Early environmental factors and somatic comorbidity in schizophrenia and nonschizophrenic psychoses: A 50-year follow-up of the Northern Finland Birth Cohort 1966

Background.

We studied the cumulative incidence of physical illnesses, and the effect of early environmental factors (EEFs) on somatic comorbidity in schizophrenia, in nonschizophrenic psychosis and among nonpsychotic controls from birth up to the age of 50 years.

Methods.

The sample included 10,933 members of the Northern Finland Birth Cohort 1966, of whom, 227 had schizophrenia and 205 had nonschizophrenic psychosis. Diagnoses concerning physical illnesses were based on nationwide registers followed up to the end of 2016 and classified into 13 illness categories. Maternal education and age, family type at birth and paternal socioeconomic status were studied as EEFs of somatic illnesses.

Results.

When adjusted by gender and education, individuals and especially women with nonschizophrenic psychosis had higher risk of morbidity in almost all somatic illness categories compared to controls, and in some categories, compared to individuals with schizophrenia. The statistically significant adjusted hazard ratios varied from 1.27 to 2.42 in nonschizophrenic psychosis. Regarding EEFs, single-parent family as the family type at birth was a risk factor for a higher somatic score among men with schizophrenia and women with nonschizophrenic psychosis. Maternal age over 35 years was associated with lower somatic score among women with nonschizophrenic psychosis.

Conclusions.

Persons with nonschizophrenic psychoses have higher incidence of somatic diseases compared to people with schizophrenia and nonpsychotic controls, and this should be noted in clinical work. EEFs have mostly weak association with somatic comorbidity in our study.

Suicide following acute admissions for physical illnesses across England and Wales

BACKGROUND

The study aim was to establish and quantify suicide risk following acute admissions for all major physical illnesses, for confirmatory purposes, from two independent information sources from different countries.

METHODS

Record linkage of inpatient and death certificate data for 11 004 389 acute admissions for physical illnesses in England and 713 496 in Wales. The main outcome measure was standardised mortality ratios (SMRs) for suicide at 1 year following discharge from hospital.

RESULTS

There were 1781 suicides within 1 year of discharge in England (SMR = 1.7; 95% = 1.6-1.8) and 131 in Wales (SMR = 2.0; 1.7-2.3). Of 48 major physical illnesses that were associated with at least eight suicides in either country, there was high consistent suicide mortality (significant SMR >3) in both countries for constipation (SMR = 4.1 in England, 7.5 in Wales), gastritis (4.4 and 4.9) and upper gastrointestinal bleeding (3.4 and 4.5). There was high suicide mortality in one country for alcoholic liver disease, other liver disease and chronic pancreatitis; for epilepsy and Parkinson's disease; for diabetes, hypoglycaemia and hypo-osmolality & hyponatraemia; and for pneumonia, back pain and urinary tract infections.

CONCLUSIONS

There is little or no increased suicide mortality following acute admissions for most physical illnesses. Much of the increased suicide mortality relates to gastrointestinal disorders that are often alcohol related or specific chronic conditions, which may be linked to side effects from certain therapeutic medications. Acute hospital admissions for physical illnesses may therefore provide an opportunity for targeted suicide prevention among people with certain conditions, particularly alcohol related disorders.

Coexisting geriatric anxiety and depressive disorders may increase the risk of ischemic heart disease mortality-a nationwide longitudinal cohort study

OBJECTIVES

In the elderly, the risk of mortality because of physical illnesses related to anxiety disorders varies with potential confounding influences, including comorbidity with depressive disorders. Our study aimed to explore (i) whether anxiety disorders increase the risk of mortality in the elderly, and (ii) whether the risk of mortality mediated by anxiety and depressive disorders differs between physical illnesses.

METHODS

Our longitudinal cohort study included subjects aged over 60 years from the National Health Insurance Research Database. One thousand and eighty-six subjects with anxiety disorders and 50 554 control subjects without anxiety disorders were included. Propensity score-matched cohorts were analyzed. Rate ratios (RRs) were calculated for the risk of mortality associated with different physical illnesses with comorbidities of either anxiety disorders only or both anxiety and depressive disorders.

RESULTS

The risk of mortality in patients with anxiety disorders was significantly higher than controls, and was even higher when subjects had both anxiety and depressive disorder comorbidities. Furthermore, the co-occurrence of anxiety and depressive disorders increased the risk of mortality in elderly patients with ischemic heart diseases (RR = 1.60; 95% CI: 1.14-2.24).

CONCLUSIONS

Coexisting anxiety and depressive disorders could increase the risk of mortality in elderly patients with ischemic heart diseases. Copyright © 2016 John Wiley & Sons, Ltd.

Depression as a Risk Factor of Organic Diseases:An International Integrative Review

PURPOSE AND DESIGN

This integrative review offers a systematic synthesis of the international literature regarding the role of depression as a risk factor in physical illnesses and the mechanisms of this connection. Special attention is paid to those modifiable factors.

FINDINGS

Published studies of depression and physical illness and disease(N = 24) from five countries that were indexed in PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), APA PsycNET, Scopus, Dialnet, and CUIDEN were examined. Results suggest that depression is a significant risk factor for the development of physical illnesses and diseases. More commonly studied were the connections between depression and cardiovascular disease, metabolic syndrome, biochemical alterations, diabetes, dementia, cognitive impairment, Alzheimer's disease, somatization and chronic pain, asthma, arthritis, and hyperlipidemia. Less frequently studied conditions connected to depression were cancer, infections, allergies, autoimmune disease, gastric ulcer, rhinitis, thyroiditis, bronchitis, migraines, fractures, and osteoporosis.

CONCLUSIONS

Mechanisms connecting depression to physical illness appear to involve alterations in the hypothalamic-pituitary axis, unhealthy lifestyle, chronic or acute stressors including posttraumatic stress, an increase in C-reactive protein (CRP) in men, taking antidepressant medication, and social and emotional loneliness.

CLINICAL RELEVANCE

A good patient-provider relationship can help to promote decreased acute or chronic stressors, increased family and social support, decreased loneliness, modification of unhealthy lifestyles such as smoking, obesity, physical inactivity, alcohol, control of CRP, and antidepressant medication. Nurses are well placed to help prevent physical diseases through detection and referral of patients who are depressed or undiagnosed and not receiving adequate mental health treatment.

Coexisting anxiety disorders alter associations with physical disorders in the elderly: A Taiwan cross-sectional nationwide study

AIM

We used population-based analyses to explore whether anxiety disorders are associated with certain physical illnesses, as previous studies have suggested, and whether a greater number of comorbid anxiety disorders would influence physical illnesses in the elderly.

METHODS

Using the National Health Insurance Research Database, we included subjects aged over 60 years. The study included 954 subjects with anxiety disorders (as defined by the ICD-9-CM) and 4770 control subjects without anxiety disorders. Odds ratios (OR) were calculated for the risks of physical illnesses in both groups.

RESULTS

Subjects with anxiety disorders had higher OR for cardiovascular disease (OR = 1.33-2.80), cerebrovascular disease (OR = 2.07), peptic ulcer (OR = 3.41), and hyperlipidemia (OR = 2.99). Furthermore, a greater number of comorbid anxiety disorders may further increase the OR of the aforementioned physical illnesses, except for peripheral vascular disorder, when compared to those without anxiety disorders.

CONCLUSION

Elderly subjects with more anxiety disorders may be associated with vascular and metabolic problems. Clinicians should carefully assess the physical illnesses of elderly patients with anxiety disorders.

5-HTTLPR genotype, asthma, diabetes and late-life depression in an older French population

OBJECTIVE

Associations between environmental risk factors and depression have been reported to be stronger in people with the S allele of the S/L polymorphism in the serotonin transporter gene-linked promoter region (5-HTTLPR); however, most studies have focused on adverse life events as a general exposure, and interactions with physical disorders have been less investigated. We therefore investigated associations of asthma and diabetes with depression in an older community population and compared these by 5-HTTLPR genotype.

METHODS

A sample of 1617 people aged 65 years and over, from Montpellier, France, were examined for depression, using the Center for Epidemiologic Studies Depression Scale and Mini International Neuropsychiatric Interview assessments, and a standardised interview was conducted to establish physical health status. Blood samples were also taken for 5-HTTLPR genotype.

RESULTS

Depression was significantly associated with asthma and diabetes but not with 5-HTTLPR genotype. After adjustment for age, sex, education and co-residency, the association between asthma and depression did increase in strength and significance across genotype groups (odds ratios in LL, SL and SS genotypes: 1.59 (0.66-3.82), 1.88 (1.05-3.36) and 3.00 (1.26-7.13), respectively) although the interaction term fell below statistical significance (p = 0.29). No modification was observed for diabetes as an exposure.

CONCLUSIONS

The findings provided some support for effect modification by 5-HTTLPR genotype for asthma but for not diabetes as risk factors for depression.