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Utilization of psychiatric care and antidepressants among people with different severity of depression: a population-based cohort study in Stockholm, Sweden.

ABSTRACT: PURPOSE:To identify how severity of depression predicts future utilization of psychiatric care and antidepressants. METHODS:Data derived from a longitudinal population-based study in Stockholm, Sweden, include 10443 participants aged 20-64 years. Depression was assessed by Major Depression Inventory and divided into subsyndromal, mild, moderate and severe depression. Outcomes were the first time of hospitalization, specialized outpatient care and prescribed drugs obtained from national register records. The association between severity of depression and outcomes was tested by Cox regression analysis, after adjusting for gender, psychiatric treatment history and socio-environmental factors. RESULTS:The cumulative incidences of hospitalizations, outpatient care and antidepressants were 4.0, 11.2, and 21.9% respectively. Compared to the non-depressed group, people with different severity of depression (subsyndromal, mild, moderate and severe depression) all had significantly higher risk of all three psychiatric services (all log-rank test P < 0.001). Use of psychiatric care and antidepressants increased by rising severity of depression. Although the associations between severity of depression and psychiatric services were significant, the dose relationship was not present in people with previous psychiatric history or after adjusting for gender and other factors. CONCLUSIONS:People with subsyndromal to severe depression all have increased future psychiatric service utilization compared to non-depressed people.

SUBMITTER: Sun Y

PROVIDER: S-EPMC5959996 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:ObjectivesChildhood conditions have been recognised as important predictors of short-term and long-term health outcomes, but few studies have considered status position in the peer group as a possible determinant of adult health. Lower peer status, which often reflects experiences of marginalisation and rejection by peers, may impose inequality experiences and leave long-lasting imprints on health. The present study aimed to examine whether peer status is associated with the risk for circulatory disease in adulthood.DesignProspective cohort study based on the Stockholm Birth Cohort Multigenerational Study(SBC Multigen).SettingStockholm metropolitan area.ParticipantsAll individuals who were born in 1953 and resident in the greater metropolitan area of Stockholm in 1963 (n=14 608). The analytical sample consisted of 5410 males and 5990 females. Peer status was sociometrically assessed in cohort members at age 13. The survey material was linked to inpatient care registers that contained information about circulatory diseases (n=1668) across ages 20-63. Cox proportional hazard models were used for the analysis.Outcome measureCirculatory disease.ResultsPeer marginalisation at age 13 resulted in significantly higher risks of circulatory disease in adulthood among males (HR 1.34; 95% CI 1.09 to 1.64) and females (HR 1.33; 95% CI 1.04 to 1.70) alike. A graded relationship between peer status and circulatory diseases was detected in females (p=0.023). Among males there was a threshold effect, showing that only those in the lowest status position had significantly increased risks of circulatory disease. The associations remained significant after adjusting for various conditions in childhood and adulthood.ConclusionsThis study shows that circulatory diseases in adulthood may be traceable to low peer status and marginalisation in childhood. It is suggested that peer status in late childhood may precede social integration in adolescence and adulthood, acting as a long-term stressor that contributes to circulatory disease through biological, behavioural and psychosocial pathways.

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Project description:BackgroundThe relationship between statin treatment and Coronavirus Disease 2019 (COVID-19) mortality has been discussed due to the pleiotropic effects of statins on coagulation and immune mechanisms. However, available observational studies are hampered by study design flaws, resulting in substantial heterogeneity and ambiguities. Here, we aim to determine the relationship between statin treatment and COVID-19 mortality.Methods and findingsThis cohort study included all Stockholm residents aged 45 or older (N = 963,876), followed up from 1 March 2020 until 11 November 2020. The exposure was statin treatment initiated before the COVID-19-pandemic, defined as recorded statin dispensation in the Swedish Prescribed Drug Register between 1 March 2019 and 29 February 2020. COVID-19-specific mortality was ascertained from the Swedish Cause of Death Registry. Hazard ratios (HRs) were calculated using multivariable Cox regression models. We further performed a target trial emulation restricted to initiators of statins. In the cohort (51.6% female), 169,642 individuals (17.6%) were statin users. Statin users were older (71.0 versus 58.0 years), more likely to be male (53.3% versus 46.7%), more often diagnosed with comorbidities (for example, ischemic heart disease 23.3% versus 1.6%), more frequently on anticoagulant and antihypertensive treatments, less likely to have a university-level education (34.5% versus 45.4%), and more likely to have a low disposable income (20.6% versus 25.2%), but less likely to reside in crowded housing (6.1% versus 10.3%). A total of 2,545 individuals died from COVID-19 during follow-up, including 765 (0.5%) of the statin users and 1,780 (0.2%) of the nonusers. Statin treatment was associated with a lowered COVID-19 mortality (adjusted HR, 0.88; 95% CI, 0.79 to 0.97, P = 0.01), and this association did not vary appreciably across age groups, sexes, or COVID-19 risk groups. The confounder adjusted HR for statin treatment initiators was 0.78 (95% CI, 0.59 to 1.05, P = 0.10) in the emulated target trial. Limitations of this study include the observational design, reliance on dispensation data, and the inability to study specific drug regimens.ConclusionsStatin treatment had a modest negative association with COVID-19 mortality. While this finding needs confirmation from randomized clinical trials, it supports the continued use of statin treatment for medical prevention according to current recommendations also during the COVID-19 pandemic.

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Utilization of psychiatric care and antidepressants among people with different severity of depression: a population-based cohort study in Stockholm, Sweden.

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