Search PubMed⌕ Search

Biomedical subjects

P Allebeck

Publications and source records attributed to P Allebeck.

At least 19 recordsLinked to original sources
PubMed1992

Schizophrenia and city life.

Prevalence of schizophrenia and rates of first admission to hospital for this disorder are higher in most modern industrialised cities, and in urban compared with rural areas. The "geographical drift" hypothesis (ie, most schizophrenics tend to drift into city areas because of their illness or its prodrome) has remained largely unchallenged. We have investigated the association between place of upbringing and the incidence of schizophrenia with data from a cohort of 49,191 male Swedish conscripts linked to the Swedish National Register of Psychiatric Care. The incidence of schizophrenia was 1.65 times higher (95% confidence interval 1.19-2.28) among men brought up in cities than in those who had had a rural upbringing. The association persisted despite adjustment for other factors associated with city life such as cannabis use, parental divorce, and family history of psychiatric disorder. This finding cannot be explained by the widely held notion that people with schizophrenia drift into cities at the beginning of their illness. We conclude that undetermined environmental factors found in cities increase the risk of schizophrenia.

Adult↗
PubMed1992

Protective factors and social risk factors for hospitalization and mortality among young men.

The association between presumed protective factors and social risk factors for hospitalization and mortality was studied during a 14-year follow-up period in a cohort of 8,168 Swedish men aged 18-20 years at baseline. Using Cox regression analysis, the authors found that five protective factors (high social class, home well-being, school well-being, good emotional control, and self-perceived good health) were associated with lower risks of hospitalization and death. Four social risk factors (contact with police or child welfare authorities, running away from home, having divorced parents, and ever using narcotics) were significantly associated with increased risk of hospitalization and mortality. The relative hazard decreased with the number of protective factors and increased with the number of social risk factors, almost linearly. The relative hazard was 0.24 for hospitalization among those with six protective factors and 0.24 for mortality for those with five or six protective factors. The relative hazard for hospitalization was 3.09 among those with five social risk factors compared with those with none, while for mortality the relative hazard among those with four or five social risk factors was 5.74 compared with those with none. While these results indicate strong cumulative effects for both the social risk factors and the protective factors, the associations of individual factors with the two outcome measures were generally reduced in models which simultaneously adjusted for all factors, which presumably indicates collinearity among the factors. There was only limited support for a buffering, or interacting, effect between the risk factors and the protective factors.

Adolescent↗
PubMed1992

Risk of suicide by psychiatric diagnosis in Stockholm County. A longitudinal study of 80,970 psychiatric inpatients.

The risk of suicide associated with different psychiatric diagnoses was estimated in 80,970 inpatients in Stockholm County (population 1.6 million). All patients discharged with at least one psychiatric diagnosis between 1973 and 1986 were followed by linkage with the cause-of-death registry through 1987. There were 1,115 definite suicides and 467 undetermined suicides among these during the 15-year follow-up. When 12 diagnostic categories were entered in a proportional hazards model, the highest relative risk (RR) of definite suicide, controlling for sex and age, was noted for affective disorders (RR 2.82), followed by unspecified psychoses (RR 2.69), paranoid psychoses (RR 2.60), addiction to prescription drugs (RR 2.38), neuroses and reactive psychoses (RR 1.96), and schizophrenia (RR 1.64). Alcoholism, personality disorders, organic psychoses, and street drug addiction did not have significantly increased risks of suicide. Male sex increased the risk for definite suicide by 1.56, while the risk was somewhat higher among the young. Having more than one diagnosis increased the relative risk by 1.42. When undetermined suicides were included in the analysis, to alcoholism and street drug abuse were attributed significantly increased risks of suicide, probably owing to the greater difficulty of verifying such cases. We conclude that several psychiatric disorders were conductive to suicide, but that the risk did not vary much with the type of diagnosis. Further studies of confounders are needed, such as the reasons for being admitted to inpatient care, and the impact of somatic and psychiatric comorbidity.

Adolescent↗
PubMed1992

Height, body mass index and mortality: do social factors explain the association?

The aim of the study was to analyse the effects on mortality of body height and body mass index (BMI) in young men, taking into account social and behavioural characteristics in early youth. The study is a 20-year follow-up of all Swedish men (n = 50,465) conscripted for military service in 1969-70. Baseline data on body height and weight as well as interview and questionnaire data on social and behavioural characteristics were linked to mortality data up to the end of 1988. Nine hundred and forty-six men died during the follow-up. We found a significant increase in mortality by decreasing body height; persons below 165 cm had an almost twofold increased mortality compared with those of average height. This association was reduced to the limit of statistical significance when we controlled for social and behavioural characteristics in a multivariate model. Persons with a BMI above 30 had a more than twofold increased mortality compared with those of average BMI. This association remained highly significant in a multivariate model. We thus confirmed previous findings of an inverse association between body height and mortality, but found that this association was almost entirely due to social background factors. The independent association between BMI and mortality may indicate a stronger genetic influence on BMI than on body height.

Adult↗
PubMed1992

Socio-economic versus obstetric risk factors for drug addiction in offspring.

Two possible risk factors for drug addiction were weighed against each other: (1) perinatal factors associated with obstetric medication at time of birth; and (2) factors associated with familial socio-economic conditions at time of birth. The subjects comprised 200 amphetamine addicts and 200 opiate addicts born in Stockholm 1945-1966. In a matched case control study, addicts were compared to their siblings with regard to possible obstetric risk factors by means of conditional logistic regression controlling for socio-economic level and civil status. Administration of opiates, barbiturates and nitrous oxide to mothers during labour was associated with drug addiction in offspring, hence confirming results from earlier studies. In a cohort study the risk associated with birth at a given hospital and familial socio-economic level was analysed by means of log-linear analysis using 7100 controls from the general population. For amphetamine addicts, a low socio-economic level at time of birth might be of importance for the infant subsequently becoming an addict. This could not be demonstrated for the opiate addicts. An uneven distribution of births among the hospitals, most pronounced for the amphetamine addicts, is in agreement with the hypothesis that obstetric practices may be risk factors for adult drug addiction.

Adolescent↗
PubMed1992

Do cannabis drug abusers differ from intravenous drug abusers? The role of social and behavioural risk factors.

The aim of the study was to investigate the association between social and behavioural factors, and the use of different types of drugs in a cohort of 8168 Swedish men conscripted for military service in 1969-70. Data about social and behavioural characteristics, self-reported use of alcohol and narcotics was obtained from a survey of all Swedish conscripts. Information on intravenous drug abuse up to 1970 was obtained from a survey of injecting males among persons brought to the central police arrest. A higher proportion of intravenous drug abusers than cannabis abusers came from social class III, had divorced parents, had been in contact with the police and juvenile authorities, and had low emotional control. Indicators of deviant behaviour, e.g. truancy, having run away from home, and contact with police or juvenile authorities, were associated with high odds ratios for intravenous drug abuse and for cannabis abuse. In multivariate analyses, these risk factors still carried significantly increased odds ratios. In general, the odds ratios associated with these background factors were higher for intravenous drug abuse than for cannabis abuse. The risk increased, however, with increasing level of cannabis abuse. In conclusion, poor social background and deviant behaviour was strongly associated with future intravenous drug addiction, whereas the association was much weaker in the case of future cannabis abuse.

Adolescent↗
PubMed1992

Antecedents and covariates of high alcohol consumption in young men.

The role of social, behavioral, and psychological characteristics and other risk indicators for high alcohol consumption in young men was analyzed using a survey of 49,464 Swedish conscripts. A strong association between an increasing weight of adverse social and behavioral risk indicators on the one hand and high alcohol consumption on the other was found. Yet many high consumers had no or few risk indicators. In multivariate analysis, substance use and indicators of deviant behavior came out as the strongest risk indicators for high alcohol consumption. Indicators of poor social background generally had relatively low odds ratios. Poor home wellbeing, for instance, had an odds ratio of 0.9. Social group of father was nonsignificant. Very good family economy had a higher odds ratio, 1.7, than average or poor family economy. Psychosomatic symptoms had relatively low odds ratios. Among psychological variables, low emotional control had a significantly elevated odds ratio of 1.8. Increased odds ratios were found for conscripts who were never anxious or never felt insecure. In conclusion, although many high consumers of alcohol had no or few risk indicators, we identified a high-risk group characterized by high levels of alcohol consumption and several indicators of personality disturbances, early deviant behavior, and social maladjustment.

Adult↗
PubMed1992

Antecedents of anxiety syndromes in a cohort of 50,465 young men in Sweden. A prospective analysis of self-reported and professionally assessed psychosocial characteristics.

The purpose of this study was to find psychiatric, behavioral and social characteristics that predict subsequent anxiety syndromes in men. Questionnaire data were collected in a cohort of all 50,465 men in Sweden who were conscripted for military training. By record linkage with the national psychiatric inpatient register, we identified 68 probands with pure anxiety neurosis occurring in the cohort during a 13-year follow-up period. Baseline characteristics were categorized into 8 variables that were entered into logistic regression models. We found that reported treatment with psychoactive drugs and perceived mental health problems at baseline increased the odds of being admitted for anxiety neurosis by 1.9 and 1.8. Other predictors were family problems (odds ratio = 2.0) and having a family member being treated with psychoactive drugs (odds ratio = 1.7). Univariate relative risks were higher, and a psychiatric diagnosis at conscription conferred a relative risk of anxiety neurosis of 2.2. A similar profile was obtained for subjects admitted for a depressive neurosis, in support of the continuum hypothesis between anxiety and depression. We conclude that the necessity of admission for anxiety neurosis in young men originates in genuine mental symptoms in the family setting.

Adolescent↗
PubMed1992

Intravenous drug abuse in young men: risk factors assessed in a longitudinal perspective.

The role of family background as well as behavioural and psychological factors as risk factors for intravenous drug abuse was analysed in a longitudinal study of 8168 Swedish men conscripted for military service in 1969-70. Information about risk factors was obtained from a survey of all Swedish conscripts. Records on intravenous drug abuse, during a followup ending in 1986, were obtained from a survey of intravenous drug abusers among persons brought to the Central police arrest in Stockholm. Strong predictors of intravenous drug abuse were contact with the police of juvenile authorities (RR = 22.3 95% CI 15.1-33.0), high alcohol consumption (RR = 9.2 95% CI 6.7-12.7) and psychiatric diagnosis at conscription (RR = 6.0 95% CI 4.5-8.1) and low social class (RR = 3.6 95% CI 2.2-5.9). In multivariate analyses, these factors and indicators of deviant behaviour still carried significantly increased relative risk for intravenous drug abuse, although several of them are interrelated. Low emotional control, nervousness, sleeping problems and other nervous problems were associated with an increased relative risk in univariate but not in multivariate analyses.

Adolescent↗
PubMed1991

Suicides and suicide attempts in cancer patients.

Suicides and suicide attempts in cancer patients were analysed by following all patients treated for cancer in Stockholm County from 1975 to 1985. Among 59,845 patients we identified 144 suicides and 196 suicide attempts during the follow-up, which represents a more than two-fold excess mortality from suicide and a moderately increased rate of suicide attempts. Although the absolute number of deaths from suicide in cancer patients is low, the increased risk highlights the problems of coping with severe illness and the need for psychological and social support in cancer care.

Adaptation, Psychological↗
PubMed1991

High consumers of health care in emergency units: how to improve their quality of care.

Patients with non-urgent complaints and/or who attend frequently account for a substantial portion of the visits to emergency units. These patients usually require other types of care than that provided by a highly specialized emergency department (ED). In this paper we describe the development of ED utilization in the catchment area of Huddinge University Hospital, and the attempts made to improve the quality of care for high consumers of ED care. In a trial, nurse's advice and referral proved to be a feasible means of referring patients with non-urgent complaints from the hospital emergency department to more appropriate care sources, such as primary health care centres. A long-term follow-up showed that without any intervention, frequent ED users are a high-risk group as regards morbidity and mortality, especially with respect to suicide. Prevention with comprehensive and continuous treatment programmes should therefore be planned when a tendency is noted for patients to attend the ED frequently.

Catchment Area, Health↗
PubMed1991

Alcohol, social factors and mortality among young men.

In a 20-year follow-up the association between alcohol consumption, social and personal background factors and mortality was studied in a cohort of 49,464 Swedish conscripts. The relative risk of death among high consumers (those consuming more than 250 g alcohol/week at conscription) was 2.8 (95% confidence interval 2.2-3.7) compared with moderate consumers (1-100 g/week). Deaths caused by direct toxic effects of alcohol were few, less than 5%. Instead suicides and accidents predominated. Abstainers had a slightly lower mortality than moderate consumers, with a relative risk of 0.8 (0.6-1.1), due to a significantly lower risk for traffic deaths. High consumers of alcohol had more than twice as many social and personal risk factors for premature death compared with the cohort as a whole. Yet presence of social risk factors added little to the already increased relative risk of death among high consumers.

Adolescent↗
PubMed1991

Causes of death in a cohort of 50,465 young men--validity of recorded suicide as underlying cause of death.

We studied causes of death in a cohort of all young males (n = 50,465) conscripted for military service in 1969-70. Six hundred eighty three deaths occurred in the cohort during the follow-up through 1983. Injury-related deaths accounted for 75% of all deaths. Of these, 38% were definite suicides, 10% undetermined suicides and 30% motor vehicle accidents. The validity of officially recorded causes of death was studied by scrutinizing all death certificates (n = 683) and forensic reports, including police reports, toxicological and histological data, from a sample (n = 322) of deaths with unclear circumstances. Of 161 officially recorded suicides (E950-959), only one case was reevaluated into poisoning, "undetermined" (E980). Of 47 cases officially recorded "undetermined" (E980-989), 9 were reevaluated into definite suicide (E950-959) although we believe that this is still an underestimation of "true" suicide cases. An alcohol concentration of more than 0.1 g% was found in 45% of all violent deaths (E800-999), 34% of all suicides and 60% of all "undetermined" deaths. We conclude that the causes of death in most cases of injury related death in young age are recorded with high accuracy. Reevaluation of recorded deaths from "undetermined" causes revealed a number of definite suicides, although the "true" number of suicides is difficult to assess even after close scrutiny of the information available.

Accidents↗
PubMed1991

Mortality in patients with substance abuse: a follow-up in Stockholm County, 1973-1984.

A group of patients (N = 1630) hospitalized in Stockholm County with a diagnosis of substance abuse during 1971-1972 were followed through 1984 as regards mortality: 446 (296 males and 150 females) patients died. The excess mortality in the cohort was 5.3 (males 5.8, females 4.6) compared to the general population in Stockholm County. The highest mortality was found in opiate users, with an excess mortality of 18.3. Fifty-one percent of the causes of death belonged to ICD-8 chapter 17, injury and poisoning, and of these, 69% (155 patients) were definite or probable suicides. Since HIV entered the Stockholm drug addict population by the end of this follow-up, the excess mortality reported here can be even higher in the years to come. To follow and monitor the mortality among patients with substance abuse is an important aspect in the evaluation of programs for prevention and treatment.

Adolescent↗