Association between Mental Disorders and Subsequent Medical Conditions

Average lifespan variation among people with mental disorders in Denmark: a nationwide, register-based cohort study

AIMS

Mortality associated with mental disorders has been estimated using metrics such as mortality rate ratios and life expectancy. However, the variation around the average life expectancy has never been quantified. The main aim of this study was to measure life disparity for people with mental disorders as a measure of inequality at the time of death.

METHODS

Using data from Danish registries, average life disparity was introduced and calculated to measure the lifespan variation associated with major types of mental disorders. Average life expectancy is also reported for completeness.

RESULTS

Compared with the general population, people with mental disorders not only had shorter average life expectancy, but experienced larger average life disparity. For those diagnosed with a mental disorder, average life expectancy increased between 1995 and 2021; however, average life disparity declined in women only, and did not change for men. In addition, the differences in both metrics between those with mental disorders and the general population were largest for substance use disorders and schizophrenia spectrum disorders. For these disorders, the differences even increased during the study period.

CONCLUSIONS

Mortality rates for individuals with mental disorders have been declining in recent decades in Denmark; however, the increase in the average life disparity emphasizes the increasing heterogeneity and inequality in lifespans within this group, which requires measures to promote a longer and more equal life for those with mental disorders.

Global burden of depression and anxiety disorders in older adults, 1990-2019: An analysis of age-period-cohort and temporal-spatial patterns

BACKGROUND

Mental disorders are the leading causes of the global health-related burden and account for 10.6 % of total disability (in disability adjusted life years, DALYs) among older adults, with depression and anxiety disorders being the most common contributors to this burden. This study provided a comprehensive epidemiological update on their global burden in older populations, analyzing evolving temporal trends, spatial distribution shifts, and identifying high-risk subgroups and geographic regions.

METHOD

Prevalence rates and disability-adjusted life years (DALYs) for depression and anxiety disorders in older adults from 1990 to 2019 were estimated using the GBD 2019. The Age-period-cohort (APC) modeling was applied to investigate the reasons behind these trends. In addition, we assessed the spatial patterns in different regions using the global and local Moran Index.

RESULTS

In 2019, 57.78 million (95 % UI 50.04, 66.30) older adults experienced depression and 46.26 million (95 % UI 59.93, 36.57) suffered from anxiety disorders globally. Depression accounted for 9.21 million DALYs (rate: 908.94, 95 % UI 625.45, 1234.56), while anxiety disorders contributed to 4.08 million DALYs (rate: 402.95, 95 % UI 264.96, 581.75). From 1990 to 2019, the depression prevalence increased (EAPC = 0.0424, 95 % CI 0.0261, 0.0587), and DALYs rates rose slightly (EAPC = 0.0142, 95 % CI -0.0071, 0.035). In contrast, the anxiety disorders prevalence and DALYs rate declined over the same period [EAPC = -0.1476 (95 % CI -0.1924,-0.1027) and -0.1476 (95 % CI -0.1917,-0.1035)]. Age-specific trends revealed inverted U-shaped depression trajectories, peaking among individuals aged 70-74 years, whereas anxiety disorders exhibited a U-shaped decline with the steepest reductions occurring at the extremes and slower declines in middle age groups. Males exhibited faster-growing depression burdens and rising late-life rates of anxiety disorders, contrasting with the declining trend observed in females. Socio-demographic disparities highlighted low-SDI regions with the highest depression burden (e.g., sub-Saharan Africa) versus high-SDI clusters for anxiety disorders (e.g., Western Europe). Spatial analyses identified depression hotspots in sub-Saharan Africa and anxiety clusters in Latin America and Western Europe, emphasizing divergent geographic patterns.

CONCLUSION

Combining temporal and spatial patterns, we explored temporal trends and five spatial patterns in global depression and anxiety disorders. The prevalence of depression and anxiety disorders was significantly elevated in regions exhibiting both fluctuating and stable high-aggregation patterns, particularly in Eastern/Western sub-Saharan Africa and Southern Latin America. National governments prioritize implementing targeted interventions to alleviate these burdens, while future studies should validate findings through comprehensive datasets and individual-level data to refine prevention strategies for high-risk populations and regions.

Exploring the magnitude and predictors of the long-term psychological impact of COVID-19 on frontline healthcare workers in Vietnam: a multi-center, cross-sectional study

BACKGROUND

The detrimental impacts of COVID-19 on the mental well-being of frontline healthcare workers (HCWs) have been well studied. However, the long-term trajectory of their mental well-being remains relatively unexplored. We examined the magnitude and predictors of the psychological impact of COVID-19 on frontline HCWs during the transition into the "new normal" phase.

METHODS

A cross-sectional survey was performed on frontline HCWs at two largest designated COVID-19 hospitals in Ho Chi Minh City between May and November 2022. A self-administered questionnaire captured participants' demographic characteristics and psychological distress including depression, anxiety, and insomnia. Multivariable logistic regression models were used to examine factors associated with psychological distress.

RESULTS

Among 462 HCWs, 85.3% self-reported having good, very good, or excellent mental health before their COVID-19 deployment, compared to 40.7% during the deployment and 55.6% at the time of the study. The prevalence of moderate-to-severe depression was 26.8%, anxiety (20.8%), insomnia (23.4%), and overall psychological distress (73.2%). Predictors for depression included pre-existing physical (adjusted odds ratio [aOR] = 2.09, 95%CI 1.03-4.22, P = 0.04) and mental health (aOR = 3.59, 95%CI 1.31-9.84, P = 0.01) conditions and being deployed during the 3rd (aOR = 6.28, 95%CI 1.12-35.08, P = 0.04) and 4th (aOR = 5.01, 95%CI 1.08-23.16, P = 0.04) COVID-19 wave. Those with mental health conditions before the deployment (aOR = 3.95, 95%CI 1.42-11.0, P = 0.008) were more likely to report anxiety symptoms. Predictors for insomnia included physical health conditions before the deployment (aOR = 2.73, 95%CI 1.37-5.44, P = 0.004), working at field hospitals (aOR = 2.44, 95%CI 1.43-4.16, P = 0.001), and currently being deployed to respond to COVID-19 (aOR = 0.35, 95%CI 0.19-0.67, P = 0.001).

CONCLUSIONS

Given the substantial impact of COVID-19 deployment on HCWs' long-term mental well-being, comprehensive mental health support strategies are urgently needed. As HCWs may overlook their mental health issues, a screening program with psychological support services should accompany them early in future pandemics. Further nationwide studies with longer follow-ups are necessary to understand the full extent of psychological distress among frontline HCWs in Vietnam.

Survival following psychiatric diagnoses in early adulthood

AIMS

To establish the increased all-cause mortality risk after an inpatient episode of care with a diagnosis of a severe psychiatric disorder in young people.

METHODS

The data included all psychiatric inpatient episodes for psychiatric diagnoses in Western Australia between 2005 and 2022 linked with the state death registry. Participants were only included if they turned 18 years of age between 2005 and 2016, so survival from first adult admission until the study end date could be compared with age-gender matched life tables.

RESULTS

A total of 18,893 individuals had an admission with a primary or secondary diagnosis for a selected psychiatric diagnosis in the study period, across which time 485 died. Admission for substance use disorders presented the greatest risk of mortality, increasing the risk of death in early adulthood by more than three times (observed/expected = 3.07; 95% confidence interval = [2.76, 3.42]; p < 0.001), followed closely by bipolar disorders (observed/expected = 2.95; 95% confidence interval = [2.09, 4.03]; p < 0.001), while having any two or more comorbid disorders was associated with an increased death rate (observed/expected = 3.30; 95% confidence interval = [2.72, 3.97]; p < 0.001). The Kaplan-Meier curves also suggested that the proportionate increased risk of mortality remained relatively constant across the study period for all diagnoses.

CONCLUSION

Inpatient admission for psychiatric disorders increased the risk of all-cause mortality in early adulthood by between two and three times and the increased death rate did not substantively reduce over time. Effective long-term support services are needed to reduce the premature mortality observed among these young adults.

Efficacy and tolerability of antidepressants in individuals suffering from physical conditions and depressive disorders: network meta-analysis

BACKGROUND

Antidepressants are effective for depression, but most evidence excludes individuals with comorbid physical conditions.

AIMS

To assess antidepressants' efficacy and tolerability in individuals with depression and comorbid physical conditions.

METHODS

Systematic review and network meta-analysis of randomised controlled trials (RCTs). Co-primary outcomes were efficacy on depressive symptoms and tolerability (participants dropping out because of adverse events). Bias was assessed with the Cochrane Risk-of-Bias 2 tool and certainty of estimates with the Confidence in Network Meta-Analysis approach. A study protocol was registered in advance (https://osf.io/9cjhe/).

RESULTS

Of the 115 included RCTs, 104 contributed to efficacy (7714 participants) and 82 to tolerability (6083 participants). The mean age was 55.7 years and 51.9% of participants were female. Neurological and cardiocirculatory conditions were the most represented (26.1% and 18.3% of RCTs, respectively). The following antidepressants were more effective than placebo: imipramine, nortriptyline, amitriptyline, desipramine, sertraline, paroxetine, citalopram, fluoxetine, escitalopram, mianserin, mirtazapine and agomelatine, with standardised mean differences ranging from -1.01 (imipramine) to -0.34 (escitalopram). Sertraline and paroxetine were effective for the largest number of ICD-11 disease subgroups (four out of seven). In terms of tolerability, sertraline, imipramine and nortriptyline were less tolerated than placebo, with relative risks ranging from 1.47 (sertraline) to 3.41 (nortriptyline). For both outcomes, certainty of evidence was 'low' or 'very low' for most comparisons.

CONCLUSION

Antidepressants are effective in individuals with comorbid physical conditions, although tolerability is a relevant concern. Selective serotonin reuptake inhibitors (SSRIs) have the best benefit-risk profile, making them suitable as first-line treatments, while tricyclics are highly effective but less tolerated than SSRIs and placebo.

Polygenic risk for psychotic disorders in relation to cardiac autonomic dysfunction in unmedicated patients with schizophrenia

Cardiac autonomic dysfunction (CADF), mainly characterized by increased heart rate, decreased heart rate variability, and loss of vagal modulation, has been extensively described in patients with schizophrenia (SCZ) and their healthy first-degree relatives. As such, it represents an apparent physiological link that contributes to the increased cardiovascular mortality in these patients. Common genetic variation is a putative underlying mechanism, along with lifestyle factors and antipsychotic medications. However, the extent to which CADF is associated with genetic factors for SCZ is unknown. A sample of 83 drug-naive SCZ patients and 96 healthy controls, all of European origin, underwent a 30-minute autonomic assessment under resting conditions. We incorporated parameters from several domains into our model, including time and frequency domains (mean heart rate, low/high frequency ratio) and compression entropy, each of which provides different insights into the dynamics of cardiac autonomic function. These parameters were used as outcome variables in linear regression models with polygenic risk scores (PRS) for SCZ as predictors and age, sex, BMI, smoking status, principal components of ancestry and diagnosis as covariates. Of the three CADF parameters, SCZ PRS was significantly associated with mean heart rate in the combined case/control sample. However, this association was was no longer significant after including diagnosis as a covariate (p = 0.29). In contrast, diagnostic status is statistically significant for all three CADF parameters, accounting for a significantly greater proportion of the variance in mean heart rate compared to SCZ PRS (approximately 16% vs. 4%). Despite evidence for a common genetic basis of CADF and SCZ, we were unable to provide further support for an association between the polygenic burden of SCZ and cardiac autonomic function beyond the diagnostic state. This suggests that there are other important characteristics associated with SCZ that lead to CADF that are not captured by SCZ PRS.

Development of serious mental illness in young adult violent offenders: Early-life risk factors and long-term adverse outcomes

This study explored serious mental illness (SMI) in young adult offenders imprisoned for violent or sexual crimes, estimating the effects of neurodevelopmental disorders and early-life risk factors on the development of SMI, and its prospective long-term adverse outcomes. An all-male cohort of 266 violent offenders, assessed during imprisonment when aged 18-25 years (M = 21.8, SD = 1.9), was followed prospectively (Myears = 6.2, SD = 1.3) in Swedish national registers together with a general population group (n = 10,000). The baseline prevalence of SMI in late adolescence or young adulthood was 10 % (n = 26) in the violent offender cohort. Childhood-onset conduct disorder (OR 2.7 [1.0-7.1]) was associated with SMI in multivariable logistic regression analyses. Prospectively, violent offenders with, versus without, SMI exhibited heightened total crime rate (IRR 1.4 [1.0-2.2]), prison reconvictions (IRR 1.5 [1.0-2.1]), and psychiatric inpatient care (IRR 3.7 [1.6-8.4]), in zero-inflated Poisson regression models. The usage of outpatient psychiatric and somatic care was low in violent offenders with SMI, even relative to the general population group. The results emphasize the need for early identification of at-risk children, such as those with childhood-onset conduct disorder, and challenges with engaging violent offenders with SMI in healthcare.

Characteristics and outcomes of consultation-liaison psychiatry referrals: A demographic and clinical analysis

BackgroundConsultation-liaison psychiatry (CLP) provides mental health expertise in general hospitals, where psychiatric comorbidities affect approximately 30% of patients. Following implementation of a new electronic referral system at Waikato Hospital, this study aimed to analyse referral quality and service utilisation patterns.MethodsA 12-month retrospective audit was conducted from July 2023 to June 2024, analysing all CLP referrals using a new system incorporating the Identify and Rate the Aim of the Contact (IRAC) tool and referral quality metrics. Referral quality was assessed both pre- and post-patient evaluation using a five-point Likert scale.ResultsOf 939 referrals (789 unique patients), 63.7% were rated as relevant to highly relevant. The average referral quality score was 2.698 pre-assessment and 2.682 post-assessment. General Medicine generated the most referrals, while Obstetrics/Gynaecology and Neurology showed lower quality scores. The mean time from admission to referral was 5.4 days. Risk assessment and management were the primary referral purposes, with 11.4% related to suicide attempts. Each referral averaged 3.64 contacts, with 20% of referrals consuming 54% of total contacts.ConclusionsWhile most referrals were appropriate, quality scores below three indicate room for improvement. Findings suggest the need for targeted educational interventions and feedback mechanisms to enhance referral quality and optimise resource allocation in CLP services.

Association of Psychological Problems for Which Help Was Sought With Physical Illness

INTRODUCTION

Persons with mental disorders are at increased risk for physical illness. Individuals who seek help for psychological problems might benefit from timely support and interventional approaches. This study aimed to explore the associations between psychological problems for which help was sought and physical illness.

METHODS

The 7th survey of the Tromsø Study, which included 21,083 participants aged ≥40 years, was used in the study. The main exposure was psychological problems for which help was sought. Main outcomes were lifetime prevalence and time to onset of physical illness. Associations between psychological problems and physical illness were analyzed using logistic regression and survival analysis and adjusted for sex, birth year, smoking, education, and income. Data were collected in 2015-2016 and analyzed in 2023-2024.

RESULTS

Psychological problems were associated with smoking and having lower income but higher educational attainment. Psychological problems were associated with lifetime prevalence of hypertension, coronary artery disease, heart failure, atrial fibrillation, stroke, kidney disease, chronic obstructive pulmonary disease, asthma, arthrosis, migraine, chronic pain, and cancer; ORs ranged from 1.15 (95% CI=1.04, 1.27) to 2.15 (95% CI=1.76, 2.62). Survival analysis demonstrated that individuals with psychological problems are at increased risk for subsequent physical illness; hazard ratios ranged from 1.18 (95% CI=1.06, 1.32) to 2.74 (95% CI=2.06, 3.65).

CONCLUSIONS

This study found that psychological problems with or without a diagnosis of mental disorder might be an important marker of increased risk for physical illness.

Physical activity targeting patients admitted to a psychiatric hospital- a mixed method feasibility study

BACKGROUND

Physical activity (PA) shows positive effects on mental illness. PA and the use of municipal rehabilitation after discharge from psychiatric hospitalisation are inconsistent. The aim of this study was to evaluate the feasibility and acceptability of an intervention consisting of structured PA during hospitalisation and the use of a personalised physical activity plan and referral for municipal rehabilitation after discharge.

METHODS

A mixed-method design was used to explore the feasibility and acceptability of the intervention. Changes in health-related quality of life and physical function were measured using a six-minute walk test, a 30-second sit-to-stand test, handgrip strength, and patient reported outcomes (SF-36 and the Patient Specific Functional Scale [PSFS]). Qualitative results were further explored through semi-structured telephone interviews with twelve participants three weeks after discharge.

RESULTS

Twenty-six participants completed the intervention (median age: 46 years old; female: 57.7%). Improvements were seen in the PSFS. For SF-36, overall improvements were observed in the subscales physical function, well-being, and social function. Participants adhered to 61.5% of the scheduled physical activity sessions, 88% received a personalised physical activity plan, and 57% received municipal rehabilitation. The clinical provider played an important role in terms of motivation, structure, and knowledge about physical activity.

CONCLUSION

Physical activity during hospitalisation, a personalised physical activity plan, and municipal rehabilitation was feasible for persons with mental illness. Positive changes were observed in the following self-reported outcomes: Quality of life, physical function, and social function, and participants reported moderate to good acceptance of the intervention.

Burden of somatic morbidity associated with a surgically verified diagnosis of endometriosis at a young age: a register-based follow-up cohort study in Finland

STUDY QUESTION

How does the burden of somatic disorders compare between women with surgically verified endometriosis diagnosed in adolescence or early adulthood, and matched women without a history of endometriosis?

SUMMARY ANSWER

Women with endometriosis diagnosed at a young age had a higher incidence of several somatic disorders and a higher number of hospital visits compared to women without endometriosis.

WHAT IS KNOWN ALREADY

Endometriosis is associated with an increased risk of several somatic disorders, including autoimmune, inflammatory, and pain-related disorders with higher utility of health care resources. There may be differences in the experience of pain relating to the subtypes of endometriosis. Depression and anxiety are linked to endometriosis and increase overall somatic comorbidity.

STUDY DESIGN, SIZE, DURATION

Longitudinal retrospective register-based cohort study utilizing episode data from specialized care; 2680 women under 25 years with a surgical of diagnosis endometriosis in 1998-2012, and 5338 reference women of the same age and municipality followed up from the index day to the end of 2019, emigration, death or the outcome of interest.

PARTICIPANTS/MATERIALS, SETTING, METHODS

We analysed incidence rates, cumulative incidence rates, and crude hazard rate ratios (HR) with 95% CIs across 15 groups of somatic disorders. Subgroup analyses were conducted among women with endometriosis, by (i) type of endometriosis-ovarian only (n = 601) versus combined types (n = 2079), and (ii) pre-existing diagnosis of depression or anxiety (n = 270) versus those without such diagnoses (n = 2410).

MAIN RESULTS AND THE ROLE OF CHANCE

Women reached a median age of 38 (IQR 34-42) years after a median follow-up of almost 16 (12, 19) years. Compared to the reference cohort, women with endometriosis had a higher incidence of several somatic disorders during the follow-up. By the age of 40 years, 38% of women with endometriosis and 9% of the reference cohort had diagnoses of infertility (HR 5.88 [95% CI 5.24-6.61]). The corresponding figures for genital tract infections were 24% and 6% (4.64 [4.03-5.36]), symptoms and signs of pain 62% and 28% (3.27 [3.04-3.51]), migraine 15% and 6.4% (2.49 [2.13-2.92]), and chronic pain conditions 33% and 19% (2.01 [1.83-2.22]), respectively. In women with endometriosis, a higher incidence was seen also for dyspareunia, uterine myomas, celiac disease, asthma, anaemia, high blood pressure, hypercholesterolemia or cardiovascular diseases; autoimmune diseases, and disorders of the thyroid gland. For women with ovarian endometriosis only, we observed a lower HR of high blood pressure, hypercholesterolemia or cardiovascular diseases, asthma, migraine, and pain-related disorders compared to those with other or combined types of endometriosis. Within the endometriosis cohort, women with pre-existing diagnoses of depression or anxiety had higher HRs of several somatic disorders compared to those without such diagnoses. The number of hospital visits after the index day was higher in women with endometriosis when compared to the reference cohort (40 vs 18).

LIMITATIONS, REASONS FOR CAUTION

Confounding bias may arise from the reliance on registry-based hospital diagnoses, as women undergoing surgery are already engaged with health care, and, subsequently, more likely to receive new diagnoses. Furthermore, the homogenous population of Finland limits the generalizability of these findings.

WIDER IMPLICATIONS OF THE FINDINGS

Surgical diagnosis of endometriosis at a young age is associated with a burden of somatic disorders, emphasizing importance of comprehensive approach to management of endometriosis and endometriosis-related conditions. Further studies are needed to clarify the varying reasons behind these associations. However, the results of this study suggest that pain and mental health may play a key role in the development of subsequent somatic disorders. Therefore, careful management of primary dysmenorrhea and mental health in young women is essential.

STUDY FUNDING/COMPETING INTEREST(S)

Funding was received from the Hospital District of Helsinki and Uusimaa, and from Finska Läkaresällskapet. E.R. acknowledges financial support from The Finnish Society of Research for Obstetrics and Gynaecology and The Finnish Medical Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. O.H. serves occasionally on advisory boards for Bayer AG, Gedeon Richter, and Roche, has received travel support from Gedeon Richter, has received consulting fees from Orion Pharma and Nordic Pharma, and has helped to organize and lecture at educational events for Bayer AG and Gedeon Richter. The other authors report no conflict of interest concerning the present work.

TRIAL REGISTRATION NUMBER

N/A.

All-Cause and Cause-Specific Mortality Among Individuals With Major Depression: A Nationwide Danish Matched-Cohort Study

BACKGROUND

Mental disorders are associated with excess risk of death from unnatural and natural causes, but few studies have differentiated causes of death among patients with major depression. We examined cumulative and relative risks of all-cause and cause-specific mortality in individuals with major depression up to 50 years after diagnosis according to sex, age, and time since depression diagnosis.

METHODS

In this nationwide matched-cohort study, we included individuals diagnosed with major depression in Danish National Patient registries from 1970 through 2021 and a 1:5 matched sample of the general population (reference population). Individuals were followed for their underlying cause of death in the Danish Cause of Death Registry up to 2022, and we estimated cumulative risk and hazard ratios for all-cause and 10 specific causes of death.

RESULTS

The study included 330,577 adults diagnosed with major depression in Denmark (median age at first diagnosis, 45 years; 63.4%women) and 1,652,885 members of the matched reference population (median age, 45 years; 63.4%women). During the study period, 116,628 (35.2%) individuals with depression and 389,135 (23.5%) matches from the reference population died. Individuals with depression had considerably higher mortality risk at all time periods and ages compared to the reference population, and the increased risk was most pronounced in the first year after diagnosis. The lifetime risk of suicide was 11.2% in individuals with depression compared with 1% in the reference population, and before age 65 years, suicide was the leading cause of death in patients with depression. When compared with the reference population, individuals with depression also exhibited a higher risk of various specific natural causes of death before the age of 85 years.

CONCLUSIONS

The risk of death from suicide and medical disorders is elevated in individuals with depression, especially the first year after diagnosis. Because a large number of deaths can be attributed to depression shortly after onset, clinicians should be aware of this risk.

Comprehensive care processes for substance use disorders in adult mental health services: A systematic review

BACKGROUND AND OBJECTIVES

Assessment and care of substance use disorder within mental health services are essential due to the high prevalence and harms associated with comorbidity. Substance use disorder assessment and care are routinely recommended in clinical guidelines; however, processes are not agreed. This systematic review of routine clinical practice in relation to substance use disorders in adult mental health service aims to identify routine assessment and diagnosis processes, the proportion of patients and service episodes in which they occur and their outputs.

METHODS

We searched MEDLINE, PsycINFO, Embase and relevant Cochrane databases for articles until July 2024 reporting on substance use assessment, diagnosis or treatment in adults receiving routine mental health service and locating additional articles by snowballing. Variables including setting, study method, period, cohort, substances, clinical assessment type, diagnosis and care pathways were compared.

RESULTS

In 137 heterogeneous studies reporting routine practice within a wide variety of adult mental health service from 29 nations, 44 (32%) expected or reported on substance use assessment in domains of pattern or impact. However, 23 studies (17%) reported structured approaches to substance use disorder assessment, while 67 (49%) reported a diagnostic structure, including classification system. Diagnostic prevalence varied markedly. Treatment was reported in 16 studies (12%) and no substance use disorder outcomes were reported.

CONCLUSION

This systematic review shows marked variation in routine practice in mental health service across a range of substance use disorder assessment and diagnosis processes. To better identify substance use disorder, enhance its care and reduce associated morbidity, adult mental health service may benefit from standardising expectations and systematically monitoring the performance of substance use assessment and diagnosis.

A systematic analysis of the contribution of genetics to multimorbidity and comparisons with primary care data

BACKGROUND

Multimorbidity, the presence of two or more conditions in one person, is common but studies are often limited to observational data and single datasets. We address this gap by integrating large-scale primary-care and genetic data from multiple studies to interrogate multimorbidity patterns and producing digital resources to support future research.

METHODS

We defined chronic, common, and heritable conditions in individuals aged ≥65 years, using two large primary-care databases [CPRD (UK) N = 2,425,014 and SIDIAP (Spain) N = 1,053,640], and estimated heritability using the same definitions in UK Biobank (N = 451,197). We used logistic regression to estimate the co-occurrence of pairs of conditions in the primary care data. Linkage disequilibrium score regression was used to estimate genetic similarity between pairs of conditions. Meta-analyses were conducted across databases, and up to three sources of genetic data, for each pair of conditions. We classified pairs of conditions as across or within-domain based on the international classification of disease.

FINDINGS

We identified 72 chronic conditions, with 43.6% of 2546 pairs showing higher co-occurrence than chance in primary care and evidence of shared genetics. Many across-domain pairs exhibited substantial shared genetics (e.g., iron deficiency anaemia and peripheral arterial disease: genetic correlation Rg = 0.45 [95% Confidence Intervals 0.27:0.64]). 33 pairs displayed negative genetic correlations, such as skin cancer and rheumatoid arthritis (Rg = -0.14 [-0.21:-0.06]), due to potential adverse drug effects. Discordance between genetic and primary care data was also observed, e.g., abdominal aortic aneurysm and bladder cancer co-occurred in primary care but were not genetically correlated (Odds-Ratio = 2.23 [2.09:2.37], Rg = 0.04 [-0.20:0.28]) and schizophrenia and fibromyalgia were less likely to co-occur together in primary care but were positively genetically correlated (OR = 0.84 [0.75:0.94], Rg = 0.20 [0.11:0.29]).

INTERPRETATION

Most pairs of chronic conditions show evidence of shared genetics, and co-occurrence in primary care, suggesting shared mechanisms. The identified patterns of shared genetics, negative correlations and discordance between genetic and observational data provide a foundation for future multimorbidity research.

FUNDING

UK Medical Research Council [MR/W014548/1].

[Physical health in people with severe mental illness]

The interrelationships between physical illnesses and mental disorders are diverse and complex. People with severe mental illness, particularly those with psychotic and affective disorders as well as pronounced personality disorders (serious/severe mental illness, SMI), have an increased risk of mortality compared to the general population as well as a higher prevalence of numerous somatic comorbidities. In addition to disease-related factors, explanation approaches for this also relate to the healthcare system. In routine psychiatric and psychotherapeutic care it is very important to keep an eye on the somatic health of people with SMI as physical impairments can easily be overshadowed by the mental illness. This article summarizes selected aspects of the broadly covered topics taking epidemiological data into account and with a focus on collaborative medical care of frequent diseases.

Validation of a composite outcome measure for inpatient psychiatry using scales from the interRAI-MH

Background

Inpatient psychiatry is a critical service in a community-based care system for persons with serious mental illness (SMI). Currently, there are few generally accepted or widely used outcomes to assess the effectiveness of inpatient treatment.

Method

Following a Donabedian Model of Health Care Quality, we utilized eight scales from the RAI Mental Health assessment to derive a clinician-scored outcome measure consisting of 4 domains (Psychosis, Depression, Impairment, and Aggression). We combined subscales measuring these domains into a Composite Measure. We used this measure to assess the entire population (N=719) of our large specialized mental health hospital at the beginning (T1) and end (T2) of three months in the hospital (or admission to discharge in shorter stays). We evaluated the content validity of the measure by comparing items and scales with a list of putative contributors to hospital admission (symptoms and complications). To evaluate concurrent validity, we compared mean scores among hospital units with varying lengths of stay and clinical complexity (acute versus chronic versus complex chronic). We used ROC analysis to evaluate the CIIMHS's ability to predict discharge from the hospital. To evaluate construct validity, we examined the measure's responsiveness to changes among patients after treatment in the hospital.

Results

We found strong evidence for all four kinds of validity.

Conclusions

The composite measure represents a valid measure of inpatient mental health status and will serve as a valuable measure of the quality of care for inpatient psychiatry.

Depressive symptoms delayed but subsequently led to the diagnosis of transthyretin amyloidosis: a case report

Transthyretin amyloidosis is a rare disorder caused by the accumulation of misfolded transthyretin amyloid in organs. The symptoms can include neuropathy, cardiomyopathy, nephropathy, depression and cognitive decline. Because of the non-specificity of symptoms, it usually takes considerable time to diagnose, which delays specific therapy and leads to a worse prognosis. Our case highlights the psychological symptoms of this disorder that initially delayed diagnosis, and later helped to reach the correct diagnosis. We report the case of a man who presented with weakness of limbs, dizziness, vomiting, social withdrawal, loss of interest, reduced energy and difficulty concentrating. Different specialist evaluations failed to identify a cause, and the symptoms were attributed to depressive disorder. After psychiatric hospitalization to rule out depression as a possible cause, the patient was transferred to an internal medicine clinic where additional diagnostics led to a transthyretin amyloidosis diagnosis. Early-stage transthyretin amyloidosis is difficult to diagnose owing to its non-specific symptoms, but timely treatment is necessary to improve the disease course and outcome. With reference to this case, we emphasize that psychological symptoms in somatic illnesses can both delay and facilitate diagnosis of underlying disease.

Exploring the perceptions of the effect of the COVID-19 pandemic on the mental well-being and medical education of medical students in Northern Ireland, in addition to the perceived barriers to seeking support; a qualitative study

INTRODUCTION

The COVID-19 pandemic had a negative effect on population mental health. Medical students may have been particularly affected, whom prevalence of mental health conditions was already high before the pandemic hit, due to the difficult and stressful academic programme. In Northern Ireland specifically, mental well-being levels are the lowest across the UK; however limited research exists examining the medical student cohort. This study explores Northern Irish medical students' perceptions on how the pandemic affected their mental health, their progress within medical education and perceived barriers to accessing support services in Northern Ireland.

METHODS

A qualitative study of phenomenological design involving 15 in-depth semi-structured interviews. The interviews were conducted amongst individuals who were 1st-4th year medical students when the pandemic was officially declared in Northern Ireland in March 2020. The interviews were transcribed, and thematic analysis was carried out using NVivo V12 qualitative data analysis software.

RESULTS

Results demonstrated the COVID-19 pandemic had a considerable negative impact on participants' mental health; a variety of interlinked social, individual and/or psychological and organisational factors led to increased levels of stress, anxiety and depression. This had a secondary negative impact on participants' medical education progress through reducing motivation, causing burnout and impostor syndrome. Unexpectedly; there were some perceived positive outcomes, including improved appreciation for work-life balance and resilience. Participants reported various barriers to seeking help amongst this difficult time period; also categorizable into social, individual and/or psychological and organisational factors, for example; stigmatisation, fear and perfectionistic tendencies.

DISCUSSION AND CONCLUSION

There is a pressing demand for heightened support availability, personally tailored mental health assistance and an effort to reduce mental health stigma in Northern Ireland. This study highlights the complex multifactorial nature of mental health. Medical schools must provide additional services to protect well-being during particularly challenging periods and dismantle the barriers preventing individuals from accessing vital support.

The Challenging Problems of Cancer and Serious Mental Illness

PURPOSE OF REVIEW: Patients with Serious Mental Illness (SMI) are reported to be at higher risk for somatic disorders (e.g. cardiovascular and metabolic diseases) and higher mortality, compared to the general population, because of the consequences of SMI including psychotropic medication side effects, sedentary and unhealthy lifestyle, difficult access to physical health care. The aim of this review was to examine the current evidence regarding oncology, focusing on the problem of cancer among patients with SMI. RECENT FINDINGS: Compared to the general population, individuals with SMI showed a lower rate of screening for cancer, suboptimal standard cancer treatment, delayed treatment, and higher mortality from cancer. Several factors, including those related to the patient, the health-care system, and the social context, are involved in these negative outcomes. It is therefore necessary to raise awareness and alert clinicians in oncology settings to the challenging problem of cancer among patients with SMI, a marginalized and vulnerable segment of the population that can be at risk for not receiving proper cancer prevention and care. Evidence supports the mandatory need for an interdisciplinary approach involving psychiatry and mental health services.

Machine learning prediction model of the treatment response in schizophrenia reveals the importance of metabolic and subjective characteristics

Predicting early treatment response in schizophrenia is pivotal for selecting the best therapeutic approach. Utilizing machine learning (ML) technique, we aimed to formulate a model predicting antipsychotic treatment outcomes. Data were obtained from 299 patients with schizophrenia from three multicenter, open-label, non-comparative clinical trials. For prediction of treatment response at weeks 4, 8, and 24, psychopathology (both objective and subjective symptoms), sociodemographic and clinical factors, functional outcomes, attitude toward medication, and metabolic characteristics were evaluated. Various ML techniques were applied. The highest area under the curve (AUC) at weeks 4, 8 and 24 was 0.711, 0.664 and 0.678 with extreme gradient boosting, respectively. Notably, our findings indicate that BMI and attitude toward medication play a pivotal role in predicting treatment responses at all-time points. Other salient features for weeks 4 and 8 included psychosocial functioning, negative symptoms, subjective symptoms like psychoticism and hostility, and the level of prolactin. For week 24, positive symptoms, depression, education level and duration of illness were also important. This study introduced a precise clinical model for predicting schizophrenia treatment outcomes using multiple readily accessible predictors. The findings underscore the significance of metabolic parameters and subjective traits.

Cancer Incidence Among People With a Prior Hospital Record of Depression in Scotland, 1991-2019: A Cohort Study

OBJECTIVE

Current evidence on the association between depression and cancer risk is conflicting, with little understanding of how associations vary by time period or sociodemographic factors. We aimed to compare cancer incidence in people with versus without a previous hospital admission record for depression, by sociodemographic factors and over time.

METHODS

We conducted a cohort study using national linked data in Scotland from 1991 to 2019. We calculated sex-stratified age standardised incidence rates for all cancers, lung, female breast, colorectal and prostate cancer, and used quasi-Poisson regression models to obtain sex-specific estimates of cancer incidence and relative risks of cancer in those with versus without a prior hospital admission record of depression.

RESULTS

There were 128,654 people with a hospital record of depression with 12,802 incident cancers and 847,656 cancers among those without depression. Age-standardised cancer incidence rates were higher in both males and females with versus without depression. Depression was associated with a 20%-30% increased risk of all cancers combined, a difference that did not vary by sex, age or deprivation and persisted over three decades. Depression was associated with higher risks of lung (RR 1.79, 95% CI 1.70-1.88) and colorectal cancer (RR 1.12, 95% CI 1.05-1.19), but not breast or prostate cancer.

CONCLUSIONS

We identified an entrenched disparity in cancer incidence by depression status. Further research should identify underlying mechanisms and inform cancer prevention strategies in this vulnerable group. Meanwhile, health care professionals have a key role to play in optimising physical health care for people with depression.

The Role of Essential Oils on Sleep Quality and Other Sleep-related Issues: Evidence from Clinical Trials

Essential oils (EOs) are a volatile mixture of bioactive compounds extracted from aromatic plants. The composition of EOs varies, which majorly depends on the extraction methods and plant parts. Aromatherapy using EOs has been reported for its several beneficial effects in humans. Aromatherapy is considered a complementary and/ or adjuvant therapeutic approach for treating several illnesses, especially to improve mental health and well-being. The incidence of sleep disorders, specifically insomnia, is nowadays increased, possibly due to urbanization and lifestyle. The studies showed that EOs-based treatments using lavender EO, bergamot EO, cinnamon EO, and rosemary EO (alone or in combinations) could improve sleep quality, duration, and deprivation in healthy subjects and patients, those who suffer from sleep-related issues. The current manuscript details the outcomes of EO-based treatments on the sleep quality of humans and the possible mechanisms associated with the health-promoting properties of EOs. Also, the toxicity and adverse effects of EOs have been discussed. The study indicated that EOs are potent adjuvant therapeutic candidates to manage mood-associated complications in humans. Moreover, the aromatherapeutic field requires detailed studies on toxicity and dose determination, which could provide safe and effective therapeutic results.

Social support status and associated factors among methadone maintenance patients: a multicentre, cross-sectional study in Vietnam during the COVID-19 pandemic

OBJECTIVES

To investigate the social support status and associated factors among Vietnamese methadone maintenance patients during the COVID-19 pandemic.

DESIGN

Cross-sectional study.

SETTING

Three methadone clinics.

PARTICIPANTS

540 patients.

PRIMARY AND SECONDARY OUTCOME MEASURES

The Medical Outcomes Study-Social Support Survey questionnaire was employed to measure patients' social support. Factors associated with the social support status of patients were determined through multivariate linear regression models. Variables in these models were selected using the Bayesian model averaging method.

RESULTS

The average social support score of patients was 63.50±26.54 (ranger: 0-100). The average social support scores of patients living in mountainous areas (Dien Bien: 63.74±23.67, Son La: 46.15±20.31) were significantly lower than that of patients residing in metropolitan areas (Hanoi: 80.61±23.47) (p<0.001). The likelihood of gaining high social support was 1.31 times more likely among patients living with at least one person (64.21±26.25) in comparison with those living alone (48.84±28.69) (p=0.013). The higher the number of family members living with the patient and close friends/relatives, the higher the social support score. Factors significantly associated with patients' social support included the place of residence, the patient's occupation, the family's monthly income, the number of people living with the patients, and the number of close friends/relatives (p<0.001).

CONCLUSION

Methadone maintenance patients in Vietnam received a moderate level of social support during the COVID-19 pandemic. In the context of pandemics, not only the authorities but also family members and the community should give succour and strength to the patients, thereby contributing to the success of methadone treatment and the recovery of patients.

Social disconnectedness, subsequent medical conditions, and, the role of pre-existing mental disorders: a population-based cohort study

AIMS

Individuals with diminished social connections are at higher risk of mental disorders, dementia, circulatory conditions and musculoskeletal conditions. However, evidence is limited by a disease-specific focus and no systematic examination of sex differences or the role of pre-existing mental disorders.

METHODS

We conducted a cohort study using data on social disconnectedness (loneliness, social isolation, low social support and a composite measure) from the 2013 and 2017 Danish National Health Survey linked with register data on 11 broad categories of medical conditions through 2021. Poisson regression was applied to estimate incidence rate ratios (IRRs), incidence rate differences (IRDs), and explore sex differences and interaction with pre-existing mental disorders.

RESULTS

Among 162,497 survey participants, 7.6%, 3.5% and 14.8% were classified as lonely, socially isolated and with low social support, respectively. Individuals who were lonely and with low social support had a higher incidence rate in all 11 categories of medical conditions (interquartile range [IQR] of IRRs, respectively 1.26-1.49 and 1.10-1.14), whereas this was the case in nine categories among individuals who were socially isolated (IQR of IRRs, 1.01-1.31). Applying the composite measure, the highest IRR was 2.63 for a mental disorder (95% confidence interval [CI], 2.38-2.91), corresponding to an IRD of 54 (95% CI, 47-61) cases per 10,000 person-years. We found sex and age differences in some relative and absolute estimates, but no substantial deviations from additive interaction with pre-existing mental disorders.

CONCLUSIONS

This study advances our knowledge of the risk of medical conditions faced by individuals who are socially disconnected. In addition to the existing evidence, we found higher incidence rates for a broad range of medical condition categories. Contrary to previous evidence, our findings suggest that loneliness is a stronger determinant for subsequent medical conditions than social isolation and low social support.A preregistered analysis plan and statistical code are available at Open Science Framework (https://osf.io/pycrq).

The association between the Glutathione S-transferase polymorphisms and addiction to opioids and methamphetamine in the Iranian population

Introduction

Glutathione S-transferase (GST) has the ability to detoxify the cellular environment of xenobiotic compounds and by-products of oxidative stress. The expression levels of GST genes and their polymorphisms are associated with various human diseases. Methamphetamine and opiate addiction also account for a significant proportion of SUDs in Iran. Considering the oxidative stress induced by morphine and methamphetamine and the potential of GST as a therapeutic option for SUD, we aimed to investigate the association of common genetic variations of two genes from GST family, GSTT1 and GSTM1, with addiction to morphine and METH in Iranian population.

Material and methods

A total of 160 blood and urine samples were randomly collected from 50 opiums and 30 methamphetamine users and 80 healthy controls. All samples were processed by thin layer chromatography (TLC), high performance liquid chromatography, and Gas Chromatography-Mass Spectrometry (GC-MS) techniques to detect opium alkaloids (morphine, codeine, papaverine, noscapine, etc.), methamphetamine stimulants, and other legal and illegal drugs. The genotypes of GSTM1 and GSTT1 polymorphisms were determined by PCR. Statistical analysis was performed using the SPSS. This project was approved by the Research Ethics Committee of Legal Medicine Organization, Tehran, Iran.

Results

A statistically significant association was observed between the GSTM1 polymorphisms and morphine addiction under a recessive genetic model. The reference group consisted of pooled n/p and p/p genotypes, with an odds ratio (OR) of 2.15, a 95% confidence interval (CI) of 1.05 to 4.39, and a P-value of 0.03. In contrast, there was no statistically significant association between genetic variations in the GSTT1 gene and morphine or methamphetamine addiction. The results revealed no significant association between GSTT1 and GSTM1 allele frequencies and morphine and methamphetamine addiction when divided into risk allele carriers and noncarriers.

Conclusion

These findings suggest that the GSTM1 gene may be involved in the development of morphine addiction. However, further studies with larger sample sizes are required to verify these results and investigate the underlying molecular mechanisms.

Palliative Electroconvulsive Therapy: A Descriptive Cohort Study

BACKGROUND

Palliative care (PC) is the standard of care for patients with serious medical illnesses, or those conditions associated with high risk of mortality and negative impact on quality of life (QOL). Electroconvulsive therapy (ECT) is the gold standard treatment for certain psychiatric conditions, which may co-occur with serious medical illnesses. However, the use of "palliative ECT" (PECT) in this context is understudied.

METHODS

We conducted a descriptive retrospective cohort study reviewing the indications, outcomes, and regimens of PECT. We included patients who had an ECT consultation, in addition to either a PC consultation or a do-not-attempt-resuscitation code status between 2018 and 2023.

RESULTS

Thirty-one patients met our inclusion criteria, and 21 received ECT. The cohort was predominantly female (70%) with a mean age of 67.6 (range 25-90). Catatonia (64.5%) and treatment-resistant depressive disorder (35.5%) were the most common indications for ECT. At the time of ECT consultation, 16 patients (51.6%) had a serious medical illness, including cancer (19.4%) or end-organ disease (22.6%). Fourteen patients had major neurocognitive disorder (MNCD) (45.2%). Surrogate decision-makers consented for ECT in 64.5% of cases. All 21 patients who received ECT experienced psychiatric symptom improvement. ECT was associated with reduced mortality risk in 5 (23.8%) cases. Five patients initially misdiagnosed with MNCD experienced recovery in cognitive function after ECT, and the diagnosis was revised to depression-related cognitive dysfunction. Eight patients retained a comorbid MNCD diagnosis but experienced a mean Montreal Cognitive Assessment (MoCA) improvement of 5 points (range 0 to 17) with ECT.

DISCUSSION

This work highlights the use of ECT among patients with serious medical illnesses, identifying cases when ECT was beneficial or deemed unsuitable. Patients with serious medical illnesses who also had an indication for ECT experienced improved QOL with ECT. Misdiagnoses, such as confusing depression-related cognitive dysfunction and catatonia for MNCD, were effectively addressed through ECT. The findings underscore the importance of cross-specialty collaboration between C-L psychiatry and PC.

CONCLUSIONS

Patients who receive PECT experience reduced suffering and improved QOL. PECT may be helpful in scenarios of life-threatening psychiatric illnesses, terminal medical illnesses with comorbid treatment-refractory psychiatric illnesses, and diagnostic uncertainty with MNCD.

Risk of Suicide Across Medical Conditions and the Role of Prior Mental Disorder

Importance

According to the World Health Organization, more than 700 000 individuals worldwide die by suicide each year. Medical conditions likely increase the risk of suicide.

Objective

To (1) provide age- and sex-specific pairwise estimates of the risk of suicide across a comprehensive range of medical conditions, (2) investigate whether there is a dose-response-like relationship at play (ie, the higher the disability burden due to medical morbidity, the higher the risk of suicide), and (3) determine if the risk of suicide with medical conditions is particularly pronounced among those who had mental disorder preceding the medical conditions.

Design, Setting, and Participants

This cohort study was an observational study of population-based data for all individuals living in Denmark at some point between 2000 and 2020. The data analysis took place from September 2023 to May 2024.

Exposures

Thirty-one specific medical conditions as well as prior mental disorder.

Main Outcomes and Measures

The main outcome was suicide. Associations between the 31 specific medical conditions, nested within 9 categories, and suicide were examined via Poisson regression, yielding incidence rate ratios (IRRs). Subsequent analyses included an interaction term to assess whether a previous hospital-treated mental disorder modified the associations. Finally, the association between the disability burden of medical conditions and suicide was examined for those with and without prior mental disorder, respectively.

Results

A total of 6 635 857 individuals (3 337 613 females and 3 298 244 males) were included in the analyses of the associations between medical conditions and suicide. Except for endocrine disorders, all categories of medical conditions were associated with a statistically significant increased risk of suicide (which was most pronounced for gastrointestinal conditions [IRR, 1.7; 95% CI,1.5-1.8], cancer [IRR, 1.5; 95% CI, 1.4-1.6], and hematological conditions [IRR, 1.5; 95% CI, 1.3-1.6]). Interaction between mental disorder and individual medical conditions did not seem to play a major role for suicide risk. For those without but not for those with mental disorder, there was a dose-response-like relationship between the disability burden of medical conditions and suicide.

Conclusions and Relevance

Medical conditions are generally associated with increased risk of suicide in a dose-response-like manner. Individuals with hospital-treated mental disorder appear to be at such elevated risk of suicide that additional disability associated with medical conditions has little impact in this regard.

Variation in patient-sharing network characteristics of health care professionals treating different mental and substance use disorder patient sub-groups in primary care

BACKGROUND

Providing efficient and targeted services for patients with mental health problems requires efficient collaboration and coordination within healthcare providers, but measuring collaboration using traditional methods is challenging.

AIMS

To explore the patient-sharing networks of professionals taking care of different groups of patients with mental or substance use disorders.

METHOD

We used data that covered adult patients' visits to the primary care service providers of seven municipalities in Finland during year 2021. Data included 8,217 patients (147,430 visits) with mental or substance use disorders who were treated by 1,566 health care professionals. We calculated descriptive network metrics to examine the connectivity of professionals in three different patient groups (patients with substance use disorders, psychotic disorders, and depressive disorders) and compared these characteristics to a network based on all patients. We also analyzed whether patient sharing was associated with the health care professionals' attributes (occupational group, municipality) using Exponential Random Graph Models (ERGM).

RESULTS

Diagnosis-specific networks were denser and more connected compared to the all-patients network. Nurses were the most central occupation in all the diagnosis-specific networks and especially in the substance use disorder patients network. When examining all patients, two professionals were more likely to share patients when they belonged to the same occupational group. However, in the network with depressive disorder patients we found the opposite: professionals were more likely to share patients if they were of different occupational groups.

CONCLUSIONS

Patient-sharing networks within patients with a specific mental or substance use disorders are denser and more connected than networks based on all patients with mental or substance use disorders. In the substance use disorder patients network particularly, nurses were the most central occupation. Multi-professional connections were more likely in depressive disorder networks than in the all-patients network.

Flat Recovery Process in Mental Health: A Qualitative Analysis of Autoethnography

This study aims to provide a new perspective on the concept of recovery by qualitatively analyzing the experiences of mentally ill people from the Japanese perspective through autoethnography. Traditionally, the recovery process has been viewed as a series of "ups and downs" that may not apply to individuals with chronic mental health issues. A qualitative autoethnography analysis used personal diary entries from 20XX through 20XX + 4. Using text mining with KH Coder and cluster analysis, I first classified and visualized the data from the diary content and then, after confirming the content chronologically, examined the validity of the concept of the recovery process based on the theoretical framework of the Japanese cultural perspective. External validity was ensured through triangulation with the author's work. Coding revealed four to six groups of mental health recovery keywords for each year. Confirmation of the results according to the life history also revealed problems with the conventional recovery process concept and advantages of the flat recovery process based on the Japanese cultural perspective.

Cancer characteristics in patients with schizophrenia: a 25-year retrospective analysis

Schizophrenia is associated with higher cancer-related mortality, perhaps due to delayed diagnosis and limited access to treatment. The study aimed to compare patients diagnosed with cancer with and without schizophrenia to determine whether these groups differ in terms of oncological variables and survival outcomes. This was a retrospective, observational cohort study that included 30.990 patients diagnosed with cancer between 1997 and 2021. We performed univariate and bivariate analyses for the sociodemographic and clinical variables, and constructed Kaplan-Meier survival curves and used the log-rank test to perform the comparisons. All variables were compared for each cancer type. One hundred and sixty-two (0.52 %) patients had a confirmed diagnosis of schizophrenia (ICD-9 criteria). The mean age at diagnosis was significantly lower in the schizophrenia group. A significantly higher proportion of the schizophrenia group was diagnosed with cancer through the emergency department and a lower percentage through scheduled appointments. A smaller percentage of patients in the schizophrenia group received radical treatment for cancer. The mortality rate was higher in the schizophrenia group and median survival was lower. These findings suggest that cancer patients with schizophrenia have worse outcomes than patients without schizophrenia in terms of oncological variables and survival.

Bayesian Mendelian Randomization Analysis for Latent Exposures Leveraging GWAS Summary Statistics for Traits Co-Regulated by the Exposures

Mendelian Randomization analysis is a popular method to infer causal relationships between exposures and outcomes, utilizing data from genome-wide association studies (GWAS) to overcome limitations of observational research by treating genetic variants as instrumental variables. This study focuses on a specific problem setting, where causal signals may exist among a series of correlated traits, but the exposures of interest, such as biological functions or lower-dimensional latent factors that regulate the observable traits, are not directly observable. We propose a Bayesian Mendelian randomization analysis framework that allows joint analysis of the causal effects of multiple latent exposures on a disease outcome leveraging GWAS summary-level association statistics for traits co-regulated by the exposures. We conduct simulation studies to show the validity and superiority of the method in terms of type I error control and power due to a more flexible modeling framework and a more stable algorithm compared to an alternative approach and traditional single- and multi-exposure analysis approaches not specifically designed for the problem. We have also applied the method to reveal evidence of the causal effects of psychiatric factors, including compulsive, psychotic, neurodevelopmental, and internalizing factors, on neurodegenerative, autoimmune, digestive, and cardiometabolic diseases.

Co-occurrence between mental disorders and physical diseases: a study of nationwide primary-care medical records

BACKGROUND

Mental disorders and physical-health conditions frequently co-occur, impacting treatment outcomes. While most prior research has focused on single pairs of mental disorders and physical-health conditions, this study explores broader associations between multiple mental disorders and physical-health conditions.

METHODS

Using the Norwegian primary-care register, this population-based cohort study encompassed all 2 203 553 patients born in Norway from January 1945 through December 1984, who were full-time residents from January 2006 until December 2019 (14 years; 363 million person-months). Associations between seven mental disorders (sleep disturbance, anxiety, depression, acute stress reaction, substance-use disorders, phobia/compulsive disorder, psychosis) and 16 physical-health conditions were examined, diagnosed according to the International Classification of Primary Care.

RESULTS

Of 112 mental-disorder/physical-health condition pairs, 96% of associations yielded positive and significant ORs, averaging 1.41 and ranging from 1.05 (99.99% CI 1.00-1.09) to 2.38 (99.99% CI 2.30-2.46). Across 14 years, every mental disorder was associated with multiple different physical-health conditions. Across 363 million person-months, having any mental disorder was associated with increased subsequent risk of all physical-health conditions (HRs:1.40 [99.99% CI 1.35-1.45] to 2.85 [99.99% CI 2.81-2.89]) and vice versa (HRs:1.56 [99.99% CI 1.54-1.59] to 3.56 [99.99% CI 3.54-3.58]). Associations were observed in both sexes, across age groups, and among patients with and without university education.

CONCLUSIONS

The breadth of associations between virtually every mental disorder and physical-health condition among patients treated in primary care underscores a need for integrated mental and physical healthcare policy and practice. This remarkable breadth also calls for research into etiological factors and underlying mechanisms that can explain it.

Policy implications of the 2020-22 Australian study of mental health and wellbeing

The objective of this paper is to summarise the policy implications of key findings from the 2020-22 Australian National Study of Mental Health and Wellbeing (NSMHWB). We provide an analysis of policy implications of four papers in this issue of the journal from the 2020-22 NSMHWB (N = 15,893) and the 2007 NSMHWB (N = 8841). The 2020-2022 NSMHWB reported a lifetime prevalence rate of common mental disorders of 40.2% (95% confidence interval [CI] = 39.2-41.3) and 12-month prevalence rate of 20.2% (95% CI 19.5-21.0). Overall, adult Australians were significantly more likely to experience a 12-month mental disorder in 2020-22 compared with 2007, with the change most striking in among those aged 16-24 years (odds ratio [OR] 1.2, 95% CI 1.1-1.3). Individuals aged 16-24 years in 2020-22 were significantly more likely to experience a 12-month anxiety disorder (OR 2.9, 95% CI = 2.3-3.7, depressive disorder (OR 2.8 95% CI = 2.1-3.9) or comorbidity (relative risk [RR] = 1.4, 95% CI = 1.2-1.7) compared with those aged 16-24 years in 2007. In 2020-22, the proportion of Australians who had experienced suicidal ideation, suicide plans and suicide attempts in the past 12 months was 3.3%, 1.1% and 0.3%. Under half (46.5% 95% CI 44.1-48.8) of adults with a 12-month mental disorder sought treatment. Mental disorders remain an endemic feature of Australia's overall health landscape and appear to be increasing, especially in younger cohorts. While service use rates have improved over time, there is still some way to go. Epidemiological surveys such as the 2020-22 NSMHWB are important for understanding changing prevalence and the population not accessing services. Innovative prevention and treatment strategies will be needed to address the increasing rates of disorders in younger Australian adults. Equally innovative and bold policy responses will be essential.

State of the Science in Behavior Therapy: Taking Stock and Looking Forward

The scope and burdens of mental health challenges in today's world are staggering. Among the available psychological treatment approaches, cognitive and behavioral therapies, and their combinations, have garnered the strongest evidence base. That said, progress has not always been linear and most of the work is still ahead of us. Against this backdrop, Behavior Therapy has launched its State of the Science series-an exciting new journal feature offering a curated set of authoritative reviews of research in major areas of relevance to applied cognitive-behavioral science, written by distinguished scientists in each area and peer-reviewed. The vision for the Behavior Therapy State of the Science series is to launch with an initial set of articles that make up this special journal issue, with continued publication of additional State of the Science articles in future journal issues. The current article launches the State of the Science series, providing a brief summary of progress in cognitive and behavioral practice and related areas, as well as various missteps and harmful legacies that remind us that the state of the science for research focused on mental health and the alleviation of human suffering is always in flux and evolving. The 16 inaugural reviews in this special issue are then introduced one by one. Collectively, these State of the Science reviews take stock of what has been learned across key areas in the field, highlight critical knowledge gaps in need of research, and provide expert guidance for improving the effectiveness and reach of care, particularly for marginalized and underserved populations.

Hospital Admissions for Eating Disorders in Children and Adolescents in Spain: A Population-Based Study

OBJECTIVE

Limited evidence exists regarding the impact of the COVID-19 pandemic on the onset and trajectory of eating disorders (EDs) among young in Spain. This study aims to analyze the characteristics and recent trends in hospital admissions for EDs within the pediatric population.

METHODS

A retrospective analysis was conducted on hospital admissions for EDs among patients aged 10-19 years between 2016 and 2022. The main outcomes examined included hospital rates (overall, stratified by ED type and age group), psychiatric comorbidities, and length of stay.

RESULTS

A total of 8275 hospitalizations due to EDs were identified, constituting 1 in 6 hospital admissions for mental illness and behavioral disorders. Predominant characteristics of this population included female sex (93%), aged 15-19 years (58.3%), admission primarily for anorexia nervosa (71.6%), and psychiatric comorbidity (35.6%). Hospital admissions for EDs in the pediatric population showed an increasing trend, with an annual average increase of 11.1% (95% CI: 2.6, 22.6). This rise was led by children aged 10-14 years, with a yearly increase in EDs hospitalization rates of 28.4% (95% CI: 13.5, 56.3) since 2019. Each discharge related to EDs was associated with a median stay of 24 days (IQR: 10, 40).

DISCUSSION

Efforts in community healthcare should prioritize early detection and intervention for symptoms indicative of EDs in the pediatric population, aiming to mitigate the severity of cases requiring hospitalization. These findings underscore the necessity for targeted health planning policies to address the growing burden of EDs among Spanish youth.

Causal relationships between psychological disorders and functional gastrointestinal disorders: a bidirectional two-sample Mendelian randomization study

BACKGROUND AND AIMS

Observational studies have shown bidirectional associations between psychological disorders (e.g. depression and anxiety) and functional gastrointestinal disorders. However, whether the relationships are causal is uncertain. Here, we used a bidirectional two-sample Mendelian randomization method to investigate the association between psychological disorders and functional gastrointestinal disorders (FGIDs).

METHODS

We obtained genome-wide association study summary statistics for two common psychological disorders: depression (170 756 cases) and anxiety (31 977 cases), as well as for three common FGIDs: functional dyspepsia with 6666 cases, constipation with 26 919 cases, and irritable bowel syndrome (IBS) with 7053 cases. These summary statistics were retrieved from several publicly available genome-wide association study databases. The inverse variance weighted method was used as the main Mendelian randomization method.

RESULTS

Inverse variance weighted Mendelian randomization analyses showed statistically significant associations between genetically predicted depression and risk of functional dyspepsia [odds ratio (OR): 1.40, 95% confidence interval (CI): 1.08-1.82], constipation (OR: 1.28, 95% CI: 1.13-1.44), and IBS (OR: 1.51, 95% CI: 1.37-1.67). Genetically predicted anxiety was associated with a higher risk of IBS (OR: 1.13, 95% CI: 1.10-1.17) instead of functional dyspepsia and constipation. In addition, genetically predicted IBS instead of functional dyspepsia and constipation was associated with a higher risk of depression (OR: 1.33, 95% CI: 1.12-1.57) and anxiety (OR: 2.05, 95% CI: 1.05-4.03).

CONCLUSION

Depression is a causal risk factor for three common FGIDs. A bidirectional causal relationship between IBS and anxiety or depression was also identified.

Anxiety and Depression Among Patients with Diabetes in Saudi Arabia and Egypt

BACKGROUND

Mental stress plagued type II diabetes (T2DM) patients. The psychological and emotional issues related to diabetes and its effects include depression, anxiety, poor diet, and hypoglycemia fear.

AIM

Compare the impact of diabetes on depression and anxiety in Egyptian and Saudi diabetics.

METHODS

The diabetes, gastroenterology, and hepatology sections of University of Ha'il Clinic, KSA, and the Theodor Bilharz Research Institute, Egypt, conducted this retrospective study. Everyone gave informed consent before participating. Interviews with male and female outpatients and inpatients were conducted from June 2021 to December 2022. The self-administered validated Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9) scale measured sociodemographic characteristics and symptoms of depression and anxiety.

RESULTS

In patients with diabetes, the prevalence of depression was higher in KSA [34.8%] than in Egypt [18%], while anxiety was higher in Egypt [40%] than in KSA [29.1%]. Most depressed patients were 31-55 years old (61.2%) from KSA and 97.8% (41-55 years old) from Egypt. Female anxiety was 70.7% in KSA and 51.0% in Egypt, with no significant difference. The duration of diabetes in depressed patients was 5-10 years ([46.9%, Saudis] vs. [57.8%, Egyptians]), while anxious patients (5-10 years [39.0%, Saudis] vs. >20 years [65.0%, Egyptians]) were mainly type-2. Most depressive patients had an HbA1c (59.2%) from 7-10% (Saudis) and 77.8% [>10% Egyptians] compared to anxiety patients (46.3%) and 48.0% [>10% Egyptians]. Depressed and anxious patients from both nations had higher glucose, triglycerides, and cholesterol levels. Saudis and Egyptians with obesity had higher rates of sadness (75.5% vs. 68.9%) and anxiety (82.9% vs. 69.0%). Treatment adherence and serum glucose monitoring were not significantly different from depression in diabetes individuals in both ethnicities.

CONCLUSIONS

Anxiety was more common among Egyptian patients because of overcrowding, working whole days to fulfill life requirements, and the unavailability of health insurance to all citizens. Meanwhile, in KSA, obesity, unhealthy food, and less exercise reflect the high percentage of depression among patients with diabetes. The detection of depression and anxiety in the context of DM should be critical for the physical health and quality of life of Saudi and Egyptian diabetics. Further investigation is warranted to encompass anxiety and depression within the scope of future research.

Nutritional Modulation of the Gut-Brain Axis: A Comprehensive Review of Dietary Interventions in Depression and Anxiety Management

Mental health is an increasing topic of focus since more than 500 million people in the world suffer from depression and anxiety. In this multifactorial disorder, parameters such as inflammation, the state of the microbiota and, therefore, the patient's nutrition are receiving more attention. In addition, food products are the source of many essential ingredients involved in the regulation of mental processes, including amino acids, neurotransmitters, vitamins, and others. For this reason, this narrative review was carried out with the aim of analyzing the role of nutrition in depression and anxiety disorders. To reach the review aim, a critical review was conducted utilizing both primary sources, such as scientific publications and secondary sources, such as bibliographic indexes, web pages, and databases. The search was conducted in PsychINFO, MedLine (Pubmed), Cochrane (Wiley), Embase, and CinAhl. The results show a direct relationship between what we eat and the state of our nervous system. The gut-brain axis is a complex system in which the intestinal microbiota communicates directly with our nervous system and provides it with neurotransmitters for its proper functioning. An imbalance in our microbiota due to poor nutrition will cause an inflammatory response that, if sustained over time and together with other factors, can lead to disorders such as anxiety and depression. Changes in the functions of the microbiota-gut-brain axis have been linked to several mental disorders. It is believed that the modulation of the microbiome composition may be an effective strategy for a new treatment of these disorders. Modifications in nutritional behaviors and the use of ergogenic components are presented as important non-pharmacological interventions in anxiety and depression prevention and treatment. It is desirable that the choice of nutritional and probiotic treatment in individual patients be based on the results of appropriate biochemical and microbiological tests.

Genetic testing in psychiatry, the perceptions of healthcare workers and patients: a mini review

Background

Genetic testing in psychiatry has gained attention, raising questions about its application and impact. Understanding stakeholders' perspectives, including healthcare providers and patients, is vital for informed policy development. The aim of this systematic review was to focus on the perceptions and concerns of patients and healthcare workers in psychiatry regarding the use of genetic testing.

Methods

We conducted a systematic review following PRISMA guidelines, for the period 1/2/2014, to 1/1/2024, via PubMed and Embase databases identifying 50 articles in total. After excluding duplicates (n = 12), 38 articles went through screening. After careful full-text article assessment for eligibility and applying the inclusion and exclusion criteria, only fifteen (n = 15) of the articles were included.

Results

Among 15 selected studies involving 3,156 participants (2,347 healthcare professionals; 809 patients), thematic analysis identified four primary themes: Organizational-implementation concerns, Ethical Considerations, Concerns on changes in clinical praxis, and Legal implications. Despite these concerns, seven out of eleven studies indicated that healthcare workers viewed genetic testing in psychiatry positively. Patients' perspectives varied, with two of the four studies reflecting positive attitudes. No pervasive negative sentiment was observed.

Conclusion

Our review highlights the multidimensional perspectives of healthcare professionals and patients surrounding the application of genetic testing in psychiatry. These considerations need to be addressed to facilitate the implementation of genetic testing in clinical praxis in psychiatry. Further research is needed for validation of the results and to guide policies and clinicians in the integration of genetic testing into mental healthcare practice.

How Real-World Data Can Facilitate the Development of Precision Medicine Treatment in Psychiatry

Precision medicine has the ambition to improve treatment response and clinical outcomes through patient stratification and holds great potential for the treatment of mental disorders. However, several important factors are needed to transform current practice into a precision psychiatry framework. Most important are 1) the generation of accessible large real-world training and test data including genomic data integrated from multiple sources, 2) the development and validation of advanced analytical tools for stratification and prediction, and 3) the development of clinically useful management platforms for patient monitoring that can be integrated into health care systems in real-life settings. This narrative review summarizes strategies for obtaining the key elements-well-powered samples from large biobanks integrated with electronic health records and health registry data using novel artificial intelligence algorithms-to predict outcomes in severe mental disorders and translate these models into clinical management and treatment approaches. Key elements are massive mental health data and novel artificial intelligence algorithms. For the clinical translation of these strategies, we discuss a precision medicine platform for improved management of mental disorders. We use cases to illustrate how precision medicine interventions could be brought into psychiatry to improve the clinical outcomes of mental disorders.

Contribution of severe mental disorders to fatally harmful effects of physical disorders: national cohort study

BACKGROUND

It remains unknown whether severe mental disorders contribute to fatally harmful effects of physical illness.

AIMS

To investigate the risk of all-cause death and loss of life-years following the onset of a wide range of physical health conditions in people with severe mental disorders compared with matched counterparts who had only these physical health conditions, and to assess whether these associations can be fully explained by this patient group having more clinically recorded physical illness.

METHOD

Using Czech national in-patient register data, we identified individuals with 28 physical health conditions recorded between 1999 and 2017, separately for each condition. In these people, we identified individuals who had severe mental disorders recorded before the physical health condition and exactly matched them with up to five counterparts who had no recorded prior severe mental disorders. We estimated the risk of all-cause death and lost life-years following each of the physical health conditions in people with pre-existing severe mental disorders compared with matched counterparts without severe mental disorders.

RESULTS

People with severe mental disorders had an elevated risk of all-cause death following the onset of 7 out of 9 broadly defined and 14 out of 19 specific physical health conditions. People with severe mental disorders lost additional life-years following the onset of 8 out 9 broadly defined and 13 out of 19 specific physical health conditions. The vast majority of results remained robust after considering the potentially confounding role of somatic multimorbidity and other clinical and sociodemographic factors.

CONCLUSIONS

A wide range of physical illnesses are more likely to result in all-cause death in people with pre-existing severe mental disorders. This premature mortality cannot be fully explained by having more clinically recorded physical illness, suggesting that physical disorders are more likely to be fatally harmful in this patient group.

Associations between physical diseases and subsequent mental disorders: a longitudinal study in a population-based cohort

People with physical diseases are reported to be at elevated risk of subsequent mental disorders. However, previous studies have considered only a few pairs of conditions, or have reported only relative risks. This study aimed to systematically explore the associations between physical diseases and subsequent mental disorders. It examined a population-based cohort of 7,673,978 people living in Denmark between 2000 and 2021, and followed them for a total of 119.3 million person-years. The study assessed nine broad categories of physical diseases (cardiovascular, endocrine, respiratory, gastrointestinal, urogenital, musculoskeletal, hematological and neurological diseases, and cancers), encompassing 31 specific diseases, and the subsequent risk of mental disorder diagnoses, encompassing the ten ICD-10 groupings (organic, including symptomatic, mental disorders; mental disorders due to psychoactive substance use; schizophrenia and related disorders; mood disorders; neurotic, stress-related and somatoform disorders; eating disorders; personality disorders; intellectual disabilities; pervasive developmental disorders; and behavioral and emotional disorders with onset usually occurring in childhood and adolescence). Using Poisson regression, the overall and time-dependent incidence rate ratios (IRRs) for pairs of physical diseases and mental disorders were calculated, adjusting for age, sex and calendar time. Absolute risks were estimated with the Aalen-Johansen estimator. In total, 646,171 people (8.4%) were identified as having any mental disorder during follow-up. All physical diseases except cancers were associated with an elevated risk of any mental disorder. For the nine broad pairs of physical diseases and mental disorders, the median point estimate of IRR was 1.51 (range: 0.99-1.84; interquartile range: 1.29-1.59). The IRRs ranged from 0.99 (95% CI: 0.98-1.01) after cancers to 1.84 (95% CI: 1.83-1.85) after musculoskeletal diseases. Risks varied over time after the diagnosis of physical diseases. The cumulative mental disorder incidence within 15 years after diagnosis of a physical disease varied from 3.73% (95% CI: 3.67-3.80) for cancers to 10.19% (95% CI: 10.13-10.25) for respiratory diseases. These data document that most physical diseases are associated with an elevated risk of subsequent mental disorders. Clinicians treating physical diseases should constantly be alert to the possible development of secondary mental disorders.

'Whole-Body' Perspectives of Schizophrenia and Related Psychotic Illness: miRNA-143 as an Exemplary Molecule Implicated across Multi-System Dysfunctions

A wide array of biological abnormalities in psychotic illness appear to reflect non-cerebral involvement. This review first outlines the evidence for such a whole-body concept of schizophrenia pathobiology, focusing particularly on cardiovascular disease, metabolic syndrome and diabetes, immunity and inflammation, cancer, and the gut-brain axis. It then considers the roles of miRNAs in general and of miRNA-143 in particular as they relate to the epidemiology, pathobiology, and treatment of schizophrenia. This is followed by notable evidence that miRNA-143 is also implicated in each of these domains of cardiovascular disease, metabolic syndrome and diabetes, immunity and inflammation, cancer, and the gut-brain axis. Thus, miRNA-143 is an exemplar of what may be a class of molecules that play a role across the multiple domains of bodily dysfunction that appear to characterize a whole-body perspective of illness in schizophrenia. Importantly, the existence of such an exemplary molecule across these multiple domains implies a coordinated rather than stochastic basis. One candidate process would be a pleiotropic effect of genetic risk for schizophrenia across the whole body.

Association between depressive symptoms and cardiovascular diseases in the Korean geriatric population: A nationwide retrospective cohort study

INTRODUCTION

Depression has emerged as a modifiable risk factor for cardiovascular disease (CVD). However, evidence on whether depressive symptoms measured using a self-report questionnaire are associated with CVD incidence is scarce. Therefore, we aimed to investigate the association between depressive symptoms and CVD risk using data from national health examinations and insurance claim records.

METHODS

This retrospective cohort study included participants who underwent the Korean National Screening Program for Transitional Ages at age 66 years between 2007 and 2017. The presence of depressive symptoms was defined as affirmative responses to any of three questions (loss of activities and interests, worthlessness, and hopelessness) selected from the Geriatric Depression Scale. Incident composite CVD event included myocardial infarction, stroke, heart failure, and CVD death. The association between depressive symptoms and CVD risk was evaluated using hazard ratios (HRs) and 95 % confidence intervals (CIs) estimated with Cox proportional hazards models.

RESULTS

Among 88,765 participants (48.5 % women) aged 66 years, 4036 incident CVD events occurred during a mean follow-up of 6.8 years. Participants with depressive symptoms had a significantly higher risk of CVD than those without depressive symptoms (adjusted HR = 1.16 [95 % CI: 1.07-1.24]). The three individual depressive symptoms showed similar associations with CVD risk (loss of activities and interests, adjusted HR = 1.17 [95 % CI: 1.08-1.26]; worthlessness, 1.15 [1.03-1.29]; hopelessness, 1.13 [1.01-1.26]).

LIMITATIONS

The study was limited to participants aged 66 years. Despite extensive adjustment for potential confounders and multiple sensitivity analyses, residual confounding and reverse causality could not be ruled out.

CONCLUSION

The presence of depressive symptoms was associated with an increased risk of CVD. Screening for depressive symptoms in the general population may effectively mitigate the burden of CVD.

Modeling the Determinants of Subjective Well-Being in Schizophrenia

BACKGROUND

The ultimate goal of successful schizophrenia treatment is not just to alleviate psychotic symptoms, but also to reduce distress and achieve subjective well-being (SWB). We aimed to identify the determinants of SWB and their interrelationships in schizophrenia.

METHODS

Data were obtained from 637 patients with schizophrenia enrolled in multicenter, open-label, non-comparative clinical trials. The SWB under the Neuroleptic Treatment Scale (SWN) was utilized; a cut-off score of 80 indicated a high level of SWB at baseline and 6 months. Various machine learning (ML) algorithms were employed to identify the determinants of SWB. Furthermore, network analysis and structural equation modeling (SEM) were conducted to explore detailed relationship patterns.

RESULTS

The random forest (RF) model had the highest area under the curve (AUC) of 0.794 at baseline. Obsessive-compulsive symptoms (OCS) had the most significant impact on high levels of SWB, followed by somatization, cognitive deficits, and depression. The network analysis demonstrated robust connections among the SWB, OCS, and somatization. SEM analysis revealed that OCS exerted the strongest direct effect on SWB, and also an indirect effect via the mediation of depression. Furthermore, the contribution of OCS at baseline to SWB was maintained 6 months later.

CONCLUSIONS

OCS, somatization, cognition, and depression, rather than psychotic symptoms, exerted significant impacts on SWB in schizophrenia. Notably, OCS exhibited the most significant contribution not only to the current state of well-being but also to follow-up SWB, implying that OCS was predictive of SWB. The findings demonstrated that OCS management is critical for the treatment of schizophrenia.

Childhood Maltreatment and Biological Aging in Middle Adulthood: The Role of Psychiatric Symptoms

Background

Childhood maltreatment and psychiatric morbidity have each been associated with accelerated biological aging primarily through cross-sectional studies. Using data from a prospective longitudinal study of individuals with histories of childhood maltreatment and control participants followed into midlife, we tested 2 hypotheses examining whether 1) psychiatric symptoms mediate the relationship between childhood maltreatment and biological aging and 2) psychiatric symptoms of anxiety, depression, or posttraumatic stress disorder (PTSD) act in conjunction with childhood maltreatment to exacerbate the association of child maltreatment to aging.

Methods

Children (ages 0-11 years) with documented histories of maltreatment and demographically matched control children were followed into adulthood (N = 607) and interviewed over several waves of the study. Depression, anxiety, and PTSD symptoms were assessed at mean ages of 29 (interview 1) and 40 (interview 2) years. Biological age was measured from blood chemistries collected later (mean age = 41 years) using the Klemera-Doubal method. Hypotheses were tested using linear regressions and path analyses.

Results

Adults with documented histories of childhood maltreatment showed more symptoms of depression, PTSD, and anxiety at both interviews and more advanced biological aging, compared with control participants. PTSD symptoms at both interviews and depression and anxiety symptoms only at interview 2 predicted accelerated biological aging. There was no evidence of mediation; however, anxiety and depression moderated the relationship between childhood maltreatment and biological aging.

Conclusions

These new findings reveal the shorter- and longer-term longitudinal impact of PTSD on biological aging and the amplifying effect of anxiety and depression on the relationship between child maltreatment and biological aging.

Shared Genetic Liability across Systems of Psychiatric and Physical Illness

Epidemiological literature has shown that there are extensive comorbidity patterns between psychiatric and physical illness. However, our understanding of the multivariate systems of relationships underlying these patterns is poorly understood. Using Genomic SEM and Genomic E-SEM, an extension for genomic exploratory factor analysis that we introduce and validate, we evaluate the extent to which latent genomic factors from eight domains, encompassing 76 physical outcomes across 1.9 million cases, evince genetic overlap with previously identified psychiatric factors. We find that internalizing, neurodevelopmental, and substance use factors are broadly associated with increased genetic risk sharing across all physical illness domains. Conversely, we find that a compulsive factor is protective against circulatory and metabolic illness, whereas genetic risk sharing between physical illness factors and psychotic/thought disorders was limited. Our results reveal pervasive risk sharing between specific groups of psychiatric and physical conditions and call into question the bifurcation of psychiatric and physical conditions.