Kristian Tambs

The association between tinnitus and mental health in a general population sample: Results from the HUNT Study ☆,☆☆

OBJECTIVESnClinical studies indicate a strong association between tinnitus and mental health, but results from general population data are missing. The purpose of the study was to examine the association between tinnitus, mental health, and well-being in the general adult population and to identify factors that might mediate and moderate this association.nnnMETHODSnData from 51,574 adults participating in the Nord-Trøndelag Hearing Loss Study (1995-1997), part of the Nord-Trøndelag Health Study (HUNT-2), were analyzed. The association between tinnitus symptom intensity and symptoms of depression, anxiety, self-esteem, and subjective well-being was examined by multivariate ANOVA, stratified by age group and sex. Explanatory variables were age, marital status, education, hearing, dizziness, vision, physical disability, and somatic illness. In a subsample of participants with tinnitus, the effects of time since onset, predictability of tinnitus episodes, and noise sensitivity were tested.nnnRESULTSnParticipants with tinnitus scored significantly higher on anxiety and depression and lower on self-esteem and well-being than people without tinnitus. The effect sizes were small and quite similar across levels of tinnitus symptom intensity. No significant effect of time since onset was found. A significant effect of predictability of tinnitus episodes and noise sensitivity was found in some groups.nnnCONCLUSIONnA weak association between tinnitus and mental health was found in this general population study.

Genetic and environmental contributions to the variance of the body mass index in a Norwegian sample of first- and second-degree relatives

Height and weight were measured in a health screening of the population in Nord‐Trøndelag, Norway. Correlations for the body mass index were computed for 23,936 pairs of spouses, 43,586 pairs of parents and offspring, 19,151 pairs of siblings, 1,251 pairs of grandparents and grandchildren, 1,146 cognate avuncular pairs, 801 noncognate avuncular pairs, 168 pairs of same‐sexed twins, and smaller groups of other types of relatives. Correlations were largely independent of age and age difference within pairs of relatives, suggesting a stable effect of the same set of genes and familial environment throughout adulthood. No effect of convergence during marriage could be detected. Correlations were approximately .20 for parents and offspring, .26 for same‐sexed siblings, .20 for opposite‐sexed siblings, .58 for monozygotic twins, and close to zero for most second‐order relatives. Results from structural equation model‐fitting indicate a broad heritability of .4, much of which is due to genetic dominance or other genetic nonadditivity.

Age-specific genetic effects for blood pressure.

Correlations between relatives were determined for systolic and diastolic blood pressure. The correlations decrease as age differences between relatives increase in a Norwegian sample with 43,751 parent-offspring pairs, 19,140 pairs of siblings, and 169 pairs of twins. A simple biometric model specifying only age-specific genetic additive effects and environmental effects fitted well to correlations between cotwins, pairs of siblings, and parent-offspring dyads in subsets of relatives grouped by age differences. None of the environmental effects appeared to be due to environmental factors that are shared by family members. Models that excluded a parameter for the age-specific genetic influence did not fit the data. The results may partly explain what seems to be a discrepancy between relatively low parent-offspring correlations from previous nuclear family studies and high correlations from twin studies, especially in identical twins.

Brief measure of posttraumatic stress reactions: impact of Event Scale-6

BackgroundThe Impact of Event Scale-revised (IES-R) is one of the most widely used measures of posttraumatic stress reactions. However, for some purposes, such as large epidemiological studies, there is a need for briefer instruments. The aim of this study was to develop and validate an abbreviated version of the IES-R that could capture the three current symptom clusters of posttraumatic stress disorder (PTSD).MethodsStepwise multiple regression was applied to abbreviate the IES-R in one sample. The abbreviated version was then tested in three separate samples of individuals exposed to different kinds of potentially traumatic events. Agreement with a reference measure of PTSD, the PTSD checklist (PCL), was calculated for the abbreviated and the full-scale versions of IES.ResultsThe abbreviation procedure resulted in a subset of six items (the IES-6), which correlated highly (pooled correlationxa0=xa00.95) with the IES-R across samples. Correlations between the IES-6 and IES-R subscales were somewhat lower (rxa0=xa00.78–0.94). Both the IES-6 and IES-R were in high agreement with the PCL.ConclusionThe IES-6 appears to be a robust brief measure of posttraumatic stress reactions. It may be useful for research in epidemiological studies, and it may also have a role as a screening instrument in clinical practice.

Gene–environment interactions in panic disorder and CO2 sensitivity: Effects of events occurring early in life†

Heterogeneous life events (LE) precede the onset of—and potentially increase the susceptibility to—panic disorder (PD). It remains unknown whether LE can act as moderators in the context of gene‐by‐environment interactions (G×E) that alter the susceptibility to PD and the related trait of CO2 sensitivity, nor it is known whether such moderation may depend on occurrence of events at different epochs in life. In 712 general population twins we analyzed by Maximum Likelihood analyses of ordinal data whether life (major‐ and stressful) events moderate the genetic risk for PD and CO2 sensitivity, as indexed by the 35% CO2/65% O2 challenge. For CO2 sensitivity, best‐fitting models encompassed both additive and interactional effects that increased linearly with the cumulative number and severity (SEV) of events in lifetime. By analyzing the moderation effect of cumulative SEV separately for events that had occurred in adulthood (between age 18 and 37) or during childhood–adolescence (before the 18th birthday), we found evidence of G×E only within the childhood–adolescence window of risk, although twins had rated the childhood–adolescence events as significantly (Pu2009=u20090.001) less severe than those having occurred during adulthood. For PD, all interactional terms could be dropped without significant worsening of the models fit. Consistently with a diathesis‐stress model, LE appear to act as moderators of the genetic variance for CO2 sensitivity. Childhood–adolescence appears to constitute a sensitive period to the action of events that concur to alter the susceptibility to this panic‐related trait.

Risk factors for depressive disorders in the Lundby cohort : A 50 year prospective clinical follow-up

BACKGROUNDnDepressive disorders are common and disabling. The Lundby Study is a prospective study of a community sample that started in 1947 (N=2550). In 1957, 1013 newcomers were added. The latest field investigation was carried out in 1997.nnnAIMnTo identify risk factors for depressive disorders.nnnMETHODnThe Lundby database contains clinical assessments of the subjects made by psychiatrists. It also includes information about socio-demographic factors and episodes of somatic and mental disorders. Two different but partly overlapping cohorts from the same geographical area in 1947 (N=2470) and in 1957 (N=3310) were investigated. During follow-up 418 individuals experienced their first depressive disorder. For each cohort, possible risk factors were analysed by means of Cox regression analyses for the whole sample and for each sex separately.nnnCONCLUSIONnThe personality trait nervous/tense and anxiety disorders were statistically significant risk factors for depression for both genders. For males, the diagnoses alcohol disorders and tiredness disorder were risk factors. The personality trait subvalidity (low grade of energy) and nervous symptoms as a child were also risk factors for males. For females personality traits such as being easily hurt, abnormal/antisocial and tired/distracted were associated with depressive disorders.nnnCLINICAL RELEVANCEnKnowledge of risk factors may help to reduce incidence of depression.

Occupation and the risk of bothersome tinnitus: results from a prospective cohort study (HUNT)

Objectives Estimates of occupation-specific tinnitus prevalence may help identify high-risk occupations where interventions are warranted. The authors studied the effect of occupation on prevalence of bothersome tinnitus and estimated the attributable fraction due to occupation. The authors also studied how much of the effect remained after adjusting for noise exposure, education income, hearing thresholds and other risk factors. Design A prospective cohort study. Setting A health survey of the Nord-Trøndelag county of Norway. Participants A sample of the general adult population (n=49u2008948). Primary outcome measure The primary outcome measure is bothersome tinnitus. Results Occupation had a marked effect on tinnitus prevalence. The effect of occupation on tinnitus was reduced in men by controlling for self-reported occupational noise exposure and in women by controlling for education and income. Adding hearing loss as a predictor increased the effect of occupation somewhat. In men, age-adjusted prevalence ratios of tinnitus ranged from 1.5 (workshop mechanics) to 2.1 (crane and hoist operators) in the 10 occupations with highest tinnitus prevalence. In women, the most important contribution to the tinnitus prevalence was from the large group of occupationally inactive persons, with a prevalence ratio of 1.5. Conclusion This study found a moderate association between occupation and bothersome tinnitus.

The relationships between adverse events, early antecedents, and carbon dioxide reactivity as an intermediate phenotype of panic disorder: a general population study.

Background: Although adverse events have been consistently described to precede and potentially precipitate the onset of panic disorder, there is no information about their ability to alter the individual reactivity to inhaled carbon dioxide, a putative intermediate phenotype of susceptibility to panic disorder. Method: Seven-hundred twelve subjects belonging to the general population-based Norwegian Institute of Public Health Twin Panel underwent a 35% CO2/65% O2 inhalation challenge test and interview-based lifetime assessments of DSM-IV panic disorder, separation anxiety disorder, childhood parental separation/loss, major life events, adverse events of suffocative nature and common stressful life events. Regression models were applied to predict global subjective anxiety and DSM-IV panic symptoms after 35% CO2/65% O2 inhalation. Results: The responses to the challenge measured as semicontinuous variables were predicted by symptoms of childhood separation anxiety, childhood parental loss, common stressful events, major life events, suffocative events and the female gender. The role of most of these predictors was confirmed and held true after the exclusion of subjects with lifetime panic attacks/disorder from the analyses. Conclusions: Several factors which have been reported by previous clinical studies to influence the individual susceptibility to develop panic disorder seem to affect the individual reactivity to inhaled carbon dioxide in people from the general population. Some elements of risk may impact simultaneously upon the individual liability to panic and exaggerated sensitivity to hypercapnia.

Register data suggest lower intelligence in men born the year after flu pandemic.

To test the hypothesis that prenatal exposure to the Hong Kong flu, an influenza pandemic that haunted Europe during winter 1969 to 1970, was associated with reduced intelligence in adulthood.

Predictors of psychosis: a 50-year follow-up of the Lundby population

Behavioural and neuropsychological vulnerability have been associated with an increased risk of psychosis. We investigated whether certain clusters of premorbid behavioural and personality-related signs and symptoms were predictors of nonaffective and/or affective psychosis and schizophrenia, respectively, in a 50-year follow-up of an unselected general community population. Total population cohorts from the same catchment area in 1947 (nxa0=xa02,503) and 1957 (nxa0=xa03,215) that had been rated for behavioural items and enduring symptoms were followed up to 1997 regarding first-incidence of DSM-IV nonaffective and/or affective psychosis. Attrition was 1–6%. The influence of the background factors, aggregated in dichotomous variables (predictors), on time to occurrence of nonaffective and/or affective psychosis was assessed by means of Cox regression models. In multivariate models the predictors nervous-tense, blunt-deteriorated, paranoid-schizotypal and tired-distracted were significantly associated with subsequent nonaffective and/or affective psychosis. In simple models, down-semidepressed, sensitive-frail and easily hurt were significantly associated with development of psychosis. When schizophrenia was analysed separately nervous-tense remained significant in the multivariate model, although blunt-deteriorated, paranoid-schizotypal and tired-distracted did not; and abnormal-antisocial reached significance. To conclude, we found some evidence for anxiety-proneness, affective/cognitive blunting, poor concentration, personality cluster-A like traits and interpersonal sensitivity to be associated with general psychosis vulnerability.