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.

Incidence of psychotic disorders in the 50 year follow up of the Lundby population.

OBJECTIVE: The aim of the present study was to analyse first incidence of psychotic disorders in the Lundby population during a 50 year period by comparing male and female age at onset, overall incidence rates and age-specific incidence rates. METHOD: The Lundby Study is a prospective study of the mental health of a complete community population (n = 3563), which was followed from 1947 to 1997. Data from interviews, registers, case files and key informants were accumulated via four waves of field work (1947 1957, 1972 and 1997). Mean and median age at onset, and overall and age-specific incidence rates, for the first episodes of major groups of psychotic disorders according to the DSM-IV were calculated (the major groups were: any psychotic disorder, psychotic disorder due to a general medical condition, substance-induced psychotic disorder, non-affective psychotic disorder, schizophrenia, other non-affective psychotic disorder and affective psychotic disorder). Male-female differences in mean ages at onset and overall incidence rates were tested. Male-female differences in incidence by age patterns were described. RESULTS: The overall 50 year incidence rate in male subjects was higher than in female subjects for substance-induced psychotic disorder, but for the other disorders the overall rates did not differ significantly between the sexes. The male mean age at onset was lower than that for female subjects for any psychotic disorder, psychotic disorder due to a general medical condition, non-affective psychotic disorder and schizophrenia. Male and female subjects had different incidences by age patterns for any psychotic disorder, non-affective psychotic disorder, schizophrenia and other non-affective psychotic disorder, with a male preponderance among early-onset cases, and a female preponderance among late-onset cases. CONCLUSION: The differences in incidence between the sexes in this 50 year follow up may indicate psychotic disorder-delaying mechanisms in female subjects, or different aetiologies of psychosis in male and female subjects.

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 (n = 2,503) and 1957 (n = 3,215) 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.

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 and morbidity among farmers, nonfarming rural men, and urban referents: a prospective population-based study.

A cohort of 1,220 farmers, 1,130 nonfarming rural men, and 1,087 urban referents from Sweden were monitored for 12 years. Farmers had lower mortality than urban referents for all causes of death (hazard ratio [HR] = 0.51; 95% confidence interval [CI], 0.37-0.71), cancer (HR = 0.44; 95% CI, 0.24-0.78) and cardiovascular diseases (HR = 0.60; 95% CI, 0.36-0.99). Nonfarming rural men had lower mortality than urban referents for all causes of deaths (HR = 0.81; 95% CI, 0.70-0.94). Farmers and nonfarming rural men had significantly lower morbidity risks of cancer and of psychiatric disorders than urban referents. Farmers had significantly lower risk of endocrine disorders, cardiovascular disorders, and respiratory disorders. In general, morbidity was lower among nonfarming rural men compared with urban referents and was even lower among farmers. Urban referents had, however, significantly less musculoskeletal disorder morbidity. An urban-rural factor and a farming occupational or lifestyle factor results in lower mortality and morbidity rates except concerning musculoskeletal disorders.

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.

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.

Lundby revisited: first incidence of mental disorders 1947-1997.

OBJECTIVE: To investigate how first incidence of various mental disorders changed between the periods of 1947-1972 to 1972-1997 in the Lundby cohort. METHOD: First-incidence rates of mental disorders were calculated for two 25 year periods and ten 5 year periods. RESULTS: From 1947-1972 to 1972-1997 a decrease in almost all age- and sex-specific incidences of neurotic and organic brain disorders was observed, whereas incidence rates of psychotic disorders increased consistently in male subjects but decreased in most age intervals in female subjects. For both sexes the age-standardized 5 year period incidences of neurotic disorders decreased after 1972, fluctuated for psychotic disorders 1947-1997 and decreased steadily for organic disorders 1947-1997. CONCLUSIONS: The reduction in neurotic and organic brain disorder incidences may be linked to structural changes in society and medical advances.

Point prevalence of neurosis in the Lundby Study 1947-1997.

The objective of this article is to report and discuss the changing point prevalence rate of neurosis 1947-1997 in the Lundby cohort. The Lundby Study is a prospective longitudinal study of a geographically defined total population in the south of Sweden. Field investigations were performed in 1947, 1957, 1972 and in 1997, with psychiatrists interviewing the probands in a semi-structured way. Additional information was gathered from registers, case notes and key informants. Throughout the period of 50 years, the Lundby Study used its own diagnostic system with neurosis referring to non-psychotic mental illness in the absence of an organic brain disease. After 1957, no newcomers were included, and therefore only probands 40 years of age or older at the cross-sectional surveys are included in the present paper. For men aged 40-59 and 60 years or older, respectively, the age-specific point prevalence of neurosis increased from 2.5% and 0.5% in 1947, to 8.3% and 8.4% in 1972. The corresponding figures for women were 8.0% and 1.3% in 1947, and 24.2% and 20.1% in 1972. The increase could be seen in all degrees of impairment, but it was most pronounced in the mild and medium impairment groups. Except for a slight decrease in point prevalence in the female group 40-59 years of age, there were no significant changes from 1972 to 1997. A large increase in the point prevalence rate of neurosis could be seen 1947-1972, but not 1972-1997. Because of the many biases inherent in longitudinal psychiatric studies, our results must be interpreted with caution.

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.

Suicide rates in the Lundby cohort before and after the introduction of tricyclic antidepressant drugs.

The Lundby cohort consisting of 3563 subjects was investigated in 1947, 1957, 1972, and 1997. It represents a rural, but gradually urbanized Swedish sample without non-Nordic immigrants and offers an opportunity to study suicide rates before and after the introduction of tricyclic antidepressant drugs in Sweden in 1962. Since then, a fall in suicide rate among depressed individuals was observed, while there was an increase in the overall suicide rate. In fact, in 1977-1992 other psychiatric diagnoses, alcohol disorder included, were more often associated with suicide than depression. No psychiatric or alcohol disorder was registered in 7% of the suicides.

First incidence depression in the Lundby Study: a comparison of the two time periods 1947-1972 and 1972-1997.

BACKGROUND: The Lundby Study is a prospective, longitudinal study on a total population consisting of 3563 subjects during 50 years. This study compares first incidence rates of depression and cumulative probabilities for developing a depression over the two time periods 1947-1972 and 1972-1997. METHOD: The Lundby Study started in 1947. Follow-ups were carried out in 1957 and in 1972. In 1997 the surviving subjects (N=1797) were interviewed by psychiatrists with a semi-structured interview. Best-estimate consensus diagnoses were used and ICD-10 and DSM-IV diagnoses were added. Further, 1030 subjects who had died during the last follow-up period 1972-1997 were investigated. RESULTS: Women had higher incidence rates than men in both periods. The average annual incidence rate was lower for women and tended to be lower for men 1972-1997 as compared with 1947-1972. The cumulative probability for developing a depression was 22.5% for men and 30.7% for women 1972-1997. In 1947-1972 the corresponding figures were 22.8% in men and 35.7% in women. LIMITATIONS: The recall period is of considerable length, probably introducing recall bias. The inter-rater reliability over 50 years is fairly acceptable concerning depression. CONCLUSION: Lower annual standardised incidence rates were seen in 1972-1997 compared with 1947-1972. These findings suggest that the trend of increasing rates of depression in the Lundby cohort has terminated. Incidence rates and cumulative probabilities to develop a depression were higher for women than for men, indicating that gender differences continue to play a role.

Factors Influencing Number of Treatments and Seizure Duration in ECT: Drug Treatment, Social Class.

This investigation studies number of treatments and seizure duration during a course of unilateral electroconvulsive therapy (ECT) in 82 inpatients with major depressive disorders. Therapy with antidepressants or benzodiazepines preceding ECT was neither related to number of treatments nor to seizure duration. An average dose of methohexital higher than 1.2 mg/kg body weight was associated both with an increased number of treatments and a shorter average seizure duration. Concurrent therapy with neuroleptics was related to a reduced number of treatments. Patients in social class I, more often than others, received fewer treatments.