scholarly journals Psychiatric disorders and self-harm across 26 adult cancers: cumulative burden, temporal variation, excess years of life lost and unnatural causes of deaths

2021 ◽  
Author(s):  
Wai Hoong Chang ◽  
Alvina G Lai
Keyword(s):  
Mental Illness ◽  
Psychiatric Disorder ◽  
Psychiatric Disorders ◽  
Population Based ◽  
First Year ◽  
Years Of Life Lost ◽  
Patients With Cancer ◽  
Increased Risk ◽  
Self Harm ◽  
Total Burden

Background Cancer is a life-altering event causing considerable psychological distress. However, population-representative variations in the total burden of psychiatric episodes across cancer types and treatment modalities have not been examined. We sought to estimate the risk of self-harm after incident psychiatric disorder diagnosis in patients with cancer, and the risk of unnatural deaths after self-harm. Design, Setting, Participants Population-based cohort study with multiphase study designs. Population-based linked patient records in England (1998-2020) from primary care practices, hospitals, cancer registry and death registry were employed. We identified 459,542 individuals age ≥ 18 years with an incident diagnosis of a site-specific cancer of interest. Main outcome measures Using outpatient and inpatient records, we identified patients with five psychiatric disorders of interest: depression, anxiety disorder, schizophrenia, bipolar disorder and personality disorder. Cumulative burden for all psychiatric events was estimated using the mean cumulative count method. We considered 10 cancer treatment regimens, 11 chemotherapy drug classes, deprivation status and 21 non-cancer comorbidities in stratified analyses. Propensity score matching was employed to identify controls who did not have any record of a psychiatric disorder of interest. For each psychiatric disorder category, we fitted a Cox regression model to estimate the risk of self-harm. We also estimated the risk of all-cause mortality and excess years of life lost comparing patients with and without psychiatric disorders. A separate matched cohort was generated to explore the risk of suicide and unnatural deaths following self-harm. Results Depression was the most common psychiatric disorder in patients with cancer, where some of the highest cumulative burdens were observed in patients with testicular cancer (98.05 per 100 individuals [CI: 83.08-127.25]), cervical cancer (78.74 [73.61-90.14]) and Hodgkin lymphoma (69.87 [61.05-69.48]) by age 60. Patients who received chemotherapy, radiotherapy and surgery had the highest cumulative burden of psychiatric disorders, while patients who received radiotherapy alone had the lowest burden. Patients treated with alkylating agent chemotherapeutics had the highest burden of psychiatric disorders while those treated with kinase inhibitors had the lowest burden. Among patients with cancer, 5,683 individuals were identified as having an incident self-harm episode. A previous diagnosis of psychiatric disorder before self-harm was at least twice as prevalent than a subsequent diagnosis of psychiatric disorder where the prevalence ratio was the highest in patients with brain tumours (5.36, CI: 4.57-6.14). Younger individuals were more likely to be diagnosed with mental illness before the first self-harm episode. However, individuals from more deprived regions (2.46, CI: 2.32-2.60) and individuals with ≥4 pre-existing comorbidities (2.19, CI: 1.92-2.46) were less likely to be diagnosed with mental illness before self-harm. Patients with mental illness had a higher cumulative burden of self-harm events compared with matched controls. All mental illnesses were associated with an increased risk of subsequent self-harm, where the highest risk was observed within 12 months of the mental illness diagnosis. Risks of self-harm during the first year in matched cohorts were as follow: depression (adjusted HR 44.1, CI: 34.0-57.1), anxiety disorder (HR 21.1, CI: 16.4-27.0) and schizophrenia (HR 7.5, CI: 5.0-11.2). Patients with cancer and psychiatric disorder experienced excess years of life lost. Patients who harmed themselves were 6.8 times more likely to die of unnatural causes of death compared with controls within 12 months of self-harm (HR 6.8, CI: 4.3-10.7). The risk of unnatural death after 12 months was markedly lower (HR 2.0, CI: 1.5-2.7). Conclusions This study quantifies the total burden of psychiatric events and self-harm in patients with cancer. The cumulative burden of psychiatric events varies across cancer type, treatment regimen and chemotherapy type. Incident psychiatric disorder diagnoses were significantly associated with increased risk of subsequent self-harm, where risks varied across psychiatric diagnostic categories and follow-up periods. Patients who harm themselves experienced the highest risk of dying from unnatural deaths within the first year of self-harm. We provide an extensive knowledge base to help inform collaborative cancer-psychiatric care initiatives by prioritising patients who are most at risk.

scholarly journals Association between inflammatory bowel disease and psychiatric morbidity and suicide: A Swedish nationwide population-based cohort study with sibling comparisons

2021 ◽  
Author(s):  
Jonas F  Ludvigsson ◽  
Ola Olén ◽  
Henrik Larsson ◽  
Jonas Halfvarson ◽  
Catarina Almqvist ◽  
...  
Keyword(s):  
General Population ◽  
Psychiatric Disorders ◽  
Suicide Attempts ◽  
Psychiatric Morbidity ◽  
Population Based ◽  
First Year ◽  
Adult Onset ◽  
Increased Risk ◽  
Elderly Onset

Abstract Background and Aims Inflammatory bowel disease (IBD) is linked to psychiatric morbidity, but few studies have assessed general population comparators. We aimed to investigate the risk of psychiatric morbidity and suicide in adult-onset IBD patients. Methods Nationwide population-based cohort study in Sweden (1973-2013). We studied the risk of psychiatric disorders and suicide in 69,865 adult-onset IBD patients (ulcerative colitis, UC: n=43,557; Crohn’s disease, CD: n=21,245; and IBD-unclassified: n=5063) compared to 3,472,913 general population references and 66,292 siblings. Results During a median follow-up of 11 years, we found 7,465 (10.7%) first psychiatric disorders in IBD (incidence rate, IR/1000 person-years 8.4) and 306,911 (9.9%) in the general population (IR 6.6), resulting in 1.8 extra psychiatric morbidity per 100 patients followed-up for 10 years and a hazard ratio (HR) of 1.3 (95% confidence interval, 95%CI=1.2-1.3). The highest risk of overall psychiatric morbidity was seen in the first year after IBD diagnosis (HR=1.4, 95%CI=1.2-1.6) and in patients with extraintestinal manifestations (HR=1.6, 95%CI=1.5-1.7). Psychiatric morbidity was more common in all IBD subtypes (HRs 1.3 to 1.5). An increased risk of suicide attempts was observed among all IBD types (HRs=1.2 to 1.4), whereas completed suicide was explicitly associated with CD (HR=1.5) and elderly-onset (diagnosed at the age of >60 years) IBD (HR=1.7). Conclusion Adult-onset IBD was associated with an increased risk of psychiatric disorders and suicide attempts. Psychological follow-up should be provided to patients with IBD, especially those with extraintestinal manifestations and elderly-onset IBD. This follow-up should transpire within the first year after IBD diagnosis.

scholarly journals Neurodevelopmental and psychiatric disorders in females with Turner syndrome: a population-based study

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Hanna Björlin Avdic ◽  
Agnieszka Butwicka ◽  
Anna Nordenström ◽  
Catarina Almqvist ◽  
Agneta Nordenskjöld ◽  
...  
Keyword(s):  
Psychiatric Disorder ◽  
Psychiatric Disorders ◽  
Turner Syndrome ◽  
Emotional Disorders ◽  
Conditional Logistic Regression ◽  
Population Based ◽  
Autism Spectrum ◽  
Clinical Criteria ◽  
Increased Risk ◽  
National Patient

Abstract Background Turner syndrome is the result of the partial or complete absence of an X chromosome in phenotypic girls. This can cause an array of medical and developmental difficulties. The intelligence quotient in females with Turner syndrome has previously been described as uneven, but considered within normal range. Although their social, intellectual, and psychiatric profile is described, it is unclear to what extent these females meet the clinical criteria for neurodevelopmental or psychiatric diagnoses. The aim of this study was to examine the prevalence of neurodevelopmental and psychiatric disorders in females with Turner syndrome. Methods A retrospective cohort study was performed with a total of 1392 females with Turner syndrome identified through the Swedish National Patient Register and compared with 1:100 age- and sex-matched controls from the general population. The associations between Turner syndrome and diagnoses of neurodevelopmental and/or psychiatric disorders were calculated using conditional logistic regression and is presented as estimated risk (odds ratio, OR, 95% confidence interval, CI) in females with Turner syndrome compared with matched controls. Results Females with Turner syndrome had a higher risk of neurodevelopmental or psychiatric disorder (OR 1.37, 95% CI 1.20–1.57), an eightfold increased risk of intellectual disability (OR 8.59, 95% CI 6.58–11.20), and a fourfold increased risk of autism spectrum disorder (OR 4.26, 95% CI 2.94‑6.18) compared with the controls. In addition, females with Turner syndrome had twice the risk of a diagnosis of schizophrenia and related disorders (OR 1.98, 95% CI 1.36–2.88), eating disorders (OR 2.03, 95% CI 1.42–2.91), and behavioral and emotional disorders with onset in childhood (OR 2.01, 95% CI 1.35–2.99). Conclusions Females with Turner syndrome have an increased risk of receiving a diagnosis of neurodevelopmental or psychiatric disorder. This warrants extensive assessment of intellectual and cognitive functions from early age, and increased psychiatric vigilance should be a part of lifelong healthcare for females with Turner syndrome.

scholarly journals Neurodevelopmental and Psychiatric Disorders in Females With Turner Syndrome: A Population-based Study

2020 ◽  
Author(s):  
Hanna Björlin Avdic ◽  
Agnieszka Butwicka ◽  
Anna Nordenström ◽  
Catarina Almqvist ◽  
Agneta Nordenskjöld ◽  
...  
Keyword(s):  
Psychiatric Disorder ◽  
Psychiatric Disorders ◽  
Turner Syndrome ◽  
Psychotic Disorders ◽  
Conditional Logistic Regression ◽  
Population Based ◽  
Autism Spectrum ◽  
Retrospective Case ◽  
Clinical Criteria ◽  
Increased Risk

Abstract Background: Turner syndrome is the result of a missing X chromosome, partially or completely, in phenotypic girls. This can cause an array of medical and developmental difficulties. The intelligence quote has previously been described as uneven but considered within normal range. Although a social, intellectual and psychiatric profile is described in females with Turner syndrome, it is unclear to what extent they meet the clinical criteria for neurodevelopmental or psychiatric diagnoses. The aim of this study was to examine the prevalence of neurodevelopmental and psychiatric disorders in females with Turner syndrome. Methods: A retrospective case-control study was performed with a total of 1392 females with Turner syndrome identified through the Swedish National Patient Register and compared with 1:100 age- and sex matched controls from the general population. The association between Turner syndrome and diagnoses of neurodevelopmental and/ or psychiatric disorders were calculated using conditional logistic regression and is presented as estimated risk (Odds ratio, OR, 95% Confidence interval, CI) in females with Turner syndrome compared with matched controls. Results: Females with Turner syndrome had higher risk of any neurodevelopmental or psychiatric disorder (OR 1.37, 95% Cl 1.20-1.57), an eightfold (OR 8.59, 95% CI 6.58-11.20) increased risk of intellectual disability and a fourfold (OR 4.26, 95% CI 2.94-6.18) increased risk of autism spectrum disorder compared with the controls. In addition, females with Turner syndrome had an increased risk of a diagnosis of psychotic disorders (OR 1.98, 95% Cl 1.36-2.88), eating disorders (OR 2.03, 95% Cl 1.42-2.91) and behavioral disorders (OR 2.01, 95% CI 1.35-2.99). Conclusions: Females with TS have an increased risk of being diagnosed with any neurodevelopmental and psychiatric disorder. This warrants extensive assessment of intellectual and cognitive functions from early ages and increased psychiatric vigilance should be a part of lifelong healthcare for females with TS.

scholarly journals Associations between psychiatric disorders, COVID-19 testing probability and COVID-19 testing results: findings from a population-based study

BJPsych Open ◽  
2020 ◽  
Vol 6 (5) ◽  
Author(s):  
Dennis van der Meer ◽  
Justo Pinzón-Espinosa ◽  
Bochao D. Lin ◽  
Joeri K. Tijdink ◽  
Christiaan H. Vinkers ◽  
...  
Keyword(s):  
Psychiatric Disorder ◽  
Psychiatric Disorders ◽  
Population Based ◽  
Sensitivity Analyses ◽  
Test Results ◽  
Uk Biobank ◽  
Full Cohort ◽  
Population Based Study ◽  
Association Analyses ◽  
Increased Risk

Background Many psychiatrists are worried their patients, at increased risk for COVID-19 complications, are precluded from receiving appropriate testing. There is a lack of epidemiological data on the associations between psychiatric disorders and COVID-19 testing rates and testing outcomes. Aims To compare COVID-19 testing probability and results among individuals with psychiatric disorders with those without such diagnoses, and to examine the associations between testing probability and results and psychiatric diagnoses. Method This is a population-based study to perform association analyses of psychiatric disorder diagnoses with COVID-19 testing probability and such test results, by using two-sided Fisher exact tests and logistic regression. The population were UK Biobank participants who had undergone COVID-19 testing. The main outcomes were COVID-19 testing probability and COVID-19 test results. Results Individuals with psychiatric disorders were overrepresented among the 1474 UK Biobank participants with test data: 23% of the COVID-19 test sample had a psychiatric diagnosis compared with 10% in the full cohort (P < 0.0001). This overrepresentation persisted for each of the specific psychiatric disorders tested. Furthermore, individuals with a psychiatric disorder (P = 0.01), particularly substance use disorder (P < 0.005), had negative test results significantly more often than individuals without psychiatric disorders. Sensitivity analyses confirmed our results. Conclusions In contrast with our hypotheses, UK Biobank participants with psychiatric disorders have been tested for COVID-19 more frequently than individuals without a psychiatric history. Among those tested, test outcomes were more frequently negative for registry participants with psychiatric disorders than in others, countering arguments that people with psychiatric disorders are particularly prone to contract the virus.

Risk and coaggregation of major psychiatric disorders among first-degree relatives of patients with bipolar disorder: a nationwide population-based study

2018 ◽  
Vol 49 (14) ◽  
pp. 2397-2404 ◽  
Author(s):  
Mu-Hong Chen ◽  
Ju-Wei Hsu ◽  
Kei-Lin Huang ◽  
Tung-Ping Su ◽  
Cheng-Ta Li ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Psychiatric Disorders ◽  
Population Based ◽  
Autism Spectrum ◽  
The Public ◽  
First Degree Relatives ◽  
Relative Risks ◽  
Dependent Relationship ◽  
Increased Risk ◽  
Bipolar Patients

AbstractBackgroundBipolar disorder is a highly heritable mental illness that transmits intergeneratively. Previous studies supported that first-degree relatives (FDRs), such as parents, offspring, and siblings, of patients with bipolar disorder, had a higher risk of bipolar disorder. However, whether FDRs of bipolar patients have an increased risk of schizophrenia, major depressive disorder (MDD), autism spectrum disorder (ASD), and attention deficit hyperactivity disorder (ADHD) remains unclear.MethodsAmong the entire population in Taiwan, 87 639 patients with bipolar disorder and 188 290 FDRs of patients with bipolar disorder were identified in our study. The relative risks (RRs) of major psychiatric disorders were assessed among FDRs of patients with bipolar disorder.ResultsFDRs of patients with bipolar disorder were more likely to have a higher risk of major psychiatric disorders, including bipolar disorder (RR 6.12, 95% confidence interval (CI) 5.95–6.30), MDD (RR 2.89, 95% CI 2.82–2.96), schizophrenia (RR 2.64, 95% CI 2.55–2.73), ADHD (RR 2.21, 95% CI 2.13–2.30), and ASD (RR 2.10, 95% CI 1.92–2.29), than the total population did. These increased risks for major psychiatric disorders were consistent across different familial kinships, such as parents, offspring, siblings, and twins. A dose-dependent relationship was also found between risk of each major psychiatric disorder and numbers of bipolar patients.ConclusionsOur study was the first study to support the familial coaggregation of bipolar disorder with other major psychiatric disorders, including schizophrenia, MDD, ADHD, and ASD, in a Taiwanese (non-Caucasian) population. Given the elevated risks of major psychiatric disorders, the public health government should pay more attention to the mental health of FDRs of patients with bipolar disorder.

scholarly journals Increased risk of dementia in patients with Schizophrenia: A population-based cohort study in Taiwan

2018 ◽  
Vol 53 ◽  
pp. 7-16 ◽  
Author(s):  
Ching-En Lin ◽  
Chi-Hsiang Chung ◽  
Li-Fen Chen ◽  
Mei-Ju Chi
Keyword(s):  
Antipsychotic Agents ◽  
Population Based ◽  
Competing Risk ◽  
First Year ◽  
Traumatic Head Injury ◽  
Chronic Lung Diseases ◽  
Dementia Risk ◽  
Increased Risk ◽  
Cox Proportional Hazard Regression ◽  
Persons With Schizophrenia

AbstractBackground:The extent to which schizophrenia is associated with the risk of all-cause dementia is controversial. This study investigated the risk of dementia by type in patients with schizophrenia.Methods:Data were collected from the Taiwanese National Health Insurance Database 2005 and analyzed using multivariate Cox proportional hazard regression models to determine the effect of schizophrenia on the dementia risk after adjusting for demographic characteristics, comorbidities, and medications. Fine and Gray's competing risk analysis was used to determine the risk of dementia, as death can act as a competing risk factor for dementia.Results:We assessed 6040 schizophrenia patients and 24,160 propensity scale-matched control patients. Schizophrenia patients exhibited a 1.80-fold risk of dementia compared to controls (adjusted hazard ratio [aHR] = 1.80, 95% confidence interval [CI] = 1.36 ∼ 2.21,p <0.001) after adjusting for covariates. Cardiovascular disease (aHR = 5.26; 95% CI = 4.50 ∼ 6.72;p <0.001), hypertension (aHR = 1.83; 95% CI = 1.77 ∼ 2.04;p= 0.002), traumatic head injury (aHR = 1.35; 95% CI = 1.24 ∼ 1.78;p <0.001), chronic lung diseases (aHR = 1.64; 95% CI = 1.13 ∼ 2.56;p <0.001), alcohol-related disorders (aHR = 3.67; 95% CI = 2.68 ∼ 4.92;p <0.001), and Parkinson’s disease (aHR = 1.72; 95% CI = 1.25 ∼ 2.40;p <0.001) were significantly associated with dementia risk. Notably, first-generation antipsychotics (aHR = 0.80; 95% CI = 0.56 ∼ 0.95;p=0.044) and second-generation antipsychotics (aHR = 0.24; 95% CI = 0.11 ∼ 0.60;p <0.001) were associated with a lower dementia risk. Sensitivity tests yielded consistent findings after excluding the first year and first 3 years of observation. Patients with schizophrenia had the highest risk of developing Alzheimer’s [dementia/disease?] among dementia subtypes (aHR = 2.10; 95% CI = 1.88 ∼ 3.86;p< 0.001), followed by vascular dementia (aHR = 1.67; 95% CI = 1.27 ∼ 2.12;p< 0.001) and unspecified dementia (aHR = 1.30; 95% CI = 1.04 ∼ 2.01;p< 0.001).Conclusions:Schizophrenia was significantly associated with the risk of all-cause dementia. Data are scarce on the mechanisms through which antipsychotic agents protect persons with schizophrenia from developing dementia. Further research is recommended to elucidate the neurobiological mechanisms underlying the association between schizophrenia and dementia, and whether antipsychotics protect against the development of dementia in schizophrenia.

scholarly journals Collective impact of chronic medical conditions and poverty on perinatal mental illness: population-based cohort study

2019 ◽  
Vol 74 (2) ◽  
pp. 158-163
Author(s):  
Mary-Rose Faulkner ◽  
Lucy C. Barker ◽  
Simone N. Vigod ◽  
Cindy-Lee Dennis ◽  
Hilary K Brown
Keyword(s):  
Mental Illness ◽  
Population Based ◽  
Collective Impact ◽  
Income Quintile ◽  
Chronic Medical Conditions ◽  
Adjusted Relative Risk ◽  
Medical Conditions ◽  
Additive Interaction ◽  
Treatment Pathways ◽  
Increased Risk

BackgroundChronic medical conditions (CMCs) and poverty commonly co-occur and, while both have been shown to independently increase the risk of perinatal mental illness, their collective impact has not been examined.MethodsThis population-based study included 853 433 Ontario (Canada) women with a singleton live birth and no recent mental healthcare. CMCs were identified using validated algorithms and disease registries, and poverty was ascertained using neighbourhood income quintile. Perinatal mental illness was defined as a healthcare encounter for a mental health or substance use disorder in pregnancy or the first year postpartum. Modified Poisson regression was used to test the independent impacts of CMC and poverty on perinatal mental illness risk, adjusted for covariates, and additive interaction between the two exposures was assessed using the relative excess risk due to interaction (RERI) and synergy index (SI).ResultsCMC and poverty were each independently associated with increased risk of perinatal mental illness (CMC vs no CMC exposure: 19.8% vs 15.6%, adjusted relative risk (aRR) 1.21, 95% CI (CI) 1.20 to 1.23; poverty vs no poverty exposure: 16.7% vs 15.5%, aRR 1.06, 95% CI 1.05 to 1.07). However, measures of additive interaction for the collective impact of both exposures on perinatal mental illness risk were not statistically significant (RERI 0.02, 95% CI −0.01 to 0.06; SI 1.09, 95% CI 0.95 to 1.24).ConclusionCMC and poverty are independent risk factors for perinatal mental illness and should be assessed as part of a comprehensive management programme that includes prevention strategies and effective screening and treatment pathways.

Increased risk of psychiatric disorders in adult patients with vitiligo: A nationwide, population‐based cohort study in Taiwan

2020 ◽  
Vol 47 (5) ◽  
pp. 470-475 ◽  
Author(s):  
Chih‐Yu Chen ◽  
Wei‐Ming Wang ◽  
Chi‐Hsiang Chung ◽  
Chang‐Huei Tsao ◽  
Wu‐Chien Chien ◽  
...  
Keyword(s):  
Cohort Study ◽  
Psychiatric Disorders ◽  
Population Based ◽  
Adult Patients ◽  
Increased Risk
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