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Little is know about fracture risks in mentally ill adults. We aimed to estimate risks of fracture at any site, and at sites linked with osteoporosis, in this group versus the general population.
We created a population-based cohort using the UK General Practice Research Database (GPRD), with follow-up during 1987-2005. We investigated age and sex-specific fracture risks in psychotic illness (N=4283), non-psychotic affective disorder (N=95,228), and any other psychiatric conditions (N=49,439). Controls were all subjects with no psychiatric code (N=182,851) against which age-stratified relative risks were estimated: 18-44, 45-74, 75+ years. Outcomes were incident cases of fracture at any site, the hip and distal radius.
Among all mentally ill women, the highest relative risks of fracture at any site were in the youngest age group, whereas the strongest effects in men were with older age. The highest raised risk of any fracture occurred in younger women with psychotic disorders (RR 2.5, CI 1.5-4.3). Hip fracture rates were raised in elderly women and men with psychiatric illness, and were especially high in women (RR 5.1, CI 2.7-9.6) and men (RR 6.4, CI 2.6-16.1) with psychotic disorders at 45-74 years. Data were sparse for estimating relative risk of distal radius fracture, although risk was modestly (but significantly) higher among women with any mental illness in each age group.
These elevated risks are likely to be explained by a range of mechanisms. Further research is needed to elucidate these and to inform the development of targeted interventions.
Population-based evidence is lacking for risk of major birth defect with parental psychopathology, and how effects vary by maternal and paternal diagnosis. We aimed to investigate this risk in offspring of parents admitted for psychiatric treatment in a 26-year national birth cohort.
The study cohort was created using several linked Danish national registers. We identified all singleton live births during 1973-98 (N=1.45m), all parental psychiatric admissions from 1969 onwards, and all fatal birth defects until 1st Jan. 1999. Linkage and case ascertainment were virtually complete. Relative risks were estimated by Poisson regression.
Fatal birth defect risk was elevated with any maternal admission and also with affective disorders specifically, although the strongest effect found was with maternal schizophrenia. The rate was more than doubled in this group compared to the general population (RR 2.34, 95% CI 1.45-3.77); this also represented a significant excess risk versus all other admitted maternal disorders (P=0.018). Risk of death from causes other than birth defect was no higher with schizophrenia than with other maternal conditions. There was no elevation in risk of fatal birth defect if the father was admitted with schizophrenia or any other psychiatric diagnosis.
There are many possible explanations for a higher risk of fatal birth defect with maternal schizophrenia and affective disorder. These include genetic effects directly linked with maternal illness, lifestyle factors (diet, smoking, alcohol and drugs), poor antenatal care, psychotropic medication, and gene-environment interactions. Further research is needed to elucidate the causal mechanisms.
Adverse health and social outcomes are known to occur more frequently following parental death during childhood, but evidence is lacking for comparing long-term risks of internalised v. externalised harm.
This national register-based cohort study consisted of Danish persons born 1970–2000. The Civil Registration System and National Causes of Death Register were linked to ascertain parental deaths by cause before cohort members' 15th birthdays. From age 15 years, hospital-treated self-harm episodes were ascertained through linkage to the National Patient Register and the Psychiatric Central Research Register, and violent crimes were identified via linkage to the National Crime Register. Hazard ratio and cumulative incidence values were estimated.
Self-harm and violent criminality risks were elevated following parental death during childhood. Covariate adjustment for gender, birth year and first-degree relatives' mental illnesses attenuated these associations, although significantly heightened risks persisted. The estimated hazard ratios did not differ greatly according to which parent died, but losing both parents conferred particularly large risk increases. Risks for both adverse outcomes were higher in relation to unnatural v. natural parental death; violent criminality risk was especially raised among individuals exposed to parental death by unnatural causes other than suicide. The association was strongest when pre-school age children experienced parental death.
Effective early intervention is needed to help youngsters who have experienced the death of one or both parents to develop immediate and sustained coping strategies. Enhanced cooperation between health and social services and criminal justice agencies may mitigate risks for these two destructive behaviours.
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