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Arathimos R, Fabbri C, Vassos E, Davis KAS, Pain O, Gillett A, Coleman JRI, Hanscombe K, Hagenaars S, Jermy B, Corbett A, Ballard C, Aarsland D, Creese B, Lewis CM. Latent subtypes of manic and/or irritable episode symptoms in two population-based cohorts. Br J Psychiatry 2022; 221:722-731. [PMID: 35049489 DOI: 10.1192/bjp.2021.184] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Mood disorders are characterised by pronounced symptom heterogeneity, which presents a substantial challenge both to clinical practice and research. Identification of subgroups of individuals with homogeneous symptom profiles that cut across current diagnostic categories could provide insights in to the transdiagnostic relevance of individual symptoms, which current categorical diagnostic systems cannot impart. AIMS To identify groups of people with homogeneous clinical characteristics, using symptoms of manic and/or irritable mood, and explore differences between groups in diagnoses, functional outcomes and genetic liability. METHOD We used latent class analysis on eight binary self-reported symptoms of manic and irritable mood in the UK Biobank and PROTECT studies, to investigate how individuals formed latent subgroups. We tested associations between the latent classes and diagnoses of psychiatric disorders, sociodemographic characteristics and polygenic risk scores. RESULTS Five latent classes were derived in UK Biobank (N = 42 183) and were replicated in the independent PROTECT cohort (N = 4445), including 'minimally affected', 'inactive restless', active restless', 'focused creative' and 'extensively affected' individuals. These classes differed in disorder risk, polygenic risk score and functional outcomes. One class that experienced disruptive episodes of mostly irritable mood largely comprised cases of depression/anxiety, and a class of individuals with increased confidence/creativity reported comparatively lower disruptiveness and functional impairment. CONCLUSIONS Findings suggest that data-driven investigations of psychopathological symptoms that include sub-diagnostic threshold conditions can complement research of clinical diagnoses. Improved classification systems of psychopathology could investigate a weighted approach to symptoms, toward a more dimensional classification of mood disorders.
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Affiliation(s)
- Ryan Arathimos
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, UK
| | - Chiara Fabbri
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Evangelos Vassos
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, UK
| | - Katrina A S Davis
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, UK; and Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Oliver Pain
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, UK
| | - Alexandra Gillett
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Jonathan R I Coleman
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, UK
| | - Ken Hanscombe
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, UK
| | - Saskia Hagenaars
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Bradley Jermy
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, UK
| | - Anne Corbett
- Faculty of Medicine, Department of Medicine, Imperial College London, UK
| | - Clive Ballard
- Medical School, College of Medicine and Health, University of Exeter, UK
| | - Dag Aarsland
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and Centre for Age-Related Research, Stavanger University Hospital, Norway
| | - Byron Creese
- Medical School, College of Medicine and Health, University of Exeter, UK
| | - Cathryn M Lewis
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, UK; and Department of Medical and Molecular Genetics, Faculty of Life Sciences and Medicine, King's College London, UK
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Davis KAS, Carr E, Leightley D, Vitiello V, Bergin-Cartwright G, Lavelle G, Wickersham A, Malim MH, Oetzmann C, Polling C, Stevelink SAM, Razavi R, Hotopf M. Indicators of recent COVID-19 infection status: findings from a large occupational cohort of staff and postgraduate research students from a UK university. BMC Public Health 2022; 22:1514. [PMID: 35945541 PMCID: PMC9363143 DOI: 10.1186/s12889-022-13889-0] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 07/22/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Researchers conducting cohort studies may wish to investigate the effect of episodes of COVID-19 illness on participants. A definitive diagnosis of COVID-19 is not always available, so studies have to rely on proxy indicators. This paper seeks to contribute evidence that may assist the use and interpretation of these COVID-indicators. METHODS We described five potential COVID-indicators: self-reported core symptoms, a symptom algorithm; self-reported suspicion of COVID-19; self-reported external results; and home antibody testing based on a 'lateral flow' antibody (IgG/IgM) test cassette. Included were staff and postgraduate research students at a large London university who volunteered for the study and were living in the UK in June 2020. Excluded were those who did not return a valid antibody test result. We provide descriptive statistics of prevalence and overlap of the five indicators. RESULTS Core symptoms were the most common COVID-indicator (770/1882 participants positive, 41%), followed by suspicion of COVID-19 (n = 509/1882, 27%), a positive symptom algorithm (n = 298/1882, 16%), study antibody lateral flow positive (n = 124/1882, 7%) and a positive external test result (n = 39/1882, 2%), thus a 20-fold difference between least and most common. Meeting any one indicator increased the likelihood of all others, with concordance between 65 and 94%. Report of a low suspicion of having had COVID-19 predicted a negative antibody test in 98%, but positive suspicion predicted a positive antibody test in only 20%. Those who reported previous external antibody tests were more likely to have received a positive result from the external test (24%) than the study test (15%). CONCLUSIONS Our results support the use of proxy indicators of past COVID-19, with the caveat that none is perfect. Differences from previous antibody studies, most significantly in lower proportions of participants positive for antibodies, may be partly due to a decline in antibody detection over time. Subsequent to our study, vaccination may have further complicated the interpretation of COVID-indicators, only strengthening the need to critically evaluate what criteria should be used to define COVID-19 cases when designing studies and interpreting study results.
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Affiliation(s)
- Katrina A S Davis
- King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK.
- South London and Maudsley NHS Foundation Trust, London, UK.
| | - Ewan Carr
- King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Daniel Leightley
- King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Valentina Vitiello
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Gabriella Bergin-Cartwright
- King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Grace Lavelle
- King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Alice Wickersham
- King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Michael H Malim
- Faculty of Life Sciences and Medicine, King's College London School of Immunology & Microbial Sciences, London, UK
| | - Carolin Oetzmann
- King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Catherine Polling
- King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Sharon A M Stevelink
- King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Reza Razavi
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Matthew Hotopf
- King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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Arathimos R, Fabbri C, Vassos E, Davis KAS, Pain O, Gillett A, Coleman JRI, Hanscombe K, Hagenaars S, Jermy B, Corbett A, Ballard C, Aarsland D, Creese B, Lewis CM. Latent subtypes of manic and/or irritable episode symptoms in two population-based cohorts - ERRATUM. Br J Psychiatry 2022; 220:1-2. [PMID: 35193710 DOI: 10.1192/bjp.2022.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Davies MR, Buckman JEJ, Adey BN, Armour C, Bradley JR, Curzons SCB, Davies HL, Davis KAS, Goldsmith KA, Hirsch CR, Hotopf M, Hübel C, Jones IR, Kalsi G, Krebs G, Lin Y, Marsh I, McAtarsney-Kovacs M, McIntosh AM, Mundy J, Monssen D, Peel AJ, Rogers HC, Skelton M, Smith DJ, Ter Kuile A, Thompson KN, Veale D, Walters JTR, Zahn R, Breen G, Eley TC. Comparison of symptom-based versus self-reported diagnostic measures of anxiety and depression disorders in the GLAD and COPING cohorts. J Anxiety Disord 2022; 85:102491. [PMID: 34775166 DOI: 10.1016/j.janxdis.2021.102491] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 10/13/2021] [Accepted: 10/20/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Understanding and improving outcomes for people with anxiety or depression often requires large sample sizes. To increase participation and reduce costs, such research is typically unable to utilise "gold-standard" methods to ascertain diagnoses, instead relying on remote, self-report measures. AIMS Assess the comparability of remote diagnostic methods for anxiety and depression disorders commonly used in research. METHOD Participants from the UK-based GLAD and COPING NBR cohorts (N = 58,400) completed an online questionnaire between 2018 and 2020. Responses to detailed symptom reports were compared to DSM-5 criteria to generate symptom-based diagnoses of major depressive disorder (MDD), generalised anxiety disorder (GAD), specific phobia, social anxiety disorder, panic disorder, and agoraphobia. Participants also self-reported any prior diagnoses from health professionals, termed self-reported diagnoses. "Any anxiety" included participants with at least one anxiety disorder. Agreement was assessed by calculating accuracy, Cohen's kappa, McNemar's chi-squared, sensitivity, and specificity. RESULTS Agreement between diagnoses was moderate for MDD, any anxiety, and GAD, but varied by cohort. Agreement was slight to fair for the phobic disorders. Many participants with self-reported GAD did not receive a symptom-based diagnosis. In contrast, symptom-based diagnoses of the phobic disorders were more common than self-reported diagnoses. CONCLUSIONS Agreement for MDD, any anxiety, and GAD was higher for cases in the case-enriched GLAD cohort and for controls in the general population COPING NBR cohort. For anxiety disorders, self-reported diagnoses classified most participants as having GAD, whereas symptom-based diagnoses distributed participants more evenly across the anxiety disorders. Further validation against gold standard measures is required.
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Affiliation(s)
- Molly R Davies
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Joshua E J Buckman
- Centre for Outcomes Research and Effectiveness (CORE), Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London WC1E 7HB, UK; iCope - Camden and Islington Psychological Therapies Services, Camden & Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Brett N Adey
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Chérie Armour
- Stress, Trauma & Related Conditions (STARC) research lab, School of Psychology, Queens University Belfast (QUB), Belfast, Northern Ireland, UK
| | - John R Bradley
- NIHR BioResource, Cambridge University Hospitals, Cambridge Biomedical Campus, Cambridge, UK
| | - Susannah C B Curzons
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Helena L Davies
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Katrina A S Davis
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK; South London and Maudsley NHS Foundation Trust, Denmark Hill, Camberwell, London, UK
| | - Kimberley A Goldsmith
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Colette R Hirsch
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK; South London and Maudsley NHS Foundation Trust, Denmark Hill, Camberwell, London, UK
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK; South London and Maudsley NHS Foundation Trust, Denmark Hill, Camberwell, London, UK
| | - Christopher Hübel
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; National Centre for Register-based Research, Aarhus Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Ian R Jones
- National Centre for Mental Health, Division of Psychiatry and Clinical Neuroscience, Cardiff University, Cardiff, UK
| | - Gursharan Kalsi
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Georgina Krebs
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; South London and Maudsley NHS Foundation Trust, Denmark Hill, Camberwell, London, UK
| | - Yuhao Lin
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Ian Marsh
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Monika McAtarsney-Kovacs
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Andrew M McIntosh
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinurgh, UK
| | - Jessica Mundy
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Dina Monssen
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Alicia J Peel
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK
| | - Henry C Rogers
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Megan Skelton
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Daniel J Smith
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Abigail Ter Kuile
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Katherine N Thompson
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - David Veale
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK; South London and Maudsley NHS Foundation Trust, Denmark Hill, Camberwell, London, UK
| | - James T R Walters
- National Centre for Mental Health, Division of Psychiatry and Clinical Neuroscience, Cardiff University, Cardiff, UK
| | - Roland Zahn
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Gerome Breen
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Thalia C Eley
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK.
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Davis KAS, Mueller C, Ashworth M, Broadbent M, Jewel A, Molokhia M, Perera G, Stewart RJ. What gets recorded, counts: dementia recording in primary care compared with a specialist database. Age Ageing 2021; 50:2206-2213. [PMID: 34417796 PMCID: PMC8581382 DOI: 10.1093/ageing/afab164] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/21/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND databases of electronic health records are powerful tools for dementia research, but data can be influenced by incomplete recording. We examined whether people with dementia recorded in a specialist database (from a mental health and dementia care service) differ from those recorded in primary care. METHODS a retrospective cohort study of the population covered by Lambeth DataNet (primary care electronic records) between 2007 and 2019. Documentation of dementia diagnosis in primary care coded data and linked records in a specialist database (Clinical Records Interactive Search) were compared. RESULTS 3,859 people had dementia documented in primary care codes and 4,266 in the specialist database, with 2,886/5,239 (55%) documented in both sources. Overall, 55% were labelled as having Alzheimer's dementia and 29% were prescribed dementia medication, but these proportions were significantly higher in those documented in both sources. The cohort identified from the specialist database were less likely to live in a care home (prevalence ratio 0.73, 95% confidence interval 0.63-0.85), have multimorbidity (0.87, 0.77-0.98) or consult frequently (0.91, 0.88-0.95) than those identified through primary care codes, although mortality did not differ (0.98, 0.91-1.06). DISCUSSION there is under-recording of dementia diagnoses in both primary care and specialist databases. This has implications for clinical care and for generalizability of research. Our results suggest that using a mental health database may under-represent those patients who have more frailty, reflecting differential referral to mental health services, and demonstrating how the patient pathways are an important consideration when undertaking database studies.
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Affiliation(s)
- Katrina A S Davis
- King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Christoph Mueller
- King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Mark Ashworth
- King's College London Population Health Sciences, London, UK
| | | | - Amelia Jewel
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Mariam Molokhia
- King's College London Population Health Sciences, London, UK
| | - Gayan Perera
- King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Robert J Stewart
- King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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Coleman JRI, Peyrot WJ, Purves KL, Davis KAS, Rayner C, Choi SW, Hübel C, Gaspar HA, Kan C, Van der Auwera S, Adams MJ, Lyall DM, Choi KW, Dunn EC, Vassos E, Danese A, Maughan B, Grabe HJ, Lewis CM, O'Reilly PF, McIntosh AM, Smith DJ, Wray NR, Hotopf M, Eley TC, Breen G. Correction: Genome-wide gene-environment analyses of major depressive disorder and reported lifetime traumatic experiences in UK Biobank. Mol Psychiatry 2021; 26:5465. [PMID: 32424234 DOI: 10.1038/s41380-020-0779-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Jonathan R I Coleman
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
| | - Wouter J Peyrot
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Kirstin L Purves
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Katrina A S Davis
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Christopher Rayner
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Shing Wan Choi
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Christopher Hübel
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
| | - Héléna A Gaspar
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
| | - Carol Kan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sandra Van der Auwera
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | | | - Donald M Lyall
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Karmel W Choi
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Stanley Center for Psychiatric Research, The Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Erin C Dunn
- Stanley Center for Psychiatric Research, The Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Evangelos Vassos
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
| | - Andrea Danese
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- National and Specialist CAMHS Trauma and Anxiety Clinic, South London and Maudsley NHS Foundation Trust, London, UK
| | - Barbara Maughan
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Hans J Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Cathryn M Lewis
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
| | - Paul F O'Reilly
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Daniel J Smith
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Naomi R Wray
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Matthew Hotopf
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Thalia C Eley
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK.
| | - Gerome Breen
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK.
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Davis KAS, Bishara D, Molokhia M, Mueller C, Perera G, Stewart RJ. Aspirin in people with dementia, long-term benefits, and harms: a systematic review. Eur J Clin Pharmacol 2021; 77:943-954. [PMID: 33483830 PMCID: PMC8184554 DOI: 10.1007/s00228-021-03089-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/11/2021] [Indexed: 01/29/2023]
Abstract
PURPOSE People with dementia may have indications for aspirin prescription and clinicians are asked to balance the potential risks against benefits. This review examines the evidence for the risk and benefit of long-term aspirin use in people with dementia aged over 65 years, including randomised controlled trials and observational studies. METHODS We searched three databases for research published between 2007 and 2020. Each eligible article was assessed for risk of bias, and confidence in findings was rated using Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS Four papers met inclusion criteria: one randomised controlled trial, two cohort studies, and one with pooled data. All looked only at dementia of Alzheimer's type, and none addressed myocardial or cerebral infarction as outcomes. Dementia progression was reported by two studies, with conflicting results. The trial found no significant effect of aspirin on mortality (odds ratio aspirin vs. no aspirin 1.07, 95% confidence interval 0.58-1.97) but found more events of severe bleeding with aspirin (OR aspirin vs. no aspirin 6.9, 1.5-31.2). An excess in intracranial haemorrhage in the aspirin group was judged plausible based on two non-randomised studies. CONCLUSIONS The review findings are limited because studies include only people with Alzheimer's-type dementia and lack confirmatory studies, although an increased risk of bleeding events is recognised. Further research that addresses the benefits and risks of aspirin in more representative groups of people with dementia is needed to guide prescribing decisions.
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Affiliation(s)
- Katrina A S Davis
- King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK.
- South London and Maudsley NHS Foundation Trust, London, UK.
| | - Delia Bishara
- King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Mariam Molokhia
- King's College London Population Health Sciences, London, UK
| | - Christoph Mueller
- King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Gayan Perera
- King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Robert J Stewart
- King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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8
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Adams MJ, Hill WD, Howard DM, Dashti HS, Davis KAS, Campbell A, Clarke TK, Deary IJ, Hayward C, Porteous D, Hotopf M, McIntosh AM. Factors associated with sharing e-mail information and mental health survey participation in large population cohorts. Int J Epidemiol 2021; 49:410-421. [PMID: 31263887 PMCID: PMC7266553 DOI: 10.1093/ije/dyz134] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND People who opt to participate in scientific studies tend to be healthier, wealthier and more educated than the broader population. Although selection bias does not always pose a problem for analysing the relationships between exposures and diseases or other outcomes, it can lead to biased effect size estimates. Biased estimates may weaken the utility of genetic findings because the goal is often to make inferences in a new sample (such as in polygenic risk score analysis). METHODS We used data from UK Biobank, Generation Scotland and Partners Biobank and conducted phenotypic and genome-wide association analyses on two phenotypes that reflected mental health data availability: (i) whether participants were contactable by e-mail for follow-up; and (ii) whether participants responded to follow-up surveys of mental health. RESULTS In UK Biobank, we identified nine genetic loci associated (P <5 × 10-8) with e-mail contact and 25 loci associated with mental health survey completion. Both phenotypes were positively genetically correlated with higher educational attainment and better health and negatively genetically correlated with psychological distress and schizophrenia. One single nucleotide polymorphism association replicated along with the overall direction of effect of all association results. CONCLUSIONS Re-contact availability and follow-up participation can act as further genetic filters for data on mental health phenotypes.
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Affiliation(s)
- Mark J Adams
- Division of Psychiatry, Royal Edinburgh Hospital, Edinburgh, UK
| | - W David Hill
- Centre for Cognitive Ageing and Cognitive Epidemiology, Edinburgh, UK.,Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - David M Howard
- Division of Psychiatry, Royal Edinburgh Hospital, Edinburgh, UK.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Hassan S Dashti
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Katrina A S Davis
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK.,NIHR Biomedical Research Centre, London, UK
| | - Archie Campbell
- Centre for Genomic and Experimental Medicine, Institute of Genetics & Molecular Medicine, Edinburgh, UK.,Usher Institute for Population Health Sciences and Informatics, Edinburgh, UK
| | - Toni-Kim Clarke
- Division of Psychiatry, Royal Edinburgh Hospital, Edinburgh, UK
| | - Ian J Deary
- Centre for Cognitive Ageing and Cognitive Epidemiology, Edinburgh, UK.,Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Caroline Hayward
- MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - David Porteous
- Centre for Cognitive Ageing and Cognitive Epidemiology, Edinburgh, UK.,Centre for Genomic and Experimental Medicine, Institute of Genetics & Molecular Medicine, Edinburgh, UK
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK.,NIHR Biomedical Research Centre, London, UK
| | - Andrew M McIntosh
- Division of Psychiatry, Royal Edinburgh Hospital, Edinburgh, UK.,Centre for Cognitive Ageing and Cognitive Epidemiology, Edinburgh, UK
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9
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Purves KL, Coleman JRI, Meier SM, Rayner C, Davis KAS, Cheesman R, Bækvad-Hansen M, Børglum AD, Wan Cho S, Jürgen DJ, Gaspar HA, Bybjerg-Grauholm J, Hettema JM, Hotopf M, Hougaard D, Hübel C, Kan C, McIntosh AM, Mors O, Bo Mortensen P, Nordentoft M, Werge T, Nicodemus KK, Mattheisen M, Breen G, Eley TC. A major role for common genetic variation in anxiety disorders. Mol Psychiatry 2020; 25:3292-3303. [PMID: 31748690 PMCID: PMC7237282 DOI: 10.1038/s41380-019-0559-1] [Citation(s) in RCA: 154] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 07/18/2019] [Accepted: 08/19/2019] [Indexed: 01/05/2023]
Abstract
Anxiety disorders are common, complex psychiatric disorders with twin heritabilities of 30-60%. We conducted a genome-wide association study of Lifetime Anxiety Disorder (ncase = 25 453, ncontrol = 58 113) and an additional analysis of Current Anxiety Symptoms (ncase = 19 012, ncontrol = 58 113). The liability scale common variant heritability estimate for Lifetime Anxiety Disorder was 26%, and for Current Anxiety Symptoms was 31%. Five novel genome-wide significant loci were identified including an intergenic region on chromosome 9 that has previously been associated with neuroticism, and a locus overlapping the BDNF receptor gene, NTRK2. Anxiety showed significant positive genetic correlations with depression and insomnia as well as coronary artery disease, mirroring findings from epidemiological studies. We conclude that common genetic variation accounts for a substantive proportion of the genetic architecture underlying anxiety.
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Affiliation(s)
- Kirstin L. Purves
- King’s College London; Social, Genetic and Developmental Psychiatry Centre; Institute of Psychiatry, Psychology & Neuroscience; London, UK
| | - Jonathan R. I. Coleman
- King’s College London; Social, Genetic and Developmental Psychiatry Centre; Institute of Psychiatry, Psychology & Neuroscience; London, UK.,NIHR Biomedical Research Centre; South London and Maudsley NHS Trust; London, UK
| | - Sandra M. Meier
- Child and Adolescent Mental Health Centre–Mental Health Services Capital Region; Copenhagen Region; Denmark,Psychosis Research Unit, Aarhus University Hospital, Risskov, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark
| | - Christopher Rayner
- King’s College London; Social, Genetic and Developmental Psychiatry Centre; Institute of Psychiatry, Psychology & Neuroscience; London, UK
| | - Katrina A. S. Davis
- NIHR Biomedical Research Centre; South London and Maudsley NHS Trust; London, UK.,King’s College London; Institute of Psychiatry, Psychology & Neuroscience; London, UK
| | - Rosa Cheesman
- King’s College London; Social, Genetic and Developmental Psychiatry Centre; Institute of Psychiatry, Psychology & Neuroscience; London, UK
| | - Marie Bækvad-Hansen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark,Danish Centre for Neonatal Screening, Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - Anders D. Børglum
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark,Department of Biomedicine, Aarhus University, Aarhus C, Denmark,Centre for integrative Sequencing (iSEQ), Aarhus University, Aarhus C, Denmark
| | - Shing Wan Cho
- King’s College London; Social, Genetic and Developmental Psychiatry Centre; Institute of Psychiatry, Psychology & Neuroscience; London, UK
| | - Deckert J. Jürgen
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital Würzburg, Würzburg, Germany
| | - Héléna A. Gaspar
- King’s College London; Social, Genetic and Developmental Psychiatry Centre; Institute of Psychiatry, Psychology & Neuroscience; London, UK.,NIHR Biomedical Research Centre; South London and Maudsley NHS Trust; London, UK
| | - Jonas Bybjerg-Grauholm
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark,Danish Centre for Neonatal Screening, Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - John M. Hettema
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - Matthew Hotopf
- NIHR Biomedical Research Centre; South London and Maudsley NHS Trust; London, UK.,King’s College London; Institute of Psychiatry, Psychology & Neuroscience; London, UK
| | - David Hougaard
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark,Danish Centre for Neonatal Screening, Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - Christopher Hübel
- King’s College London; Social, Genetic and Developmental Psychiatry Centre; Institute of Psychiatry, Psychology & Neuroscience; London, UK.,NIHR Biomedical Research Centre; South London and Maudsley NHS Trust; London, UK.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Carol Kan
- King’s College London; Psychological Medicine; Institute of Psychiatry, Psychology & Neuroscience; London, UK
| | - Andrew M. McIntosh
- Division of Psychiatry, Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK,MRC Centre for Cognitive Ageing and Cognitive Epidemiology, Edinburgh, UK
| | - Ole Mors
- Psychosis Research Unit, Aarhus University Hospital, Risskov, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark
| | - Preben Bo Mortensen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark,Centre for integrative Sequencing (iSEQ), Aarhus University, Aarhus C, Denmark,National Centre for Register-Based Research, Aarhus University, Aarhus C, Denmark
| | - Merete Nordentoft
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark,Mental Health Centre Copenhagen, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Werge
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark,Institute of Biological Psychiatry, Mental Health Centre Sct. Hans, Copenhagen University Hospital, Roskilde, Denmark,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kristin K. Nicodemus
- Centre for Genomic and Experimental Medicine, MRC Institute of Genetics & Molecular Medicine, The University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Manuel Mattheisen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Denmark,Department of Biomedicine, Aarhus University, Aarhus C, Denmark,Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital Würzburg, Würzburg, Germany,Department of Clinical Neuroscience, Centre for Psychiatric Research, Karolinska Institutet, Stockholm, Sweden
| | - Gerome Breen
- King's College London; Social, Genetic and Developmental Psychiatry Centre; Institute of Psychiatry, Psychology & Neuroscience, London, UK. .,NIHR Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK.
| | - Thalia C. Eley
- King’s College London; Social, Genetic and Developmental Psychiatry Centre; Institute of Psychiatry, Psychology & Neuroscience; London, UK.,NIHR Biomedical Research Centre; South London and Maudsley NHS Trust; London, UK
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10
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Mansour H, Mueller C, Davis KAS, Burton A, Shetty H, Hotopf M, Osborn D, Stewart R, Sommerlad A. Severe mental illness diagnosis in English general hospitals 2006-2017: A registry linkage study. PLoS Med 2020; 17:e1003306. [PMID: 32941435 PMCID: PMC7498001 DOI: 10.1371/journal.pmed.1003306] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 07/21/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The higher mortality rates in people with severe mental illness (SMI) may be partly due to inadequate integration of physical and mental healthcare. Accurate recording of SMI during hospital admissions has the potential to facilitate integrated care including tailoring of treatment to account for comorbidities. We therefore aimed to investigate the sensitivity of SMI recording within general hospitals, changes in diagnostic accuracy over time, and factors associated with accurate recording. METHODS AND FINDINGS We undertook a cohort study of 13,786 adults with SMI diagnosed during 2006-2017, using data from a large secondary mental healthcare database as reference standard, linked to English national records for 45,706 emergency hospital admissions. We examined general hospital record sensitivity across patients' subsequent hospital records, for each subsequent emergency admission, and at different levels of diagnostic precision. We analyzed time trends during the study period and used logistic regression to examine sociodemographic and clinical factors associated with psychiatric recording accuracy, with multiple imputation for missing data. Sensitivity for recording of SMI as any mental health diagnosis was 76.7% (95% CI 76.0-77.4). Category-level sensitivity (e.g., proportion of individuals with schizophrenia spectrum disorders (F20-29) who received any F20-29 diagnosis in hospital records) was 56.4% (95% CI 55.4-57.4) for schizophrenia spectrum disorder and 49.7% (95% CI 48.1-51.3) for bipolar affective disorder. Sensitivity for SMI recording in emergency admissions increased from 47.8% (95% CI 43.1-52.5) in 2006 to 75.4% (95% CI 68.3-81.4) in 2017 (ptrend < 0.001). Minority ethnicity, being married, and having better mental and physical health were associated with less accurate diagnostic recording. The main limitation of our study is the potential for misclassification of diagnosis in the reference-standard mental healthcare data. CONCLUSIONS Our findings suggest that there have been improvements in recording of SMI diagnoses, but concerning under-recording, especially in minority ethnic groups, persists. Training in culturally sensitive diagnosis, expansion of liaison psychiatry input in general hospitals, and improved data sharing between physical and mental health services may be required to reduce inequalities in diagnostic practice.
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Affiliation(s)
- Hassan Mansour
- Division of Psychiatry, University College London, United Kingdom
| | - Christoph Mueller
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Katrina A. S. Davis
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Alexandra Burton
- Division of Psychiatry, University College London, United Kingdom
| | - Hitesh Shetty
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Matthew Hotopf
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - David Osborn
- Division of Psychiatry, University College London, United Kingdom
- Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Robert Stewart
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Andrew Sommerlad
- Division of Psychiatry, University College London, United Kingdom
- Camden and Islington NHS Foundation Trust, London, United Kingdom
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11
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Coleman JRI, Peyrot WJ, Purves KL, Davis KAS, Rayner C, Choi SW, Hübel C, Gaspar HA, Kan C, Van der Auwera S, Adams MJ, Lyall DM, Choi KW, Dunn EC, Vassos E, Danese A, Maughan B, Grabe HJ, Lewis CM, O'Reilly PF, McIntosh AM, Smith DJ, Wray NR, Hotopf M, Eley TC, Breen G. Genome-wide gene-environment analyses of major depressive disorder and reported lifetime traumatic experiences in UK Biobank. Mol Psychiatry 2020; 25:1430-1446. [PMID: 31969693 PMCID: PMC7305950 DOI: 10.1038/s41380-019-0546-6] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 07/20/2019] [Accepted: 08/19/2019] [Indexed: 02/01/2023]
Abstract
Depression is more frequent among individuals exposed to traumatic events. Both trauma exposure and depression are heritable. However, the relationship between these traits, including the role of genetic risk factors, is complex and poorly understood. When modelling trauma exposure as an environmental influence on depression, both gene-environment correlations and gene-environment interactions have been observed. The UK Biobank concurrently assessed Major Depressive Disorder (MDD) and self-reported lifetime exposure to traumatic events in 126,522 genotyped individuals of European ancestry. We contrasted genetic influences on MDD stratified by reported trauma exposure (final sample size range: 24,094-92,957). The SNP-based heritability of MDD with reported trauma exposure (24%) was greater than MDD without reported trauma exposure (12%). Simulations showed that this is not confounded by the strong, positive genetic correlation observed between MDD and reported trauma exposure. We also observed that the genetic correlation between MDD and waist circumference was only significant in individuals reporting trauma exposure (rg = 0.24, p = 1.8 × 10-7 versus rg = -0.05, p = 0.39 in individuals not reporting trauma exposure, difference p = 2.3 × 10-4). Our results suggest that the genetic contribution to MDD is greater when reported trauma is present, and that a complex relationship exists between reported trauma exposure, body composition, and MDD.
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Affiliation(s)
- Jonathan R I Coleman
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
| | - Wouter J Peyrot
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | - Kirstin L Purves
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Katrina A S Davis
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Christopher Rayner
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Shing Wan Choi
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Christopher Hübel
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
| | - Héléna A Gaspar
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
| | - Carol Kan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sandra Van der Auwera
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | | | - Donald M Lyall
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Karmel W Choi
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Stanley Center for Psychiatric Research, The Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Erin C Dunn
- Stanley Center for Psychiatric Research, The Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Evangelos Vassos
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
| | - Andrea Danese
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- National and Specialist CAMHS Trauma and Anxiety Clinic, South London and Maudsley NHS Foundation Trust, London, UK
| | - Barbara Maughan
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Hans J Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Cathryn M Lewis
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
| | - Paul F O'Reilly
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Daniel J Smith
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Naomi R Wray
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD, Australia
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Matthew Hotopf
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Thalia C Eley
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK.
| | - Gerome Breen
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Trust, London, UK.
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12
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Campos AI, Verweij KJH, Statham DJ, Madden PAF, Maciejewski DF, Davis KAS, John A, Hotopf M, Heath AC, Martin NG, Rentería ME. Genetic aetiology of self-harm ideation and behaviour. Sci Rep 2020; 10:9713. [PMID: 32546850 PMCID: PMC7297971 DOI: 10.1038/s41598-020-66737-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 05/11/2020] [Indexed: 12/21/2022] Open
Abstract
Family studies have identified a heritable component to self-harm that is partially independent from comorbid psychiatric disorders. However, the genetic aetiology of broad sense (non-suicidal and suicidal) self-harm has not been characterised on the molecular level. In addition, controversy exists about the degree to which suicidal and non-suicidal self-harm share a common genetic aetiology. In the present study, we conduct genome-wide association studies (GWAS) on lifetime self-harm ideation and self-harm behaviour (i.e. any lifetime self-harm act regardless of suicidal intent) using data from the UK Biobank (n > 156,000). We also perform genome wide gene-based tests and characterize the SNP heritability and genetic correlations between these traits. Finally, we test whether polygenic risk scores (PRS) for self-harm ideation and self-harm behaviour predict suicide attempt, suicide thoughts and non-suicidal self-harm (NSSH) in an independent target sample of 8,703 Australian adults. Our GWAS results identified one genome-wide significant locus associated with each of the two phenotypes. SNP heritability (hsnp2) estimates were ~10%, and both traits were highly genetically correlated (LDSC rg > 0.8). Gene-based tests identified seven genes associated with self-harm ideation and four with self-harm behaviour. Furthermore, in the target sample, PRS for self-harm ideation were significantly associated with suicide thoughts and NSSH, and PRS for self-harm behaviour predicted suicide thoughts and suicide attempt. Follow up regressions identified a shared genetic aetiology between NSSH and suicide thoughts, and between suicide thoughts and suicide attempt. Evidence for shared genetic aetiology between NSSH and suicide attempt was not statistically significant.
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Affiliation(s)
- Adrian I Campos
- Department of Genetics & Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia.
- Faculty of Medicine, The University of Queensland, Herston, QLD, Australia.
| | - Karin J H Verweij
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, the Netherlands
| | - Dixie J Statham
- Discipline of Psychology, School of Health and Life Sciences, Federation University, Ballarat, VIC, 3550, Australia
| | - Pamela A F Madden
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Dominique F Maciejewski
- Department of Developmental Psychopathology, Behavioural Science Institute, Nijmegen, the Netherlands
| | - Katrina A S Davis
- KCL Institute of Psychiatry, Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Ann John
- HDRUK, Swansea University Medical School, Swansea, UK
| | - Matthew Hotopf
- KCL Institute of Psychiatry, Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Andrew C Heath
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Nicholas G Martin
- Department of Genetics & Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia
| | - Miguel E Rentería
- Department of Genetics & Computational Biology, QIMR Berghofer Medical Research Institute, Brisbane, QLD 4006, Australia.
- Faculty of Medicine, The University of Queensland, Herston, QLD, Australia.
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Dregan A, Rayner L, Davis KAS, Bakolis I, Arias de la Torre J, Das-Munshi J, Hatch SL, Stewart R, Hotopf M. Associations Between Depression, Arterial Stiffness, and Metabolic Syndrome Among Adults in the UK Biobank Population Study: A Mediation Analysis. JAMA Psychiatry 2020; 77:598-606. [PMID: 31995135 PMCID: PMC6990710 DOI: 10.1001/jamapsychiatry.2019.4712] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 12/01/2019] [Indexed: 02/06/2023]
Abstract
Importance Previous research has linked a history of depression with arterial stiffness (AS) during midlife. Objective To assess the association of depression with elevated midlife AS and to investigate the extent to which this association is mediated via metabolic syndrome (MetS). Design, Settings, and Participants This population-based retrospective cohort study analyzed data collected between March 2006 and December 2010 from 124 445 participants aged 40 to 69 years from the UK Biobank. Participants without data on AS at baseline (n = 332 780) or who reported a previous diagnosis of cardiovascular disease (n = 45 374) were not eligible. Data analysis was performed from May to August 2019. Exposures Lifetime history of depression was assessed via verbal interview and linked hospital-based clinical depression diagnosis. Metabolic syndrome was defined as the presence of 3 or more of hypertension, dyslipidemia, hyperglycemia, hypertriglyceridemia, and unhealthy waist circumference. Main Outcomes and Measures Peripherally assessed AS index (ASI) using digital photoplethysmography. Results Of 124 445 included participants with ASI assessed, 71 799 (57.7%) were women, and the mean (SD) age was 56 (8) years. A total of 10 304 participants (8.3%) reported a history of depression. Study findings indicated a significant direct association between depression and ASI levels (β = 0.25; 95% CI, 0.17-0.32). A significant indirect association was also observed between depression and ASI levels (β = 0.10; 95% CI, 0.07-0.13), indicating that 29% of the association of depression with ASI was mediated by MetS. The proportion of mediation increased to 37% when C-reactive protein was added to the MetS criteria (direct association: β = 0.21; 95% CI, 0.15-0.28; indirect association: β = 0.13; 95% CI, 0.10-0.17). Concerning components of MetS, the strongest indirect association was for waist circumference, accounting for 25% of the association between depression and ASI levels (direct association: β = 0.26; 95% CI, 0.18-0.34; indirect association: β = 0.09; 95% CI, 0.06-0.11). Among men, hypertriglyceridemia accounted for 19% of the association between depression and ASI (direct association: β = 0.22; 95% CI, 0.05-0.40; indirect association: β = 0.05; 95% CI, 0.02-0.08). Conclusions and Relevance One-third of the association of depression with elevated ASI levels during midlife may be accounted for by combined MetS and inflammatory processes. Unhealthy waist circumference and hypertriglyceridemia emerged as the most important potential targets for preventive interventions within women and men, respectively.
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Affiliation(s)
- Alex Dregan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
| | - Lauren Rayner
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
| | - Katrina A. S. Davis
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
| | - Ioannis Bakolis
- Biostatistics and Health Informatics, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
- Centre for Implementation Science, Health Services and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
| | - Jorge Arias de la Torre
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
| | - Jayati Das-Munshi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
| | - Stephani L. Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
| | - Robert Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
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Davis KAS, Farooq S, Hayes JF, John A, Lee W, MacCabe JH, McIntosh A, Osborn DPJ, Stewart RJ, Woelbert E. Pharmacoepidemiology research: delivering evidence about drug safety and effectiveness in mental health. Lancet Psychiatry 2020; 7:363-370. [PMID: 31780306 DOI: 10.1016/s2215-0366(19)30298-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 07/19/2019] [Accepted: 07/29/2019] [Indexed: 12/13/2022]
Abstract
Research that provides an evidence base for the pharmacotherapy of people with mental disorders is needed. The abundance of digital data has facilitated pharmacoepidemiology and, in particular, observational research on the effectiveness of real-world medication. Advantages of pharmacoepidemiological research are the availability of large patient samples, and coverage of under-researched subpopulations in their naturalistic conditions. Such research is also cheaper and quicker to do than randomised controlled trials, meaning that issues regarding generic medication, stopping medication (deprescribing), and long-term outcomes are more likely to be addressed. Pharmacoepidemiological methods can also be extended to pharmacovigilance and to aid the development of new purposes for existing drugs. Drawbacks of observational pharmacoepidemiological studies come from the non-randomised nature of treatment selection, leading to confounding by indication. Potential methods for managing this drawback include active comparison groups, within-individual designs, and propensity scoring. Many of the more rigorous pharmacoepidemiology studies have been strengthened through multiple analytical approaches triangulated to improve confidence in inferred causal relationships. With developments in data resources and analytical techniques, it is encouraging that guidelines are beginning to include evidence from robust observational pharmacoepidemiological studies alongside randomised controlled trials. Collaboration between guideline writers and researchers involved in pharmacoepidemiology could help researchers to answer the questions that are important to policy makers and ensure that results are integrated into the evidence base. Further development of statistical and data science techniques, alongside public engagement and capacity building (data resources and researcher base), will be necessary to take full advantage of future opportunities.
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Affiliation(s)
- Katrina A S Davis
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK.
| | - Saeed Farooq
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire, UK
| | - Joseph F Hayes
- Camden and Islington NHS Foundation Trust, London, UK; Division of Psychiatry, University College London, London, UK
| | - Ann John
- Health Data Research UK Institute of Health Informatics Research, Swansea University Medical School, Swansea, UK
| | - William Lee
- University of Exeter Medical School, Exeter, UK
| | - James H MacCabe
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - Andrew McIntosh
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - David P J Osborn
- Camden and Islington NHS Foundation Trust, London, UK; Division of Psychiatry, University College London, London, UK
| | - Robert J Stewart
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
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Davis KAS, Bishara D, Perera G, Molokhia M, Rajendran L, Stewart RJ. Benefits and Harms of Statins in People with Dementia: A Systematic Review and Meta-Analysis. J Am Geriatr Soc 2020; 68:650-658. [PMID: 32039479 DOI: 10.1111/jgs.16342] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 12/22/2019] [Accepted: 12/30/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVES More people with dementia also fall into the category of high vascular risk, for which a statin is usually prescribed. However, these recommendations are based on studies in people without dementia. We aimed to evaluate the evidence for the long-term effectiveness and harm of statin therapy in patients with dementia. DESIGN Systematic review of randomized controlled trials and observational research. SETTING Publications from developed countries indexed in the PubMed, Web of Science, and Cochrane trial database between 2007 and 2019. PARTICIPANTS Trials including people with all types of dementia with a mean age older than 65 years. INTERVENTION Treatment with a statin for 6 months or longer. MEASUREMENTS Major adverse cardiovascular events, dementia progression, and general health at 2 years, or medication adverse events (AEs) at any time. Each article was assessed for bias using the Newcastle-Ottawa or Cochrane Collaboration tools. A narrative synthesis and pooled analyses are reported. RESULTS Five articles met the inclusion criteria. They reported only on dementia of the Alzheimer's type. There was no evidence regarding cardiovascular events or general health. We made a very low confidence finding that statins reduce dementia progression based on three cohort studies of heterogeneous design. We made a very low confidence finding of no significant difference in AEs based on two randomized controlled trials of 18 months: odds ratios of any AE = 1.21 (95% confidence interval [CI] = .83-1.77), serious AE = 1.03 (95% CI = .76-1.87), and death = 1.69 (95% CI = .79-3.62). CONCLUSION Evidence was insufficient to fully evaluate the efficacy of statins in people with dementia. We found that statins may have a small benefit delaying progression in Alzheimer's dementia, although this conflicted with previous findings from shorter randomized trials. For safety, the trial data lacked power to show clinically important differences between the groups. We recommend that clinical data be leveraged for further observational studies to inform prescribing decisions. J Am Geriatr Soc 68:650-658, 2020.
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Affiliation(s)
- Katrina A S Davis
- King's College London (KCL) Institute of Psychiatry, Psychology and Neuroscience, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Delia Bishara
- King's College London (KCL) Institute of Psychiatry, Psychology and Neuroscience, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Gayan Perera
- King's College London (KCL) Institute of Psychiatry, Psychology and Neuroscience, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Mariam Molokhia
- King's College London (KCL) School of Population Health and Environmental Sciences, London, UK
| | - Lawrence Rajendran
- King's College London (KCL) Institute of Psychiatry, Psychology and Neuroscience, London, UK.,UK Dementia Research Institute, multisite, UK
| | - Robert J Stewart
- King's College London (KCL) Institute of Psychiatry, Psychology and Neuroscience, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
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16
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Davis KAS, Coleman JRI, Adams M, Allen N, Breen G, Cullen B, Dickens C, Fox E, Graham N, Holliday J, Howard LM, John A, Lee W, McCabe R, McIntosh A, Pearsall R, Smith DJ, Sudlow C, Ward J, Zammit S, Hotopf M. Mental health in UK Biobank - development, implementation and results from an online questionnaire completed by 157 366 participants: a reanalysis. BJPsych Open 2020; 6:e18. [PMID: 32026800 PMCID: PMC7176892 DOI: 10.1192/bjo.2019.100] [Citation(s) in RCA: 148] [Impact Index Per Article: 37.0] [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] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND UK Biobank is a well-characterised cohort of over 500 000 participants including genetics, environmental data and imaging. An online mental health questionnaire was designed for UK Biobank participants to expand its potential. AIMS Describe the development, implementation and results of this questionnaire. METHOD An expert working group designed the questionnaire, using established measures where possible, and consulting a patient group. Operational criteria were agreed for defining likely disorder and risk states, including lifetime depression, mania/hypomania, generalised anxiety disorder, unusual experiences and self-harm, and current post-traumatic stress and hazardous/harmful alcohol use. RESULTS A total of 157 366 completed online questionnaires were available by August 2017. Participants were aged 45-82 (53% were ≥65 years) and 57% women. Comparison of self-reported diagnosed mental disorder with a contemporary study shows a similar prevalence, despite respondents being of higher average socioeconomic status. Lifetime depression was a common finding, with 24% (37 434) of participants meeting criteria and current hazardous/harmful alcohol use criteria were met by 21% (32 602), whereas other criteria were met by less than 8% of the participants. There was extensive comorbidity among the syndromes. Mental disorders were associated with a high neuroticism score, adverse life events and long-term illness; addiction and bipolar affective disorder in particular were associated with measures of deprivation. CONCLUSIONS The UK Biobank questionnaire represents a very large mental health survey in itself, and the results presented here show high face validity, although caution is needed because of selection bias. Built into UK Biobank, these data intersect with other health data to offer unparalleled potential for crosscutting biomedical research involving mental health.
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Affiliation(s)
- Katrina A S Davis
- Researcher, Institute of Psychiatry, Psychology and Neuroscience, King's College London; and South London and Maudsley NHS Foundation Trust, NIHR Biomedical Research Centre, UK
| | - Jonathan R I Coleman
- Lecturer in Statistical Genetics, Institute of Psychiatry, Psychology and Neuroscience, King's College London; and South London and Maudsley NHS Foundation Trust, NIHR Biomedical Research Centre, UK
| | - Mark Adams
- Data Scientist, Division of Psychiatry, University of Edinburgh, UK
| | - Naomi Allen
- Professor, University of Oxford; and Chief Scientist, UK Biobank, Nuffield Department of Population Health, University of Oxford Big Data Institute, UK
| | - Gerome Breen
- Professor of Psychiatric Genetics, Institute of Psychiatry, Psychology and Neuroscience, King's College London; and South London and Maudsley NHS Foundation Trust, NIHR Biomedical Research Centre, UK
| | - Breda Cullen
- Senior Lecturer, Institute of Health and Wellbeing, University of Glasgow, UK
| | - Chris Dickens
- Professor of Psychological Medicine, Institute of Health Research, University of Exeter Medical School, University of Exeter, UK
| | - Elaine Fox
- Professor of Psychology and Affective Neuroscience, Department of Experimental Psychology, University of Oxford, UK
| | - Nick Graham
- Clinical Lecturer in General Psychiatry, Institute of Health and Wellbeing, University of Glasgow, UK
| | - Jo Holliday
- Senior Research Facilitator, University of Oxford; and UK Biobank: UK Biobank, Nuffield Department of Population Health, University of Oxford Big Data Institute, UK
| | - Louise M Howard
- NIHR Research Professor in Women's Mental Health and NIHR Senior Investigator, Section of Women's Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Ann John
- Professor of Public Health and Psychiatry and Consultant Public Health Medicine, Population Data Science, Farr Institute of Health Informatics Research, Swansea University Medical School, Swansea University; and Public Health Wales NHS Trust, UK
| | - William Lee
- Consultant Liaison Psychiatrist and Honorary Clinical Senior Lecturer, Devon Partnership NHS Trust; and University of Exeter Medical School, University of Exeter, UK
| | - Rose McCabe
- Professor of Clinical Communication, School of Health Sciences, City, University of London, UK
| | - Andrew McIntosh
- Professor of Biological Psychiatry, Division of Psychiatry, University of Edinburgh, UK
| | - Robert Pearsall
- Consultant Psychiatrist and Honorary Clinical Senior Lecturer in Psychiatry, Institute of Health and Wellbeing, University of Glasgow, UK
| | - Daniel J Smith
- Lecturer in Psychiatry, Institute of Health and Wellbeing, University of Glasgow, UK
| | - Cathie Sudlow
- Director of the British Heart Foundation Data Science Centre, BHF Data Science Centre; Former Chief Scientist, UK Biobank; and Chair of Neurology and Clinical Epidemiology, Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, UK
| | - Joey Ward
- Researcher, Institute of Health and Wellbeing, University of Glasgow, UK
| | - Stan Zammit
- Professor of Psychiatric Epidemiology, Centre for Academic Mental Health, University of Bristol; and Institute of Psychological Medicine and Clinical Neurosciences, University of Cardiff, Cardiff University School of Medicine, UK
| | - Matthew Hotopf
- Director, National Institute of Health Research Biomedical Research Centre at the Maudsley; Institute of Psychiatry, Psychology and Neuroscience, King's College London; and South London and Maudsley NHS Foundation Trust, NIHR Biomedical Research Centre, UK
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17
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Legge SE, Jones HJ, Kendall KM, Pardiñas AF, Menzies G, Bracher-Smith M, Escott-Price V, Rees E, Davis KAS, Hotopf M, Savage JE, Posthuma D, Holmans P, Kirov G, Owen MJ, O’Donovan MC, Zammit S, Walters JTR. Association of Genetic Liability to Psychotic Experiences With Neuropsychotic Disorders and Traits. JAMA Psychiatry 2019; 76:1256-1265. [PMID: 31553412 PMCID: PMC6764002 DOI: 10.1001/jamapsychiatry.2019.2508] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 06/20/2019] [Indexed: 12/12/2022]
Abstract
Importance Psychotic experiences, such as hallucinations and delusions, are reported by approximately 5% to 10% of the general population, although only a small proportion develop psychotic disorders such as schizophrenia. Studying the genetic causes of psychotic experiences in the general population, and its association with the genetic causes of other disorders, may increase the understanding of their pathologic significance. Objectives To determine whether genetic liability to psychotic experiences is shared with schizophrenia and/or other neuropsychiatric disorders and traits and to identify genetic loci associated with psychotic experiences. Design, Setting and Participants Analyses of genetic correlation, polygenic risk scores, and copy number variation were performed using data from participants in the UK Biobank from April 1, 2018, to March 20, 2019, to assess whether genetic liability to psychotic experiences is shared with schizophrenia and/or other neuropsychiatric disorders and traits. Genome-wide association studies of psychotic experience phenotypes were conducted to identify novel genetic loci. Participants in the final analyses after exclusions included 6123 individuals reporting any psychotic experience, 2143 individuals reporting distressing psychotic experiences, and 3337 individuals reporting multiple occurrences of psychotic experiences. A total of 121 843 individuals who did not report a psychotic experience formed the comparator group. Individuals with a psychotic disorder were excluded from all analyses. Main Outcomes and Measures Genetic associations with psychotic experience phenotypes. Results The study included a total of 127 966 participants (56.0% women and 44.0% men; mean [SD] age, 64.0 [7.6] years). Psychotic experiences were genetically correlated with major depressive disorder, schizophrenia, autism spectrum disorder, and attention-deficit/hyperactivity disorder. Analyses of polygenic risk scores identified associations between psychotic experiences and genetic liability for major depressive disorder, schizophrenia, bipolar disorder, autism spectrum disorder, and attention-deficit/hyperactivity disorder. Individuals reporting psychotic experiences had an increased burden of copy number variations previously associated with schizophrenia (odds ratio [OR], 2.04; 95% CI, 1.39-2.98; P = 2.49 × 10-4) and neurodevelopmental disorders more widely (OR, 1.75; 95% CI, 1.24-2.48; P = 1.41 × 10-3). Genome-wide association studies identified 4 significantly associated loci, including a locus in Ankyrin-3 (ANK3 [GenBank NM_020987]) (OR, 1.16; 95% CI, 1.10-1.23; P = 3.06 × 10-8) with any psychotic experience, and a locus in cannabinoid receptor 2 gene (CNR2 [GenBank NM_001841]) (OR, 0.66; 95% CI, 0.56-0.78; P = 3.78 × 10-8) with distressing psychotic experiences. The genome-wide association study of any psychotic experience had a low single-nucleotide polymorphism-based heritability estimate (h2 = 1.71%; 95% CI, 1.02%-2.40%). Conclusions and Relevance A large genetic association study of psychotic experiences from the population-based UK Biobank sample found support for a shared genetic liability between psychotic experiences and schizophrenia, major depressive disorder, bipolar disorder, and neurodevelopmental disorders.
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Affiliation(s)
- Sophie E. Legge
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Hannah J. Jones
- Centre for Academic Mental Health, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Medical Research Centre, Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol National Health Service Foundation Trust, University of Bristol, Bristol, United Kingdom
| | - Kimberley M. Kendall
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Antonio F. Pardiñas
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Georgina Menzies
- UK-Dementia Research Institute at Cardiff, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Matthew Bracher-Smith
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Valentina Escott-Price
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom
- UK-Dementia Research Institute at Cardiff, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Elliott Rees
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Katrina A. S. Davis
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- South London and Maudsley National Health Service Foundation Trust, London, United Kingdom
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- South London and Maudsley National Health Service Foundation Trust, London, United Kingdom
| | - Jeanne E. Savage
- Department of Complex Trait Genetics, Centre for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, Vrije Universiteit, Amsterdam, the Netherlands
| | - Danielle Posthuma
- Department of Complex Trait Genetics, Centre for Neurogenomics and Cognitive Research, Amsterdam Neuroscience, Vrije Universiteit, Amsterdam, the Netherlands
| | - Peter Holmans
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - George Kirov
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Michael J. Owen
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Michael C. O’Donovan
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Stanley Zammit
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom
- Centre for Academic Mental Health, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol National Health Service Foundation Trust, University of Bristol, Bristol, United Kingdom
| | - James T. R. Walters
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, United Kingdom
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18
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Davies MR, Kalsi G, Armour C, Jones IR, McIntosh AM, Smith DJ, Walters JTR, Bradley JR, Kingston N, Ashford S, Beange I, Brailean A, Cleare AJ, Coleman JRI, Curtis CJ, Curzons SCB, Davis KAS, Dowey LRC, Gault VA, Goldsmith KA, Bennett MH, Hirose Y, Hotopf M, Hübel C, Kanz C, Leng J, Lyall DM, Mason BD, McAtarsney-Kovacs M, Monssen D, Moulton A, Ovington N, Palaiologou E, Pariante CM, Parikh S, Peel AJ, Price RK, Rimes KA, Rogers HC, Sambrook J, Skelton M, Spaul A, Suarez ELA, Sykes BL, Thomas KG, Young AH, Vassos E, Veale D, White KM, Wingrove J, Eley TC, Breen G. The Genetic Links to Anxiety and Depression (GLAD) Study: Online recruitment into the largest recontactable study of depression and anxiety. Behav Res Ther 2019; 123:103503. [PMID: 31715324 PMCID: PMC6891252 DOI: 10.1016/j.brat.2019.103503] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 09/04/2019] [Accepted: 10/23/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Anxiety and depression are common, debilitating and costly. These disorders are influenced by multiple risk factors, from genes to psychological vulnerabilities and environmental stressors, but research is hampered by a lack of sufficiently large comprehensive studies. We are recruiting 40,000 individuals with lifetime depression or anxiety and broad assessment of risks to facilitate future research. METHODS The Genetic Links to Anxiety and Depression (GLAD) Study (www.gladstudy.org.uk) recruits individuals with depression or anxiety into the NIHR Mental Health BioResource. Participants invited to join the study (via media campaigns) provide demographic, environmental and genetic data, and consent for medical record linkage and recontact. RESULTS Online recruitment was effective; 42,531 participants consented and 27,776 completed the questionnaire by end of July 2019. Participants' questionnaire data identified very high rates of recurrent depression, severe anxiety, and comorbidity. Participants reported high rates of treatment receipt. The age profile of the sample is biased toward young adults, with higher recruitment of females and the more educated, especially at younger ages. DISCUSSION This paper describes the study methodology and descriptive data for GLAD, which represents a large, recontactable resource that will enable future research into risks, outcomes, and treatment for anxiety and depression.
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Affiliation(s)
- Molly R Davies
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Gursharan Kalsi
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Chérie Armour
- School of Psychology, Queens University Belfast (QUB), Belfast, Northern Ireland, UK
| | - Ian R Jones
- MRC Centre for Neuropsychiatric Genetics and Genomics, Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK
| | - Andrew M McIntosh
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinurgh, UK
| | - Daniel J Smith
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - James T R Walters
- MRC Centre for Neuropsychiatric Genetics and Genomics, Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, UK
| | - John R Bradley
- NIHR BioResource, Cambridge University Hospitals NHS Foundation, Cambridge Biomedical Campus, Cambridge, UK
| | - Nathalie Kingston
- NIHR BioResource, Cambridge University Hospitals NHS Foundation, Cambridge Biomedical Campus, Cambridge, UK; Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Sofie Ashford
- NIHR BioResource, Cambridge University Hospitals NHS Foundation, Cambridge Biomedical Campus, Cambridge, UK; Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Ioana Beange
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinurgh, UK
| | - Anamaria Brailean
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK
| | - Anthony J Cleare
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, UK
| | - Jonathan R I Coleman
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Charles J Curtis
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Susannah C B Curzons
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Katrina A S Davis
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, UK
| | - Le Roy C Dowey
- School of Biomedical Sciences, Ulster University, Coleraine Campus, Northern Ireland, UK; GreenLight Pharmaceuticals Limited, Unit 2, Block E, Nutgrove Office Park, Dublin 14, Ireland
| | - Victor A Gault
- School of Biomedical Sciences, Ulster University, Coleraine Campus, Northern Ireland, UK
| | - Kimberley A Goldsmith
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Megan Hammond Bennett
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Yoriko Hirose
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinurgh, UK
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, UK
| | - Christopher Hübel
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Carola Kanz
- NIHR BioResource, Cambridge University Hospitals NHS Foundation, Cambridge Biomedical Campus, Cambridge, UK; Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Jennifer Leng
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Donald M Lyall
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Bethany D Mason
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Monika McAtarsney-Kovacs
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Dina Monssen
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Alexei Moulton
- NIHR BioResource, Cambridge University Hospitals NHS Foundation, Cambridge Biomedical Campus, Cambridge, UK; Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Nigel Ovington
- NIHR BioResource, Cambridge University Hospitals NHS Foundation, Cambridge Biomedical Campus, Cambridge, UK; Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Elisavet Palaiologou
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Carmine M Pariante
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, UK
| | - Shivani Parikh
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Alicia J Peel
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Ruth K Price
- School of Biomedical Sciences, Ulster University, Coleraine Campus, Northern Ireland, UK
| | - Katharine A Rimes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK
| | - Henry C Rogers
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Jennifer Sambrook
- NIHR BioResource, Cambridge University Hospitals NHS Foundation, Cambridge Biomedical Campus, Cambridge, UK; Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
| | - Megan Skelton
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Anna Spaul
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Eddy L A Suarez
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Bronte L Sykes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Keith G Thomas
- School of Biomedical Sciences, Ulster University, Coleraine Campus, Northern Ireland, UK
| | - Allan H Young
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, UK
| | - Evangelos Vassos
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK
| | - David Veale
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, UK
| | - Katie M White
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Janet Wingrove
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, UK
| | - Thalia C Eley
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK
| | - Gerome Breen
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, Camberwell, London, UK; UK National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley Hospital, London, UK.
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Davis KAS, Cullen B, Adams M, Brailean A, Breen G, Coleman JRI, Dregan A, Gaspar HA, Hübel C, Lee W, McIntosh AM, Nolan J, Pearsall R, Hotopf M. Indicators of mental disorders in UK Biobank-A comparison of approaches. Int J Methods Psychiatr Res 2019; 28:e1796. [PMID: 31397039 PMCID: PMC6877131 DOI: 10.1002/mpr.1796] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 04/04/2019] [Accepted: 05/20/2019] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES For many research cohorts, it is not practical to provide a "gold-standard" mental health diagnosis. It is therefore important for mental health research that potential alternative measures for ascertaining mental disorder status are understood. METHODS Data from UK Biobank in those participants who had completed the online Mental Health Questionnaire (n = 157,363) were used to compare the classification of mental disorder by four methods: symptom-based outcome (self-complete based on diagnostic interviews), self-reported diagnosis, hospital data linkage, and self-report medication. RESULTS Participants self-reporting any psychiatric diagnosis had elevated risk of any symptom-based outcome. Cohen's κ between self-reported diagnosis and symptom-based outcome was 0.46 for depression, 0.28 for bipolar affective disorder, and 0.24 for anxiety. There were small numbers of participants uniquely identified by hospital data linkage and medication. CONCLUSION Our results confirm that ascertainment of mental disorder diagnosis in large cohorts such as UK Biobank is complex. There may not be one method of classification that is right for all circumstances, but an informed and transparent use of outcome measure(s) to suit each research question will maximise the potential of UK Biobank and other resources for mental health research.
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Affiliation(s)
- Katrina A S Davis
- Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.,NIHR Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Breda Cullen
- Mental Health and Wellbeing, The Academic Centre, Gartnavel Royal Hospital, University of Glasgow, Glasgow, UK
| | - Mark Adams
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - Anamaria Brailean
- Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Gerome Breen
- Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.,NIHR Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Jonathan R I Coleman
- Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.,NIHR Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Alexandru Dregan
- Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Héléna A Gaspar
- Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.,NIHR Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Christopher Hübel
- Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.,NIHR Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - William Lee
- Peninsula Schools of Medicine and Dentistry, Plymouth University, Plymouth, UK.,Devon Partnership NHS Trust, Psychological Medicine, Exeter, UKUK Biobank, Office of the UKB Chief Scientist, Edinburgh, UK
| | | | - John Nolan
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK.,Office of the UKB Chief Scientist, UK Biobank, Edinburgh, UK
| | - Robert Pearsall
- Mental Health and Wellbeing, The Academic Centre, Gartnavel Royal Hospital, University of Glasgow, Glasgow, UK
| | - Matthew Hotopf
- Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.,NIHR Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
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Davis KAS, Coleman JRI, Adams M, Allen N, Breen G, Cullen B, Dickens C, Fox E, Graham N, Holliday J, Howard LM, John A, Lee W, McCabe R, McIntosh A, Pearsall R, Smith DJ, Sudlow C, Ward J, Zammit S, Hotopf M. Mental health in UK Biobank: development, implementation and results from an online questionnaire completed by 157 366 participants - RETRACTED. BJPsych Open 2019; 5:e56. [PMID: 31530304 PMCID: PMC6611070 DOI: 10.1192/bjo.2019.46] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Russ TC, Woelbert E, Davis KAS, Hafferty JD, Ibrahim Z, Inkster B, John A, Lee W, Maxwell M, McIntosh AM, Stewart R. How data science can advance mental health research. Nat Hum Behav 2018; 3:24-32. [DOI: 10.1038/s41562-018-0470-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 10/11/2018] [Indexed: 02/07/2023]
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22
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Davis KAS, Coleman JRI, Adams M, Allen N, Breen G, Cullen B, Dickens C, Fox E, Graham N, Holliday J, Howard LM, John A, Lee W, McCabe R, McIntosh A, Pearsall R, Smith DJ, Sudlow C, Ward J, Zammit S, Hotopf M. Erratum: Mental health in UK Biobank: development, implementation and results from an online questionnaire completed by 157 366 participants - CORRIGENDUM. BJPsych Open 2018; 4:352-353. [PMID: 30140447 PMCID: PMC6094179 DOI: 10.1192/bjo.2018.47] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
[This corrects the article DOI: 10.1192/bjo.2018.12.].
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Davis KAS, Coleman JRI, Adams M, Allen N, Breen G, Cullen B, Dickens C, Fox E, Graham N, Holliday J, Howard LM, John A, Lee W, McCabe R, McIntosh A, Pearsall R, Sudlow C, Ward J, Zammit S, Hotopf M. Erratum: Mental health in UK Biobank: development, implementation and results from an online questionnaire completed by 157 366 participants - CORRIGENDUM. BJPsych Open 2018; 4:136. [PMID: 29974892 PMCID: PMC6020280 DOI: 10.1192/bjo.2018.19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
[This corrects the article DOI: 10.1192/bjo.2018.12.].
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Davis KAS, Coleman JRI, Adams M, Allen N, Breen G, Cullen B, Dickens C, Fox E, Graham N, Holliday J, Howard LM, John A, Lee W, McCabe R, McIntosh A, Pearsall R, Smith DJ, Sudlow C, Ward J, Zammit S, Hotopf M. Mental health in UK Biobank: development, implementation and results from an online questionnaire completed by 157 366 participants. BJPsych Open 2018; 4:83-90. [PMID: 29971151 PMCID: PMC6020276 DOI: 10.1192/bjo.2018.12] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [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: 12/08/2017] [Revised: 01/08/2018] [Accepted: 01/26/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND UK Biobank is a well-characterised cohort of over 500 000 participants that offers unique opportunities to investigate multiple diseases and risk factors. AIMS An online mental health questionnaire completed by UK Biobank participants was expected to expand the potential for research into mental disorders. METHOD An expert working group designed the questionnaire, using established measures where possible, and consulting with a patient group regarding acceptability. Case definitions were defined using operational criteria for lifetime depression, mania, anxiety disorder, psychotic-like experiences and self-harm, as well as current post-traumatic stress and alcohol use disorders. RESULTS 157 366 completed online questionnaires were available by August 2017. Comparison of self-reported diagnosed mental disorder with a contemporary study shows a similar prevalence, despite respondents being of higher average socioeconomic status than the general population across a range of indicators. Thirty-five per cent (55 750) of participants had at least one defined syndrome, of which lifetime depression was the most common at 24% (37 434). There was extensive comorbidity among the syndromes. Mental disorders were associated with high neuroticism score, adverse life events and long-term illness; addiction and bipolar affective disorder in particular were associated with measures of deprivation. CONCLUSIONS The questionnaire represents a very large mental health survey in itself, and the results presented here show high face validity, although caution is needed owing to selection bias. Built into UK Biobank, these data intersect with other health data to offer unparalleled potential for crosscutting biomedical research involving mental health. DECLARATION OF INTEREST G.B. received grants from the National Institute for Health Research during the study; and support from Illumina Ltd. and the European Commission outside the submitted work. B.C. received grants from the Scottish Executive Chief Scientist Office and from The Dr Mortimer and Theresa Sackler Foundation during the study. C.S. received grants from the Medical Research Council and Wellcome Trust during the study, and is the Chief Scientist for UK Biobank. M.H. received grants from the Innovative Medicines Initiative via the RADAR-CNS programme and personal fees as an expert witness outside the submitted work.
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Affiliation(s)
- Katrina A S Davis
- Institute of Psychiatry Psychology and Neuroscience, King's College London, South London and Maudsley NHS Foundation Trust and NIHR Biomedical Research Centre, London, UK
| | - Jonathan R I Coleman
- Institute of Psychiatry Psychology and Neuroscience, King's College London, South London and Maudsley NHS Foundation Trust and NIHR Biomedical Research Centre, London, UK
| | - Mark Adams
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - Naomi Allen
- UK Biobank and Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Oxford, UK
| | - Gerome Breen
- Institute of Psychiatry Psychology and Neuroscience, King's College London, South London and Maudsley NHS Foundation Trust and NIHR Biomedical Research Centre, London, UK
| | - Breda Cullen
- Mental Health and Wellbeing, University of Glasgow, and The Academic Centre, Gartnavel Royal Hospital, Glasgow, UK
| | - Chris Dickens
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Elaine Fox
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Nick Graham
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Jo Holliday
- UK Biobank and Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Oxford, UK
| | - Louise M Howard
- Institute of Psychiatry Psychology and Neuroscience: Section of Women's Mental Health, King's College London and David Goldberg Centre, London, UK
| | - Ann John
- Farr Institute of Health Informatics Research, Swansea University Medical School, Swansea, UK
| | - William Lee
- Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, and Devon Partnership NHS Trust, Exeter, UK
| | - Rose McCabe
- University of Exeter Medical School, Exeter, UK
| | - Andrew McIntosh
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - Robert Pearsall
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Daniel J Smith
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Cathie Sudlow
- UK Biobank and Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Joey Ward
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Stan Zammit
- Centre for Academic Mental Health, University of Bristol, Bristol, and Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| | - Matthew Hotopf
- Institute of Psychiatry Psychology and Neuroscience, King's College London, South London and Maudsley NHS Foundation Trust, and NIHR Biomedical Research Centre, London, UK
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Davis KAS, Sudlow CLM, Hotopf M. Can mental health diagnoses in administrative data be used for research? A systematic review of the accuracy of routinely collected diagnoses. BMC Psychiatry 2016; 16:263. [PMID: 27455845 PMCID: PMC4960739 DOI: 10.1186/s12888-016-0963-x] [Citation(s) in RCA: 154] [Impact Index Per Article: 19.3] [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: 02/08/2016] [Accepted: 07/05/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There is increasing availability of data derived from diagnoses made routinely in mental health care, and interest in using these for research. Such data will be subject to both diagnostic (clinical) error and administrative error, and so it is necessary to evaluate its accuracy against a reference-standard. Our aim was to review studies where this had been done to guide the use of other available data. METHODS We searched PubMed and EMBASE for studies comparing routinely collected mental health diagnosis data to a reference standard. We produced diagnostic category-specific positive predictive values (PPV) and Cohen's kappa for each study. RESULTS We found 39 eligible studies. Studies were heterogeneous in design, with a wide range of outcomes. Administrative error was small compared to diagnostic error. PPV was related to base rate of the respective condition, with overall median of 76 %. Kappa results on average showed a moderate agreement between source data and reference standard for most diagnostic categories (median kappa = 0.45-0.55); anxiety disorders and schizoaffective disorder showed poorer agreement. There was no significant benefit in accuracy for diagnoses made in inpatients. CONCLUSIONS The current evidence partly answered our questions. There was wide variation in the quality of source data, with a risk of publication bias. For some diagnoses, especially psychotic categories, administrative data were generally predictive of true diagnosis. For others, such as anxiety disorders, the data were less satisfactory. We discuss the implications of our findings, and the need for researchers to validate routine diagnostic data.
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Affiliation(s)
- Katrina A. S. Davis
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, Kings College London, London, UK
| | - Cathie L. M. Sudlow
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, SE5 8AZ UK
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, Kings College London, London, UK. .,Department of Psychological Medicine and SLaM/IoPPN BRC, Kings College London, PO62, Weston Education Centre, Cutcombe Road, London, SE5 9RJ, UK.
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