Childhood-onset type 1 diabetes (T1D) is associated with substantial psychiatric morbidity in later life, but it remains unknown whether these associations are due to common underlying biological mechanisms or the impacts of living with the condition and its treatment. Here, using Czech national register data, we identified children with T1D aged ≤14 years between 1994 and 2007 and estimated the risk of psychiatric disorders up to 24 years later. We found that children diagnosed with T1D had an elevated risk of developing substance use, mood, anxiety and personality disorders, and behavioral syndromes. Conversely, we found that children with T1D had a lower risk of developing psychotic disorders. In Mendelian randomization analysis, we found an association with schizophrenia, which, however, did not persist following multiple testing adjustment. The combined observational and Mendelian randomization evidence suggests that T1D diagnosis in childhood predisposes to far-reaching, extensive psychiatric morbidity, which is unlikely to be explicable by common underlying biological mechanisms. The findings of this study highlight that monitoring and addressing the mental health needs of children with T1D is imperative, whereas glucose dysregulation and/or inflammation implicated in schizophrenia pathogenesis warrants future research.

• Publication type
• Journal Article MeSH

BACKGROUND: Evidence suggests reduced survival rates following Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection in people with preexisting mental disorders, especially psychotic disorders, before the broad introduction of vaccines. It remains unknown whether this elevated mortality risk persisted at later phases of the pandemic and when accounting for the confounding effect of vaccination uptake and clinically recorded physical comorbidities. METHODS AND FINDINGS: We used data from Czech national health registers to identify first-ever serologically confirmed SARS-CoV-2 infections in 5 epochs related to different phases of the pandemic: 1st March 2020 to 30th September 2020, 1st October 2020 to 26th December 2020, 27th December 2020 to 31st March 2021, 1st April 2021 to 31st October 2021, and 1st November 2021 to 29th February 2022. In these people, we ascertained cases of mental disorders using 2 approaches: (1) per the International Classification of Diseases 10th Revision (ICD-10) diagnostic codes for substance use, psychotic, affective, and anxiety disorders; and (2) per ICD-10 diagnostic codes for the above mental disorders coupled with a prescription for anxiolytics/hypnotics/sedatives, antidepressants, antipsychotics, or stimulants per the Anatomical Therapeutic Chemical (ATC) classification codes. We matched individuals with preexisting mental disorders with counterparts who had no recorded mental disorders on age, sex, month and year of infection, vaccination status, and the Charlson Comorbidity Index (CCI). We assessed deaths with Coronavirus Disease 2019 (COVID-19) and from all-causes in the time period of 28 and 60 days following the infection using stratified Cox proportional hazards models, adjusting for matching variables and additional confounders. The number of individuals in matched-cohorts ranged from 1,328 in epoch 1 to 854,079 in epoch 5. The proportion of females ranged from 34.98% in people diagnosed with substance use disorders in epoch 3 to 71.16% in individuals diagnosed and treated with anxiety disorders in epoch 5. The mean age ranged from 40.97 years (standard deviation [SD] = 15.69 years) in individuals diagnosed with substance use disorders in epoch 5 to 56.04 years (SD = 18.37 years) in people diagnosed with psychotic disorders in epoch 2. People diagnosed with or diagnosed and treated for psychotic disorders had a consistently elevated risk of dying with COVID-19 in epochs 2, 3, 4, and 5, with adjusted hazard ratios (aHRs) ranging from 1.46 [95% confidence intervals (CIs), 1.18, 1.79] to 1.93 [95% CIs, 1.12, 3.32]. This patient group demonstrated also a consistently elevated risk of all-cause mortality in epochs 2, 3, 4, and 5 (aHR from 1.43 [95% CIs, 1.23, 1.66] to 1.99 [95% CIs, 1.25, 3.16]). The models could not be reliably fit for psychotic disorders in epoch 1. People diagnosed with substance use disorders had an increased risk of all-cause mortality 28 days postinfection in epoch 3, 4, and 5 (aHR from 1.30 [95% CIs, 1.14, 1.47] to 1.59 [95% CIs, 1.19, 2.12]) and 60 days postinfection in epoch 2, 3, 4, and 5 (aHR from 1.22 [95% CIs, 1.08, 1.38] to 1.52 [95% CIs, 1.16, 1.98]). Cases ascertained based on diagnosis of substance use disorders and treatment had increased risk of all-cause mortality in epoch 2, 3, 4, and 5 (aHR from 1.22 [95% CIs, 1.03, 1.43] to 1.91 [95% CIs, 1.25, 2.91]). The models could not be reliably fit for substance use disorders in epoch 1. In contrast to these, people diagnosed with anxiety disorders had a decreased risk of death with COVID-19 in epoch 2, 3, and 5 (aHR from 0.78 [95% CIs, 0.69, 0.88] to 0.89 [95% CIs, 0.81, 0.98]) and all-cause mortality in epoch 2, 3, 4, and 5 (aHR from 0.83 [95% CIs, 0.77, 0.90] to 0.88 [95% CIs, 0.83, 0.93]). People diagnosed and treated for affective disorders had a decreased risk of both death with COVID-19 and from all-causes in epoch 3 (aHR from 0.87 [95% CIs, 0.79, 0.96] to 0.90 [95% CIs, 0.83, 0.99]), but demonstrated broadly null effects in other epochs. Given the unavailability of data on a number of potentially influential confounders, particularly body mass index, tobacco smoking status, and socioeconomic status, part of the detected associations might be due to residual confounding. CONCLUSIONS: People with preexisting psychotic, and, less robustly, substance use disorders demonstrated a persistently elevated risk of death following SARS-CoV-2 infection throughout the pandemic. While it cannot be ruled out that part of the detected associations is due to residual confounding, this excess mortality cannot be fully explained by lower vaccination uptake and more clinically recorded physical comorbidities in these patient groups.

• MeSH
• Betacoronavirus MeSH
• COVID-19 * mortality   epidemiology   complications   MeSH
• Adult MeSH
• Mental Disorders * epidemiology   MeSH
• Cohort Studies MeSH
• Comorbidity MeSH
• Coronavirus Infections mortality   epidemiology   complications   MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Pandemics * MeSH
• Cause of Death MeSH
• Registries MeSH
• SARS-CoV-2 * MeSH
• Aged MeSH
• Pneumonia, Viral mortality   epidemiology   complications   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Czech Republic MeSH

BACKGROUND: It remains unknown whether severe mental disorders contribute to fatally harmful effects of physical illness. AIMS: To investigate the risk of all-cause death and loss of life-years following the onset of a wide range of physical health conditions in people with severe mental disorders compared with matched counterparts who had only these physical health conditions, and to assess whether these associations can be fully explained by this patient group having more clinically recorded physical illness. METHOD: Using Czech national in-patient register data, we identified individuals with 28 physical health conditions recorded between 1999 and 2017, separately for each condition. In these people, we identified individuals who had severe mental disorders recorded before the physical health condition and exactly matched them with up to five counterparts who had no recorded prior severe mental disorders. We estimated the risk of all-cause death and lost life-years following each of the physical health conditions in people with pre-existing severe mental disorders compared with matched counterparts without severe mental disorders. RESULTS: People with severe mental disorders had an elevated risk of all-cause death following the onset of 7 out of 9 broadly defined and 14 out of 19 specific physical health conditions. People with severe mental disorders lost additional life-years following the onset of 8 out 9 broadly defined and 13 out of 19 specific physical health conditions. The vast majority of results remained robust after considering the potentially confounding role of somatic multimorbidity and other clinical and sociodemographic factors. CONCLUSIONS: A wide range of physical illnesses are more likely to result in all-cause death in people with pre-existing severe mental disorders. This premature mortality cannot be fully explained by having more clinically recorded physical illness, suggesting that physical disorders are more likely to be fatally harmful in this patient group.

• MeSH
• Adult MeSH
• Mental Disorders * epidemiology   MeSH
• Cohort Studies MeSH
• Comorbidity MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Cause of Death * MeSH
• Registries statistics & numerical data   MeSH
• Aged MeSH
• Health Status MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Czech Republic MeSH

BACKGROUND: Substance use disorders constitute a major global public health problem, attributable largely to their subsequent comorbidity with other health conditions. This study aimed to investigate the risk of all-cause death and life-years lost following hospitalisation for 28 subsequent physical comorbid conditions in people with a previous hospitalisation for substance use disorder, compared with matched counterparts without substance use disorder. METHODS: We did a retrospective cohort study on data from Czech nationwide registers of all-cause hospitalisations and deaths during the period from Jan 1, 1994, to Dec 31, 2017. The cohorts consisted of individuals who had initially been hospitalised between 15 and 70 years of age (index hospitalisation) and who were subsequently hospitalised with one or more of 28 comorbid physical health conditions. We included individuals with an index hospitalisation for substance use disorders and up to three counterparts without substance use disorders with a subsequent hospitalisation for the same physical health condition, with matching on sex, age (±3 years), work status, and discharge year at first hospitalisation for the subsequent condition. Data on ethnicity were not available. Risk of death due to any cause following the first hospitalisation for each physical health condition until Dec 31, 2017, and life-years lost after disease onset at ages 30, 45, and 60 years, and before 81 years of age, were examined. FINDINGS: From a total 56 229 563 records of hospitalisations identified, we included 121 153 people with hospitalisation for substance use disorders and 6 742 134 people without hospitalisation for substance use disorders in the study. The 28 condition-specific cohorts comprised a median of 6444 individuals (IQR 2033-12 358), ranging from 444 for multiple sclerosis to 36 356 for diseases of the circulatory system. Across the cohorts, the proportion of males ranged from 31·4% for thyroid disorder to 100·0% for prostate disorders. The mean baseline age ranged from 30·0 years (SD 9·1) for chronic viral hepatitis in people with pre-existing substance use disorders to 62·2 years (9·7) for Parkinson's disease in people without pre-existing substance use disorders. After adjusting for potential confounders using stratified Cox proportional hazards models, individuals with a pre-existing substance use disorder had an increased risk of death due to any cause after the onset of 26 out of 28 physical health conditions, relative to their counterparts without substance use disorders, with adjusted hazard ratios ranging from 1·15 (1·09-1·21) for chronic liver disease to 3·86 (2·62-5·67) for thyroid disorder. For seven subsequent health conditions, the risk of death was more than doubled in the group with pre-existing substance use disorders. When compared with the general population via mortality tables, people with pre-existing substance use disorders had substantial losses in life-years after the onset of most of the subsequent physical health conditions regardless of age of onset, and, for the majority of comorbidities, lost considerably more life-years than their counterparts without substance use disorders. INTERPRETATION: A history of hospitalisation for substance use disorders appears to have a significant negative effect on prognosis following the development of various subsequent physical health conditions. These findings strongly suggest that clinical vigilance and high-quality integrated treatment for people with substance use disorders could be life-saving and should be given higher priority on the public health agenda. FUNDING: National Institute for Health and Care Research Applied Research Collaboration East of England at Cambridge and Peterborough National Health Service Foundation Trust.

• MeSH
• Adult MeSH
• Comorbidity MeSH
• Humans MeSH
• Substance-Related Disorders * epidemiology   MeSH
• Registries MeSH
• Retrospective Studies MeSH
• State Medicine * MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Research Support, N.I.H., Extramural MeSH
• Geographicals
• Czech Republic MeSH

The aim was to investigate the pattern and rate of cognitive decline across distinctive trajectories of depressive symptoms in older adults. In this prospective multinational cohort study on 69,066 participants (on average 64 years at baseline, 55% women), assessments of cognitive functions (immediate recall, delayed recall, verbal fluency) and depressive symptoms (EURO-D scale) were conducted at 2-year intervals. The trajectories of depressive symptoms were obtained using latent growth mixture modelling, cognitive decline was assessed using smoothing splines and linear mixed effects models. Four distinct trajectories of depressive symptoms were identified: constantly low (n = 49,660), constantly high (n = 2999), increasing (n = 6828) and decreasing (n = 9579). Individuals with increasing and constantly high depressive symptoms showed linear cognitive decline, while those with constantly low and decreasing depressive symptoms had fluctuating cognition. Participants with increasing depressive symptoms had the fastest decline, while those with decreasing symptoms were spared from decline in cognition. This study suggests that the pattern as well as the rate of cognitive decline co-occurs with specific patterns of changes in depressive symptoms over time. The most pronounced cognitive decline is present in individuals, in whom depressive symptoms increase late in life. Unique mechanisms of cognitive decline may exist for subgroups of the population, and are associated with the trajectory of depressive symptoms.

• MeSH
• Depression physiopathology   psychology   MeSH
• Depressive Disorder physiopathology   MeSH
• Cognition physiology   MeSH
• Cognitive Dysfunction physiopathology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Prospective Studies MeSH
• Aged MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Research Support, N.I.H., Extramural MeSH

Stigmatizace lidí s duševním onemocněním představuje závažný problém zdravotnictví. Přispívá k jejich zhoršené zdravotní a preventivní péči, ke snížení jejich ochoty vyhledat odbornou pomoc, a snižuje tak kvalitu a průměrnou délku jejich života. Cílem studie je vyhodnotit efektivitu destigmatizační intervence READ v rámci psychiatrického modulu u studentů medicíny. Intervenci vedl psychiatr a peer lektor. Jedná se o součást mezinárodního projektu INDIGO. Studie se zúčastnilo celkem 53 studentů lékařské fakulty (32 v intervenční skupině, 21 v kontrolní). Respondenti vyplňovali dotazník měřící postoje, znalosti, empatii a meziskupinovou úzkost před účastí na intervenci READ a po ní. U intervenční skupiny došlo ke snížení stigmatizujících postojů, zvýšení znalostí a snížení meziskupinové úzkosti. Kontrolní skupina dosáhla v následném měření zvýšení znalostí a snížení meziskupinové úzkosti. Z výsledků lze vyvodit, že běžný psychiatrický modul (teorie a praxe na odděleních) na lékařské fakultě nemá dostatečný destigmatizační potenciál. Intervence READ se zapojením peer lektorů se zdá být vhodným nástrojem jak snižovat stigmatizaci lidí s duševním onemocněním na lékařských fakultách. Kontakt s lidmi, kteří již nejsou v akutní fázi duševního onemocnění, je klíčový pro snižování stigmatizace.

Stigmatization of people with mental illness in health care is a serious problem contributing to poor provision of health care and preventive medicine, it decreases their willingness to seek help and reduces quality of their life and life expectancy. The aim of this study is to evaluate the impact of the anti-stigma training READ on medical students during their psychiatric module. The training was held by a psychiatrist and a peer lecturer. This study is a part of the international project INDIGO. A total of 53 medical students participated in this study (32 in intervention group, 21 in control group). Participants completed questionnaire at baseline and at immediate follow-up. It contained scales measuring attitudes, knowledge, empathy and intergroup anxiety. The intervention group demonstrated reductions in stigma-related attitudes, improvements in mental illness knowledge and reductions in intergroup anxiety. At immediate follow-up the control group demonstrated improvements in mental illness knowledge and reductions in intergroup anxiety. Based on the results of this study common psychiatric module at the medical school (including theoretical and practical education) does not contribute to the sufficient reduction of stigma. The training READ with an involvement of peer lecturers appears to be a convenient instrument how to reduce stigmatization of people with mental illness at medical schools. The contact with people who are not in the acute state of the illness is crucial for destigmatization.

• MeSH
• Persons with Psychiatric Disorders * psychology   MeSH
• Humans MeSH
• Attitude MeSH
• Surveys and Questionnaires MeSH
• Social Stigma MeSH
• Students, Medical * psychology   MeSH
• Check Tag
• Humans MeSH
• Geographicals
• Czech Republic MeSH

INTRODUCTION: We aimed to estimate the prevalence of current mental disorders in the Czech population, and to identify associated disability. METHODS: We conducted a representative cross-sectional household survey of the Czech adult, community-dwelling population. We used the Mini International Neuropsychiatric Interview (M.I.N.I.), WHO Disability Assessment Schedule (WHODAS) 2.0, and Self-Identification as Mentally Ill (SELFI) scale alongside sociodemographic and other covariates. We reached 75% response rate. Descriptive statistics of the sample were assessed and median (M) disability levels with interquartile range (IQR) according diagnosis were calculated on a scale ranging from 12 to 50. Linear regression models were used to identify factors associated with disability. RESULTS: In our sample of 3 306 participants, 21.9% experienced a mental disorder in 2017. Prevalence rates for mood, anxiety, alcohol use, non-alcohol substance use, and psychotic disorders corresponded to 5.5%, 7.3%, 10.8%, 2.9%, and 1.5% respectively. Alcohol dependence was identified in 6.6%, and major depression in 4.0% of the sample. Disability in the general population was significantly lower (M = 12; IQR = 12, 17) than in those with mood (M = 20; IQR = 14; 29), anxiety (M = 18; IQR = 13; 26), alcohol use (M = 14; IQR = 12; 18), non-alcohol substance use (M = 15; IQR = 12; 19), or psychotic disorders (M = 22; IQR = 16.4; 29.4). CONCLUSIONS: People with mental disorders have considerably elevated disability in comparison to mentally healthy participants. The prevalence of mental disorders in the Czech Republic is mostly in line with European prevalence rates but it is lower for anxiety disorders and two times higher for alcohol use disorders.

• MeSH
• Alcoholism * diagnosis   epidemiology   MeSH
• Demography MeSH
• Adult MeSH
• Mental Disorders * classification   diagnosis   epidemiology   psychology   MeSH
• Mental Health statistics & numerical data   MeSH
• Humans MeSH
• Disability Evaluation MeSH
• Prevalence MeSH
• Cross-Sectional Studies MeSH
• Psychiatric Status Rating Scales MeSH
• Socioeconomic Factors MeSH
• Cross-Cultural Comparison MeSH
• Anxiety * diagnosis   epidemiology   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• Czech Republic MeSH
• Europe MeSH

BACKGROUND: A large variation in cognitive performance exists between European regions. However, it is unclear how older Europeans differ in the rate of cognitive decline. METHODS: We analysed data from 22 181 individuals (54% women; median age 71) who participated in the Survey on Health, Ageing and Retirement in Europe. Cognition was measured using tests on verbal fluency, immediate and delayed recall. We used linear regression and linear mixed effects regression to examine regional differences in the level of cognitive performance and the rate of cognitive decline. RESULTS: Scandinavians had the highest baseline cognitive scores (mean standardized overall cognitive score 0.3), followed by Western Europeans (mean 0.2), Central and Eastern Europeans (mean 0.1) and individuals from Mediterranean countries (mean -0.4). These differences persisted even after adjustment for sociodemographic and clinical characteristics. The annual cognitive decline in Scandinavia (0.59%) was approximately two times greater than in Western Europe (0.28%), Central and Eastern Europe (0.25%) and Mediterranean countries (0.23%). DISCUSSION: There are substantial differences in cognitive performance as well as rates of cognitive decline among the elderly throughout European regions. This might be explained by differing levels of cognitive reserve.

• MeSH
• Geriatric Assessment MeSH
• Cognition * MeSH
• Cognitive Dysfunction diagnosis   epidemiology   MeSH
• Cognition Disorders diagnosis   epidemiology   MeSH
• Cohort Studies MeSH
• Humans MeSH
• Linear Models MeSH
• Prospective Studies MeSH
• Surveys and Questionnaires MeSH
• Aged MeSH
• Aging psychology   MeSH
• Health Status * MeSH
• Geography statistics & numerical data   MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Research Support, N.I.H., Extramural MeSH
• Geographicals
• Europe MeSH