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Pauline Warselius,1 Sven Cnattingius,1 Jiong Li,2 Dang Wei,3 Unnur Anna Valdimarsdottir,4,5 Kyriaki Kosidou,3,6 Johan Reutfors,1 Jørn Olsen,2,7 Mogens Vestergaard,8,9 Carsten Obel,8,9 Krisztina D László31Department of Medicine Solna, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden; 2Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark; 3Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; 4Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; 5Faculty of Medicine, University of Iceland, Reykjavik, Iceland; 6Centre for Epidemiology and Community Medicine, Stockholm County’s Health Care District, Stockholm, Sweden; 7Department of Epidemiology, School of Public Health, University of California, Los Angeles, CA, USA; 8Department of Public Health, Aarhus University, Aarhus, Denmark; 9Research Unit and Section for General Practice, Department of Public Health, University of Aarhus, Aarhus, DenmarkPurpose: Postpartum psychosis is a rare but severe complication following childbirth, with unknown etiology. This study investigated whether the death of a close family member — a source of severe stress — the year before or during pregnancy was associated with an increased risk of psychotic illness in the postpartum period among women without and with a history of psychiatric disorder.Methods: We studied live births in Denmark during 1978–2008 and births in Sweden during 1973–2006 (n=5,246,978). Information on death of women’s relatives and partners and sociodemographic, health-, and pregnancy-related factors was obtained through linkage with nationwide registries.Results: The death of a close relative the year before or during pregnancy was not associated with psychotic illness during the first 90 days postpartum among women without (adjusted HR 1.02, 95% CI 0.76–1.37) or with a history of psychiatric disorder (HR 0.96, 95% CI 0.74–1.25). Similarly, there was no association between bereavement and risk of postpartum psychosis according to the timing of the loss (the year before or during pregnancy), the relative’s cause of death (natural or unnatural), or the woman’s relationship to the deceased (parent/sibling or partner/older child).Conclusions: Death of a close relative, one of the most severe sources of stress, before or during pregnancy was not associated with postpartum psychosis. Therefore, these data do not support the hypothesis that severely stressful life events, such as bereavement around the time of pregnancy, are associated with postpartum psychosis.Keywords: postpartum, psychosis, bereavement, stress, pregnancy, cohort study

Background: A role for prenatal steroid hormones in the etiology of autism has been proposed, but evidence is conflicting., Methods: Here, we examined serum levels of maternal estradiol, testosterone, 17-hydroxyprogesterone (OHP), and cortisol from the first trimester of gestation (mean = 10.1 weeks) in relation to the odds of diagnosed autism with and without co-occurring intellectual disability (ID) in the offspring (n = 118 autism with ID, n = 249 autism without ID, n = 477 control). Levels of maternal hormones were measured using highly sensitive liquid chromatography tandem mass spectrometry, standardized according to gestational timing of sample collection, and analyzed with restricted cubic spline logistic regression models adjusting for child's sex and maternal health, demographic, and socioeconomic factors., Results: We observed significant nonlinear associations between maternal estradiol, 17-OHP, and cortisol with autism, which varied with the presence of co-occurring ID. Compared to mean levels, lower levels of estradiol were associated with higher odds of autism with ID (odds ratio for concentrations 1 SD below the mean = 1.66; 95% CI, 1.24-2.11), while higher cortisol levels were associated with lower odds (odds ratio for 1 SD above the mean = 0.55; 95% CI, 0.36-0.88). In contrast, higher 17-OHP was associated with increased odds of autism without ID (odds ratio for 1 SD above the mean = 1.49; 95% CI, 1.11-1.99). We observed no evidence for interaction with sex of the child., Conclusions: These findings support the notion that the maternal steroid hormonal environment in early pregnancy may contribute to autism, but also emphasize the complex relationship between early-life steroid exposure and autism., (Copyright © 2024. Published by Elsevier Inc.)

Background: The potential association between mode of obstetrical delivery and subsequent sexual outcomes of the birthing parent remains uncertain and has not been well investigated from the perspective of positive sexual life satisfaction., Objective: This study aimed to investigate if there was any association between mode of delivery and subsequent sexual life satisfaction of the birthing parent. A secondary aim was to assess the extent to which this association changed when stratified by time elapsed since delivery., Study Design: The study matched participants in the Stockholm Public Health Cohort with deliveries recorded in the Swedish Medical Birth Register. Any deliveries recorded in the registry before the participation in the Stockholm Public Health Cohort were included (n=46,078). The length of time from delivery to outcome assessment varied from 1 month to 41 years (mean, 18 years [±10.8]). Mode of delivery was retrieved from the same registry, whereas self-perceived sexual life satisfaction was retrieved from the Stockholm Public Health Cohort Questionnaires where participants had assessed their sexual life satisfaction as 1 out of 5 mutually exclusive options. Multinomial logistic regression was used to test for any association between mode of delivery (cesarean, instrumental, and spontaneous vaginal delivery) and sexual life satisfaction, both overall and stratified by time elapsed since delivery., Results: After adjusting for covariates, no statistically significant (P < .05) difference in subsequent sexual life satisfaction of the birthing parent between modes of delivery was identified. Adjusted odds ratios for assessing sexual life satisfaction as the lowest level ("very unsatisfactory") were 1.11 (95% confidence interval, 0.98-1.25) for cesarean delivery and 1.16 (95% confidence interval, 0.99-1.35) for instrumental delivery, compared with spontaneous vaginal delivery. The difference in covariate-adjusted prevalence of the lowest level of sexual life satisfaction among the different groups categorized by time since delivery was small: 4.0% (95% confidence interval, 2.4%-5.6%) for cesarean delivery as opposed to 2.8% (95% confidence interval, 2.1%-3.6%) for spontaneous vaginal delivery within 2 years since delivery., Conclusion: These findings do not support any impact of mode of delivery on the subsequent self-perceived sexual life satisfaction among birthing people, either overall or across different time periods since delivery., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Novel HIV pre-exposure prophylaxis (PrEP) methods including a potential future HIV vaccine, will increase prevention options for adolescent girls and young women (AGYW) at high risk of HIV infection in Eastern and Southern Africa, yet data on AGYW's preferences for various PrEP methods is limited. We investigated preferences for five biomedical PrEP methods (oral, injectable, vaginal ring, implant, HIV vaccine) among 14-24-years-old AGYW in Kampala, Uganda., Methods: From January to December 2019, we conducted a mixed methods study including 265 high-risk AGYW. After receiving two education sessions on the five PrEP methods, participants were asked about their "most preferred PrEP method." Multinomial logistic regression (oral PrEP as reference category) was used to determine participant characteristics associated with method preference. Results are presented as adjusted relative risk ratios (aRRR) with 95% confidence intervals (CI). In-depth interviews were conducted with 20 selected participants to examine reasons influencing PrEP preferences and suggestions for method improvements. Transcripts were analyzed thematically., Results: Participants preferred methods were: HIV vaccine (34.7%), oral PrEP (25.7%), injectable PrEP (24.9%), PrEP implant (13.6%), and vaginal ring (1.1%). Preference for injectable PrEP increased with every year of age (aRRR 1.22; 95% CI 1.04-1.44) and among participants with chlamydia or gonorrhoea (aRRR 2.53; 95% CI 1.08-5.90), while it was lower among participants having sexual partner(s) living with HIV or of unknown HIV status (aRRR 0.30; 95% CI 0.10-0.91). Preference for PrEP implants also increased with age (aRRR 1.42; 95% CI 1.14-1.77) and was strong among participants having ≥10 sexual partners in the past 3 months (aRRR 3.14; 95% CI 1.16-8.55), while it was lower among those with sexual partner(s) living with HIV or of unknown HIV status (aRRR 0.25; 95% CI 0.07-0.92). PrEP method preference was influenced by product attributes and prior experiences with similar product forms commonly used in health care., Conclusion: AGYW have varied preferences for biomedical PrEP method and those with higher sexual behavioral risk prefer long-acting methods. As we anticipate more available PrEP options, oral PrEP use should be supported among AGYW, especially for those with sexual partners living with HIV or of unknown HIV status., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Mayanja, Kayesu, Kamacooko, Lunkuse, Muturi-Kioi, Price, Kosidou and Ekström.)

Aims: Sexual harassment is common and may have serious consequences for well-being and health. We investigated the prevalence of sexual harassment in the general population of Stockholm County across socio-demographic groups and sexual identity, and its association with self-reported health., Methods: Experiences of sexual harassment in the previous 12 months and its associations with self-reported health (depression, anxiety, suicidal ideation) were assessed in 2021/2022 among a random sample of 22,890 residents in Stockholm County aged 16 and older. Analyses were done using descriptive statistics and multivariate logistic regression (odds ratios and 95% confidence intervals (CI)). Calibration weights were used to estimate population-representative rates with 95% CI., Results: The highest weighted prevalence was observed among 16- to 24-year-olds (18.9%, 95% CI 16.9%-20.9%). Women (9.5%; 95% CI 8.8%-10.1%) reported a higher prevalence than men (2.9%; 95% CI 2.5%-3.3%). Compared to heterosexual people, bisexual and homosexual people reported a higher prevalence of sexual harassment. No significant difference was observed related to country of birth. People who were students, unemployed or on sick leave were more exposed than employed people, although this was not significant when adjusted for age and registered sex. Experiences of sexual harassment was associated with higher odds of all aspects of self-reported health., Conclusions: Experiences of sexual harassment in the general population are common and associated with adverse self-reported health. There is a need for enhanced efforts to prevent sexual harassment in the general population and to empower specific risk groups such as women and sexual minorities., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Aims: To investigate the self-reported impact of COVID-19 measures on access to testing for HIV and other sexually transmitted infections (STIs) and condoms and factors associated with reduced access among adults in Sweden., Methods: Cross-sectional data were collected in late 2020 through a web panel with adults (18-49 years) in Sweden as part of the International Sexual Health And REproductive health survey (I-SHARE) ( N =1307). The primary outcome was self-reported access to HIV/STI testing and condoms during COVID-19 measures. Logistic regression was used to assess adjusted odds ratios of experiencing reduced access to HIV/STI testing and condoms in relation to sociodemographic characteristics, changes in sexual behaviours and COVID-19-related factors., Results: Of the 1138 sexually active respondents, 17% wanted an HIV/STI test, and of those over half (57%) reported reduced access during the COVID-19 measures in 2020. Compared with cis-women, transgender or non-binary respondents were more likely to experience lower access to testing. Among those who usually used condoms ( n =568), 23% reported hampered condom access due to COVID-19 restrictions. Reduced condom access was associated with identifying as non-cis gender and a cis-man compared with cis-woman, non-heterosexual orientation, being foreign-born and financially worried., Conclusions: Findings indicate that access to HIV/STI testing and condoms among sexually active adults of reproductive age in Sweden was disrupted during the COVID-19 pandemic in 2020 with varied impact depending on sexual orientation, gender identity or socioeconomic situation. This signals the importance of ensuring equitable access to sexual and reproductive health services and commodities in future crises response., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Sexual health is an important contributor to the well-being and life satisfaction of people aged ≥85 years, known as the oldest old . However, little is known about sexual health in this population., Aim: To examine aspects of sexual health among the oldest old and explore its associations with sociodemographic, health-related, and lifestyle factors., Methods: We conducted a population-based cross-sectional study including 183 individuals aged ≥85 years who were residents in Stockholm County, Sweden. Responders (response rate, 63%) were interviewed on a range of health, sociodemographic, and lifestyle parameters, including aspects of sexual health. Participants' responses to the sexual health items were reported as proportions with 95% CIs. Associations were examined with multivariable logistic regression., Outcomes: We examined sexual activity, sexual satisfaction, problems related to sexual health, and inquiries on sexual health by a health care provider., Results: Twelve percent of participants (95% CI, 8%-17.6%) were sexually active, and 63.9% (95% CI, 56.5%-70.9%) were satisfied with their sexual lives during the past year. A third (35%; 95% CI, 28.4%-42.2%) reported at least a problem related to sexual health. Only 2.2% (95% CI, 0.6%-5.5%) were asked about sexual health by a health care provider, while 8.2% (95% CI, 4.7%-13.2%) identified a need for such an assessment. Yet, 85.2% (95% CI, 79.3%-90.0%) indicated no need for their sexual health to be evaluated by a health care provider. Being partnered was positively associated with sexual activity (adjusted odds ratio, 9.13; 95% CI, 2.53-32.90), whereas having strong social support was positively associated with being satisfied with one's sexual life (adjusted odds ratio, 2.96; 95% CI, 1.53-5.74)., Clinical Implications: Health care providers should be proactive in assessing the sexual health of the oldest individuals., Strengths and Limitations: A representative sample of an underresearched population was used in this study. However, the generalizability of our findings may be restricted due to the small sample. To maintain statistical power from a relatively small sample, we might have lost explanatory power. Given the observational cross-sectional nature of the data, we cannot draw causal inferences based on the observed associations., Conclusions: A 10th of participants were sexually active, and the majority were satisfied with their sexual lives. Although many participants reported problems related to sexual health, few expressed the need to discuss sexual health with health care providers. Future studies should explore potential barriers to addressing sexual health and unmet health care needs among the oldest old., Competing Interests: The authors have no relevant financial or nonfinancial interests to disclose. The authors have no conflicts of interest to declare that are relevant to the content of this article. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or nonfinancial interest in the subject matter or materials discussed in this article. The authors have no financial or proprietary interests in any material discussed in this article., (© The Author(s) 2024. Published by Oxford University Press on behalf of The International Society of Sexual Medicine.)

Background: Digital health care services have the potential to improve access to sexual and reproductive health care for youth but require substantial implementation efforts to translate into individual and public health gains. Health care providers are influential both regarding implementation and utilization of the services, and hence, their perceptions of digital health care services and the implementation process are essential to identify and address. The aim of this study was to explore midwives' perception of digital sexual and reproductive health care services for youth, and to identify perceived barriers and facilitators of the implementation of digital health care provision in youth clinics., Methods: We performed semi-structured interviews with midwives (n = 16) working at youth clinics providing both on-site and digital sexual and reproductive health care services to youth in Stockholm, Sweden. Interview data were analyzed using a content analysis approach guided by the Consolidated Framework for Implementation Research (CFIR)., Results: Midwives acknowledged that the implementation of digital health care improved the overall access and timeliness of the services at youth clinics. The ability to accommodate the needs of youth regarding their preferred meeting environment (digital or on-site) and easy access to follow-up consultations were identified as benefits of digital health care. Challenges to provide digital health care included communication barriers, privacy and confidentiality concerns, time constraints, inability to offer digital appointments for social counselling, and midwives' preference for in person consultations. Experiencing organizational support during the implementation was appreciated but varied between the respondents., Conclusion: Digital sexual and reproductive health care services could increase access and are valuable complements to on-site services in youth clinics. Sufficient training for midwives and organizational support are crucial to ensure high quality health care. Privacy and safety concerns for the youth might aggravate implementation of digital health care. Future research could focus on equitable access and youth' perceptions of digital health care services for sexual and reproductive health., (© 2024. The Author(s).)

Objectives: To detail the relationship between parental mental illness and the likelihood of out-of-home care (OHC) among their children, and to identify factors which modify this relationship., Methods: Using Swedish national registers, children born in 2000 to 2011 (n = 1 249 463) were linked to their parents. Time-dependent parental mental illness (nonaffective and affective psychosis, substance misuse, depression, anxiety and stress, eating disorders, personality disorders, attention deficit hyperactivity disorder, autism, and intellectual disability), was identified through International Classification of Diseases codes., Results: After adjustment for socioeconomic factors, children living with mentally ill parents were 4 times as likely to be placed in OHC than children without (95% confidence interval [CI] 4.24-4.61). The highest hazard ratio (HR) was in the youngest children aged 0 to 1 year (5.77, 95% CI 5.42-6.14), exposed to maternal illness (HR 4.56, 95% CI 4.37-4.76), and parental intellectual disability (HR 4.73, 95% CI 4.09-5.46). Children with parental mental illness with multiple risk factors were at particularly high risk. Compared with children without parental mental illness, and those with university-educated parents, children whose parents had mental illness and only had education to age 16 had a 15 times higher risk of OHC (95% CI 13.75-16.54)., Conclusions: Children with parental mental illness are considerably more likely to be removed from home into care during childhood, particularly during the first year of life and if they are from socially disadvantaged families. Greater knowledge of these risks should lead to increased support for vulnerable new families., (Copyright © 2024 by the American Academy of Pediatrics.)

Importance: Adversity during childhood can limit children's chances of achieving their optimal developmental and psychological outcomes. Well-designed observational studies might help identify adversities that are most implicated in this, thereby helping to identify potential targets for developing interventions., Objective: To compare the association between preventing childhood poverty, parental mental illness and parental separation, and the population rate of offspring common mental disorders (ages 16-21 years) or average school grades (age 16 years)., Design, Setting, and Participants: A population-based, longitudinal cohort study using Swedish registries was conducted. A total of 163 529 children born in Sweden between January 1, 1996, and December 31, 1997, were followed up until their 21st birthday. They were linked to registries using Sweden's national personal identification number. Children were linked to birth parents, hospital records, and school data. Parents were linked to registries containing health, income, sociodemographic, and obstetric data. Analyses were conducted between January 10, 2021, and August 26, 2022., Exposures: Childhood adversities of relative poverty (household disposable income <50% of the median), parental inpatient admission for a mental illness, or parental separation. Adversities were categorized into developmental periods: ages 0 to 3, 4 to 7, 8 to 11, and 12 to 16 years., Main Outcomes and Measures: The main outcomes were children's hospital records with a diagnosis of anxiety or depression between ages 16 and 21 years and school grades at the end of compulsory education (age 16 years). The parametric g-formula modeled population changes in outcomes associated with the counterfactual, hypothetical preventing adversity exposures, accounting for fixed and time-varying confounders. Adjustments were made for parental demographic characteristics, obstetric variables, and socioeconomic data at birth., Results: A total of 163 529 children were included in the cohort (51.2% boys, 51.4% born in 1996). Preventing all adversities was associated with an estimated change in the prevalence of offspring common mental disorders from 10.2% to 7.6% and an improvement in school grades with an SD of 0.149 (95% CI, 0.147-0.149). Preventing parental separation provided for the greatest improvement, with an estimated 2.34% (95% CI, 2.23%-2.42%) fewer children with a common mental disorder and an improvement in school grades by 0.127 SDs (0.125-0.129). Greater improvements were shown by hypothetically targeting adolescents (age 12-16 years) and those whose parents had a mental illness when the child was born., Conclusions and Relevance: The results of this cohort modeling study suggest that preventing childhood adversity could provide notable improvements in the rates of common mental disorders and school grades. Many children might achieve better life outcomes if resources are properly allocated to the right adversities (parental separation), the right groups (children with parental mental illness), and at the right time (adolescence).

There is a male sex disadvantage in morbidity and mortality due to COVID-19. Proposed explanations to this disparity include gender-related health behaviors, differential distribution of comorbidities and biological sex differences. In this study, we investigated the association between sex and risk of severe COVID-19 while adjusting for comorbidities, socioeconomic factors, as well as unmeasured factors shared by cohabitants which are often left unadjusted. We conducted a total-population-based cohort study (n = 1,854,661) based on individual-level register data. Cox models was used to estimate the associations between sex and risk for severe COVID-19. We additionally used a within-household design and conditional Cox models aiming to account for unmeasured factors shared by cohabitants. A secondary aim was to compare the risk of COVID-19 related secondary outcomes between men and women hospitalized due to COVID-19 using logistic regression. Men were at higher risk for hospitalization (HR = 1.63;95%CI = 1.57-1.68), ICU admission (HR = 2.63;95%CI = 2.38-2.91) and death (HR = 1.81;95%CI = 1.68-1.95) due to COVID-19, based on fully adjusted models. However, the effect of sex varied significantly across age groups: Among people in their 50s, men had > four times higher risk of COVID-19 death. The within-household design did not provide any further explanation to the sex disparity. Among patients hospitalized due to COVID-19, men had an increased risk for viral pneumonia, acute respiratory distress syndrome, acute respiratory insufficiency, acute kidney injury, and sepsis which persisted in fully adjusted models. Recognition of the combined effect of sex and age on COVID-19 outcomes has implications for policy strategies to reduce the adverse effects of the disease., (© 2022. The Author(s).)

Background: Previous studies suggest a protective effect of parenthood on suicide, but little is known about how the association may change across the lifespan, or in relation to sex, marital status or occurrence of psychiatric disorders., Methods: We followed a cohort of over 5 million Swedish women and men, from 1991 to 2011, up to max. age 75, for death by suicide using national registers. Information on childbirths/adoptions, potential confounders and modifying factors were obtained from national registers. We assessed the associations between parenthood and suicide across adulthood using within time-stratified Cox regression models, with parenthood as a time-dependent exposure., Results: Parents had a lower risk of suicide than non-parents across the lifespan, after adjusting for sociodemographic factors. The association was most pronounced in young adults, especially young women, but attenuated with increasing age and converged between sexes in older age groups. The lower risk of suicide over the life course was similar whether parents were married, unmarried or divorced, apart from married men; among them, parents only had a lower risk above age 55. The lower risk in parents was also evident in people with a history of psychiatric hospitalizations, but disappeared from age 55 in this population., Conclusion: The lower risk of suicide was present in both parents, was most pronounced in young adulthood and weakened with increasing age. Our results are consistent with a plausible mechanism where feelings of responsibility and connectedness are protective against suicide in parents., (© 2022. The Author(s).)

Mental illness has been previously linked with autoimmune diseases, yet the associations between parental mental illness and offspring's risk of autoimmune diseases is largely unknown. We conducted a population-based cohort study of 2,192,490 Swedish children born between 1991 and 2011 and their parents to determine the associations between parental mental illness and risk of autoimmune diseases among the offspring. Time-dependent diagnoses of parental mental illness (psychosis, alcohol/drug misuse, depression, anxiety, eating disorders, personality disorders, attention deficit hyperactivity disorder, autism spectrum disorder) and offspring autoimmune diseases (type 1 diabetes (T1D), juvenile idiopathic arthritis (JIA), systemic lupus erythematosus, psoriasis, multiple sclerosis, inflammatory bowel disease (IBD), coeliac disease) were identified from inpatient/outpatient healthcare visits. Associations were measured by hazard ratios (HRs) adjusted for potential confounders. Overall, parental mental illness was associated with a small increase in risk of offspring's autoimmune diseases (HR 1.05, 95% CI 1.02-1.08). However, parental common mental disorder (anxiety/depression) was associated with higher risk of JIA, psoriasis, and T1D (HR T1D 1.11, 95% CI 1.01-1.22), while maternal psychosis with reduced risk of coeliac disease (HR 0.68, 95% CI 0.49-0.95) and paternal alcohol/drug misuse with reduced risk of IBD (HR 0.80, 95% CI 0.64-0.99). Maternal eating disorders were associated with a markedly increased risk for T1D (HR 1.41, 95% CI 1.05-1.89). Further studies are needed to confirm these findings and to understand underlying mechanisms. There is a need for greater clinical awareness about potential risk of JIA, psoriasis, and T1D among children of parents with common psychiatric morbidity., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

It is debated whether men with borderline personality disorder (BPD) are less often treated for their disorder, compared to women, even when they have sought care. Here, the aim was to examine gender differences in the treatment of patients with BPD. Through linkage to Swedish health and administrative registers, we identified all patients diagnosed with BPD ( n = 5530) in Stockholm County from 2012 to 2016. We ascertained information on sociodemographic characteristics, comorbid psychiatric diagnoses, and all mental health care utilization within inpatient and outpatient mental health care, including receipt of psychiatric medication and various psychological therapies. We identified 802 men and 4,728 women with BPD during the study period. Men with BPD were less likely than their female counterparts to be treated with psychotherapy as well as psychiatric medication. Most of the differences in treatment with psychological therapies were nonsignificant in the multivariate model, indicating they are likely the result of differences in sociodemographic variables and comorbidity between men and women with BPD. Men with BPD were in average 4 years older than women at the time of the first BPD diagnosis, had lower education, and were also more likely to receive social welfare support. In conclusion, few men are diagnosed with BPD and those who are diagnosed are likely to receive somewhat less psychiatric medication and psychological therapies compared to women. Researchers and clinicians need to focus more on men with BPD to improve help-seeking and recognition of this disabling condition in men and enable equal treatment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

In a large, population-based sample in Sweden, we sought to examine mental health disparities between lesbian, gay and bisexual (LGB) and heterosexual individuals with different immigration statuses. We conducted a population-based study including 1799 LGB and 69,324 heterosexual individuals, recruited in 2010 and 2014 as part of the Stockholm Public Health Cohort. Data were obtained from self-administered surveys that were linked to nationwide registers. We examined associations between mental health outcomes (i.e., psychological distress, suicidal ideation, and suicide attempt) and sexual orientation (LGB versus heterosexual), immigration status (immigrant versus Nordic-born), and their interaction. Sex-stratified weighted multivariable logistic regression analyses were used to calculate adjusted odds ratios with 95% confidence intervals. LGB individuals demonstrated substantially elevated odds of all mental health outcomes compared to heterosexuals; immigrants reported moderately elevated odds of psychological distress and suicide attempt, but not suicidal ideation, compared to Nordic-born individuals. Interaction terms between sexual orientation and immigration status were significant at p < 0.05 for psychological distress for both sexes and for suicidal ideation and attempt among women. Unexpectedly, models probing interactions generally demonstrated that Nordic-born LGB individuals demonstrated greater risk of psychological distress, suicidal ideation, and suicide attempt than did immigrant LGB individuals, especially among women. Supplemental analyses showed that Nordic-born bisexual women demonstrated the highest risk of all studied outcomes. Being LGB in Sweden is generally a stronger risk factor for poor mental health among Nordic-born than immigrant populations. These findings call for future intersectionality-focused research to delineate the unique cultural, social, and psychological factors associated with mental health and resilience among LGB immigrants., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: To determine whether parenthood among 25- to 44-year-olds is associated with a lower suicide rate in men and women in Sweden, and whether this is explained by selection into parenthood., Methods: In total, 1,582,360 Swedish women and men, born between 1967 and 1985, and childless at their 25 th birthday, were followed from 1992 to 2011. All data originated from linkage to national Swedish registers. Cox regression models were used with time-varying parenthood status to estimate adjusted hazard ratios and 95% confidence intervals (aHR;CI) for suicide., Results: Having one, two, three or more children was associated with 64%, 79% and 78% lower suicide rate, respectively, compared with having no children, in models with basic adjustments. When a wide range of indicators of selection into parenthood were taken into account, the suicide rate was 58% lower in parents with one child and 70% lower in parents with two or more children compared with childless individuals (aHR 0.42 [95% CI 0.36-0.48]; 0.30 [95% CI 0.25-0.35]; 0.30 [95% CI 0.21-0.42]). In fathers with one, two, three or more children suicide rate was 54%, 64% and 59% lower, respectively, compared with non-fathers whereas in mothers was 70%, 83% and 93% lower, respectively, compared with non-mothers., Conclusion: Parenthood among 25-to 44-year-olds is associated with a lower suicide risk in both men and women but to a larger extent among women, and particularly in parents with two or more children. Although selection into parenthood is possible, a protective effect of parenthood on suicide is likely in both men and women., (© 2020 The Authors. Acta Psychiatrica Scandinavica published by John Wiley & Sons Ltd.)

Background: Children of parents with mental illness are a vulnerable group, but their numbers and their exposure to adversity have rarely been examined. We examined the prevalence of children with parents with mental illness in Sweden, trends in prevalence from 2006 to 2016, and these children's exposure to socioeconomic adversity., Methods: We did a population-based cohort study among all children (aged <18 years) born in Sweden between Jan 1, 1991, and Dec 31, 2011, and their parents, followed up between Jan 1, 2006, and Dec 31, 2016. We included children who were identified in the Total Population Register and linked to their birth parents, excluding adopted children and those with missing information on both birth parents. We used a comprehensive register linkage, Psychiatry Sweden, to follow up for indicators of parental mental illness and socioeconomic adversity. Marginal predictions from a standard logistic regression model were used to estimate age-specific, 3-year period prevalence of parental mental illness and trends in prevalence for 2006-16. Using cross-sectional data on each child, indicators of socioeconomic adversity were compared between children with and without concurrent parental mental illness using logistic regression., Findings: Of 2 198 289 children born in Sweden between Jan 1, 1991, and Dec 31, 2011, we analysed 2 110 988 children (96·03% of the total population). The overall prevalence of children with diagnosed parental mental illness between 2006 and 2016 was 9·53% (95% CI 9·50-9·57). This prevalence increased with age of the child, from 6·72% (6·65-6·78) of the youngest children (0 to <3 years) to 10·80% (10·73-10·89) in the oldest (15 to <18 years). The prevalence of diagnosed parental mental illness increased from 8·62% (8·54-8·69) in 2006-09 up to 10·95% (10·86-11·03) in 2013-16. Children with any type of parental mental illness had markedly higher risk of socioeconomic adversity, such as living in poorer households or living separately from their parents., Interpretation: Currently, 11% of all Swedish children have a parent with a mental illness treated within secondary care. These children have markedly higher risk of broad socioeconomic adversity than do other children. There is a need to understand how socioeconomic adversity and parental mental illness influence vulnerability to poor life outcomes in these children., Funding: European Research Council, National Institute for Health Research, Region Stockholm, and the Swedish Research Council., (Copyright © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Background: Recent studies suggest that disruption of the colonic microbiota homeostasis is associated with low-grade systemic inflammation and mental disorders. The cecal appendix may influence the homeostasis of the colonic microbiota. In this large population-based study, we investigated whether early removal of the appendix is associated with an increased risk of mental disorders later in life., Materials and Methods: All Swedish individuals born between 1973 and 1992 (N = 1,937,488) were included and followed prospectively until December 31, 2016 for any psychiatric International Classification of Disease diagnosis from age 14 or later in life. The main exposure was defined as having a history of appendectomy before age 14 (N = 44,259); the second exposure, appendicitis before age 14 but without appendectomy (N = 1,542), and the third exposure studied was a history of hernia surgery before age 14 (N = 35,523). Control groups for each respective exposure were all unexposed individuals in the study population., Results: Individuals exposed to appendectomy before age 14 had a 19% increased risk of depressive disorder (adjusted hazard ratio [aHR] = 1.19; 95% confidence interval [95% CI]: 1.15-1.23), 27% increased risk of bipolar affective disorder (aHR = 1.27; 95% CI: 1.17-1.37), and a 20% increased risk of an anxiety disorder (aHR = 1.20; 95% CI: 1.16-1.23) compared to individuals unexposed to childhood appendectomy. We found no association between appendectomy and increased risk of obsessive-compulsive disorder and schizophrenia and there was no association between appendicitis without appendectomy and mental disorders. The association between childhood hernia surgery and mental disorders later in life was small but significant., Conclusion: Childhood appendectomy, but not appendicitis without appendectomy, was associated with a significantly increased risk of mood and anxiety disorders in adulthood., (© 2020 The Authors. Depression and Anxiety published by Wiley Periodicals LLC.)

Background: Endometriosis is a common gynecologic condition affecting women of reproductive age. It has been linked with greater rates of depression and anxiety in small, cross-sectional, and clinical studies. Other studies have reported that women with endometriosis have increased risk of bipolar disorder. These reports suggest that psychiatric disorders might be more common among women with endometriosis, contributing to increased burden of mental ill-health in this population of women. However, this hypothesis has not been adequately studied., Objectives: In this population-based study, we investigated the overall psychiatric comorbidity among women with endometriosis, and the role of familial liability., Study Design: Several Swedish national registers were linked and used to follow all women born in Sweden in 1973-1990 for diagnosed psychiatric disorders and endometriosis from age 14 years until year 2016. Sibling comparison analyses were performed in a subsample of 173,650 families., Results: After adjustment for birth characteristics and education, women with endometriosis had an increased risk of being later diagnosed with depressive-, anxiety and stress-related disorders, alcohol/drug dependence, and attention-deficit hyperactivity disorder compared with the general population and with their sisters without endometriosis. The adjusted hazard ratios ranged from 1.56 (95% confidence interval, 1.29-1.88) for depressive disorders to 1.98 (95% confidence interval, 1.34-2.93) for attention-deficit hyperactivity disorder in the sibling analysis. Also, women with previous affective psychotic disorders, depressive-, anxiety and stress-related disorders, eating disorders, personality disorders, and attention-deficit hyperactivity disorder were more likely to be later diagnosed with endometriosis. The adjusted hazard ratios ranged from 1.51 (95% confidence interval, 1.30-1.76) for depressive disorders to 1.93 (95% confidence interval, 1.47-2.52) for personality disorders., Conclusion: These findings reveal a high degree of comorbidity between endometriosis and many psychiatric disorders that was not entirely explained by shared familial confounding. Clinical practice may consider psychosocial support to women with endometriosis and treating them from a multidisciplinary perspective., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Children of parents with mental disorder face multiple challenges., Aims: To summarise evidence about parental mental disorder and child physical health., Method: We searched seven databases for cohort or case-control studies quantifying associations between parental mental disorders (substance use, psychotic, mood, anxiety, obsessive-compulsive, post-traumatic stress and eating) and offspring physical health. Studies were excluded if: they reported perinatal outcomes only (<28 days) or outcomes after age 18; they measured outcome prior to exposure; or the sample was drawn from diseased children. A meta-analysis was conducted. The protocol was registered on the PROSPERO database (CRD42017072620)., Results: Searches revealed 15 945 non-duplicated studies. Forty-one studies met our inclusion criteria: ten investigated accidents/injuries; eight asthma; three other atopic diseases; ten overweight/obesity; ten studied other illnesses (eight from low-and middle-income countries (LMICs)). Half of the studies investigated maternal perinatal mental health, 17% investigated paternal mental disorder and 87% examined maternal depression. Meta-analysis revealed significantly higher rates of injuries (OR = 1.15, 95% CI 1.04-1.26), asthma (OR = 1.26, 95% CI 1.12-1.41) and outcomes recorded in LMICs (malnutrition: OR = 2.55, 95% CI 1.74-3.73; diarrhoea: OR = 2.16, 95% CI 1.65-2.84). Evidence was inconclusive for obesity and other atopic disorders., Conclusions: Children of parents with mental disorder have health disadvantages; however, the evidence base is limited to risks for offspring following postnatal depression in mothers and there is little focus on fathers in the literature. Understanding the physical health risks of these vulnerable children is vital to improving lives. Future work should focus on discovering mechanisms linking physical and mental health across generations., Declaration of Interest: None.

Background: Changes in care may mean women with serious mental illness (SMI) are more fertile. We investigated 1) the live-birth and pregnancy rate of women with and without SMI over time, 2) the likelihood of pregnancy when using second or first-generation antipsychotics., Method: Retrospective cohort study of women (15-45 years) registered in Clinical Practice Research Datalink (CPRD) general practices between 1992 and 2017. Each analysis year, women with SMI (affective and non-affective psychotic disorder) were matched with up to four women with no record of SMI on age, calendar year and general practice. Pregnancy and live-birth rates and the rate ratio (RR) comparing women with and without SMI were estimated. The stability of the RR between years was tested. For women with SMI, the pregnancy rates when on or off first or second-generation antipsychotics were calculated and compared using Poisson regression models., Results: In total, 12,524 women with SMI were matched to 50,074 women without SMI, median age 34 [IQR 28-39] years. Between 1992 and 2017 women with SMI had 50% fewer live-births than women without SMI (RR 0..50, 95%CI 0.45-0.55). The pregnancy rate ratio increased from 0.64 (95%CI 0.48-0.86) (1992-1994) to 1.00 (95%CI 0.81-1.22) (2016-2017), (p < 0.0001), but this change was only seen in women with affective disorders. Women are most likely to become pregnant after discontinuing either a second-generation or first-generation antipsychotic (RR 1.74, 95%CI 1.42-2.13)., Conclusions: Women with SMI are increasingly experiencing pregnancy but not live-birth, which suggests the reproductive health needs of these women are unmet., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Infections during brain development appear to contribute to cognitive impairment and aggressive behavior, as well as to a number of developmental mental disorders closely associated with violent criminal behavior. Yet, no study has thus far ever investigated whether infections during brain development increases the risk of violent criminality later in life. In this population-based cohort study, about 2.2 million individuals born in Sweden between the years 1973 and 1995 were included in an effort to estimate the association between infections during childhood (registered ICD-10 diagnoses of infections incurred before the age of 14 years) and violent criminal behavior (registered convictions for a violent crime between the ages of 15 and 38 years, prior to December 31, 2011). After inclusion of several sociodemographic parameters, risks of violent criminal behavior conferred by childhood infections - expressed as hazard ratios (HRs) and 95% confidence intervals (CIs) - were calculated by means of Cox regression. Mediation analyses were performed to explore the effect of psychiatric disorders on the association between infections during childhood and violent criminality. Results revealed a modest, yet significant, association between an infection during childhood and violent criminality later in life (adjusted HR 1.14, 95% CI 1.12-1.16). Infections during the first year of life and infections in the central nervous system were associated with the highest risks of subsequent violent criminality (adjusted HR 1.20, 95% CI 1.18-1.23, and adjusted HR 1.17, 95% CI 1.08-1.26, respectively). The association was partly mediated by the presence of a psychiatric disorder. In summary, independent of a wide range of covariates, our results suggest that infections during brain development could be part of the genesis of violent criminal behavior., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Attention Deficit/Hyperactivity Disorder (ADHD) is the most common psychiatric disorder in childhood. It is unclear whether ADHD increases the risk of non-affective psychotic disorder (NAPD). The study included a matched cohort, drawn from all born in Sweden 1987-1991 (n = 548,852). ADHD was defined as ICD diagnosis and/or prescription of ADHD medication. We distinguished between stimulants and non-stimulants, and usage duration (<1 year, 1-2 years and ≥2 years). We calculated odds ratios (OR) with 95% confidence intervals (CI) for NAPD, adjusted for confounders, comorbid autism spectrum disorder (ASD) and substance abuse. ADHD cases were also compared to their unaffected full siblings. We analyzed 18,139 ADHD cases and 72,437 sex and birth year matched controls. NAPD was more common in cases than controls (2.7 and 0.4%, respectively). After adjustment for confounders, ADHD cases had markedly high risk for NAPD (OR: 6.99; 95% CI 6.03-8.10), which attenuated further after adjustment for ASD and substance abuse (OR: 2.57; 95% CI 2.09-3.16). Utilization of ADHD medication increased the risk for NAPD (ORs for change in odds of NAPD for every 5 extra prescriptions of stimulants 1.06 (95% CI 1.02-1.10) and, non-stimulants 1.15 (95% CI 1.01-1.30)). There was no association between usage length of medication and risk for NAPD. The risk was higher in individuals with ADHD than their unaffected siblings (OR: 2.95 (95% CI 2.07-4.20)). Overall, ADHD was associated with elevated risk for NAPD, which is not entirely explained by shared familial factors. The clinical severity leading to medical treatment may also increase NAPD risk. Ethics approval: Approved by the ethical committee in Stockholm, Sweden (dnrs: 2010-1185-31/5 and 2013/1118-32)., Competing Interests: Declaration of competing interest On behalf of all authors, the corresponding author states that is no conflict of interest., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Clozapine treatment may have beneficial effects on behavioral outcomes in psychotic disorders, including violent offending. Although clozapine and other antipsychotics have been linked to lower levels of violent behavior, these have been primarily in small selected samples, and population-based estimates have been limited and imprecise. We aimed to assess the effect of clozapine treatment on the rate of violent and nonviolent offending. We carried out a within-person mirror-image study of the Swedish population with linked prescription, hospitalization, and sociodemographic registers. Outcomes were violent, nonviolent, and overall offences occurring before and after clozapine, or olanzapine, initiation. Comparison of effects of clozapine and olanzapine on key variables was modeled with interaction terms. We found periods of mirror-image observation time with clozapine treatment were associated with a much lower rate of violent offending compared to periods before treatment (rate ratio [RR]: 0.13 (95% CI: 0.05, 0.34). Reductions in nonviolent offences were smaller in magnitude (RR: 0.37, 95% CI: 0.17, 0.80). There was a statistically greater rate reduction effect on violent offences for clozapine than olanzapine (RR for interaction: 4.84, 95% CI: 1.56, 14.86, P = .002). In patients with psychotic disorders, clozapine treatment is associated with a lower rate of violent offending compared to olanzapine., (© The Author(s) 2019. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: Adolescents' high academic expectations predict future health and successful societal integration. Yet, little is known about which factors may promote adolescents' expectations of their future education and academic achievement., Aims: To explore whether potentially modifiable factors such as parents' engagement and expectations regarding their child's education; or student individual factors such as school engagement, academic achievement, sense of identity, and positive mental health predict positive development of academic expectations in early adolescence., Methods: A longitudinal study of 3,203 adolescents and their parents was conducted with information collected between 7th grade (13 years of age) and 9th grade (16 years of age). Parental and adolescents' own academic expectations and engagement in school, academic achievement, identity synthesis, and mental health were self-reported in annual questionnaires. We used logistic regression to analyze the associations between the aforementioned factors and two binary outcomes related to changes in expectations from 7th to 9th grade: A. resolved uncertainty regarding own academic expectations; B. raised academic expectations., Results: Student engagement, and higher academic grades predicted both resolved uncertainty in expectations and raised academic expectations. Higher parental involvement in education was related to resolved uncertainty, while high parental expectations were related to raised student expectations. Identity synthesis and mental health did not appear to predict either outcome., Conclusion: Our findings indicate that a supportive parental attitude concerning their child's education during adolescence, student engagement, and positive progressions in academic achievements may contribute to a positive development of academic expectations, thus to positive educational trajectories., Competing Interests: The authors have declared that no competing interests exist.

Objective: To examine the effects of neighborhood socioeconomic disadvantage and ethnic composition on the utilization of ADHD medication in schoolchildren after accounting for individual- and family-level characteristics. Method: A cohort of all schoolchildren living in Stockholm County was prospectively followed for new prescriptions of ADHD medication ( N = 276,955). Three-level logistic regression models were used with individual/family characteristics (e.g., immigrant background) at the first level and small area market statistics (SAMS) and municipality characteristics (i.e., socioeconomic disadvantage and ethnic composition) at the second and third level. Results: SAMS socioeconomic disadvantage was associated with increased utilization of ADHD medication. The utilization of ADHD medication was lower among immigrant children as compared with natives, and their odds of not utilizing medication increased as the degree of concentration of foreign-born increased. Conclusion: These results suggest that interventions at the neighborhood level may offer an additional route for the prevention of the disorder and/or alleviation of its consequences.

Background: Childhood adversity (CA) is a risk indicator for psychiatric morbidity. Although CA has been linked to violent offending, limited research has considered adolescent psychiatric disorder as a mediating factor. The current study examined whether adolescent psychiatric disorder mediates the association between CA and violent offending., Methods: We used a cohort of 476 103 individuals born in 1984-1988 in Sweden. Register-based CAs included parental death, substance abuse and psychiatric disorder, parental criminal offending, parental separation, public assistance, child welfare intervention and residential instability. Adolescent psychiatric disorder was defined as being treated with a psychiatric diagnosis prior to age 20. Estimates of risk of violent offending after age 20 were calculated as incidence rate ratios (IRRs) with 95% confidence intervals (CIs). Mediation was tested with the bootstrap method., Results: Exposure to CA was positively associated with violent offending, especially when accumulated. Individuals exposed to 4+ CAs who were also treated for psychiatric disorder had a 12-fold elevated risk for violent offending (adjusted IRR 12.2, 95% CI 10.6-14.0). Corresponding IRR among 4+ CA youth with no psychiatric disorder was 5.1 (95% CI 4.5-5.6). Psychiatric disorder mediated the association between CA and violent offending., Conclusion: CA is associated with elevated risk for violent offending in early adulthood, and the association is partly mediated by adolescent psychiatric disorder. Individuals exposed to cumulative CA who also develop adolescent psychopathology should be regarded as a high-risk group for violent offending, by professionals in social and health services that come into contact with this group., (© The Author(s) 2019. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

Objective: The World Health Organization (WHO) Adult ADHD Self-Report Scale (ASRS) is intended to measure population prevalence of ADHD. The short version ASRS-6 has yet not been validated in a population setting. Our aim was to examine the validity of the ASRS-6 in a general population. Method: We used the Stockholm Public Health Cohort 2014. The convergent validity was assessed using item response theory (IRT). The discriminant validity was assessed by examining the correlation between the ASRS and known correlates. Results: The ASRS-6 was unidimensional albeit with hyperactivity and impulsivity items fitting less good. IRT analysis showed that the item difficulty ranged between easy to hard and that the four items on inattention had good or very good discriminatory ability. Correlates were all in the expected direction. Conclusion: The ASRS-6 has adequate validity in the general population but reflects the duality of ADHD having both inattention and hyperactivity/impulsivity as sufficient and non-necessary criteria.

Debate persists about whether parental sexual orientation affects children's well-being. This study utilized information from the 2013 to 2015 U.S., population-based National Health Interview Survey to examine associations between parental sexual orientation and children's well-being. Parents reported their children's (aged 4-17 years old, N = 21,103) emotional and mental health difficulties using the short form Strengths and Difficulties Questionnaire (SDQ). Children of bisexual parents had higher SDQ scores than children of heterosexual parents. Adjusting for parental psychological distress (a minority stress indicator) eliminated this difference. Children of lesbian and gay parents did not differ from children of heterosexual parents in emotional and mental health difficulties, yet, the results among children of bisexual parents warrant more research examining the impact of minority stress on families., (© 2017 The Authors. Child Development © 2017 Society for Research in Child Development, Inc.)

Purpose: We investigated parental academic expectations and their agreement with child expectations as predictors of offspring's mental health. We additionally analyzed whether these associations were moderated by parent-child relationship factors and whether similar associations were found when using aspirations as the predictor., Methods: Dyads of parents and children (aged 13 years) in Sweden answered three annual surveys asking how far in education parents (or their children) expected to go (respondents' wave 1: N = 3,383, wave 2: N = 3,096, wave 3: N = 2,905). Children's mental health was measured using the internalizing and externalizing subscales of the Strengths and Difficulties Questionnaire. Multilevel logistic models for repeated measures were built to analyze the associations between parental expectations or the concordance of parent and child expectations and child's high internalizing (>9) or externalizing (>11) score in waves 2 and 3., Results: Parental expectations lower than university were associated with an increased odds of offspring's high externalizing score (adjusted odds ratio: 1.49, 95% confidence interval: 1.11-2.01). The odds of high externalizing score were increased among adolescents when either the parent's or own expectations were lower than university compared with the situation where both expected a university education; there was a more than twofold increased odds when both had low expectations (odds ratio: 2.32, 95% confidence interval: 1.55-3.48). No significant associations were found with internalizing problems. There was some evidence of moderation according to democratic parenting. All associations were similar when considering academic aspirations., Conclusions: Low academic expectations among parents and their children may negatively impact on children's externalizing symptoms., (Copyright © 2018 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Little information exists about the prevalence of children exposed to maternal mental illness. We aimed to estimate the prevalence of children and adolescents exposed to maternal mental illness in the UK between 2005 and 2017 using primary care data., Methods: In this national retrospective cohort study, we included children aged 0-16 years born between Jan 1, 1991, and Dec 31, 2015, who were linked to their mothers and registered on the primary care Clinical Practice Research Datalink (CPRD) between 2005 and 2017. We extracted data on diagnosis, symptoms, and therapy from the CRPD to define the following maternal mental illnesses: depression, anxiety, non-affective psychosis, affective psychosis, eating disorders, personality disorders, alcohol misuse disorder, and substance misuse disorder. We also extracted data on socioeconomic status from the Index of Multiple Deprivation 2010 and data on ethnicity from the Hospital Episode Statistics dataset. The main outcome was prevalence of maternal mental illness. Prevalence was calculated for each 2-year period of childhood (from age 0-<2 to 14-<16 years) using marginal predictions from a logistic regression model. We used survival analysis to estimate the incidence and cumulative risk of children experiencing maternal mental illness by age 16 years., Findings: We identified 783 710 children registered in the UK CPRD mother-baby link database, and included 547 747 children (381 685 mothers) in our analysis. Overall prevalence of maternal mental illness was 23·2% (95% CI 23·1-23·4), which increased during childhood (21·9%, 21·7-22·1 among the 0-<2 year age group vs 27·3%, 26·8-27·8 among the 14-<16 year age group). Depression and anxiety were the most prevalent maternal mental illnesses. The proportion of children exposed to maternal mental illness increased from 22·2% (21·9-22·4) between 2005 and 2007 to 25·1% (24·8-25·5) between 2015 and 2017. Geographically, the highest prevalence of maternal mental illness was observed in Northern Ireland (29·8%, 29·0-30·5). In England, prevalence of maternal mental illness was highest among children in the most deprived areas (28·3%, 27·8-28·8). The incidence of maternal mental illness was highest between 0-3 months (26·7 per 100 person years, 26·4-27·1). By age 16 years, the cumulative risk of maternal mental illness was 53·1% (52·8-53·3)., Interpretation: One in four children aged 0-16 years are exposed to maternal mental illness and the prevalence of diagnosed and treated maternal mental illness is increasing. Policy makers and commissioners should consider this information and channel resources to target individuals in greatest need., Funding: The European Research Council and the National Institute for Health Research., (Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Background: The proportion of young adults on disability benefits due to mental disorders has increased in Europe since the early 2000's. Poor educational achievement is a risk factor for disability benefits due to mental disorders in early adulthood, yet no study has examined whether this association has become stronger over time., Methods: All residents of Stockholm County at the time of graduation from compulsory education between 2000 and 2007 (N = 169,125) were followed prospectively for recipient of disability benefits due to a mental disorder from 2003 to 2011. Information about the study participants was obtained by linkage of national registers. Low school performance in the last year of compulsory school was defined as having a merit rating corresponding to the lowest quintile. The association between school performance and disability benefits was examined using Cox proportional hazards models., Results: Low school performers had a greater risk of disability benefits due to mental disorders during early adulthood, as compared to their better performing counterparts, and this association was more pronounced for the more recent graduation cohorts (OR = 1.12, 95% CI 1.08-1.16)., Conclusions: The association between low school performance and the risk of disability benefits due to mental disorders seems to become stronger during the first decade of the twenty-first century. It is plausible that this trend indicates an increased vulnerability of poor school performers to exclusion from the labor market. Prevention of school failure and adjustment of the labour market to individual variability in academic performance appear to be critical approaches to counteract this trend.

Background: The autism-spectrum quotient scale was developed to study autism as a spectrum. Few studies have examined the psychometric properties of the 10 item AQ (AQ-10). We examine the AQ-10 measurement ability and convergent validity in a population health survey (n = 44,722)., Methods: The item severity and item discrimination was assessed using item response theory. Convergent validity was assessed by regressing on ADHD, psychological distress (PD) and having an education in the sciences., Results: Whilst unidimensional, the AQ-10 had some poorly fitting items. Item discrimination ranged from very low to very high. The scale correlated as hypothesised with the regress expected when factoring in ADHD, PD and possessing an eduction in the sciences., Conclusion: The AQ-10 has adequate validity in the present sample and may be used in s as a measure of autistic traits. In Conclusion, The AQ-10 has adequate validity to be used in health surveys as a measure of autistic traits, although some items may perform poorly.