated (β = .028; SE = 0.002; P < .001) by IQ. Childhood infection had a greater association with NAP risk in the lower, compared with higher, IQ range. Conclusions and Relevance: Early childhood is a sensitive period for the effects of infection on IQ and NAP. The associations of adult NAP with early-childhood infection and adolescent IQ are not fully explained by shared familial factors and may be causal. Lower premorbid IQ in individuals with psychosis arises from unique environmental factors, such as early-childhood infection. Early-childhood infections may increase the risk of NAP by affecting neurodevelopment and by exaggerating the association of cognitive vulnerability with psychosis.Dr Khandaker is supported by an Intermediate Clinical Fellowship from the Wellcome Trust (201486/Z/16/Z) and a Clinical Lecturer Starter Grant from the Academy of Medical Sciences, UK (80354). Dr Jones reports having grant support from the Wellcome Trust (095844/Z/11/Z and 088869/Z/09/Z) and from the National Institute for Health Research: RP-PG-0616-20003, Cambridge Biomedical Research Centre and Collaboration for Leadership in Applied Health Research and Care East of England. Dr Dalman reports grant support from the Swedish Research Council. Dr Karlsson reports grant support from the Stanley Medical Research Institute

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

Publisher's version (útgefin grein)Purpose: 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. © 2019 Warselius et al.This work was supported by the Swedish Society of Medicine (grant SLS588081 to KDL), Karolinska Institutet Research Foundation (grant 2016fobi50733 to KDL), Swedish Council for Working Life and Social Research (grant 2015-00837 to KDL), Danish Council for Independent Research (grant DFF-6110-00019 to JL), Karen Elise Jensens Fond (grant 2016 to JL), Nordic Cancer Union (grants 176673, 186200, and R217-A13234-18-S65 to JL), Novo Nordisk Fonden (grant NNF18OC0052029 to JL), TrygFonden (grants 904414 and 15199 to CO), and the Lundbeck Foundation (grant R155-2012-11280 to MV). The funders were not involved in the design of the study, analyses, interpretation of the results, writing of the manuscript, or decision to submit the manuscript for publication.Peer Reviewe

Has the association between low school performance and the risk of disability benefit due to mental disorders become stronger over time?

Abstract Background The proportion of young adults on disability benefits due to mental disorders has increased in Europe since the early 2000’s. Poor educational achievement is a risk factor for disability benefits due to mental disorders in early adulthood, yet no study has examined whether this association has become stronger over time. Methods All residents of Stockholm County at the time of graduation from compulsory education between 2000 and 2007 (N = 169,125) were followed prospectively for recipient of disability benefits due to a mental disorder from 2003 to 2011. Information about the study participants was obtained by linkage of national registers. Low school performance in the last year of compulsory school was defined as having a merit rating corresponding to the lowest quintile. The association between school performance and disability benefits was examined using Cox proportional hazards models. Results Low school performers had a greater risk of disability benefits due to mental disorders during early adulthood, as compared to their better performing counterparts, and this association was more pronounced for the more recent graduation cohorts (OR = 1.12, 95% CI 1.08–1.16). Conclusions The association between low school performance and the risk of disability benefits due to mental disorders seems to become stronger during the first decade of the twenty-first century. It is plausible that this trend indicates an increased vulnerability of poor school performers to exclusion from the labor market. Prevention of school failure and adjustment of the labour market to individual variability in academic performance appear to be critical approaches to counteract this trend

School performance and the risk of suicidal thoughts in young adults: population-based study.

Although low school performance is related to attempted and completed suicide, its relationship with suicidal thoughts has been less clear. We conducted a population-based study including 10081 individuals aged 18-29 years in Stockholm, Sweden, and found a clear positive gradient in the risk of lifetime suicidal thoughts with decreasing levels of compulsory school leaving grades. This relationship was somewhat attenuated but remained significant in multivariate models accounting for family background, severe adult psychopathology and adult socioeconomic conditions. School failure is associated with an increased risk of experiencing suicidal thoughts and may also increase the tendency of acting upon them

Childhood social adversity and risk of depressive symptoms in adolescence in a US national sample.

ObjectiveChildhood social adversity has been associated with an increased risk of depression and other psychiatric disorders in adolescence and early adulthood. However, the role of timing and accumulation of adversities has not yet been established in longitudinal studies. We examined the association between childhood adversities and adolescent depressive symptoms, and the impact of timing and accumulation of adversity.MethodLongitudinal data were obtained from the Child Development Supplement to the Panel Study of Income Dynamics (n=2223), a nationally representative survey of US families that incorporates data from parents and their children. Negative binomial regression analysis was used to estimate effects of childhood social adversity on adolescent depressive symptoms, presented as Incidence Rate Ratios with 95% confidence intervals.ResultsChildren exposed to social adversity reported higher levels of adolescent depressive symptoms captured by two depression scales. Single-parent household and residential instability were particularly associated with depressive symptoms. A positive relationship was found between cumulative adversity and the risk of adolescent depression. The timing of exposure appeared to have little effect on the risk of adolescent depressive symptoms.LimitationsThe structure of the data implies that alternative causal pathways cannot be fully discounted. The self- or parent-reported data is subject to recall bias.ConclusionOur findings support the long-term negative impact of childhood adversity on adolescent depressive symptoms, regardless of when in childhood the adversity occurs. Policies and interventions to reduce adolescent depressive symptoms need to consider the social background of the family as an important risk or protective factor

Childhood social adversity and risk of depressive symptoms in adolescence in a US national sample.

ObjectiveChildhood social adversity has been associated with an increased risk of depression and other psychiatric disorders in adolescence and early adulthood. However, the role of timing and accumulation of adversities has not yet been established in longitudinal studies. We examined the association between childhood adversities and adolescent depressive symptoms, and the impact of timing and accumulation of adversity.MethodLongitudinal data were obtained from the Child Development Supplement to the Panel Study of Income Dynamics (n=2223), a nationally representative survey of US families that incorporates data from parents and their children. Negative binomial regression analysis was used to estimate effects of childhood social adversity on adolescent depressive symptoms, presented as Incidence Rate Ratios with 95% confidence intervals.ResultsChildren exposed to social adversity reported higher levels of adolescent depressive symptoms captured by two depression scales. Single-parent household and residential instability were particularly associated with depressive symptoms. A positive relationship was found between cumulative adversity and the risk of adolescent depression. The timing of exposure appeared to have little effect on the risk of adolescent depressive symptoms.LimitationsThe structure of the data implies that alternative causal pathways cannot be fully discounted. The self- or parent-reported data is subject to recall bias.ConclusionOur findings support the long-term negative impact of childhood adversity on adolescent depressive symptoms, regardless of when in childhood the adversity occurs. Policies and interventions to reduce adolescent depressive symptoms need to consider the social background of the family as an important risk or protective factor

Individual and familial factors predict formation and improvement of adolescents' academic expectations: A longitudinal study in Sweden.

BACKGROUND:Adolescents' high academic expectations predict future health and successful societal integration. Yet, little is known about which factors may promote adolescents' expectations of their future education and academic achievement. AIMS:To explore whether potentially modifiable factors such as parents' engagement and expectations regarding their child's education; or student individual factors such as school engagement, academic achievement, sense of identity, and positive mental health predict positive development of academic expectations in early adolescence. METHODS:A longitudinal study of 3,203 adolescents and their parents was conducted with information collected between 7th grade (13 years of age) and 9th grade (16 years of age). Parental and adolescents' own academic expectations and engagement in school, academic achievement, identity synthesis, and mental health were self-reported in annual questionnaires. We used logistic regression to analyze the associations between the aforementioned factors and two binary outcomes related to changes in expectations from 7th to 9th grade: A. resolved uncertainty regarding own academic expectations; B. raised academic expectations. RESULTS:Student engagement, and higher academic grades predicted both resolved uncertainty in expectations and raised academic expectations. Higher parental involvement in education was related to resolved uncertainty, while high parental expectations were related to raised student expectations. Identity synthesis and mental health did not appear to predict either outcome. CONCLUSION:Our findings indicate that a supportive parental attitude concerning their child's education during adolescence, student engagement, and positive progressions in academic achievements may contribute to a positive development of academic expectations, thus to positive educational trajectories

Association between childhood adversity and a diagnosis of personality disorder in young adulthood : a cohort study of 107,287 individuals in Stockholm County

Childhood adversity (CA) may increase the risk for later developing of personality disorder (PD). However, less is known about the association between cumulative CA and PD, and the role of childhood psychopathology and school performance. The current study examined the relationship between a range of CAs and a diagnosis of PD in young adulthood, and the roles of childhood psychopathology and school performance in this relationship. All individuals born in Stockholm County 1987-1991 (n = 107,287) constituted our cohort. Seven CAs were measured between birth and age 14: familial death, parental criminality, parental substance abuse and psychiatric morbidity, parental separation and/or single-parent household, household public assistance and residential instability. Individuals were followed from their 18th birthday until they were diagnosed with PD or until end of follow-up (December 31st 2011). Adjusted estimates of risk of PD were calculated as hazard ratios (HR) with 95% confidence intervals (CI). Associations were observed between cumulative CA and PD. During the follow-up 770 individuals (0.7%) were diagnosed with PD. Individuals exposed to 3+ CAs had the highest risks of being diagnosed with PD (HR 3.0, 95% CI 2.4-3.7). Childhood psychopathology and low school grades further increased the risk of PD among individuals exposed to CA. Cumulative CA is strongly associated with a diagnosis of PD in young adulthood. Our findings indicate that special attention should be given in schools and health services to children exposed to adversities to prevent decline in school performance, and to detect vulnerable individuals that may be on negative life-course trajectories