Mental disorder and long-term risk of mortality: 41 years of follow-up of a population sample in Stockholm, Sweden.

BACKGROUND: An increased mortality risk associated with mental disorder has been reported for patients, but there are few studies are based on random samples with interview-based psychiatric diagnoses. Part of the increased mortality for those with mental disorder may be attributable to worse somatic health or hazardous health behaviour - consequences of the disorder - but somatic health information is commonly lacking in psychiatric samples. This study aims to examine long-term mortality risk for psychiatric diagnoses in a general population sample and to assess mediation by somatic ill health and hazardous health behaviour. METHOD: We used a double-phase stratified random sample of individuals aged 18-65 in Stockholm County 1970-1971 linked to vital records. First phase sample was 32 186 individuals screened with postal questionnaire and second phase was 1896 individuals (920 men and 976 women) that participated in a full-day examination (participation rate 88%). Baseline examination included both a semi-structured interview with a psychiatrist, with mental disorders set according to the 8th version of the International Classification of Disease (ICD-8), and clinical somatic examination, including measures of body composition (BMI), hypertension, fasting blood glucose, pulmonary function and self-reported tobacco smoking. Information on vital status was obtained from the Total Population Register for the years 1970-2011. Associations with mortality were studied with Cox proportional hazard analyses. RESULTS: A total of 883 deaths occurred among the participants during the 41-year follow-up. Increased mortality rates were found for ICD-8 functional psychoses (hazard ratio, HR = 2.22, 95% confidence interval (95% CI): 1.15-4.30); psycho-organic symptoms (HR = 1.94, 95% CI: 1.31-2.87); depressive neuroses (HR = 1.71, 95% CI: 1.23-2.39); alcohol use disorder (HR = 1.91, 95% CI: 1.40-2.61); drug dependence (HR = 3.71, 95% CI: 1.80-7.65) and psychopathy (HR = 2.88, 95% CI: 1.02-8.16). Non-participants (n = 349) had mortality rates similar to participants (HR = 0.98, 95% CI: 0.81-1.18). In subgroup analyses of those with psychoses, depression or alcohol use disorder, adjusting for the potential mediators smoking and pulmonary function, showed only slight changes in the HRs. CONCLUSIONS: This study confirms the increased risk of mortality for several psychiatric diagnoses in follow-up studies on American, Finnish and Swedish population-based samples. Only a small part of the increased mortality hazard was attributable to differences in somatic health or hazardous health behaviour measured at baseline.

Brief interventions for risk consumption of alcohol at an emergency surgical ward.

Patients admitted to an emergency surgical ward were screened for alcohol problems and randomized between an extensive alcohol counseling and a brief assessment followed by feedback of risky alcohol consumption. Some 165 patients were assessed for risk consumption and followed up 6 to 12 months, and it was found that patients in both interventions significantly reduced the amount they drank per occasion although they drank as often as before. The patients had also moved to a stage more ready to change. No differences in effect were found between the interventions. A brief assessment with feedback about risk consumption can be done on an emergency surgical ward by the surgical staff with a few hours of training and may reduce risky alcohol consumption significantly.

Prevalence of mental disorder in an urban population in central Sweden.

The principal reason for this epidemiological study was the lack of psychiatric morbidity studies in a predominantly urban population, by psychiatrists in direct interviews. The psychiatric examination, covering 1970-71, included a representative selection of 2,283 persons, 18-65 years old from "former" Stockholm County, and the 12-month prevalence of mental disorders was measured. The total of non-participants was 12%. Forty-seven percent had a psychiatric diagnosis - significantly more women (54%) than men (40%). Excluding the psychosomatic diagnoses, 31% of the population received a psychiatric diagnosis, which agrees closely with other contemporary studies of mental disorder in the Nordic countries. The primary diagnoses were: neuroses 26%, psychosomatic diagnoses 16%, schizophrenic/paranoid conditions or other psychoses 0.6%, affective disorders 0.2%, psychoorganic syndromes 1.2%, psychopathy 0.2%, character neurosis 1%, drug dependence 0.2% (as a primary or a secondary diagnosis 0.6%), alcoholism 1.4% (as a primary or a secondary diagnosis 3.1%) and mental retardation 0.4% (as a primary or a secondary diagnosis 0.8%).

Prevalence of mental disorder in an urban population in central Sweden in relation to social class, marital status and immigration.

A representative selection of 2,283 persons, 18-65 years old in "former" Stockholm County were examined by psychiatrists in 1970-71. The total non-response was 12%. The 12-month prevalence of mental disorders in relation to social class (I-III), marital status and immigration was estimated. The "psychiatric diagnoses of moderate and severe degree" were significantly more prevalent in social class III (14% and 2.7%) than in I (6.9% and 0.6%) and II (9.8% and 0.9%) and significantly more prevalent among single (16% and 4.6%) than among cohabiting persons (9.6% and 1.0%). The mental disorder/immigration relationship should here be interpreted with certain reservations. One significant difference was noted: the "psychiatric diagnosis of severe degree" was significantly more prevalent for men born in Sweden (1.5%) than for men born abroad (0.3%).

Alcohol consumption and alcoholism in an urban population in central Sweden.

A representative selection of 2,283 individuals, 18-65 years old, in "former" Stockholm County, were examined by psychiatrists in 1970-71. The total of non-participants was 12%. The alcohol consumption pattern and the prevalence of the diagnosis alcoholism for the last 12 months are reported. Significantly more men than women confirmed "very high" and "high" consumption, respectively. The diagnosis alcoholism was given to 4.8% men and 1.4% women. Significantly more women in social class I than in II and III, as significantly more men in social class I than in II stated "very high" or "high" consumption. Social consequences of alcohol consumption, in the form of entries in the Penal Register of the National Board of Excise (Kontrollstyrelsens straffregister) for the years 1965-71, were, on the other hand, found significantly more frequently among men in social class III than in social classes I and II.

Mortality in an urban population in central Sweden in relation to mental disorder and alcohol consumption. A prospective study.

A representative selection of 2,283 individuals, 18-65 years old in "former" Stockholm County were called to examinations by psychiatrists during the period 1970-1971. During the period from the original examination to 1980, inclusive, a total of 114 examined persons (77 men, 37 women) had died. The relative death rate of those studied was 1.05 for men 0.90 for women (average for Sweden = 1). Women in social class III had a significantly higher relative death rate (1.23) compared with women in social class I (0.35). Those individuals who had a psychiatric diagnosis of moderate or severe degree had a significantly higher relative death rate (1.73) than those having a psychiatric diagnosis of mild degree (0.69). Men without psychiatric diagnosis had a significantly higher relative death rate (1.17) than men with a psychiatric diagnosis of mild degree (0.49). Individuals with high or very high alcohol consumption had a higher, although not statistically significant, relative death rate (1.69) compared with those with a low-moderate consumption (0.93).

A 6-month controlled naltrexone study: combined effect with cognitive behavioral therapy in outpatient treatment of alcohol dependence.

BACKGROUND: In several studies, patients with alcohol dependence treated with the opioid antagonist naltrexone have shown fewer relapses to heavy drinking than those receiving placebo. An interaction between the naltrexone effect and the type of psychological therapy has been observed. METHODS: A 6-month, double-blind, placebo-controlled, parallel-group study was performed at 10 different investigation sites. After a placebo run-in period of 1 week, 118 patients were randomized into 4 treatment groups-50 mg of naltrexone daily or placebo in combination with either cognitive behavioral therapy (CBT) or supportive therapy. The CBT was performed over nine sessions according to the manual of Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity). The supportive therapy was defined as "the treatment as usual." Alcohol consumption, craving, carbohydrate-deficient transferrin, medication compliance by tablet count, and adverse clinical events were assessed at all visits. Other liver enzymes and psychiatric symptoms were also determined. RESULTS: Ninety-one (77%) patients completed the study, and 92 (78%) were 80% compliant with the medication regimen. A lower percentage of heavy-drinking days was shown in the naltrexone group (p = 0.045) compared with the placebo group, as was a lower craving score (p = 0.029). These results are supported by the lower levels of liver enzyme activities (p < 0.010 for aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyltransferase), but not by the carbohydrate-deficient transferrin levels, in the naltrexone group. The mean time period before the first day of heavy drinking was longer for the group treated with CBT (p = 0.010), especially in combination with naltrexone (p = 0.007). Naltrexone was well tolerated, and no patients discontinued the study due to side effects. CONCLUSIONS: This study supports the effect of naltrexone in outpatient treatment of alcohol dependence and suggests that a beneficial interaction effect with CBT can be expected.