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Antidepressant medication and suicide in Sweden.

https://arctichealth.org/en/permalink/ahliterature46040
Source
Pharmacoepidemiol Drug Saf. 2001 Oct-Nov;10(6):525-30
Publication Type
Article
Author
A. Carlsten
M. Waern
A. Ekedahl
J. Ranstam
Author Affiliation
Department of Social Medicine, University of Göteborg, Sweden. anders.carlsten@telia.com
Source
Pharmacoepidemiol Drug Saf. 2001 Oct-Nov;10(6):525-30
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Aged
Antidepressive Agents - therapeutic use
Depressive Disorder - drug therapy - epidemiology
Drug Utilization
Female
Humans
Male
Middle Aged
Models, Statistical
Research Support, Non-U.S. Gov't
Serotonin Uptake Inhibitors - therapeutic use
Sex Factors
Suicide - statistics & numerical data
Sweden - epidemiology
Abstract
OBJECTIVE: To explore a possible temporal association between changes in antidepressant sales and suicide rates in different age groups. METHODS: A time series analysis using a two-slope model to compare suicide rates in Sweden before and after introduction of the selective serotonin reuptake inhibitors, SSRIs. RESULTS: Antidepressant sales increased between 1977-1979 and 1995-1997 in men from 4.2 defined daily doses per 1000 inhabitants and day (DDD/t.i.d) to 21.8 and in women from 8.8 to 42.4. Antidepressant sales were twice as high in the elderly as in the 25-44-year-olds and eight times that in the 15-24-year-olds. During the same time period suicide rates decreased in men from 48.2 to 33.3 per 10(5) inhabitants/year and in women from 20.3 to 13.4. There was significant change in the slope in suicide rates after the introduction of the SSRI, for both men and women, which corresponds to approximately 348 fewer suicides during 1990-1997. Half of these 'saved lives' occurred among young adults. CONCLUSION: We demonstrate a statistically significant change in slope in suicide rates in men and women that coincided with the introduction of the SSRI antidepressants in Sweden. This change preceded the exponential increase in antidepressant sales.
PubMed ID
11828835 View in PubMed
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Cardiovascular fitness in early adulthood and future suicidal behaviour in men followed for up to 42 years.

https://arctichealth.org/en/permalink/ahliterature257666
Source
Psychol Med. 2014 Mar;44(4):779-88
Publication Type
Article
Date
Mar-2014
Author
M A I Åberg
J. Nyberg
K. Torén
A. Sörberg
H G Kuhn
M. Waern
Author Affiliation
Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.
Source
Psychol Med. 2014 Mar;44(4):779-88
Date
Mar-2014
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Cardiovascular Diseases - physiopathology - prevention & control
Depression - epidemiology
Forecasting
Humans
Intelligence - physiology
Longitudinal Studies
Male
Middle Aged
Physical Fitness - physiology
Proportional Hazards Models
Registries - statistics & numerical data
Risk
Suicide - statistics & numerical data
Suicide, Attempted - statistics & numerical data
Sweden - epidemiology
Young Adult
Abstract
Cardiovascular fitness influences many aspects of brain function. However, the relationship between cardiovascular fitness and suicidal behaviour is unknown. Therefore, we aimed to determine whether cardiovascular fitness at age 18 years is associated with future risk of suicide attempt/death.
We performed a population-based Swedish longitudinal cohort study of male conscripts with no previous or ongoing mental illness (n = 1,136,527). The conscription examination, which took place during 1968-2005, included the cycle ergonometric test and tests of cognitive performance. Future risk of suicide attempt/death over a 5- to 42-year follow-up period was calculated with Cox proportional hazards models controlling for several confounders including familial factors.
At least one suicide attempt was recorded for 12,563 men. Death by suicide without a prior attempt was recorded in 4814 additional individuals. In fully adjusted models low cardiovascular fitness was associated with increased risk for future attempt/death by suicide [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.64-1.94]. The HR changed only marginally after exclusion of persons who received in-patient care for depression (HR 1.76, 95% CI 1.61-1.94). Poor performance on both the cardiovascular fitness and cognitive tests was associated with a fivefold increased risk of suicide attempt or suicide death (HR 5.46, 95% CI 4.78-6.24).
Lower cardiovascular fitness at age 18 years was, after adjustment for a number of potential confounders, associated with an increased risk of attempt/death by suicide in adulthood. It remains to be clarified whether interventions designed to improve fitness in teens can influence the risk of suicidal behaviour later in life.
PubMed ID
23739044 View in PubMed
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Cardiovascular fitness in late adolescent males and later risk of serious non-affective mental disorders: a prospective, population-based study.

https://arctichealth.org/en/permalink/ahliterature296229
Source
Psychol Med. 2018 02; 48(3):416-425
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
02-2018
Author
J Nyberg
M Henriksson
M A I Åberg
A Rosengren
M Söderberg
N D Åberg
H G Kuhn
M Waern
Author Affiliation
Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg,Gothenburg,Sweden.
Source
Psychol Med. 2018 02; 48(3):416-425
Date
02-2018
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adolescent
Adult
Cardiorespiratory fitness
Exercise Test
Follow-Up Studies
Humans
Male
Middle Aged
Military Personnel - psychology
Neuropsychological Tests
Neurotic Disorders - epidemiology
Proportional Hazards Models
Prospective Studies
Psychotic Disorders - epidemiology
Risk factors
Schizophrenia - epidemiology
Sweden - epidemiology
Young Adult
Abstract
Cardiovascular fitness in late adolescence is associated with future risk of depression. Relationships with other mental disorders need elucidation. This study investigated whether fitness in late adolescence is associated with future risk of serious non-affective mental disorders. Further, we examined how having an affected brother might impact the relationship.
Prospective, population-based cohort study of 1 109 786 Swedish male conscripts with no history of mental illness, who underwent conscription examinations at age 18 between 1968 and 2005. Cardiovascular fitness was objectively measured at conscription using a bicycle ergometer test. During the follow-up (3-42 years), incident cases of serious non-affective mental disorders (schizophrenia and schizophrenia-like disorders, other psychotic disorders and neurotic, stress-related and somatoform disorders) were identified through the Swedish National Hospital Discharge Register. Cox proportional hazards models were used to assess the influence of cardiovascular fitness at conscription and risk of serious non-affective mental disorders later in life.
Low fitness was associated with increased risk for schizophrenia and schizophrenia-like disorders [hazard ratio (HR) 1.44, 95% confidence interval (CI) 1.29-1.61], other psychotic disorders (HR 1.41, 95% CI 1.27-1.56), and neurotic or stress-related and somatoform disorders (HR 1.45, 95% CI 1.37-1.54). Relationships persisted in models that included illness in brothers.
Lower fitness in late adolescent males is associated with increased risk of serious non-affective mental disorders in adulthood.
PubMed ID
28655366 View in PubMed
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Familial clustering of suicide risk: a total population study of 11.4 million individuals.

https://arctichealth.org/en/permalink/ahliterature133173
Source
Psychol Med. 2011 Dec;41(12):2527-34
Publication Type
Article
Date
Dec-2011
Author
D. Tidemalm
B. Runeson
M. Waern
T. Frisell
E. Carlström
P. Lichtenstein
N. Långström
Author Affiliation
Department of Clinical Neuroscience, Karolinska Institutet, Division of Psychiatry, Stockholm, Sweden. dag.tidemalm@ki.se
Source
Psychol Med. 2011 Dec;41(12):2527-34
Date
Dec-2011
Language
English
Publication Type
Article
Keywords
Cluster analysis
Databases, Factual
Family - psychology
Family Relations
Female
Humans
Male
Risk factors
Spouses - psychology - statistics & numerical data
Suicide - statistics & numerical data
Suicide, Attempted - statistics & numerical data
Sweden - epidemiology
Twins, Dizygotic - psychology
Twins, Monozygotic - psychology
Abstract
Research suggests that suicidal behaviour is aggregated in families. However, due to methodological limitations, including small sample sizes, the strength and pattern of this aggregation remains uncertain.
We examined the familial clustering of completed suicide in a Swedish total population sample. We linked the Cause of Death and Multi-Generation Registers and compared suicide rates among relatives of all 83 951 suicide decedents from 1952-2003 with those among relatives of population controls.
Patterns of familial aggregation of suicide among relatives to suicide decedents suggested genetic influences on suicide risk; the risk among full siblings (odds ratio 3.1, 95% confidence interval 2.8-3.5, 50% genetic similarity) was higher than that for maternal half-siblings (1.7, 1.1-2.7, 25% genetic similarity), despite similar environmental exposure. Further, monozygotic twins (100% genetic similarity) had a higher risk than dizygotic twins (50% genetic similarity) and cousins (12.5% genetic similarity) had higher suicide risk than controls. Shared (familial) environmental influences were also indicated; siblings to suicide decedents had a higher risk than offspring (both 50% genetically identical but siblings having a more shared environment, 3.1, 2.8-3.5 v. 2.0, 1.9-2.2), and maternal half-siblings had a higher risk than paternal half-siblings (both 50% genetically identical but the former with a more shared environment). Although comparisons of twins and half-siblings had overlapping confidence intervals, they were supported by sensitivity analyses, also including suicide attempts.
Familial clustering of suicide is primarily influenced by genetic and also shared environmental factors. The family history of suicide should be considered when assessing suicide risk in clinical settings or designing and administering preventive interventions.
Notes
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PubMed ID
21733212 View in PubMed
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Future marginalisation and mortality in young Swedish men with non-psychotic psychiatric disorders and the resilience effect of cognitive ability: a prospective, population-based study.

https://arctichealth.org/en/permalink/ahliterature287545
Source
BMJ Open. 2016 Aug 10;6(8):e010769
Publication Type
Article
Date
Aug-10-2016
Author
J. Löve
G. Hensing
M. Söderberg
K. Torén
M. Waern
M. Åberg
Source
BMJ Open. 2016 Aug 10;6(8):e010769
Date
Aug-10-2016
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Anxiety Disorders - epidemiology - psychology
Cognition
Cohort Studies
Depressive Disorder - epidemiology - psychology
Follow-Up Studies
Humans
Intelligence
Intelligence Tests
Logistic Models
Male
Men
Mental Disorders - epidemiology - psychology
Middle Aged
Mortality
Odds Ratio
Pensions - statistics & numerical data
Personality Disorders - epidemiology - psychology
Proportional Hazards Models
Prospective Studies
Public Assistance - utilization
Resilience, Psychological
Social Marginalization - psychology
Social Security - utilization
Substance-Related Disorders - epidemiology - psychology
Sweden - epidemiology
Unemployment - statistics & numerical data
Young Adult
Abstract
Large-scale studies examining future trajectories of marginalisation and health in adolescents with mental illness are scarce. The aim of this study was to examine if non-psychotic psychiatric disorders (NPDs) were associated with future indicators of marginalisation and mortality. We also aimed to determine whether these associations might be mediated by education level and attenuated by high cognitive ability.
This is a prospective cohort study with baseline data from the Swedish Conscription register.
The study was carried out in Sweden from 1969 to 2005.
All of the participants were 18-year-old men at mandatory conscription in Sweden between 1969 and 2005 (n=1 609 690).
NPDs were clinically diagnosed at conscription. Cognitive ability was measured by a standardised IQ test at conscription. National register data covered information on welfare support, long-term unemployment, disability pension (DP) and mortality over a period of 1-36 years.
NPD at the age of 18 years was a predictor of future welfare support, OR 3.73 (95% CI 3.65 to 3.80); long-term unemployment, OR 1.97 (95% CI 1.94 to 2.01); DP, HR 2.95 (95% CI 2.89 to 3.02); and mortality, HR 2.45 (2.33-2.52). The adjusted models suggested that these associations were not confounded by fathers' educational level, cognitive ability had only a minor attenuating effect on most associations and the mediating effect of own educational level was small.
The present study underlines a higher prevalence of future adversities in young men experiencing NPDs at the age of 18 years. It also indicates that higher cognitive ability may work as a potential resilience factor against future marginalisation and mortality.
Notes
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PubMed ID
27515748 View in PubMed
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High rate of antidepressant treatment in elderly people who commit suicide.

https://arctichealth.org/en/permalink/ahliterature210595
Source
BMJ. 1996 Nov 2;313(7065):1118
Publication Type
Article
Date
Nov-2-1996
Author
M. Waern
J. Beskow
B. Runeson
I. Skoog
Author Affiliation
Institute of Clinical Neuroscience, Section of Psychiatry, Sahlgrenska Hospital, Göteborg, Sweden.
Source
BMJ. 1996 Nov 2;313(7065):1118
Date
Nov-2-1996
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Antidepressive Agents - adverse effects
Depression - drug therapy - epidemiology
Female
Humans
Lithium - therapeutic use
Male
Scandinavia - epidemiology
Suicide
Notes
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PubMed ID
8916699 View in PubMed
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Impulsive suicide attempts among young people-A prospective multicentre cohort study in Sweden.

https://arctichealth.org/en/permalink/ahliterature298448
Source
J Affect Disord. 2019 01 15; 243:421-426
Publication Type
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Date
01-15-2019
Author
K Beckman
A U Lindh
M Waern
L Stromsten
E S Renberg
B Runeson
M Dahlin
Author Affiliation
Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm City Council, St. Goran, SE-112 61, Stockholm. Electronic address: karin.beckman@ki.se.
Source
J Affect Disord. 2019 01 15; 243:421-426
Date
01-15-2019
Language
English
Publication Type
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Keywords
Adolescent
Adult
Cohort Studies
Female
Humans
Impulsive Behavior
Logistic Models
Male
Middle Aged
Prevalence
Prospective Studies
Risk factors
Suicide, Attempted - statistics & numerical data
Sweden - epidemiology
Young Adult
Abstract
We aimed to compare the prevalence of impulsive suicide attempts (ISA) among young adults and those over 25 who present at hospital in connection with attempted suicide. We also aimed to identify factors associated with ISA in young adults and to assess medical severity as well as the probability of repeated suicide attempts in this age group.
A prospective multicentre cohort study included hospital known cases of suicide attempt (N?=?666). The prevalence of ISA was compared between young adults (18-25) and adults aged?>?26. We used logistic regression models to identify factors associated with ISA, associations of ISA with high medical severity and prediction of new fatal or non-fatal suicide attempts within 6 months.
43.7% of the young patients had made an ISA, and 30.2% among those aged?>?26 (p?=?0.001). Among the young, substance use disorder was associated with ISA; crude odds ratio (OR) 2.0 (1.0-4.2), and adjusted OR 2.1 (0.99-4.4). Affective disorder and unemployment/ sickness absence implied lower odds of ISA. ISA resulted in injuries of high medical severity as often as more planned attempts and non-fatal or fatal repetition within 6 months was equally common (30%) in both groups.
The study was set in psychiatric emergency services, which limits the generalizability.
Clinicians should acknowledge that suicide attempts among youth often occur without previous planning and may result in medically severe injuries. The probability of new fatal or non-fatal suicide attempts should be kept in mind also after an impulsive suicide attempt.
PubMed ID
30268958 View in PubMed
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Life events and psychosocial factors in elderly suicides--a case-control study.

https://arctichealth.org/en/permalink/ahliterature68341
Source
Psychol Med. 2001 Oct;31(7):1193-202
Publication Type
Article
Date
Oct-2001
Author
E. Rubenowitz
M. Waern
K. Wilhelmson
P. Allebeck
Author Affiliation
Department of Social Medicine, Göteborg University, Sweden.
Source
Psychol Med. 2001 Oct;31(7):1193-202
Date
Oct-2001
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Case-Control Studies
Catchment Area (Health)
Female
Humans
Life Change Events
Male
Psychiatric Status Rating Scales
Psychophysiologic Disorders - epidemiology - psychology
Questionnaires
Research Support, Non-U.S. Gov't
Suicide - psychology - statistics & numerical data
Sweden - epidemiology
Abstract
BACKGROUND: Stressful life events, such as family conflicts, separation, bereavement, somatic illness and financial problems are common antecedents of suicide. Studies on suicide among younger persons dominate the literature, despite the fact that a large proportion of suicides occur among elderly persons. METHODS: The occurrence of stressful life events was investigated among elderly suicide cases and population controls. The study was conducted in the southwestern part of Sweden and included 85 persons (46 males and 39 females) 65 years and above who had committed suicide from January 1994 to May 1996. Population controls (84 males and 69 females) were randomly selected. Interviews were carried out with the controls and with informants for the suicide cases. Questions on sociodemographic background, mental and somatic health status, and life events (0-6, 7-12 and 13-24 months preceding suicide/interview) were included in the interviews. RESULTS: Somatic illness, family discord and financial trouble were significant risk factors during all three time periods. Other risk factors were mental disorder, lower education, feelings of loneliness and previous suicide in the family. Factors associated with a decreased risk included active participation in organizations and having a hobby. Variables that remained in the multivariate logistic regression model were mental disorder (men, odds ratio (OR) = 62.4, 95% CI 17.9-217.5; women, OR = 55.9, 95% CI 14.1-222.3) and family discord (men, OR = 10.0. 95% CI 1.7-59.8; women, OR = 9.2, 95% CI 1.9-44.8). CONCLUSIONS: Mental disorder and family discord were the two major risk factors for suicide among elderly men and women.
PubMed ID
11681545 View in PubMed
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Longitudinal associations between physical activity and depression scores in Swedish women followed 32 years.

https://arctichealth.org/en/permalink/ahliterature276685
Source
Acta Psychiatr Scand. 2015 Dec;132(6):451-8
Publication Type
Article
Date
Dec-2015
Author
P. Gudmundsson
M. Lindwall
D R Gustafson
S. Östling
T. Hällström
M. Waern
I. Skoog
Source
Acta Psychiatr Scand. 2015 Dec;132(6):451-8
Date
Dec-2015
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Depression - epidemiology
Female
Humans
Longitudinal Studies
Middle Aged
Motor Activity
Sweden - epidemiology
Abstract
Physical activity is negatively associated with depressive symptoms. However, few studies consider dynamic associations of changes in physical activity and reciprocal relationships. This study aimed to perform comprehensive evaluations of relationships between physical activity and depression scores in women followed from mid- to late life.
The Prospective Population Study of Women in Gothenburg, Sweden, provided repeated measures of self-reported physical activity and depressive symptoms between 1974 and 2005 (baseline N = 676, 84.5% response rate). Depressive symptoms were assessed using the Montgomery-Åsberg Depression Rating Scale, and physical activity was evaluated by the Saltin-Grimby Physical Activity Level Scale. Latent growth curve analyses were used to evaluate associations of change, and cross-lagged models were used to study the reciprocal relationship between physical activity and depression scores.
At baseline, lower levels of physical activity were related to higher depression scores. Individuals with decreasing physical activity over time evidenced higher depression scores at 32-year follow-up. Higher average baseline depression score was related to declining levels of physical activity at subsequent examinations.
Reduced physical activity may be a long-term consequence of depression. It is important to address individual changes in physical activity and not merely absolute levels of physical activity in relationship to depression.
Notes
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PubMed ID
25865488 View in PubMed
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Performance of the SF-36 health survey in screening for depressive and anxiety disorders in an elderly female Swedish population.

https://arctichealth.org/en/permalink/ahliterature45666
Source
Qual Life Res. 2005 Jun;14(5):1263-74
Publication Type
Article
Date
Jun-2005
Author
E. Silveira
C. Taft
V. Sundh
M. Waern
S. Palsson
B. Steen
Author Affiliation
Department of Geriatric Medicine, Mölndal Hospital, Sahlgrenska Academy at Göteborg University, Sweden. mail@ellensilveira.com
Source
Qual Life Res. 2005 Jun;14(5):1263-74
Date
Jun-2005
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Aged, 80 and over
Anxiety Disorders - diagnosis - epidemiology
Depressive Disorder - diagnosis - epidemiology
Diagnostic and Statistical Manual of Mental Disorders
Female
Health Status Indicators
Humans
Mass Screening - instrumentation
Psychiatric Status Rating Scales
Research Support, Non-U.S. Gov't
Sensitivity and specificity
Sweden - epidemiology
Women's health
Abstract
OBJECTIVE: To assess the sensitivity, specificity and predictive validity of suggested cut-off scores in the SF-36 mental health (MH) and mental component summary (MCS) in screening for depressive and anxiety disorders in a population sample of older Swedish women. METHOD: The sample comprised 586 randomly selected females aged 70-84 years who took part in an in-depth psychiatric examination. This provided the 'gold standard' against which the usefulness of SF-36 recommended thresholds for screening for depressive and anxiety disorders in older Swedish women was examined. RESULTS: Based on DSM-III-R criteria, 69 women (12%) were diagnosed with depression (major depression, dysthymia and/or depression NOS) and 49 (8%) with generalised anxiety and panic disorders. The previously recommended MH and MCS cut-offs (i.e. 52 and 42) gave a specificity for diagnosis of depression of 92 and 82% and sensitivity of 58 and 71%, respectively. Both the MH and MCS were good predictors of depressive disorders but poor predictors of anxiety disorders. CONCLUSION: The study supports the predictive validity of suggested SF-36 MH and MCS cut-off scores in screening for depressive disorder but not for anxiety disorder in older women in Sweden.
PubMed ID
16047502 View in PubMed
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