Fotios C. Papadopoulos

Excess mortality, causes of death and prognostic factors in anorexia nervosa

BACKGROUND Anorexia nervosa is a mental disorder with high mortality. AIMS To estimate standardised mortality ratios (SMRs) and to investigate potential prognostic factors. METHOD Six thousand and nine women who had in-patient treatment for anorexia nervosa were followed-up retrospectively using Swedish registers. RESULTS The overall SMR for anorexia nervosa was 6.2 (95% CI 5.5-7.0). Anorexia nervosa, psychoactive substance use and suicide had the highest SMR. The SMR was significantly increased for almost all natural and unnatural causes of death. The SMR 20 years or more after the first hospitalisation remained significantly high. Lower mortality was found during the last two decades. Younger age and longer hospital stay at first hospitalisation was associated with better outcome, and psychiatric and somatic comorbidity worsened the outcome. CONCLUSIONS Anorexia nervosa is characterised by high lifetime mortality from both natural and unnatural causes. Assessment and treatment of psychiatric comorbidity, especially alcohol misuse, may be a pathway to better long-term outcome.

A role of sunshine in the triggering of suicide

Several reports indicate that suicide follows a seasonal pattern with a dominant peak during the month of maximum daylight. The purpose of this study was to evaluate the hypothesis that sunshine exposure may trigger suicidal behavior. We found a remarkably consistent pattern of seasonality with peak incidence around June in the northern hemisphere and December in the southern hemisphere. Moreover, there was a positive association between the seasonal amplitude of suicide (measured by relative risk) and total sunshine in the corresponding country. These findings indicate that sunshine may have a triggering effect on suicide, and suggests further research in the field of sunshine-regulated hormones, particularly melatonin.

Doping use among tertiary education students in six developed countries

Data on doping among young non-professional athletes are scarce. In order to estimate the prevalence and predictors of doping use, a standardized, anonymous questionnaire was self-administered by 2650 tertiary education students from five European Union countries (Finland, France, Germany, Greece, Italy) and Israel. The reported usage rate of a doping agent (at least once) was 2.6%, with no significant variation in the frequency of doping reporting among the participating countries. Doping was, however, less common among students of biomedical schools (OR: 0.49, 95% CI: 0.27–0.89) and was higher among males (OR: 2.16, 95% CI: 1.25–3.74). Students, who use to drink coffee or recall frequent occasions of involvement in drunkenness episodes, were more likely (twice and three times, respectively) to report doping, and students using nutritional supplements or having participated in a major athletic event were more likely (four times and twice, respectively) to report doping in comparison with students who do not. Of note is the high odds ratio for reporting individual doping when having a friend who uses doping (OR: 8.61, 95% CI: 4.49–16.53). Given the large size of the physically active young individuals in the population and the small number of professional athletes, doping in the general population may be, in absolute terms, as sizeable problem as it is among the professional athletes. There was evidence that high-risk behaviour and supplement use increased the risk of doping.

Factors affecting motorcycle helmet use in the population of Greater Athens, Greece

Objectives—Helmet use is the best preventive measure available against two wheel motorized vehicle (TWMV) related head injuries. In some countries, however, helmets are used only by a minority of TWMV riders. In collaboration with the Road Traffic Police Department, an inspection survey was undertaken to assess the prevalence and to determine predictors of helmet use. Setting—The Greater Athens area, Greece, during July and August 1998. Methods—A total of 982 TWMVs were stopped, 349 of which had two riders (36%). All riders were interviewed by staff members of the Centre for Research and Prevention of Injuries among the Young. Results—The average prevalence of helmet use was 20.2%. It ranged from 9.7% on small suburban roads to 50.8% on highways. Prevalence of use was significantly lower during the weekend days and at night. Women were significantly more likely to wear a helmet and, controlling for gender, drivers were significantly more likely to be helmet users. Riders of more powerful TWMVs and passengers, who themselves had a TWMV driving license, were helmet users more frequently. Among non-users, the majority (46%) indicated that “the helmet made them feel uncomfortable”, particularly in warm weather, whereas 18% claimed that there was little need for a helmet in low speed riding. Conclusions—A multipronged campaign is urgently needed in Greece to increase the prevalence of helmet use by TWMV riders. The campaign should include not only police enforcement but also initiatives to make helmets more convenient to wear and less expensive.

Risk of postpartum depression in association with serum leptin and interleukin-6 levels at delivery: A nested case–control study within the UPPSAT cohort

Although postpartum depression (PPD) is a common condition, it often goes undiagnosed and untreated, with devastating consequences for the womans ability to perform daily activities, to bond with her infant and to relate to the infants father. Leptin, a protein synthesised in the adipose tissue and involved in regulation of food intake and energy expenditure has been related to depressive disorders, but studies report conflicting results. The aim of this study was to evaluate the association between serum leptin levels at the time of delivery and the subsequent development of postpartum depression in women, using data from a population-based cohort of delivering women in Uppsala, Sweden. Three hundred and forty seven women from which serum was obtained at the time of delivery filled out at least one of three structured questionnaires containing the Edinburgh Scale for Postnatal Depression (EPDS) at five days, six weeks and six months after delivery. Mean leptin levels at delivery did not significantly differ between the 67 cases of PPD and the 280 controls. Using linear regression analysis and adjusting for maternal age, body-mass index, smoking, interleukin-6 levels, duration of gestation and gender of the newborn, the EPDS scores at six weeks and six months after delivery were found to be negatively associated with leptin levels at delivery (p<0.05). Serum leptin levels at delivery were found to be negatively associated with self-reported depression during the first six months after delivery. No such association was found concerning serum IL-6 levels at delivery. If these finding are replicated by other studies, leptin levels at delivery could eventually serve as a biological marker for the prediction of postpartum depression.

Seasonality of suicide in Sweden: Relationship with psychiatric disorder

BACKGROUND Little is known as to whether suicide seasonality is related to psychiatric disorders affecting suicide risk/incidence. The present study aims to assess suicide seasonality patterns with regard to the history of psychiatric morbidity among suicide victims. METHODS The history of psychiatric inpatient diagnoses in the five years prior to suicide was identified among all suicides in Sweden from 1992 to 2003. Suicide seasonality was estimated as the relative risk of suicide during the month of highest to that in the month of lowest suicide incidence. Analyses were performed with respect to sex, suicide method and history of inpatient treatment of psychiatric disorder. RESULTS Among both male (n=9,902) and female (n=4,128) suicide victims, there were peaks in suicide incidence in the spring/early summer. This seasonal variation was more evident in suicide victims with a psychiatric inpatient diagnosis than in those without such a diagnosis. A seasonal variation was found in most diagnostic groups, with significant peaks in males with a history of depression and in females with a history of a neurotic, stress-related, or somatoform disorder. Overall, suicide seasonality was more evident in violent than in non-violent suicide methods. LIMITATION Only psychiatric disorders severe enough to require hospital admission were studied. CONCLUSION A history of inpatient-treated psychiatric disorder appears to be associated with an increase in suicide seasonality, especially in violent suicide methods. This increase is found in several psychiatric disorders.

Postpartum depression symptoms: a case–control study on monoaminergic functional polymorphisms and environmental stressors

Objective Postpartum depression (PPD) is an under diagnosed and under treated mood disorder, with negative impact on both the mother and the infants health. The aim of this study is to examine whether genetic variations in the monoaminergic neurotransmitter system, together with environmental stressors, contribute to the development of PPD symptoms. Methods This nested case–control study included 275 women from a population-based cohort of delivering women in Sweden. A questionnaire containing the Edinburgh Postnatal Depression Scale was collected at 6 weeks and 6 months postpartum. Three functional polymorphisms were genotyped, catechol-O-methyltransferase (COMT)-Val158Met, monoamine oxidase A (MAOA)-upstream variable number tandem repeat (uVNTR) and serotonin transporter linked polymorphic region (5HTT-LPR). Stressful life events, maternity stressors and previous psychiatric contact were considered as potential risk factors. Results COMT-Val158Met was significantly associated with PPD symptoms at 6 weeks, but not at 6 months postpartum. A significant gene–gene interaction effect was present between COMT-Val158Met and MAOA-uVNTR. In a gene–environment multivariate model, COMT-Val158Met, psychiatric contact and maternity stressors were significantly associated with PPD symptoms. Among those with history of psychiatric problems, the COMT-Val158Met and 5HTT-LPR risk variants were associated with PPD symptoms, whereas in the absence of previous psychiatric contact only maternity stressors were related to PPD symptoms. Conclusion The interaction effect between monoaminergic genes and environmental stressors is likely to contribute to vulnerability for PPD. The different patterns of association according to history of psychiatric problems, if replicated, might be helpful in screening strategies.

Cognitive impairment and dietary habits among elders: the Velestino Study.

To investigate the association of dietary habits with cognitive function among elders (>65 years). Complete sociodemographic, dietary information, serum measurements, and Mini-Mental State Examination (MMSE) assessments were available for 237 elderly men and 320 women residing in Velestino, Greece (a rural Greek town). All models were adjusted for age, education, social activity, smoking, depression symptomatology (using the Geriatric Depression Scale), MedDietScore (range 0-55), and metabolic syndrome. About 49.8% men and 66.6% women had MMSE scores <24, with a mean MMSE score of 22.7±4.43 and 21.1±4.73, respectively. Adherence to the Mediterranean diet was moderate (mean MedDietScore of 34.1±3.25 in men and 35.1±2.48 in women). Indicative cognitive impairment (MMSE score <24) was positively associated with age and low education in women and with depressive symptoms, low education status, and low social activity in men. Adherence to the Mediterranean diet was positively associated with MMSE score in men (P=.02), but inversely associated in women (P=.04). Concerning the food groups studied, intake of pulses, nuts, and seeds was associated with lower likelihood of having MMSE score<24 in men (P=.04). Only the Mediterranean dietary pattern showed a significant association with MMSE score positive for cognitive impairment (i.e., protective in men, but not in women), while individual food groups or nutrients did not achieve significance. The latter findings support the role of whole diet in the prevention of mental disorders, and state a research hypothesis for a sex-diet interaction on cognitive function among elders.

Seasonality of Violent Suicides in the Athens Greater Area

The aim of the study was to ascertain suicide seasonality in the Greek population and to associate this seasonal variation with age, sex, and suicide method. Studying seasonality can be of help in establishing a public health policy, related with suicide prevention. This is an epidemiologic study based on forensic evidence. We studied the deaths caused by self-injury (trauma), namely deaths by violent suicide (not self-poisoning). Statistically significant suicide seasonality was established with a peak in May. This seasonal variation is attributed mainly to males. As for the method, suicide by hanging peaks in June and by shooting in April. It was also observed that seasonality for individuals above the age of 45 peaks in early May.

Suicides during pregnancy and 1 year postpartum in Sweden, 1980-2007.

BACKGROUND Although the incidence of suicide among women who have given birth during the past 12 months is lower than that of women who have not given birth, suicide remains one of the most common causes of death during the year following delivery in high-income countries, such as Sweden. AIMS To characterise women who died by suicide during pregnancy and postpartum from a maternal care perspective. METHOD We traced deaths (n = 103) through linkage of the Swedish Cause of Death Register with the Medical Birth and National Patient Registers. We analysed register data and obstetric medical records. RESULTS The maternal suicide ratio was 3.7 per 100 000 live births for the period 1980-2007, with small magnitude variation over time. The suicide ratio was higher in women born in low-income countries (odds ratio 3.1 (95% CI 1.3-7.7)). Violent suicide methods were common, especially during the first 6 months postpartum. In all, 77 women had received psychiatric care at some point, but 26 women had no documented psychiatric care. Antenatal documentation of psychiatric history was inconsistent. At postpartum discharge, only 20 women had a plan for psychiatric follow-up. CONCLUSIONS Suicide prevention calls for increased clinical awareness and cross-disciplinary maternal care approaches to identify and support women at risk.