Stress-related disorders – a major challenge of 21st century medical sciences

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Low Birth Weight, Small for Gestational Age and Preterm Births before and after the Economic Collapse in Iceland: A Population Based Cohort Study

Objective: Infants born small for gestational age (SGA) or preterm have increased rates of perinatal morbidity and mortality. Stressful events have been suggested as potential contributors to preterm birth (PB) and low birth weight (LBW). We studied the effect of the 2008 economic collapse in Iceland on the risks of adverse birth outcomes. Study design The study population constituted all Icelandic women giving birth to live-born singletons from January 1st 2006 to December 31st 2009. LBW infants were defined as those weighing <2500 grams at birth, PB infants as those born before 37 weeks of gestation and SGA as those with a birth weight for gestational age more than 2 standard deviations (SD's) below the mean according to the Swedish fetal growth curve. We used logistic regression analysis to estimate odds ratios [OR] and corresponding 95 percent confidence intervals [95% CI] of adverse birth outcomes by exposure to calendar time of the economic collapse, i.e. after October 6th 2008. Results: Compared to the preceding period, we observed an increased adjusted odds in LBW-deliveries following the collapse (aOR = 1.24, 95% CI [1.02, 1.52]), particularly among infants born to mothers younger than 25 years (aOR = 1.85, 95% CI [1.25, 2.72]) and not working mothers (aOR = 1.61, 95% CI [1.10, 2.35]). Similarly, we found a tendency towards higher incidence of SGA-births (aOR = 1.14, 95% CI [0.86, 1.51]) particularly among children born to mothers younger than 25 years (aOR = 1.87, 95% CI [1.09, 3.23]) and not working mothers (aOR = 1.86, 95% CI [1.09, 3.17]). No change in risk of PB was observed. The increase of LBW was most distinct 6–9 months after the collapse. Conclusion: The results suggest an increase in risk of LBW shortly after the collapse of the Icelandic national economy. The increase in LBW seems to be driven by reduced fetal growth rate rather than shorter gestation

Perinatal mental health: how nordic data sources have contributed to existing evidence and future avenues to explore

Purpose Perinatal mental health disorders affect a significant number of women with debilitating and potentially life-threatening consequences. Researchers in Nordic countries have access to high quality, population-based data sources and the possibility to link data, and are thus uniquely positioned to fill current evidence gaps. We aimed to review how Nordic studies have contributed to existing evidence on perinatal mental health. Methods We summarized examples of published evidence on perinatal mental health derived from large population-based longitudinal and register-based data from Denmark, Finland, Iceland, Norway and Sweden. Results Nordic datasets, such as the Danish National Birth Cohort, the FinnBrain Birth Cohort Study, the Icelandic SAGA cohort, the Norwegian MoBa and ABC studies, as well as the Swedish BASIC and Mom2B studies facilitate the study of prevalence of perinatal mental disorders, and further provide opportunity to prospectively test etiological hypotheses, yielding comprehensive suggestions about the underlying causal mechanisms. The large sample size, extensive follow-up, multiple measurement points, large geographic coverage, biological sampling and the possibility to link data to national registries renders them unique. The use of novel approaches, such as the digital phenotyping data in the novel application-based Mom2B cohort recording even voice qualities and digital phenotyping, or the Danish study design paralleling a natural experiment are considered strengths of such research. Conclusions Nordic data sources have contributed substantially to the existing evidence, and can guide future work focused on the study of background, genetic and environmental factors to ultimately define vulnerable groups at risk for psychiatric disorders following childbirth

Pregnancy-Induced Hypertensive Disorders before and after a National Economic Collapse: A Population Based Cohort Study.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Files. This article is open access.Data on the potential influence of macroeconomic recessions on maternal diseases during pregnancy are scarce. We aimed to assess potential change in prevalence of pregnancy-induced hypertensive disorders (preeclampsia and gestational hypertension) during the first years of the major national economic recession in Iceland, which started abruptly in October 2008.Women whose pregnancies resulted in live singleton births in Iceland in 2005-2012 constituted the study population (N = 35,211). Data on pregnancy-induced hypertensive disorders were obtained from the Icelandic Medical Birth Register and use of antihypertensive drugs during pregnancy, including β-blockers and calcium channel blockers, from the Icelandic Medicines Register. With the pre-collapse period as reference, we used logistic regression analysis to assess change in pregnancy-induced hypertensive disorders and use of antihypertensives during the first four years after the economic collapse, adjusting for demographic and pregnancy characteristics, taking aggregate economic indicators into account. Compared with the pre-collapse period, we observed an increased prevalence of gestational hypertension in the first year following the economic collapse (2.4% vs. 3.9%; adjusted odds ratio [aOR] 1.47; 95 percent confidence interval [95%CI] 1.13-1.91) but not in the subsequent years. The association disappeared completely when we adjusted for aggregate unemployment rate (aOR 1.04; 95% CI 0.74-1.47). Similarly, there was an increase in prescription fills of β-blockers in the first year following the collapse (1.9% vs.3.1%; aOR 1.43; 95% CI 1.07-1.90), which disappeared after adjusting for aggregate unemployment rate (aOR 1.05; 95% CI 0.72-1.54). No changes were observed for preeclampsia or use of calcium channel blockers between the pre- and post-collapse periods.Our data suggest a transient increased risk of gestational hypertension and use of β-blockers among pregnant women in Iceland in the first and most severe year of the national economic recession.RANNIS/12045202

Early life residency associated with the risk of developing type 2 diabetes - the population-based Reykjavík study

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenInngangur: Kyrrseta og ofneysla orkuríkrar fæðu tengjast aukinni áhættu á að fá sykursýki af tegund 2 en áhrif aðbúnaðar í uppvexti á slíka áhættu síðar á ævinni hafa lítt verið athuguð. Tilgangur þessarar rannsóknar var að kanna tengsl búsetu í dreifbýli fyrstu 20 æviárin við áhættu á að fá sykursýki 2 miðað við búsetu í Reykjavík frá fæðingu. Efniviður og aðferðir: Í lýðgrunduðu þýði 17.811 karla (48%) og kvenna, meðalaldur 53 ár (aldursbil 33-81), sem tóku þátt í Reykjavíkurrannsókn Hjartaverndar á árunum 1967-1991, bjuggu 29% í sveit og 35% í sjávarþorpum að meðaltali í 20 ár áður en þeir fluttu til Reykjavíkur, en 36% bjuggu í Reykjavík frá fæðingu. Reiknuð var hlutfallsleg áhætta á að fá sykursýki 2 eftir búsetu. Niðurstöður: Hlutfallsleg áhætta á að fá sykursýki 2 var 43% lægri í körlum (RR 0,57; 95% CI 0,43-0,77) og 26% lægri í konum (RR 0,74; 95% CI 0,56-0,99) sem bjuggu í sveit fyrstu 20 ár ævinnar í samanburði við þá sem bjuggu í Reykjavík frá fæðingu. Hið lága algengi meðal þeirra sem ólust upp í sveit fannst bæði í aldurshópunum 55-64 ára og 65 ára og eldri. Ályktanir: Niðurstöður okkar benda til þess að þeir sem bjuggu í sveit á fyrri hluta 20. aldar á Íslandi voru í minni hættu á að fá sykursýki 2 síðar á ævinni, en jafnaldrar þeirra sem bjuggu í Reykjavík frá fæðingu. Við vörpum fram þeirri tilgátu að aðbúnaður snemma á ævinni hafi langvarandi áhrif á sykurefnaskipti líkamans.Sedentary lifestyle and energy rich food have been associated with the risk of developing type 2 diabetes; limited data are available on environmental conditions in childhood on this risk later in life. The objective was to study if residency in the first 20 years of life affected the risk of developing type 2 diabetes. In a cohort of 17811 men (48%) and women, mean age 53 years (range 33-81) participating in the population-based Reykjavík Study from 1967-91, 29% grew up in rural and 35% in coastal areas for an average of 20 years before moving to urban Reykjavík, but 36% lived in Reykjavík from birth. The prevalence of type 2 diabetes according to residency in early life was examined. The relative risk of developing type 2 diabetes was 43% lower in men (RR 0.57; 95% CI 0.43-0.77) and 26% lower (RR 0.74; 95% CI 0.56-0.99) in women living in rural areas for the first 20 years of their life compared with those living in urban Reykjavík from birth. The low prevalence among those that grew up in rural areas was maintained through the age categories of 55-64 years and 65 years and older. Our findings indicate that persons growing up in rural areas in early 20th century Iceland had lower risk of developing type 2 diabetes later in life when compared with peers living in Reykjavík from birth. We postulate a prolonged effect of early development on glucose metabolism and risk of developing type 2 diabetes

Psychiatric comorbidities in women with cardiometabolic conditions with and without ADHD : a population-based study

© 2023. The Author(s).BACKGROUND: Leveraging a large nationwide study of Icelandic women, we aimed to narrow the evidence gap around female attention-deficit/hyperactivity disorder (ADHD) and cardiometabolic comorbidities by determining the prevalence of obesity, hypertension, type 2 diabetes, and cardiovascular diseases among women with ADHD and examine the association between cardiometabolic conditions and co-occurring ADHD with anxiety and mood disorders, alcoholism/substance use disorder (SUD), self-harm, and suicide attempts. METHODS: We conducted a cross-sectional analysis of the nationwide, all-female, population-based SAGA Cohort Study (n = 26,668). To ascertain diagnoses and symptoms, we used self-reported history of ADHD diagnoses, selected cardiometabolic conditions and psychiatric disorders, and measured current depressive, anxiety, and PTSD symptoms through appropriate questionnaires (PHQ-9, GAD-7, and PCL-5). We calculated age-adjusted prevalences of cardiometabolic conditions by women's ADHD status and estimated adjusted prevalence ratios (PR) and 95% confidence intervals (CI), using modified Poisson regression models. Similarly, we assessed the association of cardiometabolic conditions and co-occurring ADHD with current psychiatric symptoms and psychiatric disorders, using adjusted PRs and 95% CIs. RESULTS: We identified 2299 (8.6%) women with a history of ADHD diagnosis. The age-adjusted prevalence of having at least one cardiometabolic condition was higher among women with ADHD (49.5%) than those without (41.7%), (PR = 1.19, 95% CI 1.14-1.25), with higher prevalence of all measured cardiometabolic conditions (myocardial infarctions (PR = 2.53, 95% CI 1.83--3.49), type 2 diabetes (PR = 2.08, 95% CI 1.66-2.61), hypertension (PR = 1.23, 95% CI 1.12-1.34), and obesity (PR = 1.18, 95% CI 1.11-1.25)). Women with cardiometabolic conditions and co-occurring ADHD had, compared with those without ADHD, substantially increased prevalence of (a) all measured mood and anxiety disorders, e.g., depression (PR = 2.38, 95% CI 2.19-2.58), bipolar disorder (PR = 4.81, 95% CI 3.65-6.35), posttraumatic stress disorder (PR = 2.78, 95% CI 2.52-3.07), social phobia (PR = 2.96, 95% CI 2.64-3.32); (b) moderate/severe depressive, anxiety, and PTSD symptoms with PR = 1.76 (95% CI 1.67-1.85), PR = 1.97 (95% CI 1.82-2.12), and PR = 2.01 (95% CI 1.88-2.15), respectively; (c) alcoholism/SUD, PR = 4.79 (95% CI 3.90-5.89); and (d) self-harm, PR = 1.47 (95% CI 1.29-1.67) and suicide attempts, PR = 2.37 (95% CI 2.05-2.73). CONCLUSIONS: ADHD is overrepresented among women with cardiometabolic conditions and contributes substantially to other psychiatric comorbidities among women with cardiometabolic conditions.Peer reviewe

Sleep disturbances among women in a Subarctic region: a nationwide study

Funding Information: Approval for the study was granted by the Icelandic Bioethics Committee (nr. VSNb2017110046/03.01) Publisher Copyright: © 2022 Sleep Research Society. Published by Oxford University Press on behalf of the Sleep Research Society.STUDY OBJECTIVES: To date, few studies have assessed sleep problems among women residing in Subarctic regions. Therefore, the aim of this large-scale population-based study was to assess the prevalence of severe sleep problems and associated factors among Icelandic women, living at 63-66°N. METHODS: Participants were 29 681 women (18-69 years old) who took part in the Icelandic Stress-And-Gene-Analysis study in 2018-2019. Background information, health-related behavior, and mental health symptoms were assessed with an online questionnaire. The Pittsburgh Sleep Quality Index (PSQI) was used to assess severe sleep problems during the past month. Adjusting for age, marital status, number of children, education, personal income, work schedule, region, and response period, we used modified Poisson log-linear models to obtain prevalence ratios (PRs) with 95% confidence intervals (CIs). RESULTS: Overall, 24.2% of women reported severe sleep problems (PSQI >10). Women responding in the winter presented with an overall higher prevalence of severe sleep problems, compared to those responding in the summer (PR 1.21; 95% CI, 1.15 to 1.28). Severe sleep problems were more prevalent among young and late-midlife women, those who were single, had children, socio-economic challenges, worked shifts, and flexible hours. Furthermore, obesity, suboptimal health behaviors, excessive screen time, and mental health problems were associated with severe sleep problems. CONCLUSION: Severe sleep problems are more common among women in Subarctic regions than elsewhere, particularly during winter. These findings motivate the development of preventive strategies and interventions for women in the Subarctic who suffer from sleep problems.Peer reviewe

A population-based study of stimulant drug treatment of ADHD and academic progress in children.

To access publisher's full text version of this article. Please click on the hyperlink in Additional Links field.We evaluated the hypothesis that later start of stimulant treatment of attention-deficit/hyperactivity disorder adversely affects academic progress in mathematics and language arts among 9- to 12-year-old children. We linked nationwide data from the Icelandic Medicines Registry and the Database of National Scholastic Examinations. The study population comprised 11,872 children born in 1994-1996 who took standardized tests in both fourth and seventh grade. We estimated the probability of academic decline (drop of ≥ 5.0 percentile points) according to drug exposure and timing of treatment start between examinations. To limit confounding by indication, we concentrated on children who started treatment either early or later, but at some point between fourth-grade and seventh-grade standardized tests. In contrast with nonmedicated children, children starting stimulant treatment between their fourth- and seventh-grade tests were more likely to decline in test performance. The crude probability of academic decline was 72.9% in mathematics and 42.9% in language arts for children with a treatment start 25 to 36 months after the fourth-grade test. Compared with those starting treatment earlier (≤ 12 months after tests), the multivariable adjusted risk ratio (RR) for decline was 1.7 (95% confidence interval [CI]: 1.2-2.4) in mathematics and 1.1 (95% CI: 0.7-1.8) in language arts. The adjusted RR of mathematics decline with later treatment was higher among girls (RR, 2.7; 95% CI: 1.2-6.0) than boys (RR, 1.4; 95% CI: 0.9-2.0). Later start of stimulant drug treatment of attention-deficit/hyperactivity disorder is associated with academic decline in mathematicsPfizer Novartis University of Iceland Icelandic Centre for Research (RANNIS

Association of Maternal Autoimmune Diseases with Risk of Mental Disorders in Offspring in Denmark

Funding Information: László); grants 19410713500 and 2018SHZDZX01 from the Science and Technology Commission of Shanghai Municipality (Dr F. Li); grants GWV-10.1-XK07, 2020CXJQ01, and 2018YJRC03 from the Shanghai Municipal Commission of Health and Family Planning (Dr F Li); and grant 2018B030335001 from the Guangdong Key Project (Dr F Li) . Funding Information: Funding/Support: This study was supported by grant NNF18OC0052029 from the Novo Nordisk Foundation (Dr J. Li) ; grants DFF-6110-00019B, DFF-9039-00010B, and DFF-1030-00012B from the Danish Council for Independent Research (Dr J. Li); grant R275-A15770 from the Nordic Cancer Union (Dr J. Li); grant 2016 from the Karen Elise Jensens Fond (Dr J. Li); grants 81761128035, 81930095, and 82125032 (Dr F. Li) and grant 82073570 (Dr J. Li) from the National Natural Science Foundation of China; grant 20180306 from the Swedish Heart and Lung Foundation (Dr László); grant 2015-00837 from the Swedish Council for Working Life and Social Research (Dr Publisher Copyright: © 2022 American Medical Association. All rights reserved.Importance: Maternal immune activation during pregnancy is associated with increased risks of several mental disorders in offspring during childhood, but little is known about how maternal autoimmune diseases during pregnancy are associated with mental health in offspring during and after childhood. Objective: To investigate the association between maternal autoimmune diseases before childbirth and risk of mental disorders among offspring up to early adulthood. Design, Setting, and Participants: This population-based nationwide cohort study used data from Danish national registers on singletons born in Denmark from 1978 to 2015 with up to 38 years of follow-up. Data analyses were conducted from March 1, 2020, through September 30, 2021. Exposures: Maternal autoimmune disease diagnosed before or during pregnancy according to the Danish National Patient Register. Main Outcomes and Measures: The main outcome was mental disorders, defined by hospital diagnoses, in offspring. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% CIs for mental disorders. Results: Of the 2254234 singleton infants included in the study (median age, 16.7 years [IQR, 10.5-21.7 years]; 51.28% male), 2.26% were born to mothers with autoimmune diseases before childbirth. Exposed participants had an increased risk of overall mental disorders compared with their unexposed counterparts (HR, 1.16; 95% CI, 1.13-1.19; incidence, 9.38 vs 7.91 per 1000 person-years). Increased risks of overall mental disorders in offspring were seen in different age groups for type 1 diabetes (1-5 years: HR, 1.35 [95% CI, 1.17-1.57]; 6-18 years: HR, 1.24 [95% CI, 1.15-1.33]; >18 years: HR, 1.19 [95% CI, 1.09-1.30]) and rheumatoid arthritis (1-5 years: HR, 1.42 [95% CI, 1.16-1.74]; 6-18 years: HR, 1.19 [95% CI, 1.05-1.36]; >18 years: HR, 1.28 [95% CI, 1.02-1.60]). Regarding specific mental disorders, increased risk after exposure to any maternal autoimmune disorder was observed for organic disorders (HR, 1.54; 95% CI, 1.21-1.94), schizophrenia (HR, 1.35; 95% CI, 1.21-1.51), obsessive-compulsive disorder (HR, 1.42; 95% CI, 1.24-1.63), mood disorders (HR, 1.12; 95% CI, 1.04-1.21), and a series of neurodevelopmental disorders (eg, childhood autism [HR, 1.21; 95% CI, 1.08-1.36] and attention-deficit/hyperactivity disorder [HR, 1.19; 95% CI, 1.12-1.26]). Conclusions and Relevance: In this cohort study in Denmark, prenatal exposure to maternal autoimmune diseases was associated with increased risks of overall and type-specific mental disorders in offspring. Maternal type 1 diabetes and rheumatoid arthritis during pregnancy were associated with offspring's mental health up to early adulthood. Individuals prenatally exposed to autoimmune disease may benefit from long-term surveillance for mental disorders.Peer reviewe