This work-area, led by Ingmar Skoog, studies interactions between psychosocial, biological and genetic risk factors for the development of mental disorders (e.g. depression, anxiety disorders, alcohol and drug abuse, suicidal behavior) and whether the influence of these risk factors and their interactions changes with age and over time. Other objectives are to study whether the rates of mental disorders differ between different birth cohorts and different age groups, whether individuals with these disorders are recognized and properly treated by the health care system, to study preclinical symptoms of depression, to study the influence of genetic factors and biological brain changes on mental disorders in old age, and to study long-term prognosis of mental disorders in relation to recurrence, diagnostic change, chronicity, functional ability, institutionalization, mortality rate, and levels of care. The examinations include psychiatric, genetic, somatic and psychosocial examinations, brain imaging, cerebrospinal fluid and body composition examinations, personality inventories and psychometric testings. The work plan consists primarily of six projects as described below. The studies in WA2.2-6 use identical or similar instruments to evaluate mental symptoms and risk factors.
Mental disorders from young adulthood to midlife
The aim of the longitudinal population study "Women and Alcohol in Gothenburg" (WAG) is to examine determinants of alcohol abuse and other substance use related problems in women. Specific areas of interest include early life factors, adult psychosocial factors, depression, anxiety, consumption of prescription drugs and illegal drugs, patterns of help-seeking behavior and sick leave. The study, which is led by Fredrik Spak together with Gunnel Hensing at the Department of Social Medicine, was initiated in 1986. The design is two-phase with a postal screening questionnaire followed by face-to face interviews with selected samples. New cohorts have been added at follow-up waves allowing for a current emphasis on young adulthood. In an ongoing collaboration with Margda Waern, predictors of suicidal behavior are studied, which is of particular interest as suicide rates are higher among young women in Sweden than in most other European countries. This work, particularly the socioeconomic dimension, will be conducted in close connection with WA1.
Mental disorders from midlife to late life
Middle aged women were examined within the PPSW (Prospective population study of women) in 1968 and followed continuously with the most recent follow-up carried out in 2009-2010. Extensive examinations of medical records extending back to the 1920s and registry data are done continuously to track new cases and also to identify cases in early life. This gives the opportunity to measure life-time frequency of mental disorders, as well as predictors, risk factors and long-term prognosis of these disorders.
Mental disorders in late-life
Representative populations of elderly individuals have been followed longitudinally from age 70 (H70-study) and age 85 (H85-study) until age 105 or death and examined with extensive psychiatric examinations. The PPSW also includes individuals above age 70 who have been followed longitudinally. This gives the opportunity to examine the frequency of mental disorders in old age, and its risk factors and prognosis. We also examine the utility of different diagnostic criteria to detect individuals with mental disorders (collaboration with Prof Johannes Wancata, Vienna). Other collaborations are with Dr Paul Duberstein, Rochester, regarding the influence of personality factors. The studies are also included in the European Union's concerted action on depression in the elderly, organised by the University of Liverpool, (Prof. John Copeland). The aim is to compare the frequency of depression in different European countries and to study risk factors in pooled data. A total of 22 000 individuals in 12 countries are included. EpiLife researchers have access to the database for studies of psychotic symptoms, suicidal feelings and sleep disorders. The Gothenburg Study on Late-Onset Psychosis examines patients with psychosis using the same instruments as those used in the population studies, thus making it possible to do case-control studies using population-based controls.
Mental disorders in very old age
The 95 study is the largest population study in the world on individuals above age 95. More than 800 individuals have been included so far. The aim of this longitudinal study is to examine the frequency of mental disorders in very old age (the fastest growing segment of Western populations) and to examine determinants of mentally healthy survival. This work will be conducted in close collaboration with WA4.
Secular trends in the frequency of mental disorders and their risk factors
70-year olds born 1901-02, 1906-07, 1922 and 1930 were examined with identical methods. 70-year-olds born 1940 was examined in 2010. A re-examination of those born 1930 at the age of 75 was concluded in 2006. This birth-cohort will be re-examined at ages 79, 81, 83 and 85 in a similar way as the birth cohort born 1901-02, thus making it possible to compare two birth cohorts followed longitudinally 30 years apart. This will provide a unique opportunity to study changing patterns in the frequency of mental disorders in old age, and associated risk factors. This work represents a collaborative effort involving risk factors and outcomes central to all 4 work-areas.
Suicidal behaviour through the life span
Young and middle-aged adults (aged 18-69 years) who seek care at Sahlgrenska University Hospital after a suicide attempt are invited to participate in an interview with a psychiatric nurse and followed up at 8 weeks. Areas of special interest include potential associations between different types of sleep disturbance and suicidality. Further, there is a particular focus on predictors of treatment resistant suicidality. A second study on suicide attempters includes 101 persons aged 70 years and above who sought care in connection with a suicide attempt at any of the five hospitals in western Sweden and who took part in an interview with a research psychologist. Five age- and sex matched controls were randomly selected from H70/PPSW (see above) for each suicide attempt patient, yielding a population reference group. Potential predictors of suicidal behavior that will be tested include interpersonal conflict, loneliness, psychiatric morbidity, alcohol problems, personality factors, physical health and functional disability, decreased cognitive ability and white matter changes. Further, a follow-up interview one year after the suicide attempt is included. Predictors of treatment resistant suicidality and mortality will be identified. Suicidal thoughts are also examined in the population studies (H70, H85, PPSW, 95 ).
Neuropsychiatric Epidemiology >>