Associations between maternal stress and smoking: findings from a population-based prospective cohort study

Aims To investigate associations between maternal stress and smoking prior to, during and 6 months after the pregnancy. Design A prospective population‐based cohort study. Setting Norway. Participants A total of 71 757 women in the Norwegian Mother and Child Cohort Study (MoBa) participating twice during pregnancy and at 6 months postpartum. Measurements Respondents' estimates of anxiety and depression, relationship discord and negative life events were measured, along with self‐reports of smoking behaviour and demographic variables. Smoking was assessed at gestation weeks 17 and 30 and at 6 months postpartum. Findings Of the 27.5% women who smoked at conception, 55.8% quit smoking during pregnancy. At 6 months postpartum, 28.9% of quitters had relapsed to smoking. In total, 12.9% of the sample reported smoking during the pregnancy. Adjusted for well‐known risk factors, women reporting high levels of anxiety and depression had a decreased likelihood of quitting smoking during pregnancy [odds ratio (OR) 0.80, 95% confidence interval (CI): 0.73, 0.88) and an increased likelihood of relapsing after delivery (OR 1.26, 95% CI: 1.11, 1.44). Both relationship discord (OR 0.82, 95% CI: 0.75, 0.90) and exposure to negative life events (OR 0.93, 95%: CI 0.90, 0.96) had a negative influence on quitting smoking during pregnancy but had no influence on relapse to smoking postpartum. Conclusions Maternal stress and relationship discord may inhibit smoking cessation during pregnancy and promote resumption of smoking after pregnancy in women who have achieved abstinence.     

Postpartum mental health service utilization in women with Human Immunodeficiency Virus (HIV): a population-based study

ABSTRACT

Women with HIV have higher rates of psychiatric disorders than HIV-negative women, yet little is known about their postpartum mental health and associated service use. The purpose of this study was to characterize HIV-positive women’s use of ambulatory and acute mental health services in the first year postpartum, relative to HIV-negative women. Using health administrative data, we identified 861,365 women who had a live birth delivery from April 1, 2002 to March 31, 2012 in Ontario, Canada, of whom 530 were identified to be HIV-positive. We described their use of mental health services, including outpatient mental health visits, psychiatric emergency department (ED) visits and hospitalizations using adjusted odds ratios (aORs) and 95% confidence intervals (CIs). HIV-positive women were more likely to access outpatient mental health services (31.5% vs. 21.0%, aOR, 1.26; 95% CI, 1.03–1.55), but more likely to remain engaged in psychiatrist services only (15.6% vs. 6.5%, aOR, 2.35; 95% CI, 1.41–3.72). They were also more likely to require a psychiatric ED visit or hospitalization (3.3% vs. 1.1%, aOR, 2.74; 95% CI, 1.72–4.12). Our findings highlight the importance of considering postpartum mental health as part of comprehensive reproductive health care for women with HIV.     

Smoking, nicotine dependence and mental health among young adults: a 13-year population-based longitudinal study

Aims   To investigate prospectively the associations between daily smoking and nicotine dependence and anxiety, depression and suicide attempts.
Methods   Data were from the Young in Norway Longitudinal Study. A population-based sample ( n  = 1501) was followed for 13 years from ages 13–27 years. Data were gathered on smoking patterns and nicotine dependence; and depression, anxiety and parasuicide. Extensive information on socio-demographic factors, parental and family conditions, parental rearing practices, educational career, conduct problems, alcohol problems and use of illegal substances was also collected.
Results   Young adults who were nicotine-dependent had clearly elevated rates of anxiety, depression and parasuicide. These rates declined after controlling for a previous history of mental health problems and potential confounding factors. After adjustment, nicotine dependence was still associated with anxiety, depression and parasuicide. There was also a significant association with later depression in the group of non-dependent daily smokers. Measures of reduced mental health did not predict later smoking initiation or the development of nicotine dependence.
Conclusions   Mental health was reduced more seriously in nicotine-dependent smokers than in non-dependent smokers. These findings are consistent with the hypothesis that smoking, in particular nicotine dependence, influences mental health.     

Association between self-rated health and asthma: a population-based study

Introduction: Self‐rated health (SRH) is a relevant measure of health as it can predict morbidity, mortality and health‐care use. Studies have shown an association between poor SRH and elevated levels of circulating inflammatory cytokines. It is therefore interesting to learn more about the association between asthma, a chronic inflammatory disease with a recognised systemic component and SRH. Objectives: To compare SRH ratings in respondents with and without current asthma. A second aim was to compare SRH with quality‐of‐life ratings in the same groups. Methods: In 1995, we randomly selected 8200 persons ≥18 years from the population of Stockholm County, Sweden and mailed them a questionnaire. A total of 5355 persons (67.5%) responded. Respondents were divided in two groups, those with and those without current asthma. The groups were further divided by sex and age (18–44 and ≥45 years). SRH was measured with the question ‘How do you rate your general health status?’ and quality of life with the Gothenburg Quality of Life Instrument and the Ladder of Life. Results: Respondents with asthma rated their health significantly worse than did those without asthma, except women aged 18–44 years. SRH was associated at least as strong as quality of life to asthma with the advantage of being easier to apply (only one item). Conclusion: Information on SRH is easy to obtain and represents an important dimension of health status that potentially can be used as a complement to identify patients who need extra attention to manage their asthma and its consequences. Please cite this paper as: Syk J, Alving K and Undén A‐L. Association between self‐rated health and asthma: a population‐based study. Clin Respir J 2012; 6: 150–158.     

Frequency of health service use in the year prior to asthma death

Objective: High frequency health service use (HSU) is associated with poorly controlled asthma, and is a recognized risk factor for near-fatal or fatal asthma. The objective of this study was to describe the frequency of HSU in the year prior to asthma death. Methods: Individuals aged 0–99 years who died from asthma from April 1996 to December 2011 in Ontario, Canada were identified as cases. Cases were matched to 4–5 live asthma controls by age, sex, rural/urban residence, socioeconomic status, duration of asthma and a co-diagnosis of COPD. HSU records in the year prior to death [hospitalization, emergency department (ED) and outpatient visits] were assembled. The association of prior HSU and asthma death was measured by conditional logistic regression models. Results: From 1996 to 2011, 1503 individuals died from asthma. While the majority of cases did not have increased HSU as defined in the study, compared to matched live asthma controls, the cases were 8-fold more likely to have been hospitalized two or more times (OR?=?7.60; 95% CI: 4.90, 11.77), 13-fold more likely to have had three or more ED visits (OR?=?13.28; 95% CI: 7.55, 23.34) and 4-fold more likely to have had five or more physician visits for asthma (OR?=?4.41; 95% CI: 3.58, 5.42). Conclusions: Frequency of HSU in the year prior was substantially higher in those died from asthma. Specifically, more than one asthma hospital admission, three ED visits or five physician visits increased the asthma mortality risk substantially and exponentially.     

Impact of a history of maternal depression and anxiety on asthma control during pregnancy

Objective: To determine the impact of self-reported maternal depression/anxiety on asthma control during pregnancy. Method: Pregnant women with a doctor diagnosis of asthma (n = 189) were prospectively recruited at their antenatal booking visit, and the presence of maternal depression and anxiety was identified using self-report and routine questionnaire assessments. Data on exacerbations and asthma control were collected during gestation. Asthma control was assessed using the Juniper Asthma Control Questionnaire (ACQ) and women were classified as having recurrent uncontrolled asthma if their ACQ score was >1.5 during two or more consecutive study visits. Exacerbations were defined as events that led to increased treatment requirements, and doctor or hospital visits. Results: There were 85 women with self-reported depression/anxiety and 104 women without self-reported depression/anxiety. The presence of depression/anxiety was associated with an increased likelihood (adjusted hazard ratio (HR) 1.67: 95% confidence interval (CI) 1.03–2.72) and incidence (adjusted incidence rate ratio (IRR) 1.71: 95% CI 1.13–2.58) of uncontrolled asthma during pregnancy, as well as an increased risk of recurrent uncontrolled asthma during 2 or more study visits (adjusted relative risk (RR) 1.98: 95% CI 1.00–3.91). No impact of depression/anxiety was observed with respect to the likelihood (adjusted HR 0.70: 95% CI 0.35–1.41) or incidence of exacerbations during pregnancy (adjusted IRR 0.66: 95% CI 0.35–1.26). Conclusions: This study provides evidence that the presence of maternal depression/anxiety is associated with an increased likelihood and incidence of uncontrolled asthma during pregnancy. Given the high prevalence of co-morbid depression/anxiety among asthmatics, further research investigating such associations is urgently required.     

Prevalence and incidence of mental illness in diabetes: a national population-based cohort study

Background

: This study aimed to investigate the prevalence and incidence of mental illness among diabetic patients in Taiwan.

Methods

: Study subjects were identified by at least one service claim for ambulatory or inpatient care with a principal diagnosis of mental illness, and at least two claims for ambulatory care or one claim for inpatient care with a principal diagnosis of diabetes from 2000 to 2004.

Results

: The one-year prevalence of mental illness among diabetic patients was 20.6% in 2000, and the cumulative prevalence increased to 42.2% in 2004. Diabetic patients had a higher cumulative prevalence and annual incidence than the general population throughout the observation period. A higher prevalence was associated with age ≥45 and low income, and a lower prevalence with male gender and residing in rural areas. Cox regression analysis revealed that a higher incidence was associated with female gender, age ≥45, and low income.

Conclusions

: The prevalence and annual incidence density of mental illness in diabetic patients were significantly higher than in the general population. Females had higher prevalence and incidence density of mental illness among diabetic patients. Mental illness in diabetic patients was more prevalent in elderly females of low income, and less in rural areas.     

The prevalence of mental health medication use in a cohort of New Zealand patients with diabetes

AimsDiabetes is associated with depression, anxiety and psychosis via complex bidirectional relationships that are affected by factors such as the type of diabetes and socioeconomic status. The aim of the study was to estimate the prevalence of mental health conditions in patients with diabetes in a New Zealand primary care population using proxy medication dispensing data.MethodsPrimary care data (July 1 2016 – June 30, 2018) was collected from the Patient Management System of 15 different general practices, and was linked via National Health Index number to clinical records at the Waikato District Health Board and the New Zealand Ministry of Health Pharmaceutical database.ResultsA total of 3978 patients with diabetes were identified from an enrolled patient population of 74,250. Of these, 18.0% of patients with diabetes were dispensed an antidepressant, anxiolytic, or antipsychotic. These medications were prescribed more in New Zealand Europeans (20.9% versus 13.9% in Māori), women, type 2 diabetes, those on insulin, and those with a higher BMI (all P < 0.001).ConclusionsApproximately one fifth of patients with diabetes in primary care have mental health disorders. Appropriate management requires concomitant treatment of both the diabetes and the mental health disorder to improve patient outcomes.     

农村地区老年人照料者的社会支持、卫生服务使用与精神卫生状况

目的 探讨我国农村地医老年人照料者的社会支持、卫生服务使用及精神卫生状况及其相互关系。方法 采用社会支持量表、社会网络量表、卫生服务使用问卷、流行病学调查用抑郁自评量表对199位60岁以是老人的长期照料者进行评估。结果 大多数照料者为老人的配偶儿子和儿媳。照料者最常使用的卫生服务方式为看医生。回归分析表明，抑郁量表评分与照料者年龄和收入、受照料老人性别和年龄、照料时间及社会网络量表总分有密切关系。结论 我国农村地区家庭在老人照料中承担着主要角色，大多数照料者选择使用医疗服务资源。照料过程中出现的抑郁体验与照料者及受照料老人的背景有关，社会支持力量可能起一定中介作用。     

Smoking is associated with first-ever incidence of mental disorders: a prospective population-based study

AIMS: It is well established that tobacco use is associated with mental disorders. However, the association between tobacco use and mental disorders has not yet been examined sufficiently in prospective, population-based studies. The current study is aimed at examining whether smoking is associated with first-ever incidence of mental disorders. DESIGN, SETTING AND PARTICIPANTS: We conducted a prospective, population-based epidemiological study (the Netherlands Mental Health Survey and Incidence Study: NEMESIS) in which a representative sample of adults aged 18-64 years (n = 7076) were interviewed to establish the presence of a broad range of mental disorders. We re-interviewed them at 1 year (n = 5618; response 79.4%) and 3 years (n = 4796; 67.8%) after baseline. MEASUREMENTS: The presence of mental disorders was assessed according to DSM-III-R criteria with the Composite International Diagnostic Interview (CIDI), which was administered by trained lay interviewers. Tobacco use was assessed by asking respondents whether they had smoked in the past year, and how many cigarettes they smoked. FINDINGS: Subjects who smoked but never had a mental disorder in their life, had an increased risk of developing a mental disorder (P < 0.01), and this remained significant after correcting for major risk indicators of mental disorders. CONCLUSIONS: Smoking is associated not only with the prevalence, but also with first-ever incidence of mental disorders. More research is needed to study the causal pathways.     

Asthma-like symptoms,diagnostic tests,and asthma medication use in children and adolescents: a population-based nationwide survey

Objective: This study aimed to estimate the prevalence of asthma-like symptoms, current asthma (CA), asthma diagnostic tests, and inhaled medication use in a nationwide pediatric population (<18 years). Methods: Pediatric-specific data from a cross-sectional, population-based telephone survey (INAsma study) in Portugal were analyzed. CA was defined as lifetime asthma and (1) wheezing, (2) waking with breathlessness, or (3) asthma attack in the previous 12 months, and/or (4) taking asthma medication at the time of the interview. Results: In total, 716 children were included. The prevalence of asthma-like symptoms was 39.4% [95% confidence interval (95% CI): 35.7–43.3]. The most common symptoms were waking with cough (30.9%) and wheezing (19.1%). The prevalence of CA was 8.4% (95% CI: 6.6–10.7). Among children with CA, 79.9% and 52.9% reported prior allergy testing and pulmonary function testing (PFT), respectively. Inhaled medication use in the previous 12 months was reported by 67.6% (reliever inhalers, 40.1%; controller inhalers, 41.5%). Those who only used inhaled reliever medications experienced more asthma attacks [odds ratio (OR): 2.69]. Significantly fewer children with CA living in rural areas than those living in urban areas had undergone PFT or used inhaled medication (OR: 0.06 for PFT, 0.20 for medication]. Conclusions: The prevalence of CA in the Portuguese pediatric population was 8.4%. Only half of children with CA had ever undergone PFT; more than half did not use controller inhalers, and those who only used reliever inhalers reported more asthma attacks. These findings suggest that asthma management has been substandard, mainly in rural areas.     

Prevalence and correlates of alcohol use: a population-based study in Hong Kong

Objective To estimate the prevalence and pattern of alcohol use and to analyse the socio‐demographic and biological correlates of alcohol drinking in Hong Kong Chinese. Design A population‐based cross‐sectional study conducted from December 1994 to October 1996. Setting and participants 2900 randomly selected subjects age 25–74 years who participated in the Cardiovascular Risk Factor Prevalence Study in Hong Kong. Results Alcohol consumers comprised 55.4% (95% CI: 52.8–58.0) of men and 19.4% (95% CI: 17.4–21.4) of women. The median weekly ethanol consumed by male and female drinkers were 9.6 g and 3.6 g, respectively. Beer was the main source of alcohol; 61.5% of drinkers consumed beer as their main drink. In stepwise multiple regression among drinkers, male sex, smoking, high density lipoprotein cholesterol, primary or below education, diastolic blood pressure and separated or widowed marital status were associated positively with weekly ethanol consumption. Conclusion In this representative sample of Hong Kong adults, the majority were either non‐drinkers or very light drinkers, which can be used as a benchmark to measure changes in drinking pattern in the future. The putative protective effect of alcohol on heart disease could be due to the higher level of HDL in moderate drinkers.     

Acute respiratory symptoms and general illness during the first year of life: a population-based birth cohort study

Respiratory symptoms are common in infancy. Most illnesses occurring among children are dealt with by parents and do not require medical attention. Nevertheless, few studies have prospectively and on a community-basis assessed the amount of respiratory symptoms and general illness in normal infants. In this population-based birth cohort study, 228 healthy infants from Copenhagen, Denmark were followed from birth to 1 year of age during 2004-2006. Symptoms were registered using daily diaries and monthly home visits. Interviews were performed at inclusion and every second month. Risk factor analysis was carried out by multiple logistic regression analysis. On average, children had general symptoms for 3.5 months during their first year of life, nasal discharge being most frequent followed by cough. Frequency of all symptoms increased steeply after 6 months of age. Each child had on average 6.3 episodes (median: 5.1, inter-quartile range (IQR): 3.3-7.8) of acute respiratory tract illness (ARTI) (nasal discharge and > or = 1 of the following symptoms: cough, fever, wheezing, tachypnea, malaise, or lost appetite) and 5.6 episodes (median: 4.3, IQR: 2.1-7.3) of simple rhinitis per 365 days at risk. Determinants for respiratory symptoms were increasing age, winter season, household size, size of residence, day-care attendance, and having siblings aged 1-3 years attending a day nursery. In conclusion, the present study provides detailed data on the occurrence of disease symptoms during the first year of life in a general population cohort and emphasizes the impact of increasing age, seasonality, and living conditions on the occurrence of ARTI.     

The influence of asthma control on psychosocial outcomes for pregnant women with asthma

Objective: To investigate the relationship between asthma control and psychosocial outcomes in pregnant women with asthma. Methods: Secondary analysis (N?=?221) of a randomized controlled trial of treatment adjustments, based on fractional exhaled nitric oxide versus clinical guideline-based algorithms. Psychosocial variables included generic and asthma-specific quality of life (SF12, AQLQ-M), illness perceptions (BIPQ), perceived control (PCAQ), perceived risk of side effects (PRSE) and anxiety (STAI-6). Asthma control was defined as controlled (Asthma Control Questionnaire (ACQ7)?≤1.5 at randomization and end of study), improved (ACQ7?>?1.5 at randomization and ≤1.5 at end of study) and unimproved (ACQ7?>1.5 at end of study). Regression models were fitted for each psychosocial measure at the end of the study, with adjustment for baseline values and smoking status, with predictor variable asthma control. Results: Women with unimproved asthma had poorer physical (SF12, p?=?0.012) and asthma-specific quality of life across all domains (AQLQ-M, p?≤?0.012) compared to women with controlled asthma. They believed that they had less control over their asthma (PCAQ total p?=?0.014), had more symptoms and that their illness had a greater effect on their emotions and their lives in general (BIPQ identity, consequences, concern, emotional response p?≤?0.015). Women with improved asthma control had significantly lower AQLQ-M breathlessness (p?=?0.048) and lower total scores (p?=?0.04) than women with controlled asthma. Conclusions: Pregnant women who are not able to get control of their asthma symptoms may experience worse quality of life and are likely to have more negative perceptions about their condition.     

Urbanization factors associated with childhood asthma and prematurity: a population-based analysis aged from 0 to 5 years in Taiwan by using Cox regression within a hospital cluster model

Objective: Childhood asthma and premature birth are both common; however, no studies have reported urbanization association between asthma and prematurity and the duration of prematurity affect asthma development. We use Taiwan Longitudinal Health Insurance Database (LHID) to explore association between asthma and prematurity among children by using a population-based analysis. Methods: This is a retrospective cohort study with registration data derived from Taiwan LHID. We evaluated prematurely born infants and children aged <5 years (n?=?532) and age-matched control patients (n?=?60505) using Cox proportional hazard regression analysis within a hospital cluster model. Of the 61?037 examinees, 14?012 experienced asthma during the 5-year follow-up, including 161 (72.26 per 1000 person-years) infants and children born prematurely and 13?851 (40.27 per 1000 person-years) controls. Results: The hazard ratio for asthma during 5-year follow-up period was 1.95 (95% confidence interval?=?1.67–2.28) among children born prematurely. Boys born prematurely aged 0–2 years were associated with higher asthma rates compared with girls in non-premature and premature groups. Living in urban areas, those born prematurely were associated with higher rates of asthma compared with non-prematurity. Those born prematurely lived in northern region had higher asthma hazard ratio than other regions. Conclusion: Our analyses indicated that sex, age, urbanization level, and geographic region are significantly associated with prematurity and asthma. Based on cumulative asthma-free survival curve generated using the Kaplan–Meier method, infants born prematurely should be closely monitored to see if they would develop asthma until the age of 6 years.     

The relationship between childhood depressive symptoms and problem alcohol use in early adolescence: findings from a large longitudinal population-based study

Aims Depressive symptomatology can increase risk of development of alcohol problems in young people. Tension reduction and family interactional theories may explain the relationship between depression and problematic alcohol use in youth. This study addresses the nature of the longitudinal relationship between these two behaviours. The available literature is currently inconclusive about whether there are gender differences in these relationships; this is also examined. Design The association between childhood depressive behaviours and adolescence problematic alcohol use was examined using ordered logistic regression models. Evidence of gender differences and the impact of relevant covariates on these relations were examined. Missing data were imputed using a Multiple Imputation by Chained Equation (MICE) approach. Settings The Avon Longitudinal Study of Parents and Children (ALSPAC), a large UK population‐based birth cohort. Participants A total of 4220 British boys and girls. Measurements Depressive symptomatology was assessed in childhood (mean age = 10.6, SD = 0.2) using the Short Mood and Feelings Questionnaire (SMFQ). Problematic alcohol use was assessed from several questions queried in adolescence (mean age = 13.8, SD = 0.2). Findings Childhood depressive symptoms were associated with increased risk of problematic alcohol use in early adolescence for girls [odds ratio (OR) = 1.14, P = 0.016] but not boys. This association for girls weakened (OR = 1.12, P = 0.058) when a priori selected covariates were taken into account, particularly the family and greater social environment. Conclusions Problematic alcohol use in girls (but not boys) is associated with prior depressive symptoms. This association may be attributable to several family and social environment factors, suggesting that a family interactional theoretical model may explain these findings.