Mats Bogren

Long-term suicide risk of depression in the Lundby cohort 1947-1997--severity and gender.

Objective:  The long‐term suicide risk of depression was evaluated in a community sample by severity and gender.

The long-term course of depressive disorders in the Lundby Study

BACKGROUND The Lundby Study is a longitudinal cohort study on a geographically defined population consisting of 3563 subjects. Information about episodes of different disorders was collected during field investigations in 1947, 1957, 1972 and in 1997. Interviews were carried out about current health and past episodes since the last investigation; for all subjects information was also collected from registers, case-notes and key informants. This paper describes the course and outcome of 344 subjects who had their first onset of depression during the follow-up. METHOD In this study individuals who had experienced their first episode of depression were followed up. Their course was studied with regard to recurrence of depression related to duration of follow-up, transition to other psychiatric disorders including alcohol disorders, as well as incidence and risk factors of suicide. RESULTS Median age at first onset of depression was around 35 years for individuals followed up for 30-49 years. The recurrence rate was about 40% and varied from 17% to 76% depending on length of follow-up. Transition to diagnoses other than depression was registered in 21% of the total sample, alcohol disorders in 7% and bipolar disorder in 2%. Five per cent committed suicide; male gender and severity of depression were significant risk factors. CONCLUSION The low rates of recurrence and suicide suggest a better prognosis for community samples than for in- and out-patient samples.

Q-space trajectory imaging for multidimensional diffusion MRI of the human brain.

This work describes a new diffusion MR framework for imaging and modeling of microstructure that we call q-space trajectory imaging (QTI). The QTI framework consists of two parts: encoding and modeling. First we propose q-space trajectory encoding, which uses time-varying gradients to probe a trajectory in q-space, in contrast to traditional pulsed field gradient sequences that attempt to probe a point in q-space. Then we propose a microstructure model, the diffusion tensor distribution (DTD) model, which takes advantage of additional information provided by QTI to estimate a distributional model over diffusion tensors. We show that the QTI framework enables microstructure modeling that is not possible with the traditional pulsed gradient encoding as introduced by Stejskal and Tanner. In our analysis of QTI, we find that the well-known scalar b-value naturally extends to a tensor-valued entity, i.e., a diffusion measurement tensor, which we call the b-tensor. We show that b-tensors of rank 2 or 3 enable estimation of the mean and covariance of the DTD model in terms of a second order tensor (the diffusion tensor) and a fourth order tensor. The QTI framework has been designed to improve discrimination of the sizes, shapes, and orientations of diffusion microenvironments within tissue. We derive rotationally invariant scalar quantities describing intuitive microstructural features including size, shape, and orientation coherence measures. To demonstrate the feasibility of QTI on a clinical scanner, we performed a small pilot study comparing a group of five healthy controls with five patients with schizophrenia. The parameter maps derived from QTI were compared between the groups, and 9 out of the 14 parameters investigated showed differences between groups. The ability to measure and model the distribution of diffusion tensors, rather than a quantity that has already been averaged within a voxel, has the potential to provide a powerful paradigm for the study of complex tissue architecture.

Does it make sense to do repeated surveys? – the Lundby Study, 1947–1997

Objective:  To describe the Lundby Study and the difficulties in doing repeated surveys.

Mortality in alcohol use disorder in the Lundby Community Cohort--a 50 year follow-up.

AIMS To describe the mortality and causes of death among subjects with alcohol use disorder in comparison with those without alcohol disorder and to study whether mental disorders increase mortality in alcoholics. DESIGN AND SETTING Data were analysed from the database of the Lundby Study, comprising 3563 subjects followed from 1947 to 1997. METHOD A community-based sample was investigated in 1947 with follow-ups in 1957, 1972 and 1997. Best-estimate consensus diagnoses of mental disorders, including alcohol use disorder, were assessed. In the total cohort, 427 cases of alcohol use disorders were identified. Differences in mortality between subjects with alcohol use disorders and non-alcoholics were studied using Cox regression models and causes of death were compared between alcoholic subjects and other participants. Risk factors for mortality among the 348 individuals with alcohol use disorders and known age-of-onset were analysed by means of Cox regression analyses. RESULTS The hazard ratio for mortality was higher for alcoholics compared to other subjects in the cohort. A substantial proportion of the causes of death among the alcoholics was suicide N=27 (6.3%) (26 males, 1 female). In the multivariate models of risk factors in alcohol use disorders, anxiety disorders, psychotic disorders, alcohol induced psychotic disorders and dementia were risk factors for premature death. CONCLUSION The mortality risk for subjects with alcohol use disorder was increased, females were especially vulnerable. The risk for suicide was high among males with alcohol problems. Anxiety disorders and severity of alcohol use disorder turned out as risk factors for premature death.

Mental disorders in suicide and undetermined death in the Lundby Study. The contribution of severe depression and alcohol dependence.

To evaluate the role of severe depression, i.e., depression with melancholic and/or psychotic features and alcohol dependence in suicide and undetermined death. The Lundby Study is a prospective, longitudinal study of a population consisting of 3563 subjects. In a long-term follow up 1947–2006 there were 66 suicide cases, including 19 undetermined deaths. Depression and alcoholism were as expected the major contributors to suicide (44% and 23% respectively). Severe depression with psychotic and/or melancholic features was diagnosed in 66% of all depressions and in 29% of all suicide cases, as compared to 15% for major depression only. Alcohol dependence was related to undetermined death. Major depressive disorder with melancholic and/or psychotic features appears to be an important contributor to accomplished suicide in the depression group, and alcohol dependence appears to be related to undetermined death.

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

BACKGROUND Depressive 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. AIM To identify risk factors for depressive disorders. METHOD The 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. CONCLUSION The 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. CLINICAL RELEVANCE Knowledge of risk factors may help to reduce incidence of depression.

Risk of mental disorders in subjects with intellectual disability in the Lundby cohort 1947–97

The Lundby Study is a prospective cohort study, which has followed a Swedish unselected community sample between 1 July 1947 and 1 July 1997. The aim was to study the risks of mental morbidity and different DSM-IV disorders in subjects with intellectual disability (ID) in the Lundby cohort between 1 July 1947 to 30 June 1997. The diagnosis of ID was re-evaluated according to DSM-IV in subjects who had been considered to have ID between 1947 and 1997. Multiple sources of information were used to obtain best estimate consensus diagnoses of mental disorders. The relative risk of mental disorder was 1.34 in subjects with ID as compared with the reference group. Dual diagnosis was more prevalent in mild ID than in moderate ID. No subject with severe ID was diagnosed with mental disorder. The cumulative incidence of any mental disorder in subjects with ID was 44%. The most common DSM-IV diagnoses were: Mood Disorders (11.5%), Anxiety Disorders (11.5%), Schizophrenia and Other Psychotic Disorders (8%), Mental Disorder NOS Due to a General Medical Condition (8%), Dementia (3.8%) and Alcohol Abuse (1.9%). Mental disorders were more common in subjects with ID than in the reference group.

How common are psychotic and bipolar disorders? A 50-year follow-up of the Lundby population

Background: The purpose was to present the prevalence of all psychotic and bipolar (BP) disorders in a total general population (n=3563), which has been followed from 1947 to 1997. Materials and Methods: Best-estimate consensus DSM-IV diagnoses, supported by data from interviews, case notes, registers and key-informants, were assessed. The period prevalence from 1947 to 1997 and the lifetime prevalence (LTP) in 1997, respectively, was calculated. Results: The period prevalence per 100 was: 4.24 for any psychotic or BP disorder, 2.25 for non-affective psychotic (NAP) disorder, 0.76 for psychotic disorder related to a general medical condition (GMC), 0.62 for affective psychotic (AP) disorder and 0.59 for substance-induced psychotic (SIP) disorder. The LTP per 100 was: 2.82 for any psychotic or BP disorder, 1.38 for NAP disorder, 0.54 for psychotic disorder related to a GMC, 0.48 for SIP disorder and 0.42 for AP disorder. The specific diagnosis with the highest period prevalence 1.43 per 100 and LTP 0.84 per 100, respectively, was schizophrenia. The LTP of psychotic disorder related to a GMC, SIP disorder, schizophrenia and delusional disorder, respectively, was higher than in most recent community studies while the LTP of brief psychotic disorder, schizophreniform disorder and AP disorder, respectively, was lower. However, the findings were in approximate accord with the estimates in the Psychoses in Finland (PIF) Study 1. Conclusions: The findings suggest that psychotic disorders are common in the community, and should be considered a major public health concern.

Mortality of subjects with mood disorders in the Lundby community cohort: A follow-up over 50 years.

AIMS To compare causes of death and mortality among subjects with and without mood disorder in the Lundby Cohort and to analyse additional mental disorders as risk factors for mortality in subjects with mood disorders. BACKGROUND The Lundby study is a longitudinal study that investigated mental health in an unselected population. The study commenced in 1947; the population was further investigated in 1957, 1972, and 1997. METHODS Experienced psychiatrists performed semi-structured diagnostic interviews, and best estimate consensus diagnoses of mental disorders were assessed at each field investigation. Subjects with mood disorder (n=508, 195 males, 313 females) were identified until 1997. Causes and dates of death between 1947 and 2011 were obtained from the Swedish cause of death register and were compared between subjects diagnosed with mood disorder and other participants. Mortality was compared between those with mood disorders and the remaining cohort with Cox regression analyses. Other mental disorders were considered as risk factors for death for subjects with mood disorders. RESULTS The hazard ratio for mortality in mood disorders was HR=1.18. However, the mortality was elevated only for males, HR=1.5. Comorbid anxiety disorders, organic disorders, dementia and psychotic disorders were significant risk factors for death. A total of 6.3% of the participants with mood disorder and 1.2% of the remaining participants committed suicide. CONCLUSIONS As expected, the suicide rate was higher among participants with mood disorders. Only males with mood disorders had elevated mortality. The impact on mortality from other mental disorders seems to vary between the genders.