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Total Abstinence Not the Only Treatment Goal in SUD
In patients with stimulant use disorder (SUD), even slight reductions in drug use can lessen depression and reduce cravings, a new analysis showed.
Abstinence has long been the overall goal of SUD treatment, the investigators noted. The findings from this pooled analysis of randomized clinical trials support what investigators noted was a growing recognition that reducing stimulant use can lead to better outcomes.
“This study provides evidence that reducing the overall use of drugs is important and clinically meaningful,” study author Mehdi Farokhnia, MD, MPH, of the National Institute on Drug Abuse, North Bethesda, Maryland, wrote in a press release. “This shift may open opportunities for medication development that can help individuals achieve these improved outcomes, even if complete abstinence is not immediately achievable or wanted.”
The findings were published online on January 10, 2024, in Addiction.
Not the Only Indicator of Success
To compare clinical indicators of improvement among those with SUDs who achieved abstinence or reduced their use, investigators pooled data from 13 randomized clinical trials with more than 2000 patients seeking treatment for cocaine or methamphetamine use disorders at centers in the United States from 2001 to 2017.
The trials used similar study protocols, including similar eligibility criteria, recruitment methods, and outcome measures. Participants were 18 or older and met criteria for methamphetamine or cocaine dependence at the beginning of each trial.
Among the participants, 1196 sought treatment for cocaine use disorder and 866 for methamphetamine use disorder. Of those, just 1487 had outcomes available by the end of the trial.
Most participants had no change in the level of use or increased their use through the trial (68%) or transitioned from low (1-4 days a month) to high (5 or more days a month) frequency use.
Nearly one third of participants (32%) stopped or reduced drug use, including 18% who cut down on stimulant use and 14% who abstained altogether.
Participants using methamphetamine were more likely to be in the abstinence vs reduced use category (21.3% vs 13.9%, respectively), whereas participants using cocaine were less likely to be in the abstinence vs reduced use category (9.1% vs 20.9%).
Those who reached abstinence showed better clinical improvement than those who reduced use on most clinical measures (P < .009).
However, there were no significant differences between groups on the Addiction Severity Index (ASI) psychiatric problems subscale and cravings for secondary drugs.
“Our findings suggest that reduced frequency of stimulant use is also associated with improved psychosocial functioning,” the authors wrote. “These findings suggest the need to re-evaluate the traditional approach of exclusively relying on total abstinence as the only indicator of successful treatment, a goal that may not be achievable for all patients, especially after one treatment episode.”
Those who reduced drug intake showed a significant association with nearly all clinical indicators of improvement (P < .010) compared with those who didn’t, except for the ASI psychiatric problems subscale and family/social relationship domains of the Problem Free Functioning scale, and HIV risk behavior.
Study limitations included short follow-up time in most trials and follow-up measures were based only on urine drug screens. There were also a substantial number of missing assessment points.
The study was funded by the National Institute on Drug Abuse and the National Institute of Health. There were no reported disclosures.
A version of this article appeared on Medscape.com.
In patients with stimulant use disorder (SUD), even slight reductions in drug use can lessen depression and reduce cravings, a new analysis showed.
Abstinence has long been the overall goal of SUD treatment, the investigators noted. The findings from this pooled analysis of randomized clinical trials support what investigators noted was a growing recognition that reducing stimulant use can lead to better outcomes.
“This study provides evidence that reducing the overall use of drugs is important and clinically meaningful,” study author Mehdi Farokhnia, MD, MPH, of the National Institute on Drug Abuse, North Bethesda, Maryland, wrote in a press release. “This shift may open opportunities for medication development that can help individuals achieve these improved outcomes, even if complete abstinence is not immediately achievable or wanted.”
The findings were published online on January 10, 2024, in Addiction.
Not the Only Indicator of Success
To compare clinical indicators of improvement among those with SUDs who achieved abstinence or reduced their use, investigators pooled data from 13 randomized clinical trials with more than 2000 patients seeking treatment for cocaine or methamphetamine use disorders at centers in the United States from 2001 to 2017.
The trials used similar study protocols, including similar eligibility criteria, recruitment methods, and outcome measures. Participants were 18 or older and met criteria for methamphetamine or cocaine dependence at the beginning of each trial.
Among the participants, 1196 sought treatment for cocaine use disorder and 866 for methamphetamine use disorder. Of those, just 1487 had outcomes available by the end of the trial.
Most participants had no change in the level of use or increased their use through the trial (68%) or transitioned from low (1-4 days a month) to high (5 or more days a month) frequency use.
Nearly one third of participants (32%) stopped or reduced drug use, including 18% who cut down on stimulant use and 14% who abstained altogether.
Participants using methamphetamine were more likely to be in the abstinence vs reduced use category (21.3% vs 13.9%, respectively), whereas participants using cocaine were less likely to be in the abstinence vs reduced use category (9.1% vs 20.9%).
Those who reached abstinence showed better clinical improvement than those who reduced use on most clinical measures (P < .009).
However, there were no significant differences between groups on the Addiction Severity Index (ASI) psychiatric problems subscale and cravings for secondary drugs.
“Our findings suggest that reduced frequency of stimulant use is also associated with improved psychosocial functioning,” the authors wrote. “These findings suggest the need to re-evaluate the traditional approach of exclusively relying on total abstinence as the only indicator of successful treatment, a goal that may not be achievable for all patients, especially after one treatment episode.”
Those who reduced drug intake showed a significant association with nearly all clinical indicators of improvement (P < .010) compared with those who didn’t, except for the ASI psychiatric problems subscale and family/social relationship domains of the Problem Free Functioning scale, and HIV risk behavior.
Study limitations included short follow-up time in most trials and follow-up measures were based only on urine drug screens. There were also a substantial number of missing assessment points.
The study was funded by the National Institute on Drug Abuse and the National Institute of Health. There were no reported disclosures.
A version of this article appeared on Medscape.com.
In patients with stimulant use disorder (SUD), even slight reductions in drug use can lessen depression and reduce cravings, a new analysis showed.
Abstinence has long been the overall goal of SUD treatment, the investigators noted. The findings from this pooled analysis of randomized clinical trials support what investigators noted was a growing recognition that reducing stimulant use can lead to better outcomes.
“This study provides evidence that reducing the overall use of drugs is important and clinically meaningful,” study author Mehdi Farokhnia, MD, MPH, of the National Institute on Drug Abuse, North Bethesda, Maryland, wrote in a press release. “This shift may open opportunities for medication development that can help individuals achieve these improved outcomes, even if complete abstinence is not immediately achievable or wanted.”
The findings were published online on January 10, 2024, in Addiction.
Not the Only Indicator of Success
To compare clinical indicators of improvement among those with SUDs who achieved abstinence or reduced their use, investigators pooled data from 13 randomized clinical trials with more than 2000 patients seeking treatment for cocaine or methamphetamine use disorders at centers in the United States from 2001 to 2017.
The trials used similar study protocols, including similar eligibility criteria, recruitment methods, and outcome measures. Participants were 18 or older and met criteria for methamphetamine or cocaine dependence at the beginning of each trial.
Among the participants, 1196 sought treatment for cocaine use disorder and 866 for methamphetamine use disorder. Of those, just 1487 had outcomes available by the end of the trial.
Most participants had no change in the level of use or increased their use through the trial (68%) or transitioned from low (1-4 days a month) to high (5 or more days a month) frequency use.
Nearly one third of participants (32%) stopped or reduced drug use, including 18% who cut down on stimulant use and 14% who abstained altogether.
Participants using methamphetamine were more likely to be in the abstinence vs reduced use category (21.3% vs 13.9%, respectively), whereas participants using cocaine were less likely to be in the abstinence vs reduced use category (9.1% vs 20.9%).
Those who reached abstinence showed better clinical improvement than those who reduced use on most clinical measures (P < .009).
However, there were no significant differences between groups on the Addiction Severity Index (ASI) psychiatric problems subscale and cravings for secondary drugs.
“Our findings suggest that reduced frequency of stimulant use is also associated with improved psychosocial functioning,” the authors wrote. “These findings suggest the need to re-evaluate the traditional approach of exclusively relying on total abstinence as the only indicator of successful treatment, a goal that may not be achievable for all patients, especially after one treatment episode.”
Those who reduced drug intake showed a significant association with nearly all clinical indicators of improvement (P < .010) compared with those who didn’t, except for the ASI psychiatric problems subscale and family/social relationship domains of the Problem Free Functioning scale, and HIV risk behavior.
Study limitations included short follow-up time in most trials and follow-up measures were based only on urine drug screens. There were also a substantial number of missing assessment points.
The study was funded by the National Institute on Drug Abuse and the National Institute of Health. There were no reported disclosures.
A version of this article appeared on Medscape.com.
Struggling to Stay Awake While Driving a Sign of OSA?
TOPLINE:
Individuals who frequently used one or more coping strategies to stay awake while driving are significantly more likely to be diagnosed with obstructive sleep apnea (OSA) than are those who don’t use such coping strategies, new research showed.
METHODOLOGY:
- Investigators analyzed data on 119 participants with an Epworth Sleepiness Score (ESS) of > 10 who were being considered for a continuous positive airway pressure (CPAP) trial or who drove regularly.
- A total of 105 healthy volunteers with an ESS score of < 10 with no symptoms of OSA were recruited as controls.
- All participants completed questionnaires about how sleepiness affected their driving.
TAKEAWAY:
- Participants with OSA were more likely to feel sleepy while driving than controls (P = .0002).
- Participants with OSA were significantly more likely than were controls to use at least one coping strategy “frequently” vs control participants (43.7% vs 10.5%; P ≤ .0001).
- Strategies included rolling down the window, drinking tea or coffee, or listening to music at a high volume.
- Participants with OSA were significantly more likely to have either reported an accident or have been involved in an accident irrespective of any insurance claims in the last year than controls (16.8% vs 2.85%; P ≤ .0013).
IN PRACTICE:
“Our research suggests that untreated OSA patients often use coping strategies that could be surrogate markers of sleepiness,” lead author Akshay Dwarakanath, MD, said in a press release. “Asking about these strategies in the clinic may help doctors identifying patients who are at risk of driving incidents and to advise appropriately.”
SOURCE:
Akshay Dwarakanath, MD, of St. James University Hospital in Leeds, England, led the study, which was published online on January 17, 2024, in ERJ Open Research.
LIMITATIONS:
Investigators only evaluated patients with OSA with symptoms severe enough to warrant a CPAP trial and who needed to be assessed to determine if they should be allowed to continue to drive. Participant reporting and recall bias was another potential limitation.
DISCLOSURES:
There was no information available about study funding, and study authors had no disclosures.
A version of this article appeared on Medscape.com.
TOPLINE:
Individuals who frequently used one or more coping strategies to stay awake while driving are significantly more likely to be diagnosed with obstructive sleep apnea (OSA) than are those who don’t use such coping strategies, new research showed.
METHODOLOGY:
- Investigators analyzed data on 119 participants with an Epworth Sleepiness Score (ESS) of > 10 who were being considered for a continuous positive airway pressure (CPAP) trial or who drove regularly.
- A total of 105 healthy volunteers with an ESS score of < 10 with no symptoms of OSA were recruited as controls.
- All participants completed questionnaires about how sleepiness affected their driving.
TAKEAWAY:
- Participants with OSA were more likely to feel sleepy while driving than controls (P = .0002).
- Participants with OSA were significantly more likely than were controls to use at least one coping strategy “frequently” vs control participants (43.7% vs 10.5%; P ≤ .0001).
- Strategies included rolling down the window, drinking tea or coffee, or listening to music at a high volume.
- Participants with OSA were significantly more likely to have either reported an accident or have been involved in an accident irrespective of any insurance claims in the last year than controls (16.8% vs 2.85%; P ≤ .0013).
IN PRACTICE:
“Our research suggests that untreated OSA patients often use coping strategies that could be surrogate markers of sleepiness,” lead author Akshay Dwarakanath, MD, said in a press release. “Asking about these strategies in the clinic may help doctors identifying patients who are at risk of driving incidents and to advise appropriately.”
SOURCE:
Akshay Dwarakanath, MD, of St. James University Hospital in Leeds, England, led the study, which was published online on January 17, 2024, in ERJ Open Research.
LIMITATIONS:
Investigators only evaluated patients with OSA with symptoms severe enough to warrant a CPAP trial and who needed to be assessed to determine if they should be allowed to continue to drive. Participant reporting and recall bias was another potential limitation.
DISCLOSURES:
There was no information available about study funding, and study authors had no disclosures.
A version of this article appeared on Medscape.com.
TOPLINE:
Individuals who frequently used one or more coping strategies to stay awake while driving are significantly more likely to be diagnosed with obstructive sleep apnea (OSA) than are those who don’t use such coping strategies, new research showed.
METHODOLOGY:
- Investigators analyzed data on 119 participants with an Epworth Sleepiness Score (ESS) of > 10 who were being considered for a continuous positive airway pressure (CPAP) trial or who drove regularly.
- A total of 105 healthy volunteers with an ESS score of < 10 with no symptoms of OSA were recruited as controls.
- All participants completed questionnaires about how sleepiness affected their driving.
TAKEAWAY:
- Participants with OSA were more likely to feel sleepy while driving than controls (P = .0002).
- Participants with OSA were significantly more likely than were controls to use at least one coping strategy “frequently” vs control participants (43.7% vs 10.5%; P ≤ .0001).
- Strategies included rolling down the window, drinking tea or coffee, or listening to music at a high volume.
- Participants with OSA were significantly more likely to have either reported an accident or have been involved in an accident irrespective of any insurance claims in the last year than controls (16.8% vs 2.85%; P ≤ .0013).
IN PRACTICE:
“Our research suggests that untreated OSA patients often use coping strategies that could be surrogate markers of sleepiness,” lead author Akshay Dwarakanath, MD, said in a press release. “Asking about these strategies in the clinic may help doctors identifying patients who are at risk of driving incidents and to advise appropriately.”
SOURCE:
Akshay Dwarakanath, MD, of St. James University Hospital in Leeds, England, led the study, which was published online on January 17, 2024, in ERJ Open Research.
LIMITATIONS:
Investigators only evaluated patients with OSA with symptoms severe enough to warrant a CPAP trial and who needed to be assessed to determine if they should be allowed to continue to drive. Participant reporting and recall bias was another potential limitation.
DISCLOSURES:
There was no information available about study funding, and study authors had no disclosures.
A version of this article appeared on Medscape.com.
Migraine Associated With Increased Risk for IBD
TOPLINE:
Migraine is associated with a significantly increased risk of developing inflammatory bowel disease (IBD), including both Crohn’s disease (CD) and ulcerative colitis (UC), a new nationwide, population-based cohort study showed.
METHODOLOGY:
- Investigators analyzed data from South Korea’s National Health Insurance Service (NHIS) database, which houses data for the nationwide obligatory health system for South Korean citizens.
- Individuals aged ≥ 20 years who had at least one national health screening in 2009 were enrolled in the study and followed until December 2019.
- Investigators searched the data for International Classification of Diseases (10th Revision) codes corresponding to migraine and IBD. IBD diagnoses were also based on clinical manifestation, endoscopic findings, and pathologic findings.
TAKEAWAY:
- More than 10 million people were enrolled in the study (55% male; mean age, 47 years), and of these, 2.8% were diagnosed with migraine during the study period.
- During a median follow-up of 10 years, the incidence of IBD was significantly higher in patients with migraine (adjusted hazard ratio [aHR], 1.31; P < .001), CD (aHR, 1.58; P < .001) and UC (aHR, 1.26; P < .001) than in those without migraine.
- in men vs women (aHR, 1.43 vs 1.12; P = .042).
- Investigators could only speculate about the mechanisms underlying the association between migraine and IBD but suggest pathological processes underlying both migraine and IBD, including proinflammatory cytokines and tumor necrosis factor alpha, may be involved.
IN PRACTICE:
“Clinicians should be aware of the potential risk of IBD in patients diagnosed with migraine especially in men for the development of UC and in migraineurs with a long disease duration for a further risk of CD,” the authors wrote.
SOURCE:
Hyunjung Lee, MD, of Seoul National University College of Medicine, Seoul, South Korea, led the study, which was published online on January 12, 2024, in Scientific Reports.
LIMITATIONS:
Disease severity of migraine and IBD was not available. In addition, certain medications taken to relieve migraine, such as nonsteroidal anti-inflammatory drugs like ibuprofen, could cause intestinal inflammation, but there was no medication information available.
DISCLOSURES:
There was no information about study funding nor disclosures from study authors.
A version of this article appeared on Medscape.com.
TOPLINE:
Migraine is associated with a significantly increased risk of developing inflammatory bowel disease (IBD), including both Crohn’s disease (CD) and ulcerative colitis (UC), a new nationwide, population-based cohort study showed.
METHODOLOGY:
- Investigators analyzed data from South Korea’s National Health Insurance Service (NHIS) database, which houses data for the nationwide obligatory health system for South Korean citizens.
- Individuals aged ≥ 20 years who had at least one national health screening in 2009 were enrolled in the study and followed until December 2019.
- Investigators searched the data for International Classification of Diseases (10th Revision) codes corresponding to migraine and IBD. IBD diagnoses were also based on clinical manifestation, endoscopic findings, and pathologic findings.
TAKEAWAY:
- More than 10 million people were enrolled in the study (55% male; mean age, 47 years), and of these, 2.8% were diagnosed with migraine during the study period.
- During a median follow-up of 10 years, the incidence of IBD was significantly higher in patients with migraine (adjusted hazard ratio [aHR], 1.31; P < .001), CD (aHR, 1.58; P < .001) and UC (aHR, 1.26; P < .001) than in those without migraine.
- in men vs women (aHR, 1.43 vs 1.12; P = .042).
- Investigators could only speculate about the mechanisms underlying the association between migraine and IBD but suggest pathological processes underlying both migraine and IBD, including proinflammatory cytokines and tumor necrosis factor alpha, may be involved.
IN PRACTICE:
“Clinicians should be aware of the potential risk of IBD in patients diagnosed with migraine especially in men for the development of UC and in migraineurs with a long disease duration for a further risk of CD,” the authors wrote.
SOURCE:
Hyunjung Lee, MD, of Seoul National University College of Medicine, Seoul, South Korea, led the study, which was published online on January 12, 2024, in Scientific Reports.
LIMITATIONS:
Disease severity of migraine and IBD was not available. In addition, certain medications taken to relieve migraine, such as nonsteroidal anti-inflammatory drugs like ibuprofen, could cause intestinal inflammation, but there was no medication information available.
DISCLOSURES:
There was no information about study funding nor disclosures from study authors.
A version of this article appeared on Medscape.com.
TOPLINE:
Migraine is associated with a significantly increased risk of developing inflammatory bowel disease (IBD), including both Crohn’s disease (CD) and ulcerative colitis (UC), a new nationwide, population-based cohort study showed.
METHODOLOGY:
- Investigators analyzed data from South Korea’s National Health Insurance Service (NHIS) database, which houses data for the nationwide obligatory health system for South Korean citizens.
- Individuals aged ≥ 20 years who had at least one national health screening in 2009 were enrolled in the study and followed until December 2019.
- Investigators searched the data for International Classification of Diseases (10th Revision) codes corresponding to migraine and IBD. IBD diagnoses were also based on clinical manifestation, endoscopic findings, and pathologic findings.
TAKEAWAY:
- More than 10 million people were enrolled in the study (55% male; mean age, 47 years), and of these, 2.8% were diagnosed with migraine during the study period.
- During a median follow-up of 10 years, the incidence of IBD was significantly higher in patients with migraine (adjusted hazard ratio [aHR], 1.31; P < .001), CD (aHR, 1.58; P < .001) and UC (aHR, 1.26; P < .001) than in those without migraine.
- in men vs women (aHR, 1.43 vs 1.12; P = .042).
- Investigators could only speculate about the mechanisms underlying the association between migraine and IBD but suggest pathological processes underlying both migraine and IBD, including proinflammatory cytokines and tumor necrosis factor alpha, may be involved.
IN PRACTICE:
“Clinicians should be aware of the potential risk of IBD in patients diagnosed with migraine especially in men for the development of UC and in migraineurs with a long disease duration for a further risk of CD,” the authors wrote.
SOURCE:
Hyunjung Lee, MD, of Seoul National University College of Medicine, Seoul, South Korea, led the study, which was published online on January 12, 2024, in Scientific Reports.
LIMITATIONS:
Disease severity of migraine and IBD was not available. In addition, certain medications taken to relieve migraine, such as nonsteroidal anti-inflammatory drugs like ibuprofen, could cause intestinal inflammation, but there was no medication information available.
DISCLOSURES:
There was no information about study funding nor disclosures from study authors.
A version of this article appeared on Medscape.com.
High Rate of Rehospitalization After First Ischemic Stroke
TOPLINE:
Among patients hospitalized with a first ischemic stroke, 80% were rehospitalized, primarily because of subsequent primary cardiovascular and cerebrovascular diagnoses.
METHODOLOGY:
- To gather information on post-stroke hospital admission, investigators followed 1412 participants (mean age, 72.4 years; 52.1% women, 35.3% Black individuals) from the Atherosclerosis Risk in Communities (ARIC) study who were living in Maryland, Minnesota, North Carolina, and Mississippi.
- Participants were recruited between 1987 and 1989 when they were 45-64 years old and were followed on an annual and then semiannual basis from the index discharge until discharge after their second hospitalization, death, or end of the study in December 2019.
- Specific diagnoses for each hospitalization were based on hospital records, discharge diagnoses, and annual and semiannual phone interviews.
TAKEAWAY:
- During the study period, 1143 hospitalizations occurred over 41,849 person-months.
- 81% of participants were hospitalized over a maximum of 26.6 years of follow-up. Primary cardiovascular and cerebrovascular diagnoses were reported for half of readmissions.
- Over the follow-up period, compared with cardioembolic stroke, readmission risk was lower for thrombotic/lacunar stroke (adjusted hazard ratio [aHR], 0.82; 95% CI, 0.71-0.95) and hemorrhagic stroke (aHR, 0.74; 95% CI, 0.58-0.93). However, when adjusting for atrial fibrillation and competing risk for death, there were no significant differences between stroke subtypes.
- Compared with cardioembolic stroke, thrombotic/lacunar stroke was associated with lower readmission risk within 1 month (aHR, 0.66; 95% CI, 0.46-0.93) and from 1 month to 1 year (aHR, 0.78; 95% CI, 0.62-0.97), and hemorrhagic stroke was associated with lower risk from 1 month to 1 year (aHR, 0.60; 95% CI, 0.41-0.87).
IN PRACTICE:
“These results suggest that prevention strategies focused on cardiovascular and cerebrovascular health warrant further investigation, especially within the first year after incident stroke and perhaps particularly among individuals with an incident cardioembolic stroke,” the authors wrote.
SOURCE:
Kelly Sloane, MD, of the University of Pennsylvania Perelman School of Medicine in Philadelphia, led the study along with colleagues at the National Institute of Neurological Disorders and Stroke, Johns Hopkins University in Baltimore, and the University of North Carolina, Chapel Hill. The article was published online on January 5 in Neurology.
LIMITATIONS:
The ARIC study classification of stroke subtype grouped embolic strokes of undetermined source as thrombotic strokes, and investigators were unable to distinguish between the groups. In addition, there was no way to measure stroke severity, which could have played a role in readmission risk.
DISCLOSURES:
The study was funded by the National Heart, Lung, and Blood Institute, the National Institute of Neurological Disorders and Stroke, and the National Institutes of Health.
A version of this article appeared on Medscape.com.
TOPLINE:
Among patients hospitalized with a first ischemic stroke, 80% were rehospitalized, primarily because of subsequent primary cardiovascular and cerebrovascular diagnoses.
METHODOLOGY:
- To gather information on post-stroke hospital admission, investigators followed 1412 participants (mean age, 72.4 years; 52.1% women, 35.3% Black individuals) from the Atherosclerosis Risk in Communities (ARIC) study who were living in Maryland, Minnesota, North Carolina, and Mississippi.
- Participants were recruited between 1987 and 1989 when they were 45-64 years old and were followed on an annual and then semiannual basis from the index discharge until discharge after their second hospitalization, death, or end of the study in December 2019.
- Specific diagnoses for each hospitalization were based on hospital records, discharge diagnoses, and annual and semiannual phone interviews.
TAKEAWAY:
- During the study period, 1143 hospitalizations occurred over 41,849 person-months.
- 81% of participants were hospitalized over a maximum of 26.6 years of follow-up. Primary cardiovascular and cerebrovascular diagnoses were reported for half of readmissions.
- Over the follow-up period, compared with cardioembolic stroke, readmission risk was lower for thrombotic/lacunar stroke (adjusted hazard ratio [aHR], 0.82; 95% CI, 0.71-0.95) and hemorrhagic stroke (aHR, 0.74; 95% CI, 0.58-0.93). However, when adjusting for atrial fibrillation and competing risk for death, there were no significant differences between stroke subtypes.
- Compared with cardioembolic stroke, thrombotic/lacunar stroke was associated with lower readmission risk within 1 month (aHR, 0.66; 95% CI, 0.46-0.93) and from 1 month to 1 year (aHR, 0.78; 95% CI, 0.62-0.97), and hemorrhagic stroke was associated with lower risk from 1 month to 1 year (aHR, 0.60; 95% CI, 0.41-0.87).
IN PRACTICE:
“These results suggest that prevention strategies focused on cardiovascular and cerebrovascular health warrant further investigation, especially within the first year after incident stroke and perhaps particularly among individuals with an incident cardioembolic stroke,” the authors wrote.
SOURCE:
Kelly Sloane, MD, of the University of Pennsylvania Perelman School of Medicine in Philadelphia, led the study along with colleagues at the National Institute of Neurological Disorders and Stroke, Johns Hopkins University in Baltimore, and the University of North Carolina, Chapel Hill. The article was published online on January 5 in Neurology.
LIMITATIONS:
The ARIC study classification of stroke subtype grouped embolic strokes of undetermined source as thrombotic strokes, and investigators were unable to distinguish between the groups. In addition, there was no way to measure stroke severity, which could have played a role in readmission risk.
DISCLOSURES:
The study was funded by the National Heart, Lung, and Blood Institute, the National Institute of Neurological Disorders and Stroke, and the National Institutes of Health.
A version of this article appeared on Medscape.com.
TOPLINE:
Among patients hospitalized with a first ischemic stroke, 80% were rehospitalized, primarily because of subsequent primary cardiovascular and cerebrovascular diagnoses.
METHODOLOGY:
- To gather information on post-stroke hospital admission, investigators followed 1412 participants (mean age, 72.4 years; 52.1% women, 35.3% Black individuals) from the Atherosclerosis Risk in Communities (ARIC) study who were living in Maryland, Minnesota, North Carolina, and Mississippi.
- Participants were recruited between 1987 and 1989 when they were 45-64 years old and were followed on an annual and then semiannual basis from the index discharge until discharge after their second hospitalization, death, or end of the study in December 2019.
- Specific diagnoses for each hospitalization were based on hospital records, discharge diagnoses, and annual and semiannual phone interviews.
TAKEAWAY:
- During the study period, 1143 hospitalizations occurred over 41,849 person-months.
- 81% of participants were hospitalized over a maximum of 26.6 years of follow-up. Primary cardiovascular and cerebrovascular diagnoses were reported for half of readmissions.
- Over the follow-up period, compared with cardioembolic stroke, readmission risk was lower for thrombotic/lacunar stroke (adjusted hazard ratio [aHR], 0.82; 95% CI, 0.71-0.95) and hemorrhagic stroke (aHR, 0.74; 95% CI, 0.58-0.93). However, when adjusting for atrial fibrillation and competing risk for death, there were no significant differences between stroke subtypes.
- Compared with cardioembolic stroke, thrombotic/lacunar stroke was associated with lower readmission risk within 1 month (aHR, 0.66; 95% CI, 0.46-0.93) and from 1 month to 1 year (aHR, 0.78; 95% CI, 0.62-0.97), and hemorrhagic stroke was associated with lower risk from 1 month to 1 year (aHR, 0.60; 95% CI, 0.41-0.87).
IN PRACTICE:
“These results suggest that prevention strategies focused on cardiovascular and cerebrovascular health warrant further investigation, especially within the first year after incident stroke and perhaps particularly among individuals with an incident cardioembolic stroke,” the authors wrote.
SOURCE:
Kelly Sloane, MD, of the University of Pennsylvania Perelman School of Medicine in Philadelphia, led the study along with colleagues at the National Institute of Neurological Disorders and Stroke, Johns Hopkins University in Baltimore, and the University of North Carolina, Chapel Hill. The article was published online on January 5 in Neurology.
LIMITATIONS:
The ARIC study classification of stroke subtype grouped embolic strokes of undetermined source as thrombotic strokes, and investigators were unable to distinguish between the groups. In addition, there was no way to measure stroke severity, which could have played a role in readmission risk.
DISCLOSURES:
The study was funded by the National Heart, Lung, and Blood Institute, the National Institute of Neurological Disorders and Stroke, and the National Institutes of Health.
A version of this article appeared on Medscape.com.
Can Pet Ownership Ward Off Cognitive Decline?
TOPLINE:
, a new longitudinal cohort study showed. Investigators note the findings are important because previous research suggests older adults who live alone are at higher risk for dementia.
METHODOLOGY:
- Investigators analyzed data on 7945 participants aged 50 years and older (56% female; mean age, 66 years) from the English Longitudinal Study of Ageing (ELSA) and determined whether they lived alone or had a pet.
- Every couple of years for the next 8 years after baseline, participants were assessed for verbal cognition, verbal memory, and verbal fluency. Information about covariates including age, sex, employment status, educational level, and health was also collected.
- 35% of participants were pet owners, and 27% lived alone.
TAKEAWAY:
- Pet owners who lived alone had a slower rate of decline in verbal cognition (P = .009), verbal memory (P = .04), and verbal fluency (P = .03) compared with those without pets who lived alone.
- Stratified analysis showed that pet ownership was associated with slower rates of decline in composite verbal cognition, verbal memory, and verbal fluency but only among those who lived alone (all P < .001).
- There was no significant difference in rates of decline in composite verbal cognition, verbal memory, or verbal fluency between pet owners living alone and pet owners living with others.
IN PRACTICE:
“Pet ownership completely offset the associations of living alone with declining rates in verbal memory, verbal fluency, and composite verbal cognition. Our findings provide innovative insights for developing public health policies to slow cognitive decline in older adults living alone,” the authors wrote.
SOURCE:
Ciyong Lu, PhD, of Sun Yat-sen University in Guangzhou, China, led the study, which was published online on December 26, 2023, in JAMA Network Open.
LIMITATIONS:
Whereas cognitive function includes multiple components, the study only assessed verbal memory and verbal fluency. Also, the study did not gather information on the duration of pet ownership after baseline.
DISCLOSURES:
The investigators reported no disclosures.
A version of this article appeared on Medscape.com.
TOPLINE:
, a new longitudinal cohort study showed. Investigators note the findings are important because previous research suggests older adults who live alone are at higher risk for dementia.
METHODOLOGY:
- Investigators analyzed data on 7945 participants aged 50 years and older (56% female; mean age, 66 years) from the English Longitudinal Study of Ageing (ELSA) and determined whether they lived alone or had a pet.
- Every couple of years for the next 8 years after baseline, participants were assessed for verbal cognition, verbal memory, and verbal fluency. Information about covariates including age, sex, employment status, educational level, and health was also collected.
- 35% of participants were pet owners, and 27% lived alone.
TAKEAWAY:
- Pet owners who lived alone had a slower rate of decline in verbal cognition (P = .009), verbal memory (P = .04), and verbal fluency (P = .03) compared with those without pets who lived alone.
- Stratified analysis showed that pet ownership was associated with slower rates of decline in composite verbal cognition, verbal memory, and verbal fluency but only among those who lived alone (all P < .001).
- There was no significant difference in rates of decline in composite verbal cognition, verbal memory, or verbal fluency between pet owners living alone and pet owners living with others.
IN PRACTICE:
“Pet ownership completely offset the associations of living alone with declining rates in verbal memory, verbal fluency, and composite verbal cognition. Our findings provide innovative insights for developing public health policies to slow cognitive decline in older adults living alone,” the authors wrote.
SOURCE:
Ciyong Lu, PhD, of Sun Yat-sen University in Guangzhou, China, led the study, which was published online on December 26, 2023, in JAMA Network Open.
LIMITATIONS:
Whereas cognitive function includes multiple components, the study only assessed verbal memory and verbal fluency. Also, the study did not gather information on the duration of pet ownership after baseline.
DISCLOSURES:
The investigators reported no disclosures.
A version of this article appeared on Medscape.com.
TOPLINE:
, a new longitudinal cohort study showed. Investigators note the findings are important because previous research suggests older adults who live alone are at higher risk for dementia.
METHODOLOGY:
- Investigators analyzed data on 7945 participants aged 50 years and older (56% female; mean age, 66 years) from the English Longitudinal Study of Ageing (ELSA) and determined whether they lived alone or had a pet.
- Every couple of years for the next 8 years after baseline, participants were assessed for verbal cognition, verbal memory, and verbal fluency. Information about covariates including age, sex, employment status, educational level, and health was also collected.
- 35% of participants were pet owners, and 27% lived alone.
TAKEAWAY:
- Pet owners who lived alone had a slower rate of decline in verbal cognition (P = .009), verbal memory (P = .04), and verbal fluency (P = .03) compared with those without pets who lived alone.
- Stratified analysis showed that pet ownership was associated with slower rates of decline in composite verbal cognition, verbal memory, and verbal fluency but only among those who lived alone (all P < .001).
- There was no significant difference in rates of decline in composite verbal cognition, verbal memory, or verbal fluency between pet owners living alone and pet owners living with others.
IN PRACTICE:
“Pet ownership completely offset the associations of living alone with declining rates in verbal memory, verbal fluency, and composite verbal cognition. Our findings provide innovative insights for developing public health policies to slow cognitive decline in older adults living alone,” the authors wrote.
SOURCE:
Ciyong Lu, PhD, of Sun Yat-sen University in Guangzhou, China, led the study, which was published online on December 26, 2023, in JAMA Network Open.
LIMITATIONS:
Whereas cognitive function includes multiple components, the study only assessed verbal memory and verbal fluency. Also, the study did not gather information on the duration of pet ownership after baseline.
DISCLOSURES:
The investigators reported no disclosures.
A version of this article appeared on Medscape.com.
Spike in Schizophrenia-Related ED Visits During COVID
TOPLINE:
, a new study showed. Researchers said the findings suggested a need for social policies that strengthen mental health prevention systems.
METHODOLOGY:
Investigators obtained data from the University of California (UC) Health Data Warehouse on ED visits at five large UC health systems.
They captured the ICD-10 codes relating to schizophrenia spectrum disorders for ED visits from January 2016 to December 2021 for patients aged 18 years and older.
TAKEAWAY:
Between January 2016 and December 2021, there were 377,800 psychiatric ED visits, 10% of which involved schizophrenia spectrum disorders.
The mean number of visits per month for schizophrenia spectrum disorders rose from 520 before the pandemic to 558 visits per month after March 2020.
Compared to prepandemic numbers and after controlling for visits for other psychiatric disorders, there were 70.5 additional visits (P = .02) for schizophrenia spectrum disorders at 1 month and 74.9 additional visits (P = .005) at 3 months following the initial phase of the COVID-19 pandemic in California.
Investigators noted that prior studies indicated that COVID-19 infections may induce psychosis in some individuals, which could have been one underlying factor in the spike in cases.
IN PRACTICE:
“The COVID-19 pandemic draws attention to the vulnerability of patients with schizophrenia to macrosocial shocks, underscoring the importance of social policies related to income support, housing, and health insurance for future emergency preparedness and the need to strengthen mental healthcare systems,” the authors wrote.
SOURCE:
Parvita Singh, PhD, of The Ohio State University in Columbus, led the study, which was published online in JAMA Network Open.
LIMITATIONS:
Data used in the study excluded patients younger than 18 years. In addition, there was no analysis for trends by age or sex, which could have added valuable information to the study, the authors wrote. There was also no way to identify patients with newly diagnosed schizophrenia.
DISCLOSURES:
The study was funded through the Coronavirus Response and Relief Supplemental Appropriations Act and the Ohio Department of Mental Health and Addiction Services. Study disclosures are noted in the original study.
A version of this article appeared on Medscape.com.
TOPLINE:
, a new study showed. Researchers said the findings suggested a need for social policies that strengthen mental health prevention systems.
METHODOLOGY:
Investigators obtained data from the University of California (UC) Health Data Warehouse on ED visits at five large UC health systems.
They captured the ICD-10 codes relating to schizophrenia spectrum disorders for ED visits from January 2016 to December 2021 for patients aged 18 years and older.
TAKEAWAY:
Between January 2016 and December 2021, there were 377,800 psychiatric ED visits, 10% of which involved schizophrenia spectrum disorders.
The mean number of visits per month for schizophrenia spectrum disorders rose from 520 before the pandemic to 558 visits per month after March 2020.
Compared to prepandemic numbers and after controlling for visits for other psychiatric disorders, there were 70.5 additional visits (P = .02) for schizophrenia spectrum disorders at 1 month and 74.9 additional visits (P = .005) at 3 months following the initial phase of the COVID-19 pandemic in California.
Investigators noted that prior studies indicated that COVID-19 infections may induce psychosis in some individuals, which could have been one underlying factor in the spike in cases.
IN PRACTICE:
“The COVID-19 pandemic draws attention to the vulnerability of patients with schizophrenia to macrosocial shocks, underscoring the importance of social policies related to income support, housing, and health insurance for future emergency preparedness and the need to strengthen mental healthcare systems,” the authors wrote.
SOURCE:
Parvita Singh, PhD, of The Ohio State University in Columbus, led the study, which was published online in JAMA Network Open.
LIMITATIONS:
Data used in the study excluded patients younger than 18 years. In addition, there was no analysis for trends by age or sex, which could have added valuable information to the study, the authors wrote. There was also no way to identify patients with newly diagnosed schizophrenia.
DISCLOSURES:
The study was funded through the Coronavirus Response and Relief Supplemental Appropriations Act and the Ohio Department of Mental Health and Addiction Services. Study disclosures are noted in the original study.
A version of this article appeared on Medscape.com.
TOPLINE:
, a new study showed. Researchers said the findings suggested a need for social policies that strengthen mental health prevention systems.
METHODOLOGY:
Investigators obtained data from the University of California (UC) Health Data Warehouse on ED visits at five large UC health systems.
They captured the ICD-10 codes relating to schizophrenia spectrum disorders for ED visits from January 2016 to December 2021 for patients aged 18 years and older.
TAKEAWAY:
Between January 2016 and December 2021, there were 377,800 psychiatric ED visits, 10% of which involved schizophrenia spectrum disorders.
The mean number of visits per month for schizophrenia spectrum disorders rose from 520 before the pandemic to 558 visits per month after March 2020.
Compared to prepandemic numbers and after controlling for visits for other psychiatric disorders, there were 70.5 additional visits (P = .02) for schizophrenia spectrum disorders at 1 month and 74.9 additional visits (P = .005) at 3 months following the initial phase of the COVID-19 pandemic in California.
Investigators noted that prior studies indicated that COVID-19 infections may induce psychosis in some individuals, which could have been one underlying factor in the spike in cases.
IN PRACTICE:
“The COVID-19 pandemic draws attention to the vulnerability of patients with schizophrenia to macrosocial shocks, underscoring the importance of social policies related to income support, housing, and health insurance for future emergency preparedness and the need to strengthen mental healthcare systems,” the authors wrote.
SOURCE:
Parvita Singh, PhD, of The Ohio State University in Columbus, led the study, which was published online in JAMA Network Open.
LIMITATIONS:
Data used in the study excluded patients younger than 18 years. In addition, there was no analysis for trends by age or sex, which could have added valuable information to the study, the authors wrote. There was also no way to identify patients with newly diagnosed schizophrenia.
DISCLOSURES:
The study was funded through the Coronavirus Response and Relief Supplemental Appropriations Act and the Ohio Department of Mental Health and Addiction Services. Study disclosures are noted in the original study.
A version of this article appeared on Medscape.com.
ADHD Plus Comorbidities Linked to Increased Schizophrenia Risk
TOPLINE:
Attention-deficit/hyperactivity disorder (ADHD) and comorbid psychiatric disorders are associated with a twofold increased risk for schizophrenia, new research shows.
METHODOLOGY:
- Investigators analyzed the data of 211,705 people aged 5-19 years (74% male; 54% aged 5-9 years) diagnosed with ADHD during 2010-2018 from the Health Insurance Review and Assessment Service database of South Korea.
- Participants with a diagnosis of schizophrenia or psychosis anytime in the 3 years prior to ADHD diagnosis were excluded.
- Investigators split participants into two groups — a group of those diagnosed with at least one psychiatric comorbidity within a year of ADHD diagnosis and another group comprising those with ADHD and no psychiatric comorbidities.
TAKEAWAY:
- 37% (77,890) of those with ADHD had at least one comorbid psychiatric disorder.
- Participants with one psychiatric comorbidity had a 2.1-fold increased risk for a schizophrenia diagnosis than participants with no comorbidity (adjusted hazard ratio [aHR], 2.14; 95% CI, 2.05-2.23).
- Schizophrenia risk increased with each additional comorbidity. There was a fourfold increased risk for schizophrenia in study participants with three or more psychiatric comorbidities (aHR, 4.26; 95% CI, 3.90-4.65) than those with no comorbidity.
- Psychiatric comorbidities included autism spectrum disorder, which had the strongest link to increased schizophrenia risk (aHR, 2.43; 95% CI, 2.26-2.62). Other comorbidities that showed strong associations were intellectual disability (aHR, 1.83; 95% CI, 1.72-1.95), tic disorder (aHR, 1.77; 95% CI, 1.66-1.88), depression (aHR,1.68; 95% CI, 1.60-1.77), and bipolar disorder (aHR, 1.67; 95% CI, 1.53-1.83).
IN PRACTICE:
“To our knowledge, this is the first study to investigate schizophrenia risk among children and adolescents with ADHD, with a particular focus on psychiatric comorbidities,” the researchers wrote. They also noted that although patients had no psychiatric comorbidities at the time of ADHD diagnosis, the occurrence of psychiatric comorbidities was frequently observed prior to schizophrenia diagnosis.
“These findings highlighted the significance of carefully monitoring psychiatric comorbidities in patients with ADHD to effectively mitigate the burden of schizophrenia,” they noted.
SOURCE:
Soo Min Jeon, PharmD, PhD, of Jeju National University in Jeju, South Korea, led the study, which was published online on November 30, 2023 in JAMA Network Open.
LIMITATIONS:
Since the diagnosis of ADHD, schizophrenia, and other psychiatric comorbidities were based on diagnostic codes, the possibility of underdiagnosis or overdiagnosis cannot be ruled out. Also, some patients with ADHD chose the general health consultation (International Classification of Diseases - Z code) due to the social stigma surrounding mental health problems.
DISCLOSURES:
The study was funded by the Basic Science Research Program through the Ministry of Education and the Health Insurance Review and Assessment Service. Author disclosures can be found in the original paper.
A version of this article appeared on Medscape.com.
TOPLINE:
Attention-deficit/hyperactivity disorder (ADHD) and comorbid psychiatric disorders are associated with a twofold increased risk for schizophrenia, new research shows.
METHODOLOGY:
- Investigators analyzed the data of 211,705 people aged 5-19 years (74% male; 54% aged 5-9 years) diagnosed with ADHD during 2010-2018 from the Health Insurance Review and Assessment Service database of South Korea.
- Participants with a diagnosis of schizophrenia or psychosis anytime in the 3 years prior to ADHD diagnosis were excluded.
- Investigators split participants into two groups — a group of those diagnosed with at least one psychiatric comorbidity within a year of ADHD diagnosis and another group comprising those with ADHD and no psychiatric comorbidities.
TAKEAWAY:
- 37% (77,890) of those with ADHD had at least one comorbid psychiatric disorder.
- Participants with one psychiatric comorbidity had a 2.1-fold increased risk for a schizophrenia diagnosis than participants with no comorbidity (adjusted hazard ratio [aHR], 2.14; 95% CI, 2.05-2.23).
- Schizophrenia risk increased with each additional comorbidity. There was a fourfold increased risk for schizophrenia in study participants with three or more psychiatric comorbidities (aHR, 4.26; 95% CI, 3.90-4.65) than those with no comorbidity.
- Psychiatric comorbidities included autism spectrum disorder, which had the strongest link to increased schizophrenia risk (aHR, 2.43; 95% CI, 2.26-2.62). Other comorbidities that showed strong associations were intellectual disability (aHR, 1.83; 95% CI, 1.72-1.95), tic disorder (aHR, 1.77; 95% CI, 1.66-1.88), depression (aHR,1.68; 95% CI, 1.60-1.77), and bipolar disorder (aHR, 1.67; 95% CI, 1.53-1.83).
IN PRACTICE:
“To our knowledge, this is the first study to investigate schizophrenia risk among children and adolescents with ADHD, with a particular focus on psychiatric comorbidities,” the researchers wrote. They also noted that although patients had no psychiatric comorbidities at the time of ADHD diagnosis, the occurrence of psychiatric comorbidities was frequently observed prior to schizophrenia diagnosis.
“These findings highlighted the significance of carefully monitoring psychiatric comorbidities in patients with ADHD to effectively mitigate the burden of schizophrenia,” they noted.
SOURCE:
Soo Min Jeon, PharmD, PhD, of Jeju National University in Jeju, South Korea, led the study, which was published online on November 30, 2023 in JAMA Network Open.
LIMITATIONS:
Since the diagnosis of ADHD, schizophrenia, and other psychiatric comorbidities were based on diagnostic codes, the possibility of underdiagnosis or overdiagnosis cannot be ruled out. Also, some patients with ADHD chose the general health consultation (International Classification of Diseases - Z code) due to the social stigma surrounding mental health problems.
DISCLOSURES:
The study was funded by the Basic Science Research Program through the Ministry of Education and the Health Insurance Review and Assessment Service. Author disclosures can be found in the original paper.
A version of this article appeared on Medscape.com.
TOPLINE:
Attention-deficit/hyperactivity disorder (ADHD) and comorbid psychiatric disorders are associated with a twofold increased risk for schizophrenia, new research shows.
METHODOLOGY:
- Investigators analyzed the data of 211,705 people aged 5-19 years (74% male; 54% aged 5-9 years) diagnosed with ADHD during 2010-2018 from the Health Insurance Review and Assessment Service database of South Korea.
- Participants with a diagnosis of schizophrenia or psychosis anytime in the 3 years prior to ADHD diagnosis were excluded.
- Investigators split participants into two groups — a group of those diagnosed with at least one psychiatric comorbidity within a year of ADHD diagnosis and another group comprising those with ADHD and no psychiatric comorbidities.
TAKEAWAY:
- 37% (77,890) of those with ADHD had at least one comorbid psychiatric disorder.
- Participants with one psychiatric comorbidity had a 2.1-fold increased risk for a schizophrenia diagnosis than participants with no comorbidity (adjusted hazard ratio [aHR], 2.14; 95% CI, 2.05-2.23).
- Schizophrenia risk increased with each additional comorbidity. There was a fourfold increased risk for schizophrenia in study participants with three or more psychiatric comorbidities (aHR, 4.26; 95% CI, 3.90-4.65) than those with no comorbidity.
- Psychiatric comorbidities included autism spectrum disorder, which had the strongest link to increased schizophrenia risk (aHR, 2.43; 95% CI, 2.26-2.62). Other comorbidities that showed strong associations were intellectual disability (aHR, 1.83; 95% CI, 1.72-1.95), tic disorder (aHR, 1.77; 95% CI, 1.66-1.88), depression (aHR,1.68; 95% CI, 1.60-1.77), and bipolar disorder (aHR, 1.67; 95% CI, 1.53-1.83).
IN PRACTICE:
“To our knowledge, this is the first study to investigate schizophrenia risk among children and adolescents with ADHD, with a particular focus on psychiatric comorbidities,” the researchers wrote. They also noted that although patients had no psychiatric comorbidities at the time of ADHD diagnosis, the occurrence of psychiatric comorbidities was frequently observed prior to schizophrenia diagnosis.
“These findings highlighted the significance of carefully monitoring psychiatric comorbidities in patients with ADHD to effectively mitigate the burden of schizophrenia,” they noted.
SOURCE:
Soo Min Jeon, PharmD, PhD, of Jeju National University in Jeju, South Korea, led the study, which was published online on November 30, 2023 in JAMA Network Open.
LIMITATIONS:
Since the diagnosis of ADHD, schizophrenia, and other psychiatric comorbidities were based on diagnostic codes, the possibility of underdiagnosis or overdiagnosis cannot be ruled out. Also, some patients with ADHD chose the general health consultation (International Classification of Diseases - Z code) due to the social stigma surrounding mental health problems.
DISCLOSURES:
The study was funded by the Basic Science Research Program through the Ministry of Education and the Health Insurance Review and Assessment Service. Author disclosures can be found in the original paper.
A version of this article appeared on Medscape.com.
Hypochondriasis Linked to Increased Risk for All-Cause Mortality
TOPLINE:
Hypochondriasis is linked to an 84% higher risk for death for those with the disorder and a fourfold increased risk for suicide, new population-based data show. These findings, investigators noted, suggest the need for more clinical screening and treatment of hypochondriasis, also known as health anxiety disorder.
METHODOLOGY:
- Investigators used several Swedish population-based registers to identify people who received a diagnosis of hypochondriasis between January 1997 and December 2020.
- Each individual diagnosed with hypochondriasis (n = 4129; 2342 women; median 34.5 years at diagnosis) was age- and sex-matched with 10 individuals without the disorder (n = 41,290).
- For those who died during the study period, cause of death was categorized as natural (neoplasms; diseases of the nervous system, circulatory system, or respiratory system) or unnatural (primarily suicide).
- Investigators age- and sex-matched 4129 individuals with hypochondriasis to 41,290 individuals without hypochondriasis.
TAKEAWAY:
- (adjusted hazard ratio [aHR], 1.84; 95% CI, 1.60-2.10), including a higher risk for both natural (aHR, 1.60; 95% CI, 1.38-1.85) and unnatural death (aHR, 2.43; 95% CI, 1.61-3.68).
- The majority of individuals with hypochondriasis were diagnosed with at least one additional psychiatric disorder (primarily anxiety-related and depressive disorders) vs the group without hypochondriasis (86% vs 20%, respectively; P < .001).
- The risk for suicide — the most common unnatural cause of death — was four times higher in those with hypochondriasis (aHR, 4.14; 95% CI, 2.44-7.03).
- When investigators limited analyses to include only psychiatric comorbidities recorded before the first diagnosis of hypochondriasis, suicide risk was attenuated but remained statistically significant.
IN PRACTICE:
“Taken together, these findings illustrate a paradox, whereby individuals with hypochondriasis have an increased risk for death despite their pervasive fears of illness and death. In this study, most deaths could be classified as potentially preventable. Dismissing these individuals’ somatic symptoms as imaginary may have dire consequences,” the authors wrote.
SOURCE:
David Mataix-Cols, PhD, of the Karolinska Institutet, Stockholm, Sweden, led the study, which was published online on December 13, 2023, in JAMA Psychiatry.
LIMITATIONS:
Hypochondriasis is thought to be underdiagnosed in Sweden, with only approximately 4000 cases registered within two decades. Study investigators also noted that they did not obtain data from primary care, the setting where the majority of hypochondriasis cases are diagnosed.
DISCLOSURES:
The study was funded by the Swedish Research Council for Health, Working Life and Welfare, Stockholm; the Swedish Society of Medicine, Stockholm; and Karolinska Institutet, Stockholm. Dr. Mataix-Cols reported receiving personal fees from UpToDate Inc. Author disclosures can be found in the original article.
A version of this article appeared on Medscape.com.
TOPLINE:
Hypochondriasis is linked to an 84% higher risk for death for those with the disorder and a fourfold increased risk for suicide, new population-based data show. These findings, investigators noted, suggest the need for more clinical screening and treatment of hypochondriasis, also known as health anxiety disorder.
METHODOLOGY:
- Investigators used several Swedish population-based registers to identify people who received a diagnosis of hypochondriasis between January 1997 and December 2020.
- Each individual diagnosed with hypochondriasis (n = 4129; 2342 women; median 34.5 years at diagnosis) was age- and sex-matched with 10 individuals without the disorder (n = 41,290).
- For those who died during the study period, cause of death was categorized as natural (neoplasms; diseases of the nervous system, circulatory system, or respiratory system) or unnatural (primarily suicide).
- Investigators age- and sex-matched 4129 individuals with hypochondriasis to 41,290 individuals without hypochondriasis.
TAKEAWAY:
- (adjusted hazard ratio [aHR], 1.84; 95% CI, 1.60-2.10), including a higher risk for both natural (aHR, 1.60; 95% CI, 1.38-1.85) and unnatural death (aHR, 2.43; 95% CI, 1.61-3.68).
- The majority of individuals with hypochondriasis were diagnosed with at least one additional psychiatric disorder (primarily anxiety-related and depressive disorders) vs the group without hypochondriasis (86% vs 20%, respectively; P < .001).
- The risk for suicide — the most common unnatural cause of death — was four times higher in those with hypochondriasis (aHR, 4.14; 95% CI, 2.44-7.03).
- When investigators limited analyses to include only psychiatric comorbidities recorded before the first diagnosis of hypochondriasis, suicide risk was attenuated but remained statistically significant.
IN PRACTICE:
“Taken together, these findings illustrate a paradox, whereby individuals with hypochondriasis have an increased risk for death despite their pervasive fears of illness and death. In this study, most deaths could be classified as potentially preventable. Dismissing these individuals’ somatic symptoms as imaginary may have dire consequences,” the authors wrote.
SOURCE:
David Mataix-Cols, PhD, of the Karolinska Institutet, Stockholm, Sweden, led the study, which was published online on December 13, 2023, in JAMA Psychiatry.
LIMITATIONS:
Hypochondriasis is thought to be underdiagnosed in Sweden, with only approximately 4000 cases registered within two decades. Study investigators also noted that they did not obtain data from primary care, the setting where the majority of hypochondriasis cases are diagnosed.
DISCLOSURES:
The study was funded by the Swedish Research Council for Health, Working Life and Welfare, Stockholm; the Swedish Society of Medicine, Stockholm; and Karolinska Institutet, Stockholm. Dr. Mataix-Cols reported receiving personal fees from UpToDate Inc. Author disclosures can be found in the original article.
A version of this article appeared on Medscape.com.
TOPLINE:
Hypochondriasis is linked to an 84% higher risk for death for those with the disorder and a fourfold increased risk for suicide, new population-based data show. These findings, investigators noted, suggest the need for more clinical screening and treatment of hypochondriasis, also known as health anxiety disorder.
METHODOLOGY:
- Investigators used several Swedish population-based registers to identify people who received a diagnosis of hypochondriasis between January 1997 and December 2020.
- Each individual diagnosed with hypochondriasis (n = 4129; 2342 women; median 34.5 years at diagnosis) was age- and sex-matched with 10 individuals without the disorder (n = 41,290).
- For those who died during the study period, cause of death was categorized as natural (neoplasms; diseases of the nervous system, circulatory system, or respiratory system) or unnatural (primarily suicide).
- Investigators age- and sex-matched 4129 individuals with hypochondriasis to 41,290 individuals without hypochondriasis.
TAKEAWAY:
- (adjusted hazard ratio [aHR], 1.84; 95% CI, 1.60-2.10), including a higher risk for both natural (aHR, 1.60; 95% CI, 1.38-1.85) and unnatural death (aHR, 2.43; 95% CI, 1.61-3.68).
- The majority of individuals with hypochondriasis were diagnosed with at least one additional psychiatric disorder (primarily anxiety-related and depressive disorders) vs the group without hypochondriasis (86% vs 20%, respectively; P < .001).
- The risk for suicide — the most common unnatural cause of death — was four times higher in those with hypochondriasis (aHR, 4.14; 95% CI, 2.44-7.03).
- When investigators limited analyses to include only psychiatric comorbidities recorded before the first diagnosis of hypochondriasis, suicide risk was attenuated but remained statistically significant.
IN PRACTICE:
“Taken together, these findings illustrate a paradox, whereby individuals with hypochondriasis have an increased risk for death despite their pervasive fears of illness and death. In this study, most deaths could be classified as potentially preventable. Dismissing these individuals’ somatic symptoms as imaginary may have dire consequences,” the authors wrote.
SOURCE:
David Mataix-Cols, PhD, of the Karolinska Institutet, Stockholm, Sweden, led the study, which was published online on December 13, 2023, in JAMA Psychiatry.
LIMITATIONS:
Hypochondriasis is thought to be underdiagnosed in Sweden, with only approximately 4000 cases registered within two decades. Study investigators also noted that they did not obtain data from primary care, the setting where the majority of hypochondriasis cases are diagnosed.
DISCLOSURES:
The study was funded by the Swedish Research Council for Health, Working Life and Welfare, Stockholm; the Swedish Society of Medicine, Stockholm; and Karolinska Institutet, Stockholm. Dr. Mataix-Cols reported receiving personal fees from UpToDate Inc. Author disclosures can be found in the original article.
A version of this article appeared on Medscape.com.
Early evidence supports psilocybin for bipolar depression
, a small, nonrandomized clinical trial shows. However, the investigators and other outside experts warn these results should not be overinterpreted.
Three weeks after receiving psilocybin and psychotherapy, all 15 participants’ depression scores dropped by an average of 24 points. Twelve met criteria for response and 11 for remission.
This benefit lasted until the 12-week mark, with 12 participants (80%) meeting criteria for both response and remission. There were no reports of mixed or manic symptoms, psychotic symptoms, or suicidal ideation.
Given the study’s small, open-label design, the findings should be interpreted cautiously, but the investigators say the results are promising.
“The results we saw from this trial are encouraging and further support the clinical study of psychedelics in patients with treatment-resistant bipolar II,” lead investigator Scott T. Aaronson, MD, chief science officer of the Institute for Advanced Diagnostics and Therapeutics at Sheppard Pratt Health System in Baltimore, Maryland, remarked in a press release. “One participant compared the transformation she experienced to taking a deep breath after breathing through a straw for years.”
The findings were published online on December 6, 2023, in JAMA Psychiatry.
Underserved Population
Previous studies show that psilocybin is effective in reducing the symptoms of treatment-resistant depression, major depressive disorder, and anorexia nervosa, most with only mild to moderate adverse effects.
Individuals with bipolar disorder (BPD) have been excluded from psilocybin studies in the last two decades. Investigators attribute this to anecdotal evidence that psychedelics may result in manic episodes in patients with BPD, even though empirical evidence of those effects is limited.
This study included 15 participants (9 female; mean age, 37.8 years) with BDII who had experienced an episode for more than 3 months and failed at least two medications within the current episode.
Participants stopped all psychotropic medications at least 2 weeks prior to the trial and received 25 mg of synthetic COMP360 psilocybin in a controlled setting. Psychotherapy included three sessions before dosing, one during the 8-hour dosing day, and three integration sessions posttreatment.
Depression was measured with the Montgomery Ǻsberg Depression Rating Scale (MADRS) at six points during the 12-week study.
By week 3, all 15 participants had lower MADRS scores, with a mean decrease of 24 points (P < .001). Twelve participants met the response criteria of ≥ 50% reduction in MADRS scores, and 11 met the criteria for remission of a MADRS score of ≤ 10 (both P < .001).
MADRS scores at each posttreatment time point were significantly lower than they were at baseline and the improvement persisted at 12 weeks.
Participants were also monitored for mania and suicidality at various time points during the study, and no significant changes were found from baseline.
“As a first open-label foray into this underserved and treatment-resistant population, care should be taken not to overinterpret the findings,” the authors note, adding that the findings may not apply to patients with BDI or BDII in a mixed or hypomanic phase of their illness.
No Definitive Conclusion
In an accompanying editorial, David B. Yaden, PhD, Johns Hopkins University School of Medicine, Baltimore, Maryland, and colleagues write that the findings are “tantalizingly suggestive,” but ultimately say nothing definitive about the efficacy of psilocybin for BDII.
“The danger is that some individuals will see the large (yet uncontrolled) effect size and believe that a new treatment of bipolar II has been discovered that is substantially better than all other treatments, while neglecting to mention the lack of control condition and substantial psychosocial support included in the study,” Dr. Yaden and colleagues wrote.
They also cautioned that due to the study’s limitations, which include its small sample size and lack of a control group, “it is imperative that the large effect size before to after the study is not overinterpreted.”
However, Dr. Yaden and colleagues also characterized the safety data as “compelling,” noting the safety profile could affect exclusion criteria in future studies involving people with BPD.
“The results of the present study provide preliminary evidence that perhaps those with bipolar II can be safely included in study samples without undue risk of triggering hypomanic episodes,” they wrote. “It also suggests re-evaluation of the need to exclude individuals with mere family history of bipolar II, which several studies do.”
The study was funded by COMPASS Pathways, who provided the study drug. Dr. Aaronson reported grants and nonfinancial support (supply of drug) from COMPASS Pathways during the conduct of the study and personal fees from LivaNova, Neuronetics, Genomind, and Sage Therapeutics outside the submitted work. Other disclosures are noted in the original article.
A version of this article appeared on Medscape.com.
, a small, nonrandomized clinical trial shows. However, the investigators and other outside experts warn these results should not be overinterpreted.
Three weeks after receiving psilocybin and psychotherapy, all 15 participants’ depression scores dropped by an average of 24 points. Twelve met criteria for response and 11 for remission.
This benefit lasted until the 12-week mark, with 12 participants (80%) meeting criteria for both response and remission. There were no reports of mixed or manic symptoms, psychotic symptoms, or suicidal ideation.
Given the study’s small, open-label design, the findings should be interpreted cautiously, but the investigators say the results are promising.
“The results we saw from this trial are encouraging and further support the clinical study of psychedelics in patients with treatment-resistant bipolar II,” lead investigator Scott T. Aaronson, MD, chief science officer of the Institute for Advanced Diagnostics and Therapeutics at Sheppard Pratt Health System in Baltimore, Maryland, remarked in a press release. “One participant compared the transformation she experienced to taking a deep breath after breathing through a straw for years.”
The findings were published online on December 6, 2023, in JAMA Psychiatry.
Underserved Population
Previous studies show that psilocybin is effective in reducing the symptoms of treatment-resistant depression, major depressive disorder, and anorexia nervosa, most with only mild to moderate adverse effects.
Individuals with bipolar disorder (BPD) have been excluded from psilocybin studies in the last two decades. Investigators attribute this to anecdotal evidence that psychedelics may result in manic episodes in patients with BPD, even though empirical evidence of those effects is limited.
This study included 15 participants (9 female; mean age, 37.8 years) with BDII who had experienced an episode for more than 3 months and failed at least two medications within the current episode.
Participants stopped all psychotropic medications at least 2 weeks prior to the trial and received 25 mg of synthetic COMP360 psilocybin in a controlled setting. Psychotherapy included three sessions before dosing, one during the 8-hour dosing day, and three integration sessions posttreatment.
Depression was measured with the Montgomery Ǻsberg Depression Rating Scale (MADRS) at six points during the 12-week study.
By week 3, all 15 participants had lower MADRS scores, with a mean decrease of 24 points (P < .001). Twelve participants met the response criteria of ≥ 50% reduction in MADRS scores, and 11 met the criteria for remission of a MADRS score of ≤ 10 (both P < .001).
MADRS scores at each posttreatment time point were significantly lower than they were at baseline and the improvement persisted at 12 weeks.
Participants were also monitored for mania and suicidality at various time points during the study, and no significant changes were found from baseline.
“As a first open-label foray into this underserved and treatment-resistant population, care should be taken not to overinterpret the findings,” the authors note, adding that the findings may not apply to patients with BDI or BDII in a mixed or hypomanic phase of their illness.
No Definitive Conclusion
In an accompanying editorial, David B. Yaden, PhD, Johns Hopkins University School of Medicine, Baltimore, Maryland, and colleagues write that the findings are “tantalizingly suggestive,” but ultimately say nothing definitive about the efficacy of psilocybin for BDII.
“The danger is that some individuals will see the large (yet uncontrolled) effect size and believe that a new treatment of bipolar II has been discovered that is substantially better than all other treatments, while neglecting to mention the lack of control condition and substantial psychosocial support included in the study,” Dr. Yaden and colleagues wrote.
They also cautioned that due to the study’s limitations, which include its small sample size and lack of a control group, “it is imperative that the large effect size before to after the study is not overinterpreted.”
However, Dr. Yaden and colleagues also characterized the safety data as “compelling,” noting the safety profile could affect exclusion criteria in future studies involving people with BPD.
“The results of the present study provide preliminary evidence that perhaps those with bipolar II can be safely included in study samples without undue risk of triggering hypomanic episodes,” they wrote. “It also suggests re-evaluation of the need to exclude individuals with mere family history of bipolar II, which several studies do.”
The study was funded by COMPASS Pathways, who provided the study drug. Dr. Aaronson reported grants and nonfinancial support (supply of drug) from COMPASS Pathways during the conduct of the study and personal fees from LivaNova, Neuronetics, Genomind, and Sage Therapeutics outside the submitted work. Other disclosures are noted in the original article.
A version of this article appeared on Medscape.com.
, a small, nonrandomized clinical trial shows. However, the investigators and other outside experts warn these results should not be overinterpreted.
Three weeks after receiving psilocybin and psychotherapy, all 15 participants’ depression scores dropped by an average of 24 points. Twelve met criteria for response and 11 for remission.
This benefit lasted until the 12-week mark, with 12 participants (80%) meeting criteria for both response and remission. There were no reports of mixed or manic symptoms, psychotic symptoms, or suicidal ideation.
Given the study’s small, open-label design, the findings should be interpreted cautiously, but the investigators say the results are promising.
“The results we saw from this trial are encouraging and further support the clinical study of psychedelics in patients with treatment-resistant bipolar II,” lead investigator Scott T. Aaronson, MD, chief science officer of the Institute for Advanced Diagnostics and Therapeutics at Sheppard Pratt Health System in Baltimore, Maryland, remarked in a press release. “One participant compared the transformation she experienced to taking a deep breath after breathing through a straw for years.”
The findings were published online on December 6, 2023, in JAMA Psychiatry.
Underserved Population
Previous studies show that psilocybin is effective in reducing the symptoms of treatment-resistant depression, major depressive disorder, and anorexia nervosa, most with only mild to moderate adverse effects.
Individuals with bipolar disorder (BPD) have been excluded from psilocybin studies in the last two decades. Investigators attribute this to anecdotal evidence that psychedelics may result in manic episodes in patients with BPD, even though empirical evidence of those effects is limited.
This study included 15 participants (9 female; mean age, 37.8 years) with BDII who had experienced an episode for more than 3 months and failed at least two medications within the current episode.
Participants stopped all psychotropic medications at least 2 weeks prior to the trial and received 25 mg of synthetic COMP360 psilocybin in a controlled setting. Psychotherapy included three sessions before dosing, one during the 8-hour dosing day, and three integration sessions posttreatment.
Depression was measured with the Montgomery Ǻsberg Depression Rating Scale (MADRS) at six points during the 12-week study.
By week 3, all 15 participants had lower MADRS scores, with a mean decrease of 24 points (P < .001). Twelve participants met the response criteria of ≥ 50% reduction in MADRS scores, and 11 met the criteria for remission of a MADRS score of ≤ 10 (both P < .001).
MADRS scores at each posttreatment time point were significantly lower than they were at baseline and the improvement persisted at 12 weeks.
Participants were also monitored for mania and suicidality at various time points during the study, and no significant changes were found from baseline.
“As a first open-label foray into this underserved and treatment-resistant population, care should be taken not to overinterpret the findings,” the authors note, adding that the findings may not apply to patients with BDI or BDII in a mixed or hypomanic phase of their illness.
No Definitive Conclusion
In an accompanying editorial, David B. Yaden, PhD, Johns Hopkins University School of Medicine, Baltimore, Maryland, and colleagues write that the findings are “tantalizingly suggestive,” but ultimately say nothing definitive about the efficacy of psilocybin for BDII.
“The danger is that some individuals will see the large (yet uncontrolled) effect size and believe that a new treatment of bipolar II has been discovered that is substantially better than all other treatments, while neglecting to mention the lack of control condition and substantial psychosocial support included in the study,” Dr. Yaden and colleagues wrote.
They also cautioned that due to the study’s limitations, which include its small sample size and lack of a control group, “it is imperative that the large effect size before to after the study is not overinterpreted.”
However, Dr. Yaden and colleagues also characterized the safety data as “compelling,” noting the safety profile could affect exclusion criteria in future studies involving people with BPD.
“The results of the present study provide preliminary evidence that perhaps those with bipolar II can be safely included in study samples without undue risk of triggering hypomanic episodes,” they wrote. “It also suggests re-evaluation of the need to exclude individuals with mere family history of bipolar II, which several studies do.”
The study was funded by COMPASS Pathways, who provided the study drug. Dr. Aaronson reported grants and nonfinancial support (supply of drug) from COMPASS Pathways during the conduct of the study and personal fees from LivaNova, Neuronetics, Genomind, and Sage Therapeutics outside the submitted work. Other disclosures are noted in the original article.
A version of this article appeared on Medscape.com.
FROM JAMA PSYCHIATRY
Neighborhood Disadvantage Tied to Higher Risk for ASD
TOPLINE
, a population-based prospective cohort study shows.
METHODOLOGY
- Investigators analyzed data from a large cohort of singleton children with insurance born in Kaiser Permanente Southern California hospitals between 2001 and 2014.
- They ascertained ASD diagnosis, maternal race and ethnicity, and maternal address at time of birth.
- Neighborhood disadvantage was determined by the percentage of families in the mother’s neighborhood considered to be living in poverty, unemployed, have female-headed households with children, using public assistance, less than a high school education, among other variables.
TAKEAWAY
- Among 318,300 mothers who delivered babies during the study period, 6350 children were diagnosed with ASD during follow-up, and median age at diagnosis was 3.5 years.
- Greater neighborhood disadvantage at birth was associated with a higher likelihood of ASD diagnosis (adjusted hazard ratio [aHR], 1.07; 95% CI, 1.02-1.11)
- ASD diagnoses were more likely among children of mothers who were Black (aHR, 1.13; 95% CI, 1.02-1.25), Asian/Pacific Islander (aHR, 1.11; 95% CI, 1.02-1.20), or Hispanic (aHR, 1.07; 95% CI, 1.00-1.15), even after the researchers controlled for neighborhood.
- While odds of an ASD diagnosis were higher among children from minority racial and ethnic groups, neighborhood disadvantage was significantly associated with ASD diagnosis only for children of White mothers (aHR, 1.17; 95% CI, 1.09-1.26).
IN PRACTICE
Investigators noted that they could only speculate about the factors driving the association between neighborhood disadvantage and a stronger risk for ASD diagnosis in children of White mothers. “They may be due to systemic racism, discrimination, and their impact on maternal health during pregnancy,” they wrote.
SOURCE
Xin Yu, MS, and Daniel Hackman, PhD, of the University of Southern California Los Angeles, led the study, which was published online November 15 in JAMA Psychiatry.
LIMITATIONS
The research was limited by a lack of information on fathers and variables such as incomes, which may have confounded the findings. The authors also acknowledged that the study should be replicated in other health service settings.
DISCLOSURES
The study was funded by the National Institutes on Environmental Health Sciences, the National Institutes of Health (NIH), and the Environmental Protection Agency. Dr. Hackman reported receiving grant funding from NIH during the conduct of the study. Other disclosures are available in the original study.
A version of this article appeared on Medscape.com.
TOPLINE
, a population-based prospective cohort study shows.
METHODOLOGY
- Investigators analyzed data from a large cohort of singleton children with insurance born in Kaiser Permanente Southern California hospitals between 2001 and 2014.
- They ascertained ASD diagnosis, maternal race and ethnicity, and maternal address at time of birth.
- Neighborhood disadvantage was determined by the percentage of families in the mother’s neighborhood considered to be living in poverty, unemployed, have female-headed households with children, using public assistance, less than a high school education, among other variables.
TAKEAWAY
- Among 318,300 mothers who delivered babies during the study period, 6350 children were diagnosed with ASD during follow-up, and median age at diagnosis was 3.5 years.
- Greater neighborhood disadvantage at birth was associated with a higher likelihood of ASD diagnosis (adjusted hazard ratio [aHR], 1.07; 95% CI, 1.02-1.11)
- ASD diagnoses were more likely among children of mothers who were Black (aHR, 1.13; 95% CI, 1.02-1.25), Asian/Pacific Islander (aHR, 1.11; 95% CI, 1.02-1.20), or Hispanic (aHR, 1.07; 95% CI, 1.00-1.15), even after the researchers controlled for neighborhood.
- While odds of an ASD diagnosis were higher among children from minority racial and ethnic groups, neighborhood disadvantage was significantly associated with ASD diagnosis only for children of White mothers (aHR, 1.17; 95% CI, 1.09-1.26).
IN PRACTICE
Investigators noted that they could only speculate about the factors driving the association between neighborhood disadvantage and a stronger risk for ASD diagnosis in children of White mothers. “They may be due to systemic racism, discrimination, and their impact on maternal health during pregnancy,” they wrote.
SOURCE
Xin Yu, MS, and Daniel Hackman, PhD, of the University of Southern California Los Angeles, led the study, which was published online November 15 in JAMA Psychiatry.
LIMITATIONS
The research was limited by a lack of information on fathers and variables such as incomes, which may have confounded the findings. The authors also acknowledged that the study should be replicated in other health service settings.
DISCLOSURES
The study was funded by the National Institutes on Environmental Health Sciences, the National Institutes of Health (NIH), and the Environmental Protection Agency. Dr. Hackman reported receiving grant funding from NIH during the conduct of the study. Other disclosures are available in the original study.
A version of this article appeared on Medscape.com.
TOPLINE
, a population-based prospective cohort study shows.
METHODOLOGY
- Investigators analyzed data from a large cohort of singleton children with insurance born in Kaiser Permanente Southern California hospitals between 2001 and 2014.
- They ascertained ASD diagnosis, maternal race and ethnicity, and maternal address at time of birth.
- Neighborhood disadvantage was determined by the percentage of families in the mother’s neighborhood considered to be living in poverty, unemployed, have female-headed households with children, using public assistance, less than a high school education, among other variables.
TAKEAWAY
- Among 318,300 mothers who delivered babies during the study period, 6350 children were diagnosed with ASD during follow-up, and median age at diagnosis was 3.5 years.
- Greater neighborhood disadvantage at birth was associated with a higher likelihood of ASD diagnosis (adjusted hazard ratio [aHR], 1.07; 95% CI, 1.02-1.11)
- ASD diagnoses were more likely among children of mothers who were Black (aHR, 1.13; 95% CI, 1.02-1.25), Asian/Pacific Islander (aHR, 1.11; 95% CI, 1.02-1.20), or Hispanic (aHR, 1.07; 95% CI, 1.00-1.15), even after the researchers controlled for neighborhood.
- While odds of an ASD diagnosis were higher among children from minority racial and ethnic groups, neighborhood disadvantage was significantly associated with ASD diagnosis only for children of White mothers (aHR, 1.17; 95% CI, 1.09-1.26).
IN PRACTICE
Investigators noted that they could only speculate about the factors driving the association between neighborhood disadvantage and a stronger risk for ASD diagnosis in children of White mothers. “They may be due to systemic racism, discrimination, and their impact on maternal health during pregnancy,” they wrote.
SOURCE
Xin Yu, MS, and Daniel Hackman, PhD, of the University of Southern California Los Angeles, led the study, which was published online November 15 in JAMA Psychiatry.
LIMITATIONS
The research was limited by a lack of information on fathers and variables such as incomes, which may have confounded the findings. The authors also acknowledged that the study should be replicated in other health service settings.
DISCLOSURES
The study was funded by the National Institutes on Environmental Health Sciences, the National Institutes of Health (NIH), and the Environmental Protection Agency. Dr. Hackman reported receiving grant funding from NIH during the conduct of the study. Other disclosures are available in the original study.
A version of this article appeared on Medscape.com.