Journal Articles

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    Comorbidity and temporal associations between mental disorders among college students in the world mental health international college student initiative
    (Elsevier B V, 2025-09-01) Roest AM; de Vries YA; Pozuelo JR; Petukhova MV; Lee S; Sampson NA; Albor Y; Alhadi AN; Alonso J; Al-Saud N; Altwaijri Y; Andersson C; Atwoli L; Auerbach RP; Muaka CA; Báez-Mansur PM; Ballester L; Bantjes J; Baumeister H; Bendtsen M; Benjet C; Berman AH; Bruffaerts R; Carrasco P; Chan SCN; Cohut I; Couder MAC; Crockett MA; Cuijpers P; David OA; Dong D; Ebert DD; Gaete J; Forero CG; Gili M; Gutiérrez-García R; Haro JM; Hasking P; Hunt X; Husky MM; Jaguga F; Langer ÁI; Léniz I; Liu Y; Mac-Ginty S; Martínez V; McLafferty M; Miranda A; Monroy-Velasco IR; Murray EK; Musyoka CM; Nedelcea C; Núñez D; O'Neill SM; Piqueras JA; Popescu CA; Prescivalli AP; Rapsey C; Robinson K; Rodriguez-Jimenez T; Saal W; Siu O-L; Stein DJ; Struijs SY; Tomoiaga CT; Valdés-García KP; Vargas-Contreras E; Vigo DV; Wang AY; Wong SYS; Kessler RC; World Mental Health International College Student collaborators
    Background: Mental disorders are highly prevalent among students worldwide. This study aims to examine comorbidity and temporal associations between mental disorders among students. Methods: The study included 72,288 students from 18 countries as part of the World Mental Health International College Student (WMH-ICS) Initiative, with cross-sectional data collected between 2017 and 2023. Screening for common DSM-5 disorders was conducted using validated screening measures. Latent variables were examined using exploratory principal axis factor analysis on a correlation matrix among the lifetime mental disorders. Based on age-of-onset information, multivariable poisson regression models were used to examine associations of prior disorders with the first onset of other disorders. Results: 27.0 % of students screened positive for only one lifetime disorder, 17.1 % for two, 10.9 % for three, and 10.6 % for 4+ disorders. In the factor analysis, three latent variables were found, comprising: internalizing disorders (generalized anxiety disorder, major depressive episode, post-traumatic stress disorder, and panic disorder), substance use disorders (drug use disorder and alcohol use disorder), and externalizing disorders (attention deficit/hyperactivity disorder and mania/hypomania). Prior internalizing and externalizing disorders were associated with the subsequent first onset of all other disorders with risk ratios ranging from 1.5–7.5. Substance use disorders were less consistently associated with the subsequent first onset of other disorders, but alcohol use disorder was associated with the first onset of drug use disorder and vice versa. Conclusions: Mental disorder comorbidity is common among students, and students with disorders across the internalizing and externalizing spectrum have an increased risk of future mental disorder comorbidities.
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    Molecular epidemiology and whole genome sequencing analysis of clinical Mycobacterium bovis from Ghana.
    (PLOS, 2019-03-04) Otchere ID; van Tonder AJ; Asante-Poku A; Sánchez-Busó L; Coscollá M; Osei-Wusu S; Asare P; Aboagye SY; Ekuban SA; Yahayah AI; Forson A; Baddoo A; Laryea C; Parkhill J; Harris SR; Gagneux S; Yeboah-Manu D; Spigelman M
    Background Bovine tuberculosis (bTB) caused by Mycobacterium bovis is a re-emerging problem in both livestock and humans. The association of some M. bovis strains with hyper-virulence, MDR-TB and disseminated disease makes it imperative to understand the biology of the pathogen. Methods Mycobacterium bovis (15) among 1755 M. tuberculosis complex (MTBC) isolated between 2012 and 2014 were characterized and analyzed for associated patient demography and other risk factors. Five of the M. bovis isolates were whole-genome sequenced and comparatively analyzed against a global collection of published M. bovis genomes. Results Mycobacterium bovis was isolated from 3/560(0.5%) females and 12/1195(1.0%) males with pulmonary TB. The average age of M. bovis infected cases was 46.8 years (7-72years). TB patients from the Northern region of Ghana (1.9%;4/212) had a higher rate of infection with M. bovis (OR = 2.7,p = 0.0968) compared to those from the Greater Accra region (0.7%;11/1543). Among TB patients with available HIV status, the odds of isolating M. bovis from HIV patients (2/119) was 3.3 higher relative to non-HIV patients (4/774). Direct contact with livestock or their unpasteurized products was significantly associated with bTB (p<0.0001, OR = 124.4,95% CI = 30.1–508.3). Two (13.3%) of the M. bovis isolates were INH resistant due to the S315T mutation in katG whereas one (6.7%) was RIF resistant with Q432P and I1491S mutations in rpoB. M. bovis from Ghana resolved as mono-phyletic branch among mostly M. bovis from Africa irrespective of the host and were closest to the root of the global M. bovis phylogeny. M. bovis-specific amino acid mutations were detected among MTBC core genes such as mce1A, mmpL1, pks6, phoT, pstB, glgP and Rv2955c. Additional mutations P6T in chaA, G187E in mgtC, T35A in Rv1979c, S387A in narK1, L400F in fas and A563T in eccA1 were restricted to the 5 clinical M. bovis from Ghana. Conclusion Our data indicate potential zoonotic transmission of bTB in Ghana and hence calls for intensified public education on bTB, especially among risk groups..
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    Determinants of cognitive performance and decline in 20 diverse ethno-regional groups: A COSMIC collaboration cohort study
    (Public Library of Science (PLoS), 2019-07) Lipnicki DM; Makkar SR; Crawford JD; Thalamuthu A; Kochan NA; Lima-Costa MF; Castro-Costa E; Ferri CP; Brayne C; Stephan B; Llibre-Rodriguez JJ; Llibre-Guerra JJ; Valhuerdi-Cepero AJ; Lipton RB; Katz MJ; Derby CA; Ritchie K; Ancelin M-L; Carrière I; Scarmeas N; Yannakoulia M; Hadjigeorgiou GM; Lam L; Chan W-C; Fung A; Guaita A; Vaccaro R; Davin A; Kim KW; Han JW; Suh SW; Riedel-Heller SG; Roehr S; Pabst A; van Boxtel M; Köhler S; Deckers K; Ganguli M; Jacobsen EP; Hughes TF; Anstey KJ; Cherbuin N; Haan MN; Aiello AE; Dang K; Kumagai S; Chen T; Narazaki K; Ng TP; Gao Q; Nyunt MSZ; Scazufca M; Brodaty H; Numbers K; Trollor JN; Meguro K; Yamaguchi S; Ishii H; Lobo A; Lopez-Anton R; Santabárbara J; Leung Y; Lo JW; Popovic G; Sachdev PS; for Cohort Studies of Memory in an International Consortium (COSMIC)
    Background With no effective treatments for cognitive decline or dementia, improving the evidence base for modifiable risk factors is a research priority. This study investigated associations between risk factors and late-life cognitive decline on a global scale, including comparisons between ethno-regional groups. Methods and findings We harmonized longitudinal data from 20 population-based cohorts from 15 countries over 5 continents, including 48,522 individuals (58.4% women) aged 54–105 (mean = 72.7) years and without dementia at baseline. Studies had 2–15 years of follow-up. The risk factors investigated were age, sex, education, alcohol consumption, anxiety, apolipoprotein E ε4 allele (APOE*4) status, atrial fibrillation, blood pressure and pulse pressure, body mass index, cardiovascular disease, depression, diabetes, self-rated health, high cholesterol, hypertension, peripheral vascular disease, physical activity, smoking, and history of stroke. Associations with risk factors were determined for a global cognitive composite outcome (memory, language, processing speed, and executive functioning tests) and Mini-Mental State Examination score. Individual participant data meta-analyses of multivariable linear mixed model results pooled across cohorts revealed that for at least 1 cognitive outcome, age (B = −0.1, SE = 0.01), APOE*4 carriage (B = −0.31, SE = 0.11), depression (B = −0.11, SE = 0.06), diabetes (B = −0.23, SE = 0.10), current smoking (B = −0.20, SE = 0.08), and history of stroke (B = −0.22, SE = 0.09) were independently associated with poorer cognitive performance (p < 0.05 for all), and higher levels of education (B = 0.12, SE = 0.02) and vigorous physical activity (B = 0.17, SE = 0.06) were associated with better performance (p < 0.01 for both). Age (B = −0.07, SE = 0.01), APOE*4 carriage (B = −0.41, SE = 0.18), and diabetes (B = −0.18, SE = 0.10) were independently associated with faster cognitive decline (p < 0.05 for all). Different effects between Asian people and white people included stronger associations for Asian people between ever smoking and poorer cognition (group by risk factor interaction: B = −0.24, SE = 0.12), and between diabetes and cognitive decline (B = −0.66, SE = 0.27; p < 0.05 for both). Limitations of our study include a loss or distortion of risk factor data with harmonization, and not investigating factors at midlife. Conclusions These results suggest that education, smoking, physical activity, diabetes, and stroke are all modifiable factors associated with cognitive decline. If these factors are determined to be causal, controlling them could minimize worldwide levels of cognitive decline. However, any global prevention strategy may need to consider ethno-regional differences.
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    Lifestyle Aspects As A Predictor Of Pain Among Oldest-Old Primary Care Patients – A Longitudinal Cohort Study
    (Dove Medical Press, 2019-11) Mallon T; Eisele M; König H-H; Brettschneider C; Röhr S; Pabst A; Weyerer S; Werle J; Mösch E; Weeg D; Fuchs A; Pentzek M; Heser K; Wiese B; Kleineidam L; Wagner M; Riedel-Heller S; Maier W; Scherer M
    Purpose: Dealing with the high prevalence of pain among the oldest-old (+75) is becoming a major health issue. Therefore, the aim of the study was to uncover health-related lifestyle behaviors (HLB) and age-related comorbidities which may predict, influence and prevent pain in old age. Patients and methods: In this longitudinal cohort study, data were obtained initially from 3.327 individuals aged 75+ from over 138 general practitioners (GP) during structured clinical interviews in 2003. Nine follow-ups (FU) were assessed until 2017. Available data from 736 individuals scoring in FU3 and FU7 were included in this analysis. Data were assembled in an ambulatory setting at participant’s homes. Associations were tested using a linear regression model (model 1) and ordered logistic regression model (model 2). Results: Statistical analyses revealed increased likelihood to experience pain for participants with comorbidities such as peripheral arterial disease (PAD) (coef. 13.51, P>t = 0.00) or chronic back pain (CBP) (coef. 6.64, P>t = 0.003) or higher body mass index (BMI) (coef. 0.57, P>t = 0.015) and, female gender (coef. 6.00, SE 3.0, t = 2.02, P>t = 0.044). Participants with medium education and former smokers showed significantly lower pain rating (coef. −5.05, P>t = 0.026; coef. −5.27, P>t = 0.026). Suffering from chronic back pain (OR = 2.03), osteoarthritis (OR = 1.49) or depressive symptoms (OR = 1.10) raised the odds to experience impairments in daily living due to pain. Physical activity showed no significant results. Conclusion: Chronic conditions such as PAD, or CBP, female gender and higher BMI may increase the risk of experiencing more pain while successful smoking cessation can lower pain ratings at old age. Early and consistent support through GPs should be given to older patients in order to prevent pain at old age.
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    Prevalence of pain and its associated factors among the oldest-olds in different care settings – results of the AgeQualiDe study
    (BioMed Central Ltd, 2018) Mallon T; Ernst A; Brettschneider C; König H-H; Luck T; Röhr S; Weyerer S; Werle J; Mösch E; Weeg D; Fuchs A; Pentzek M; Kleineidam L; Heser K; Riedel-Heller S; Maier W; Wiese B; Scherer M; AgeCoDe & AgeQualiDe study group
    Background The prevalence of pain is very common in the oldest age group. Managing pain successfully is a key topic in primary care, especially within the ageing population. Different care settings might have an impact on the prevalence of pain and everyday life. Methods Participants from the German longitudinal cohort study on Needs, Health Service Use, Costs and Health-related Quality of Life in a large Sample of Oldest-old Primary Care Patients (85+) (AgeQualiDe) were asked to rate their severity of pain as well as the impairment with daily activities. Besides gender, age, education, BMI and use of analgesics we focused on the current housing situation and on cognitive state. Associations of the dependent measures were tested using four ordinal logistic regression models. Model 1 and 4 consisted of the overall sample, model 2 and 3 were divided according to no cognitive impairment (NCI) and mild cognitive impairment (MCI). Results Results show a decline in pain at very old age but nonetheless a high prevalence among the 85+ year olds. Sixty-three per cent of the participants report mild to severe pain and 69% of the participants mild to extreme impairment due to pain with daily activities. Use of analgesics, depression and living at home with care support are significantly associated with higher and male gender with lower pain ratings. Conclusions Sufficient pain management among the oldest age group is inevitable. Outpatient care settings are at risk of overlooking pain. Therefore focus should be set on pain management in these settings.
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    Memory-related subjective cognitive symptoms in the adult population: prevalence and associated factors – results of the LIFE-Adult-Study
    (BioMed Central Ltd, 2018-05-21) Luck T; Roehr S; Rodriguez FS; Schroeter ML; Witte AV; Hinz A; Mehnert A; Engel C; Loeffler M; Thiery J; Villringer A; Riedel-Heller SG
    Background Subjectively perceived memory problems (memory-related Subjective Cognitive Symptoms/SCS) can be an indicator of a pre-prodromal or prodromal stage of a neurodegenerative disease such as Alzheimer’s disease. We therefore sought to provide detailed empirical information on memory-related SCS in the dementia-free adult population including information on prevalence rates, associated factors and others. Methods We studied 8834 participants (40–79 years) of the population-based LIFE-Adult-Study. Weighted prevalence rates with confidence intervals (95%-CI) were calculated. Associations of memory-related SCS with participants’ socio-demographic characteristics, physical and mental comorbidity, and cognitive performance (Verbal Fluency Test Animals, Trail-Making-Test, CERAD Wordlist tests) were analyzed. Results Prevalence of total memory-related SCS was 53.0% (95%-CI = 51.9–54.0): 26.0% (95%-CI = 25.1–27.0) of the population had a subtype without related concerns, 23.6% (95%-CI = 22.7–24.5) a subtype with some related concerns, and 3.3% (95%-CI = 2.9–3.7) a subtype with strong related concerns. Report of memory-related SCS was unrelated to participants’ socio-demographic characteristics, physical comorbidity (except history of stroke), depressive symptomatology, and anxiety. Adults with and without memory-related SCS showed no significant difference in cognitive performance. About one fifth (18.1%) of the participants with memory-related SCS stated that they did consult/want to consult a physician because of their experienced memory problems. Conclusions Memory-related SCS are very common and unspecific in the non-demented adult population aged 40–79 years. Nonetheless, a substantial proportion of this population has concerns related to experienced memory problems and/or seeks help. Already available information on additional features associated with a higher likelihood of developing dementia in people with SCS may help clinicians to decide who should be monitored more closely.
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    From diagnosis to long-term management: the experiences of older New Zealanders with obstructive sleep apnoea
    (Royal New Zealand College of General Practitioners, 28/06/2018) Gibson R; Campbell A; Mather S; Neil A
    INTRODUCTION: In New Zealand (NZ), access to public sleep services is limited to people deemed with the highest need. The prevalence of obstructive sleep apnoea (OSA) increases with age, but the symptoms and the treatment pathway is expected to differ for older compared to younger patients. This study explored the experience of older people regarding diagnosis and treatment services for OSA in order to inform considerations required in primary health and sleep services. METHODS: Patients who were initiated on Continuous Positive Airway Pressure (CPAP) therapy at the age of 65 years or older were invited to one of three 1.5-h focus group discussions. In total, 16 patients attended; nine were accompanied by their spouse or partner. Discussions were semi-structured and explored experiences with the OSA pathway, from diagnosis through to long-term management. RESULTS: Thematic analysis highlights the key symptoms of OSA. Patients’ experiences with diagnostic and treatment services were generally positive. However, there was an overarching need for greater knowledge and follow up regarding OSA and CPAP therapy. Most patients were happy with CPAP treatment. Issues associated with long-term use, comfort and daily management were highlighted, and strategies used to overcome them discussed. DISCUSSION: Focus groups reported similar experiences, positively endorsing the health value of OSA diagnosis and CPAP therapy. Mechanisms and resources are required at a primary healthcare level in order to raise awareness around sleep and aging, OSA and CPAP. This would aid earlier and more appropriate diagnosis and management of OSA and help overcome some of the gaps identified in this study.