Tore Hällström

Pregnancy and neonatal outcomes in women with eating disorders.

OBJECTIVE: This study was initiated to examine pregnancy and neonatal outcomes in women with past or current eating disorders as compared with a control group. METHODS: Forty-nine nulliparous nonsmoking women previously diagnosed with eating disorders (24 anorexia nervosa, 20 bulimia nervosa, 5 eating disorders not otherwise specified) and 68 controls were recruited in early pregnancy. Data on antenatal complications, mode of delivery, and neonatal outcome variables were collected. For comparisons between groups 1-way analysis of variance or &khgr;2 test was used. RESULTS: Twenty-two percent of the patients had a verified relapse in eating disorders during pregnancy. Women with past or current eating disorders were at increased risk of hyperemesis (P < .01) and delivered infants with significantly lower birth weight (P < .01) and smaller head circumference (P < .001) as compared with controls. They were also at greater risk of delivering infants with microcephaly (P < .05) and small for gestational age infants (P < .05). CONCLUSION: Pregnant women with past or active eating disorders seem to be at greater risk for delivering infants with lower birth weight, smaller head circumference, microcephaly, and small for gestational age. LEVEL OF EVIDENCE: II-2

Obesity, adipose tissue distribution and health in women--results from a population study in Gothenburg, Sweden.

The associations between generalized obesity measured as body mass index (BMI), or adipose tissue distribution, measured as the waist/hip circumference ratio (WHR), on one hand, and a number of socioeconomic, somatic as well as psychologic and mental health variables on the other, were analysed in a population study of women (1462 participants, aged 38-60 years, participation rate 90.1%). The anthropometric measurements were adjusted for their influence on each other. BMI, but not WHR, was negatively associated with socioeconomic status and education. Increased WHR correlated to a number of somatic diseases from different organ systems, including diabetes mellitus, infectious respiratory and abdominal diseases. Even more striking were strong correlations to a number of variables indicating accident proneness as well as mental disorder, and increased use of antidepressants and tranquilizers. BMI and WHR were also associated to different personality profiles. Furthermore, the use of alcohol and smoking were positively correlated to the WHR. In contrast, most of these associations were not seen with the BMI--sometimes even negative correlations were found. Exceptions were, however, varicose veins, joint problems and surgery for gall bladder disease, which were positively correlated to BMI only. Blood pressure, plasma triglycerides and uric acid were positively correlated to both BMI and the WHR, plasma cholesterol, however, only to the WHR. Obesity (high BMI) and abdominal adipose tissue distribution (high WHR) clearly show differences in their associations to various health variables. It is hypothesized that an arousal syndrome might be a contributing factor to cause symptoms of psychological maladjustment, including psychosomatic disease. Hypothetically, in parallel, an accumulation of depot fat in the abdominal depot, might follow as a consequence of neuroendocrine dysregulation of endocrine secretions.

Determinants of non-participation, and the effects of non-participation on potential cause-effect relationships, in the PART study on mental disorders

The study had two objectives: (i) to analyse determinants of non-participation in a general population study of mental disorder in Stockholm, and (ii) to determine whether associations between mental disorder and some potential determinants were different among participants and non-participants in the study. The study was based on a questionnaire including potential risk factors for mental disorder and symptom scales. The study group was a random sample of the Stockholm County population aged 20–64 years (19,742 persons). Replies were obtained from 10,441 participants, i. e. the response rate was 53%. The symptom scales were used to identify a group with increased likelihood of mental disorder, screening-positive, and a group with low likelihood of mental disorder, screening-negative. Random samples of the screening-positive and screening-negative respondents were summoned for interview concerning psychiatric symptoms. The database of respondents and non-respondents was linked to several population registers. The participation was higher in females, among older persons, married persons, among persons with higher income and education and among those born in the Nordic countries. There seemed to be little further risk indicator based selection to interview participation. The associations between in-patient psychiatric care and register variables were strong and similar among participants and non-participants. The occurrence of mental disorders is likely to be underestimated in studies with this design and with substantial dropout rates. However, the study participants can most likely be a base for generalising risk indicators for, or social consequences of,mental disorder, to the general population.

Obesity in women in relation to mental illness, social factors and personality traits

Abstract The relationships between obesity and a number of psychosocial variables were studied in 800 women in the age-strata 38, 46, 50 and 54 years. The women were representative of the general population of women in the age-strata studied. Obesity was defined as the upper decile of a body weight index, defined according to Broca, in the various age-strata. High social class and high performance in school were negatively related to obesity. There was no significant relationship between social class in childhood and obesity at the investigation. Nor was there a significant relationship between number of psychosocial stressors and obesity. The shift towards higher social class during life characteristic of the study population was negatively associated with obesity. There were no significant relationships between obesity and present or previous mental illness (present disability degree, depth of depression, frequency of anxiety attacks, phobia grade, present use of psychotropic drugs, maximum disability degree during life, use of psychotropic drugs during life, contact with a psychiatrist) when due allowance was made for age and social class. There were, however, significant relationships between obesity and the personality traits extraversion (EPI) and sociability (CMPS) when allowance was made for age and social class.

Gray matter density in limbic and paralimbic cortices is associated with trauma load and EMDR outcome in PTSD patients

There is converging evidence of gray matter (GM) structural alterations in different limbic structures in Post-Traumatic Stress Disorder (PTSD) patients. The aim of this study was to evaluate GM density in PTSD in relation to trauma load, and to assess the GM differences between responders (R) and non-responders (NR) to EMDR therapy. Magnetic Resonance Imaging (MRI) scans of 21 subjects exposed to occupational trauma, who developed PTSD (S), and of 22 who did not (NS), were compared by means of an optimized Voxel-Based Morphometry (VBM) analysis as implemented in SPM. Within S, further comparisons were made between 10 R and 5 NR. A regression analysis between GM density and the Traumatic Antecedents Questionnaire (TAQ) was also performed on all 43 subjects. Results showed a significantly lower GM density in S as compared to NS in the left posterior cingulate and the left posterior parahippocampal gyrus. Moreover, NR showed a significantly lower GM density as compared to R in bilateral posterior cingulate, as well as anterior insula, anterior parahippocampal gyrus and amygdala in the right hemisphere. Regression analysis showed that GM density negatively correlated with trauma load in bilateral posterior cingulate, left anterior insula, and right anterior parahippocampal gyrus. In conclusion, a GM lower density in limbic and paralimbic cortices were found to be associated with PTSD diagnosis, trauma load, and EMDR treatment outcome, suggesting a view of PTSD characterized by memory and dissociative disturbances.

Changes in women's sexual desire in middle life : the longitudinal study of women in Gothenburg

In a general population survey, 677 urban middle-aged women were interviewed about their sexual desire at two occasions 6 years apart. Data from 497 subjects, who were married at both occasions or were cohabiting with a male partner, were analyzed. Twenty-seven percent reported a decrease in sexual desire between interviews, and 10% experienced an increased desire. There were no clear cohort differences. A decrease in sexual desire was predicted by age, high sexual desire at first interview, lack of a confiding relationship, insufficient support from spouse, alcoholism in spouse, and major depression. Predictors of an increase of sexual desire were weak desire at first interview, negative marital relations before first interview, and mental disorder at first interview. Although sexual desire showed considerable stability over time, a substantial proportion of married middle-aged women experienced major changes, mostly as a decrease. Age, psychosocial factors associated with quality of marital relationship, and mental health were major contributors towards change in sexual desire.

Psychosocial factors and risk of ischaemic heart disease and death in women: a twelve-year follow-up of participants in the population study of women in Gothenburg, Sweden.

A community sample of 795 women of the ages 38, 46, 50 and 54 yr was subjected to comprehensive medical and psychiatric examinations and was followed up for 12 yr. The 12-yr incidence of angina pectoris was 3.2% and of electrocardiographic changes indicating ischaemic heart disease 5.8%. The corresponding incidence of myocardial infarction was 1.4% and death rate 4.2%. High initial ratings of passive dependency, neuroticism, experience of strain, grade of mental disorder and severity of major or minor depression were predictive of angina pectoris. A low rating of aggression was predictive of the development of electrocardiographic changes indicating ischaemic heart disease. Low ratings of guilt feelings and neurotic self-assertiveness were predictive of myocardial infarction. Death rate was not related to any of the psychosocial factors studied. These associations remained significant after adjustments for age, social class, marital status or confounding conventional risk factors for ischaemic heart disease. The results show that the different clinical manifestations of ischaemic heart disease are related to different sets of psychosocial predictors.

Mental Health in the Climacteric: The Longitudinal Study of Women in Gothenburg

Abstract. A representative sample of 899 middle‐aged urban Swedish women underwent a psychiatric interview on two occasions with 6 years between studies (waves). The point prevalence of all mental disorders was 39.9% at the first wave and 39.0% at the second. The corresponding one‐year onset rates of all mental disorders were 18.0% and 14.2%. No significant differences were found between ages or between waves. Major depressive episodes accounted for about half of the psychiatric morbidity. Those women whose menopause started early were more often mentally impaired than others and they also tended to have been more often impaired even before the climacteric (ages 30‐39).

Weight gain in adulthood in relation to socioeconomic factors, mental illness and personality traits: A prospective study of middle-aged women

Abstract The relationships between body weight change during a six-year follow-up period and a number of psychosocial variables were studied in a representative population sample of middle-aged women. Those women who had gained weight ⩾ 5.0 kg were compared with the rest of the sample taking into account age, social class and initial level of obesity. Never-married women were over- represented among the women with weight gain ⩾ 5.0 kg. Husbands social class (based on occupation) was inversely related with weight gain. Educational level, own social class and annual income were not significantly different between the two groups. There was a positive relation between mental illness (disability degree), depth of depression and weight gain. Use of psychotropic drugs, frequency of anxiety attacks and phobia grade were not related to weight gain, however. The personality trait order was positively related to weight gain, while there were no significant relationships between the other personality variables studied and weight gain. The study thus indicates that psychosocial factors might be of causal importance for the development of obesity in adult women. Further studies on the role of these factors for regulation of energy intake and expenditure seem to be justified.

Depressed adolescents in a case-series were low in vitamin D and depression was ameliorated by vitamin D supplementation

Aim:  The relationship between depression in adolescents and vitamin D was studied in a case‐series that included effects of vitamin D supplementation.