Future marginalisation and mortality in young Swedish men with non-psychotic psychiatric disorders and the resilience effect of cognitive ability: a prospective, population-based study

Abstract

ObjectiveLarge-scale studies examining future trajectories of marginalisation and health in adolescents with mental illness are scarce. The aim of this study was to examine if non-psychotic psychiatric disorders (NPDs) were associated with future indicators of marginalisation and mortality. We also aimed to determine whether these associations might be mediated by education level and attenuated by high cognitive ability.DesignThis is a prospective cohort study with baseline data from the Swedish Conscription register.SettingThe study was carried out in Sweden from 1969 to 2005.ParticipantsAll of the participants were 18-year-old men at mandatory conscription in Sweden between 1969 and 2005 (n=1 609 690).MeasuresNPDs were clinically diagnosed at conscription. Cognitive ability was measured by a standardised IQ test at conscription. National register data covered information on welfare support, long-term unemployment, disability pension (DP) and mortality over a period of 1–36 years.ResultsNPD at the age of 18 years was a predictor of future welfare support, OR 3.73 (95% CI 3.65 to 3.80); long-term unemployment, OR 1.97 (95% CI 1.94 to 2.01); DP, HR 2.95 (95% CI 2.89 to 3.02); and mortality, HR 2.45 (2.33–2.52). The adjusted models suggested that these associations were not confounded by fathers’ educational level, cognitive ability had only a minor attenuating effect on most associations and the mediating effect of own educational level was small.ConclusionsThe present study underlines a higher prevalence of future adversities in young men experiencing NPDs at the age of 18 years. It also indicates that higher cognitive ability may work as a potential resilience factor against future marginalisation and mortality.

Cause-specific mortality in Swedish males diagnosed with non-psychotic mental disorders in late adolescence: a prospective population-based study

“…Since we cannot make conclusions regarding causality and have very limited possibility to explore mechanisms, the use of PARs is advantageous in indicating the magnitude of the risk factor. Adjusting for baseline variables including IQ, cardiovascular fitness and smoking at conscription only slightly attenuated the strength of the association of NPM disorders and all cause-specific mortalities; a finding that is in line with a previous study analysing NPM disorders and all-cause mortality 18. Although the associations of alcohol and substance use with mortality due to infectious diseases are known,6 9 11 much less is known regarding depression, anxiety and personality disorders.…”

Risk factors in Swedish young men for amyotrophic lateral sclerosis in adulthood

“…First event of non-psychotic psychiatric disorders was diagnosed according to the International Classification of Diseases ( ICD ). Diagnostic codes for depressive disorders, neurotic/adjustment disorders, and personality disorders before or at conscription (Table 1 ) were pooled together in the model as non-psychotic disorders [ 30 ]. The distribution with each edition of ICD was 47,175; 13,085; 5,403 (ICD-8; ICD-9; ICD-10).…”

Effects of exercise on symptoms of anxiety, cognitive ability and sick leave in patients with anxiety disorders in primary care: study protocol for PHYSBI, a randomized controlled trial

“…They are also associated with elevated risks of cardiovascular disease [9] and premature mortality [10]. We have previously shown that anxiety disorders are associated with increased risk of future marginalization [11] as well as elevated mortality [12], emphasizing the importance of finding effective treatment strategies. Individuals with anxiety disorders frequently suffer from attentional problems, such as being easily distracted and unable to focus on ongoing tasks [13].…”