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Tate AE, Bouteloup V, van Maurik IS, Jean D, Mank A, Speh A, Boilet V, van Harten A, Eriksdotter M, Wimo A, Dufouil C, van der Flier WM, Jönsson L. Predicting sojourn times across dementia disease stages, institutionalization, and mortality. Alzheimers Dement 2024; 20:809-818. [PMID: 37779086 PMCID: PMC10916938 DOI: 10.1002/alz.13488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 08/02/2023] [Accepted: 09/01/2023] [Indexed: 10/03/2023]
Abstract
INTRODUCTION Inferring the timeline from mild cognitive impairment (MCI) to severe dementia is pivotal for patients, clinicians, and researchers. Literature is sparse and often contains few patients. We aim to determine the time spent in MCI, mild-, moderate-, severe dementia, and institutionalization until death. METHODS Multistate modeling with Cox regression was used to obtain the sojourn time. Covariates were age at baseline, sex, amyloid status, and Alzheimer's disease (AD) or other dementia diagnosis. The sample included a register (SveDem) and memory clinics (Amsterdam Dementia Cohort and Memento). RESULTS Using 80,543 patients, the sojourn time from clinically identified MCI to death across all patient groups ranged from 6.20 (95% confidence interval [CI]: 5.57-6.98) to 10.08 (8.94-12.18) years. DISCUSSION Generally, sojourn time was inversely associated with older age at baseline, males, and AD diagnosis. The results provide key estimates for researchers and clinicians to estimate prognosis.
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Affiliation(s)
- Ashley E Tate
- Division of NeurogeriatricsDepartment of NeurobiologyCare Sciences and SocietyKarolinska InstitutetStockholmSweden
| | - Vincent Bouteloup
- UnivBordeauxInserm U1219PHARes teamInstitut de Santé Publiqued'Epidémiologie et de Développement (ISPED)BordeauxFrance
- CHU BordeauxCIC 1401 ECPôle Santé PubliqueBordeauxFrance
| | - Ingrid S. van Maurik
- Alzheimer Center AmsterdamNeurology, Vrije Universiteit AmsterdamAmsterdam UMC location VUmcAmsterdamThe Netherlands
- Amsterdam NeuroscienceNeurodegenerationAmsterdamThe Netherlands
- Amsterdam UMC location Vrije Universiteit AmsterdamEpidemiology and Data ScienceVrije Universiteit AmsterdamAmsterdam UMC location VUmcAmsterdamThe Netherlands
| | - Delphine Jean
- UnivBordeauxInserm U1219PHARes teamInstitut de Santé Publiqued'Epidémiologie et de Développement (ISPED)BordeauxFrance
- CHU BordeauxCIC 1401 ECPôle Santé PubliqueBordeauxFrance
| | - Arenda Mank
- Alzheimer Center AmsterdamNeurology, Vrije Universiteit AmsterdamAmsterdam UMC location VUmcAmsterdamThe Netherlands
- Amsterdam NeuroscienceNeurodegenerationAmsterdamThe Netherlands
- Amsterdam UMC location Vrije Universiteit AmsterdamEpidemiology and Data ScienceVrije Universiteit AmsterdamAmsterdam UMC location VUmcAmsterdamThe Netherlands
| | - Andreja Speh
- Department of NeurologyUniversity Medical Center LjubljanaLjubljanaSlovenia
- Medical FacultyUniversity of LjubljanaLjubljanaSlovenia
| | - Valerie Boilet
- UnivBordeauxInserm U1219PHARes teamInstitut de Santé Publiqued'Epidémiologie et de Développement (ISPED)BordeauxFrance
- CHU BordeauxCIC 1401 ECPôle Santé PubliqueBordeauxFrance
| | - Argonde van Harten
- Alzheimer Center AmsterdamNeurology, Vrije Universiteit AmsterdamAmsterdam UMC location VUmcAmsterdamThe Netherlands
- Amsterdam NeuroscienceNeurodegenerationAmsterdamThe Netherlands
| | - Maria Eriksdotter
- Theme Inflammation and AgingKarolinska University HospitalHuddingeSweden
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden
| | - Anders Wimo
- Division of NeurogeriatricsDepartment of NeurobiologyCare Sciences and SocietyKarolinska InstitutetStockholmSweden
| | - Carole Dufouil
- UnivBordeauxInserm U1219PHARes teamInstitut de Santé Publiqued'Epidémiologie et de Développement (ISPED)BordeauxFrance
- CHU BordeauxCIC 1401 ECPôle Santé PubliqueBordeauxFrance
| | - Wiesje M. van der Flier
- Alzheimer Center AmsterdamNeurology, Vrije Universiteit AmsterdamAmsterdam UMC location VUmcAmsterdamThe Netherlands
- Amsterdam NeuroscienceNeurodegenerationAmsterdamThe Netherlands
- Amsterdam UMC location Vrije Universiteit AmsterdamEpidemiology and Data ScienceVrije Universiteit AmsterdamAmsterdam UMC location VUmcAmsterdamThe Netherlands
| | - Linus Jönsson
- Division of NeurogeriatricsDepartment of NeurobiologyCare Sciences and SocietyKarolinska InstitutetStockholmSweden
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Tate AE, Akingbuwa WA, Karlsson R, Hottenga JJ, Pool R, Boman M, Larsson H, Lundström S, Lichtenstein P, Middeldorp CM, Bartels M, Kuja-Halkola R. A genetically informed prediction model for suicidal and aggressive behaviour in teens. Transl Psychiatry 2022; 12:488. [PMID: 36411277 PMCID: PMC9678913 DOI: 10.1038/s41398-022-02245-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 10/24/2022] [Accepted: 10/28/2022] [Indexed: 11/22/2022] Open
Abstract
Suicidal and aggressive behaviours cause significant personal and societal burden. As risk factors associated with these behaviours frequently overlap, combined approaches in predicting the behaviours may be useful in identifying those at risk for either. The current study aimed to create a model that predicted if individuals will exhibit suicidal behaviour, aggressive behaviour, both, or neither in late adolescence. A sample of 5,974 twins from the Child and Adolescent Twin Study in Sweden (CATSS) was broken down into a training (80%), tune (10%) and test (10%) set. The Netherlands Twin Register (NTR; N = 2702) was used for external validation. Our longitudinal data featured genetic, environmental, and psychosocial predictors derived from parental and self-report data. A stacked ensemble model was created which contained a gradient boosted machine, random forest, elastic net, and neural network. Model performance was transferable between CATSS and NTR (macro area under the receiver operating characteristic curve (AUC) [95% CI] AUCCATSS(test set) = 0.709 (0.671-0.747); AUCNTR = 0.685 (0.656-0.715), suggesting model generalisability across Northern Europe. The notable exception is suicidal behaviours in the NTR, which was no better than chance. The 25 highest scoring variable importance scores for the gradient boosted machines and random forest models included self-reported psychiatric symptoms in mid-adolescence, sex, and polygenic scores for psychiatric traits. The model's performance is comparable to current prediction models that use clinical interviews and is not yet suitable for clinical use. Moreover, genetic variables may have a role to play in predictive models of adolescent psychopathology.
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Affiliation(s)
- Ashley E. Tate
- grid.465198.7Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Wonuola A. Akingbuwa
- grid.12380.380000 0004 1754 9227Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands ,grid.509540.d0000 0004 6880 3010Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Robert Karlsson
- grid.465198.7Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Jouke-Jan Hottenga
- grid.12380.380000 0004 1754 9227Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - René Pool
- grid.12380.380000 0004 1754 9227Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands ,grid.509540.d0000 0004 6880 3010Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Magnus Boman
- grid.5037.10000000121581746Division of Software and Computer Systems, School of Electrical Engineering and Computer Science KTH, Stockholm, Sweden ,grid.4714.60000 0004 1937 0626Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Solna, Sweden
| | - Henrik Larsson
- grid.465198.7Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden ,grid.15895.300000 0001 0738 8966School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Sebastian Lundström
- grid.8761.80000 0000 9919 9582Centre for Ethics, Law and Mental Health (CELAM), University of Gothenburg, Gothenburg, Sweden ,grid.8761.80000 0000 9919 9582Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden
| | - Paul Lichtenstein
- grid.465198.7Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Christel M. Middeldorp
- grid.12380.380000 0004 1754 9227Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands ,grid.1003.20000 0000 9320 7537Child Health Research Centre, the University of Queensland, Brisbane, QLD Australia ,grid.512914.a0000 0004 0642 3960Child and Youth Mental Health Service, Children’s Health Queensland Hospital and Health Services, Brisbane, QLD Australia
| | - Meike Bartels
- grid.12380.380000 0004 1754 9227Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ralf Kuja-Halkola
- grid.465198.7Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
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Jami ES, Hammerschlag AR, Ip HF, Allegrini AG, Benyamin B, Border R, Diemer EW, Jiang C, Karhunen V, Lu Y, Lu Q, Mallard TT, Mishra PP, Nolte IM, Palviainen T, Peterson RE, Sallis HM, Shabalin AA, Tate AE, Thiering E, Vilor-Tejedor N, Wang C, Zhou A, Adkins DE, Alemany S, Ask H, Chen Q, Corley RP, Ehli EA, Evans LM, Havdahl A, Hagenbeek FA, Hakulinen C, Henders AK, Hottenga JJ, Korhonen T, Mamun A, Marrington S, Neumann A, Rimfeld K, Rivadeneira F, Silberg JL, van Beijsterveldt CE, Vuoksimaa E, Whipp AM, Tong X, Andreassen OA, Boomsma DI, Brown SA, Burt SA, Copeland W, Dick DM, Harden KP, Harris KM, Hartman CA, Heinrich J, Hewitt JK, Hopfer C, Hypponen E, Jarvelin MR, Kaprio J, Keltikangas-Järvinen L, Klump KL, Krauter K, Kuja-Halkola R, Larsson H, Lehtimäki T, Lichtenstein P, Lundström S, Maes HH, Magnus P, Munafò MR, Najman JM, Njølstad PR, Oldehinkel AJ, Pennell CE, Plomin R, Reichborn-Kjennerud T, Reynolds C, Rose RJ, Smolen A, Snieder H, Stallings M, Standl M, Sunyer J, Tiemeier H, Wadsworth SJ, Wall TL, Whitehouse AJO, Williams GM, Ystrøm E, Nivard MG, Bartels M, Middeldorp CM. Genome-wide Association Meta-analysis of Childhood and Adolescent Internalizing Symptoms. J Am Acad Child Adolesc Psychiatry 2022; 61:934-945. [PMID: 35378236 PMCID: PMC10859168 DOI: 10.1016/j.jaac.2021.11.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/15/2021] [Accepted: 03/25/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the genetic architecture of internalizing symptoms in childhood and adolescence. METHOD In 22 cohorts, multiple univariate genome-wide association studies (GWASs) were performed using repeated assessments of internalizing symptoms, in a total of 64,561 children and adolescents between 3 and 18 years of age. Results were aggregated in meta-analyses that accounted for sample overlap, first using all available data, and then using subsets of measurements grouped by rater, age, and instrument. RESULTS The meta-analysis of overall internalizing symptoms (INToverall) detected no genome-wide significant hits and showed low single nucleotide polymorphism (SNP) heritability (1.66%, 95% CI = 0.84-2.48%, neffective = 132,260). Stratified analyses indicated rater-based heterogeneity in genetic effects, with self-reported internalizing symptoms showing the highest heritability (5.63%, 95% CI = 3.08%-8.18%). The contribution of additive genetic effects on internalizing symptoms appeared to be stable over age, with overlapping estimates of SNP heritability from early childhood to adolescence. Genetic correlations were observed with adult anxiety, depression, and the well-being spectrum (|rg| > 0.70), as well as with insomnia, loneliness, attention-deficit/hyperactivity disorder, autism, and childhood aggression (range |rg| = 0.42-0.60), whereas there were no robust associations with schizophrenia, bipolar disorder, obsessive-compulsive disorder, or anorexia nervosa. CONCLUSION Genetic correlations indicate that childhood and adolescent internalizing symptoms share substantial genetic vulnerabilities with adult internalizing disorders and other childhood psychiatric traits, which could partially explain both the persistence of internalizing symptoms over time and the high comorbidity among childhood psychiatric traits. Reducing phenotypic heterogeneity in childhood samples will be key in paving the way to future GWAS success.
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Affiliation(s)
- Eshim S Jami
- Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; University College London, London, United Kingdom.
| | - Anke R Hammerschlag
- Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; Child Health Research Centre, University of Queensland, Brisbane, Australia
| | - Hill F Ip
- Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Andrea G Allegrini
- University College London, London, United Kingdom; Social, Genetic and Developmental Psychiatry Centre, King's College London, London, United Kingdom
| | - Beben Benyamin
- University of South Australia, Adelaide, Australia; South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Richard Border
- Institute for Behavioral Genetics, University of Colorado Boulder
| | - Elizabeth W Diemer
- Erasmus University Medical Center, Rotterdam, the Netherlands; Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Chang Jiang
- Michigan State University, East Lansing; University of Florida, Gainesville
| | | | - Yi Lu
- Karolinska Institutet, Stockholm, Sweden
| | - Qing Lu
- Michigan State University, East Lansing
| | | | - Pashupati P Mishra
- Tampere University, Tampere, Finland, and Fimlab Laboratories, Tampere, Finland
| | - Ilja M Nolte
- University of Groningen, University Medical Center Groningen, the Netherlands
| | - Teemu Palviainen
- Institute for Molecular Medicine Finland - FIMM, University of Helsinki, Finland
| | - Roseann E Peterson
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond
| | - Hannah M Sallis
- School of Psychological Science, University of Bristol, United Kingdom, and Medical Research Council (MRC) Integrative Epidemiology Unit, University of Bristol, United Kingdom; Centre for Academic Mental Health, Population Health Sciences, University of Bristol, United Kingdom
| | | | | | - Elisabeth Thiering
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany; Ludwig-Maximilians-Universität, Munich, Germany
| | - Natàlia Vilor-Tejedor
- Erasmus University Medical Center, Rotterdam, the Netherlands; Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain; BarcelonaBeta Brain Research Center, (BBRC) Pasqual Maragall Foundation, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Carol Wang
- School of Medicine and Public Health, University of Newcastle, Australia
| | - Ang Zhou
- University of South Australia, Adelaide, Australia
| | | | - Silvia Alemany
- Universitat Pompeu Fabra (UPF), Barcelona, Spain; SGlobal, Barcelona Institute of Global Health, Barcelona, Spain; and CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Helga Ask
- Norwegian Institute of Public Health, Oslo, Norway
| | - Qi Chen
- Karolinska Institutet, Stockholm, Sweden
| | - Robin P Corley
- Institute for Behavioral Genetics, University of Colorado Boulder
| | - Erik A Ehli
- Avera Institute for Human Genetics, Avera McKennan Hospital & University Health Center, Sioux Falls, South Dakota
| | - Luke M Evans
- Institute for Behavioral Genetics, University of Colorado Boulder
| | | | - Fiona A Hagenbeek
- Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | | | - Anjali K Henders
- Institute for Molecular Biosciences, University of Queensland, Brisbane, Australia
| | | | - Tellervo Korhonen
- Institute for Molecular Medicine Finland - FIMM, University of Helsinki, Finland
| | - Abdullah Mamun
- Institute for Social Science Research, University of Queensland, Brisbane, Australia
| | - Shelby Marrington
- School of Public Health, University of Queensland, Brisbane, Australia
| | - Alexander Neumann
- Erasmus University Medical Center, Rotterdam, the Netherlands; Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Kaili Rimfeld
- Social, Genetic and Developmental Psychiatry Centre, King's College London, London, United Kingdom
| | | | - Judy L Silberg
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond
| | | | - Eero Vuoksimaa
- Institute for Molecular Medicine Finland - FIMM, University of Helsinki, Finland
| | - Alyce M Whipp
- Institute for Molecular Medicine Finland - FIMM, University of Helsinki, Finland
| | - Xiaoran Tong
- Michigan State University, East Lansing; University of Florida, Gainesville
| | - Ole A Andreassen
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; and Oslo University Hospital, Norway
| | | | | | | | | | | | | | | | - Catharina A Hartman
- University of Groningen, University Medical Center Groningen, the Netherlands
| | - Joachim Heinrich
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany; Ludwig-Maximilians-Universität, Munich, Germany; Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - John K Hewitt
- Institute for Behavioral Genetics, University of Colorado Boulder
| | | | - Elina Hypponen
- University of South Australia, Adelaide, Australia; South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Marjo-Riitta Jarvelin
- MRC-PHE Centre for Environment and Health, Imperial College London, United Kingdom; the Center for Life Course Health Research, University of Oulu, Oulu, Finland; and Oulu University Hospital, Oulu, Finland
| | - Jaakko Kaprio
- Institute for Molecular Medicine Finland - FIMM, University of Helsinki, Finland
| | | | | | | | | | | | - Terho Lehtimäki
- Tampere University, Tampere, Finland, and Fimlab Laboratories, Tampere, Finland
| | | | | | - Hermine H Maes
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond; Massey Cancer Center, Virginia Commonwealth University, Richmond
| | - Per Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Marcus R Munafò
- School of Psychological Science, University of Bristol, United Kingdom, and Medical Research Council (MRC) Integrative Epidemiology Unit, University of Bristol, United Kingdom; NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, United Kingdom
| | - Jake M Najman
- School of Public Health, University of Queensland, Brisbane, Australia
| | - Pål R Njølstad
- Center for Diabetes Research, University of Bergen, Bergen, Norway, and Haukeland University Hospital, Bergen, Norway
| | | | - Craig E Pennell
- School of Medicine and Public Health, University of Newcastle, Australia
| | - Robert Plomin
- Social, Genetic and Developmental Psychiatry Centre, King's College London, London, United Kingdom
| | | | - Chandra Reynolds
- University of California at Riverside, California, and Indiana University, Bloomington, Indiana
| | - Richard J Rose
- University of California at Riverside, California, and Indiana University, Bloomington, Indiana
| | - Andrew Smolen
- Institute for Behavioral Genetics, University of Colorado Boulder
| | - Harold Snieder
- University of Groningen, University Medical Center Groningen, the Netherlands
| | | | - Marie Standl
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Jordi Sunyer
- Universitat Pompeu Fabra (UPF), Barcelona, Spain; SGlobal, Barcelona Institute of Global Health, Barcelona, Spain; and CIBER Epidemiología y Salud Pública (CIBERESP), Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Henning Tiemeier
- Erasmus University Medical Center, Rotterdam, the Netherlands; Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | | | | | - Gail M Williams
- School of Public Health, University of Queensland, Brisbane, Australia
| | - Eivind Ystrøm
- Norwegian Institute of Public Health, Oslo, Norway; PROMENTA Research Center, University of Oslo, Norway
| | | | - Meike Bartels
- Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Christel M Middeldorp
- Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Child Health Research Centre, University of Queensland, Brisbane, Australia; Child and Youth Mental Health Service, Children's Health Queensland Hospital and Health Service, Brisbane, Australia
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Tate AE, Sahlin H, Liu S, Lu Y, Lundström S, Larsson H, Lichtenstein P, Kuja-Halkola R. Borderline personality disorder: associations with psychiatric disorders, somatic illnesses, trauma, and adverse behaviors. Mol Psychiatry 2022; 27:2514-2521. [PMID: 35304564 PMCID: PMC9135625 DOI: 10.1038/s41380-022-01503-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 02/01/2022] [Accepted: 02/22/2022] [Indexed: 11/09/2022]
Abstract
In one of the largest, most comprehensive studies on borderline personality disorder (BPD) to date, this article places into context associations between this diagnosis and (1) 16 different psychiatric disorders, (2) eight somatic illnesses, and (3) six trauma and adverse behaviors, e.g., violent crime victimization and self-harm. Second, it examines the sex differences in individuals with BPD and their siblings. A total of 1,969,839 Swedish individuals were identified from national registers. Cumulative incidence with 95% confidence intervals (CI) was evaluated after 5 years of follow-up from BPD diagnosis and compared with a matched cohort. Associations were estimated as hazard ratios (HR) with 95% CIs from Cox regression. 12,175 individuals were diagnosed with BPD (85.3% female). Individuals diagnosed with BPD had higher cumulative incidences and HRs for nearly all analyzed indicators, especially psychiatric disorders. Anxiety disorders were most common (cumulative incidence 95% CI 33.13% [31.48-34.73]). Other notable findings from Cox regressions include psychotic disorders (HR 95% CI 24.48 [23.14-25.90]), epilepsy (3.38 [3.08-3.70]), violent crime victimization (7.65 [7.25-8.06]), and self-harm (17.72 [17.27-18.19]). HRs in males and females with BPD had overlapping CIs for nearly all indicators. This indicates that a BPD diagnosis is a marker of vulnerability for negative events and poor physical and mental health similarly for both males and females. Having a sibling with BPD was associated with an increased risk for psychiatric disorders, trauma, and adverse behaviors but not somatic disorders. Clinical implications include the need for increased support for patients with BPD navigating the health care system.
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Affiliation(s)
- Ashley E. Tate
- grid.465198.7Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Hanna Sahlin
- grid.4714.60000 0004 1937 0626Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Shengxin Liu
- grid.465198.7Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Yi Lu
- grid.465198.7Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Sebastian Lundström
- grid.8761.80000 0000 9919 9582Centre for Ethics, Law and Mental Health (CELAM), University of Gothenburg, Gothenburg, Sweden ,grid.8761.80000 0000 9919 9582Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden
| | - Henrik Larsson
- grid.465198.7Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden ,grid.15895.300000 0001 0738 8966School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Paul Lichtenstein
- grid.465198.7Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Ralf Kuja-Halkola
- grid.465198.7Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
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5
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Tate AE, Liu S, Zhang R, Yilmaz Z, Larsen JT, Petersen LV, Bulik CM, Svensson AM, Gudbjörnsdottir S, Larsson H, Butwicka A, Kuja-Halkola R. Association and Familial Coaggregation of Type 1 Diabetes and Eating Disorders: A Register-Based Cohort Study in Denmark and Sweden. Diabetes Care 2021; 44:1143-1150. [PMID: 33824142 PMCID: PMC8132321 DOI: 10.2337/dc20-2989] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 02/12/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To ascertain the association and coaggregation of eating disorders and childhood-onset type 1 diabetes in families. RESEARCH DESIGN AND METHODS Using population samples from national registers in Sweden (n = 2,517,277) and Demark (n = 1,825,920), we investigated the within-individual association between type 1 diabetes and eating disorders and their familial coaggregation among full siblings, half siblings, full cousins, and half cousins. On the basis of clinical diagnoses, we classified eating disorders into any eating disorder (AED), anorexia nervosa (AN) and atypical AN, and other eating disorder (OED). Associations were determined with hazard ratios (HRs) with 95% CIs from Cox regressions. RESULTS Swedish and Danish individuals with a type 1 diabetes diagnosis had a greater risk of receiving an eating disorder diagnosis (HR [95% CI] Sweden: AED 2.02 [1.80-2.27], AN 1.63 [1.36-1.96], OED 2.34 [2.07-2.63]; Denmark: AED 2.19 [1.84-2.61], AN 1.78 [1.36-2.33], OED 2.65 [2.20-3.21]). We also meta-analyzed the results: AED 2.07 (1.88-2.28), AN 1.68 (1.44-1.95), OED 2.44 (2.17-2.72). There was an increased risk of receiving an eating disorder diagnosis in full siblings in the Swedish cohort (AED 1.25 [1.07-1.46], AN 1.28 [1.04-1.57], OED 1.28 [1.07-1.52]); these results were nonsignificant in the Danish cohort. CONCLUSIONS Patients with type 1 diabetes are at a higher risk of subsequent eating disorders; however, there is conflicting support for the relationship between having a sibling with type 1 diabetes and an eating disorder diagnosis. Diabetes health care teams should be vigilant about disordered eating behaviors in children and adolescents with type 1 diabetes.
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Affiliation(s)
- Ashley E Tate
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Shengxin Liu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Ruyue Zhang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Zeynep Yilmaz
- National Centre for Register-based Research, Aarhus School of Business and Social Sciences, Aarhus University, Aarhus, Denmark.,Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC.,Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Janne T Larsen
- National Centre for Register-based Research, Aarhus School of Business and Social Sciences, Aarhus University, Aarhus, Denmark.,Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus, Denmark.,Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Aarhus, Denmark
| | - Liselotte V Petersen
- National Centre for Register-based Research, Aarhus School of Business and Social Sciences, Aarhus University, Aarhus, Denmark.,Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus, Denmark.,Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Aarhus, Denmark
| | - Cynthia M Bulik
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.,Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC.,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Ann-Marie Svensson
- Swedish National Diabetes Register, Centre of Registers, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Soffia Gudbjörnsdottir
- Swedish National Diabetes Register, Centre of Registers, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.,School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Agnieszka Butwicka
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.,Child and Adolescent Psychiatry Stockholm, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.,Department of Child Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
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Li L, Taylor MJ, Bälter K, Kuja‐Halkola R, Chen Q, Hegvik T, Tate AE, Chang Z, Arias‐Vásquez A, Hartman CA, Larsson H. Attention-deficit/hyperactivity disorder symptoms and dietary habits in adulthood: A large population-based twin study in Sweden. Am J Med Genet B Neuropsychiatr Genet 2020; 183:475-485. [PMID: 33029947 PMCID: PMC7702140 DOI: 10.1002/ajmg.b.32825] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 09/14/2020] [Accepted: 09/22/2020] [Indexed: 01/28/2023]
Abstract
Associations between adult attention-deficit/hyperactivity disorder (ADHD) symptoms and dietary habits have not been well established and the underlying mechanisms remain unclear. We explored these associations using a Swedish population-based twin study with 17,999 individuals aged 20-47 years. We estimated correlations between inattention and hyperactivity/impulsivity with dietary habits and fitted twin models to determine the genetic and environmental contributions. Dietary habits were defined as (a) consumption of food groups, (b) consumption of food items rich in particular macronutrients, and (c) healthy and unhealthy dietary patterns. At the phenotypic level, inattention was positively correlated with seafood, high-fat, high-sugar, high-protein food consumptions, and unhealthy dietary pattern, with correlation coefficients ranging from 0.03 (95%CI: 0.01, 0.05) to 0.13 (95% CI: 0.11, 0.15). Inattention was negatively correlated with fruits, vegetables consumptions and healthy dietary pattern, with correlation coefficients ranging from -0.06 (95%CI: -0.08, -0.04) to -0.07 (95%CI: -0.09, -0.05). Hyperactivity/impulsivity and dietary habits showed similar but weaker patterns compared to inattention. All associations remained stable across age, sex and socioeconomic status. Nonshared environmental effects contributed substantially to the correlations of inattention (56-60%) and hyperactivity/impulsivity (63-80%) with dietary habits. The highest and lowest genetic correlations were between inattention and high-sugar food (rA = .16, 95% CI: 0.07, 0.25), and between hyperactivity/impulsivity and unhealthy dietary pattern (rA = .05, 95% CI: -0.05, 0.14), respectively. We found phenotypic and etiological overlap between ADHD and dietary habits, although these associations were weak. Our findings contribute to a better understanding of common etiological pathways between ADHD symptoms and various dietary habits.
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Affiliation(s)
- Lin Li
- School of Medical SciencesÖrebro UniversityÖrebroSweden
| | - Mark J. Taylor
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Katarina Bälter
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden,Public Health SciencesMälardalen UniversityVästeråsSweden
| | - Ralf Kuja‐Halkola
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Qi Chen
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Tor‐Arne Hegvik
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden,Department of BiomedicineUniversity of BergenBergenNorway
| | - Ashley E. Tate
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Zheng Chang
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Alejandro Arias‐Vásquez
- The Department of Psychiatry & Human GeneticsDonders Institute for Brain, Cognition, and Behavior, Radboud University Medical CenterNijmegenNetherlands
| | - Catharina A. Hartman
- Department of PsychiatryUniversity of Groningen, University Medical Center GroningenGroningenNetherlands
| | - Henrik Larsson
- School of Medical SciencesÖrebro UniversityÖrebroSweden,Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
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7
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Tate AE, McCabe RC, Larsson H, Lundström S, Lichtenstein P, Kuja-Halkola R. Predicting mental health problems in adolescence using machine learning techniques. PLoS One 2020; 15:e0230389. [PMID: 32251439 PMCID: PMC7135284 DOI: 10.1371/journal.pone.0230389] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 02/28/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Predicting which children will go on to develop mental health symptoms as adolescents is critical for early intervention and preventing future, severe negative outcomes. Although many aspects of a child's life, personality, and symptoms have been flagged as indicators, there is currently no model created to screen the general population for the risk of developing mental health problems. Additionally, the advent of machine learning techniques represents an exciting way to potentially improve upon the standard prediction modelling technique, logistic regression. Therefore, we aimed to I.) develop a model that can predict mental health problems in mid-adolescence II.) investigate if machine learning techniques (random forest, support vector machines, neural network, and XGBoost) will outperform logistic regression. METHODS In 7,638 twins from the Child and Adolescent Twin Study in Sweden we used 474 predictors derived from parental report and register data. The outcome, mental health problems, was determined by the Strengths and Difficulties Questionnaire. Model performance was determined by the area under the receiver operating characteristic curve (AUC). RESULTS Although model performance varied somewhat, the confidence interval overlapped for each model indicating non-significant superiority for the random forest model (AUC = 0.739, 95% CI 0.708-0.769), followed closely by support vector machines (AUC = 0.735, 95% CI 0.707-0.764). CONCLUSION Ultimately, our top performing model would not be suitable for clinical use, however it lays important groundwork for future models seeking to predict general mental health outcomes. Future studies should make use of parent-rated assessments when possible. Additionally, it may not be necessary for similar studies to forgo logistic regression in favor of other more complex methods.
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Affiliation(s)
- Ashley E. Tate
- Department of Medical Epidemiology and Biostatics, Karolinska Institutet, Stockholm, Sweden
| | | | - Henrik Larsson
- Department of Medical Epidemiology and Biostatics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Sebastian Lundström
- Centre for Ethics, Law and Mental Health (CELAM), University of Gothenburg, Gothenburg, Sweden
- Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatics, Karolinska Institutet, Stockholm, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatics, Karolinska Institutet, Stockholm, Sweden
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