Age- and sex-specific associations between risk scores for schizophrenia and self-reported health in the general population

Purpose The health correlates of polygenic risk (PRS-SCZ) and exposome (ES-SCZ) scores for schizophrenia may vary depending on age and sex. We aimed to examine age- and sex-specific associations of PRS-SCZ and ES-SCZ with self-reported health in the general population. Methods Participants were from the population-based Netherlands Mental Health Survey and Incidence Study–2 (NEMESIS-2). Mental and physical health were measured with the 36-item Short Form Survey 4 times between 2007 and 2018. The PRS-SCZ and ES-SCZ were respectively calculated from common genetic variants and exposures (cannabis use, winter birth, hearing impairment, and five childhood adversity categories). Moderation by age and sex was examined in linear mixed models. Results For PRS-SCZ and ES-SCZ analyses, we included 3099 and 6264 participants, respectively (age range 18–65 years; 55.7–56.1% female). Age and sex did not interact with PRS-SCZ. Age moderated the association between ES-SCZ and mental (interaction: p = 0.02) and physical health (p = 0.0007): at age 18, + 1.00 of ES-SCZ was associated with − 0.10 of mental health and − 0.08 of physical health, whereas at age 65, it was associated with − 0.21 and − 0.23, respectively (all units in standard deviations). Sex moderated the association between ES-SCZ and physical health (p < .0001): + 1.00 of ES-SCZ was associated with − 0.19 of physical health among female and − 0.11 among male individuals. Conclusion There were larger associations between higher ES-SCZ and poorer health among female and older individuals. Accounting for these interactions may increase ES-SCZ precision and help uncover populational determinants of environmental influences on health

The Epidemiology of Alcohol Use Disorders Cross-Nationally: Findings from the World Mental Health Surveys

Background: Prevalences of Alcohol Use Disorders (AUDs) and Mental Health Disorders (MHDs) in many individual countries have been reported but there are few cross-national studies. The WHO World Mental Health (WMH) Survey Initiative standardizes methodological factors facilitating comparison of the prevalences and associated factors of AUDs in a large number of countries to identify differences and commonalities. Methods: Lifetime and 12-month prevalence estimates of DSM-IV AUDs, MHDs, and associations were assessed in the 29 WMH surveys using the WHO CIDI 3.0. Results: Prevalence estimates of alcohol use and AUD across countries and WHO regions varied widely. Mean lifetime prevalence of alcohol use in all countries combined was 80%, ranging from 3.8% to 97.1%. Combined average population lifetime and 12-month prevalence of AUDs were 8.6% and 2.2% respectively and 10.7% and 4.4% among non-abstainers. Of individuals with a lifetime AUD, 43.9% had at least one lifetime MHD and 17.9% of respondents with a lifetime MHD had a lifetime AUD. For most comorbidity combinations, the MHD preceded the onset of the AUD. AUD prevalence was much higher for men than women. 15% of all lifetime AUD cases developed before age 18. Higher household income and being older at time of interview, married, and more educated, were associated with a lower risk for lifetime AUD and AUD persistence. Conclusions: Prevalence of alcohol use and AUD is high overall, with large variation worldwide. The WMH surveys corroborate the wide geographic consistency of a number of well-documented clinical and epidemiological findings and patterns

Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015 : a systematic analysis for the Global Burden of Disease Study 2015

Background Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures. Methods We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography-year datapoints. For GBD 2015, eight causes, including Ebola virus disease, were added to the previous GBD cause list for mortality. We used six modelling approaches to assess cause-specific mortality, with the Cause of Death Ensemble Model (CODEm) generating estimates for most causes. We used a series of novel analyses to systematically quantify the drivers of trends in mortality across geographies. First, we assessed observed and expected levels and trends of cause-specific mortality as they relate to the Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Second, we examined factors affecting total mortality patterns through a series of counterfactual scenarios, testing the magnitude by which population growth, population age structures, and epidemiological changes contributed to shifts in mortality. Finally, we attributed changes in life expectancy to changes in cause of death. We documented each step of the GBD 2015 estimation processes, as well as data sources, in accordance with Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Findings Globally, life expectancy from birth increased from 61.7 years (95% uncertainty interval 61.4-61.9) in 1980 to 71.8 years (71.5-72.2) in 2015. Several countries in sub-Saharan Africa had very large gains in life expectancy from 2005 to 2015, rebounding from an era of exceedingly high loss of life due to HIV/AIDS. At the same time, many geographies saw life expectancy stagnate or decline, particularly for men and in countries with rising mortality from war or interpersonal violence. From 2005 to 2015, male life expectancy in Syria dropped by 11.3 years (3.7-17.4), to 62.6 years (56.5-70.2). Total deaths increased by 4.1% (2.6-5.6) from 2005 to 2015, rising to 55.8 million (54.9 million to 56.6 million) in 2015, but age-standardised death rates fell by 17.0% (15.8-18.1) during this time, underscoring changes in population growth and shifts in global age structures. The result was similar for non-communicable diseases (NCDs), with total deaths from these causes increasing by 14.1% (12.6-16.0) to 39.8 million (39.2 million to 40.5 million) in 2015, whereas age-standardised rates decreased by 13.1% (11.9-14.3). Globally, this mortality pattern emerged for several NCDs, including several types of cancer, ischaemic heart disease, cirrhosis, and Alzheimer's disease and other dementias. By contrast, both total deaths and age-standardised death rates due to communicable, maternal, neonatal, and nutritional conditions significantly declined from 2005 to 2015, gains largely attributable to decreases in mortality rates due to HIV/AIDS (42.1%, 39.1-44.6), malaria (43.1%, 34.7-51.8), neonatal preterm birth complications (29.8%, 24.8-34.9), and maternal disorders (29.1%, 19.3-37.1). Progress was slower for several causes, such as lower respiratory infections and nutritional deficiencies, whereas deaths increased for others, including dengue and drug use disorders. Age-standardised death rates due to injuries significantly declined from 2005 to 2015, yet interpersonal violence and war claimed increasingly more lives in some regions, particularly in the Middle East. In 2015, rotaviral enteritis (rotavirus) was the leading cause of under-5 deaths due to diarrhoea (146 000 deaths, 118 000-183 000) and pneumococcal pneumonia was the leading cause of under-5 deaths due to lower respiratory infections (393 000 deaths, 228 000-532 000), although pathogen-specific mortality varied by region. Globally, the effects of population growth, ageing, and changes in age-standardised death rates substantially differed by cause. Our analyses on the expected associations between cause-specific mortality and SDI show the regular shifts in cause of death composition and population age structure with rising SDI. Country patterns of premature mortality (measured as years of life lost [YLLs]) and how they differ from the level expected on the basis of SDI alone revealed distinct but highly heterogeneous patterns by region and country or territory. Ischaemic heart disease, stroke, and diabetes were among the leading causes of YLLs in most regions, but in many cases, intraregional results sharply diverged for ratios of observed and expected YLLs based on SDI. Communicable, maternal, neonatal, and nutritional diseases caused the most YLLs throughout sub-Saharan Africa, with observed YLLs far exceeding expected YLLs for countries in which malaria or HIV/AIDS remained the leading causes of early death. Interpretation At the global scale, age-specific mortality has steadily improved over the past 35 years; this pattern of general progress continued in the past decade. Progress has been faster in most countries than expected on the basis of development measured by the SDI. Against this background of progress, some countries have seen falls in life expectancy, and age-standardised death rates for some causes are increasing. Despite progress in reducing age-standardised death rates, population growth and ageing mean that the number of deaths from most non-communicable causes are increasing in most countries, putting increased demands on health systems. Copyright (C) The Author(s). Published by Elsevier Ltd.Peer reviewe

Course of subthreshold manic symptoms and related risk factors in the general population: A three-year follow-up study

Objectives: Subthreshold manic symptoms (subM) are a risk factor for the onset and recurrence of bipolar disorder (BD). Individuals with subM may benefit from preventive interventions, however, their development is hampered by a lack of knowledge on subM prevalence and subsequent course. This study examines subM characteristics, course, and risk factors for an unfavourable course. Methods: In a Dutch representative, population-based sample aged 18–64 (N = 4618), we assessed subM, defined as the occurrence of manic core symptoms (elation/irritability), without meeting full DSM-IV criteria for BD I or II in the past 3 years. Comparison groups had either no manic symptoms (noM) or hypomania/mania in the context of BD (mBD) in the past 3 years. Furthermore, we differentiated a mild and moderate type of subM, based on the number of manic symptoms. A subsequent three-year course was assessed prospectively. Results: SubM had a three-year prevalence of 4.9%. Its prevalence, characteristics, and course were in between noM and mBD, and there were few differences between mild and moderate subM. Over the 3-year follow-up, 25.0% of individuals with subM had persistent subM and another 6.1% transitioned to mBD. Eleven significant risk factors for this unfavourable course were found. The most important were a history of depression/dysthymia (OR 3.75, p ≤ 0.001), living alone (OR 2.61, p ≤ 0.01) and elevated neuroticism score (OR 1.21, p ≤ 0.001). Conclusions: This study supports the validity and clinical relevance of subM as a BD prodrome. It demonstrates that subM symptoms often persist or increase during follow-up and identifies 11 risk factors that are associated with an unfavourable course

Zorggebruik vooral bepaald door ernst van depressie: Verschillen tussen vroege, afwachtende en niet-zorggebruikers

Doel Zorggebruik onderzoeken bij patiënten met een depressie, en nagaan welke demografische kenmerken en ernstkenmerkenpatiënten die vroegtijdig gebruikmaken van zorg, patiënten die afwachten met zorggebruik en patiënten die geen gebruikmakenvan zorg van elkaar onderscheiden. Opzet Longitudinaal, observationeel en prospectief onderzoek.MethodeWe gebruikten gegevens van de ‘Netherlands mental health survey and incidence study-2’ (NEMESIS-2). Patiënten die eendepressie rapporteerden in de 12 maanden voorafgaand aan de ‘baseline’-meting, werden geïncludeerd. Hun zorggebruik indiezelfde periode werd gerapporteerd. Na 3 jaar keken we opnieuw naar hun zorggebruik. Om verschillen te onderzoeken tussenvroege zorggebruikers (in het jaar dat ze een depressie hadden gebruikten ze ook zorg), afwachtende en niet-zorggebruikersgebruikten we een multinomiale logistische regressieanalyse. Resultaten Meer dan de helft van de respondenten was een vroege zorggebruiker (62%). Vroege zorggebruikers hadden ernstigere enpersisterende depressieve symptomen en vaker geen partner dan niet-zorggebruikers (dat wil zeggen: noch zorg in jaar waarindepressie begon, noch in 3 jaar daarna). De meerderheid van de niet-zorggebruikers (89%) was hersteld na 3 jaar. Afwachtendezorggebruikers (geen zorg in jaar waarin depressie begon, wel in 3 jaar daarna) hadden relatief geringe klachten en rapporteerdenvaker een nieuwe of aanhoudende depressieve episode na 3 jaar dan vroege zorggebruikers. Conclusie Zorggebruik door patiënten met een depressie lijkt vooral samen te hangen met ernstkenmerken en niet zozeer met demografischekenmerken zoals leeftijd, opleidingsniveau of geslacht

Zorggebruik vooral bepaald door ernst van depressie: Verschillen tussen vroege, afwachtende en niet-zorggebruikers

Doel Zorggebruik onderzoeken bij patiënten met een depressie, en nagaan welke demografische kenmerken en ernstkenmerkenpatiënten die vroegtijdig gebruikmaken van zorg, patiënten die afwachten met zorggebruik en patiënten die geen gebruikmakenvan zorg van elkaar onderscheiden. Opzet Longitudinaal, observationeel en prospectief onderzoek.MethodeWe gebruikten gegevens van de ‘Netherlands mental health survey and incidence study-2’ (NEMESIS-2). Patiënten die eendepressie rapporteerden in de 12 maanden voorafgaand aan de ‘baseline’-meting, werden geïncludeerd. Hun zorggebruik indiezelfde periode werd gerapporteerd. Na 3 jaar keken we opnieuw naar hun zorggebruik. Om verschillen te onderzoeken tussenvroege zorggebruikers (in het jaar dat ze een depressie hadden gebruikten ze ook zorg), afwachtende en niet-zorggebruikersgebruikten we een multinomiale logistische regressieanalyse. Resultaten Meer dan de helft van de respondenten was een vroege zorggebruiker (62%). Vroege zorggebruikers hadden ernstigere enpersisterende depressieve symptomen en vaker geen partner dan niet-zorggebruikers (dat wil zeggen: noch zorg in jaar waarindepressie begon, noch in 3 jaar daarna). De meerderheid van de niet-zorggebruikers (89%) was hersteld na 3 jaar. Afwachtendezorggebruikers (geen zorg in jaar waarin depressie begon, wel in 3 jaar daarna) hadden relatief geringe klachten en rapporteerdenvaker een nieuwe of aanhoudende depressieve episode na 3 jaar dan vroege zorggebruikers. Conclusie Zorggebruik door patiënten met een depressie lijkt vooral samen te hangen met ernstkenmerken en niet zozeer met demografischekenmerken zoals leeftijd, opleidingsniveau of geslacht