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BETA
von Knorring, Anne-LiisORCID iD iconorcid.org/0000-0003-3975-0063
Publications (10 of 32) Show all publications
Ssegonja, R., Alaie, I., Philipson, A., Hagberg, L., Sampaio, F., Möller, M., . . . Feldman, I. (2019). Depressive disorders in adolescence, recurrence in early adulthood, and healthcare usage in mid-adulthood: A longitudinal cost-of-illness study. Journal of Affective Disorders, 258, 33-41
Open this publication in new window or tab >>Depressive disorders in adolescence, recurrence in early adulthood, and healthcare usage in mid-adulthood: A longitudinal cost-of-illness study
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2019 (English)In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 258, p. 33-41Article in journal (Refereed) Published
Abstract [en]

Background: Depression in adolescence is associated with increased healthcare consumption in adulthood, but prior research has not recognized the heterogeneity of depressive disorders. This paper investigated the additional healthcare usage and related costs in mid-adulthood for individuals with adolescent depression, and examined the mediating role of subsequent depression in early adulthood.

Methods: This study was based on the Uppsala Longitudinal Adolescent Depression Study, initiated in Sweden in the early 1990s. Depressive disorders were assessed in adolescence (age 16-17) and early adulthood (age 19-30). Healthcare usage and related costs in mid-adulthood (age 31-40) were estimated using nationwide population-based registries. Participants with specific subtypes of adolescent depression (n = 306) were compared with matched non-depressed peers (n = 213).

Results: Women with persistent depressive disorder (PDD) in adolescence utilized significantly more healthcare resources in mid-adulthood. The association was not limited to psychiatric care, and remained after adjustment for individual and parental characteristics. The total additional annual cost for a single age group of females with a history of PDD at a population level was estimated at 3.10 million USD. Depression recurrence in early adulthood mediated the added costs for psychiatric care, but not for somatic care.

Limitations: Primary health care data were not available, presumably resulting in an underestimation of the true healthcare consumption. Estimates for males had limited precision due to a relatively small male proportion.

Conclusions: On a population level, the additional healthcare costs incurred in mid-adulthood in females with a history of adolescent PDD are considerable. Early treatment and prevention should be prioritized.

Place, publisher, year, edition, pages
ELSEVIER, 2019
Keywords
Adolescence, Depression, Direct costs, Adulthood, Psychiatric healthcare, Non-psychiatric healthcare
National Category
Psychiatry Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-393715 (URN)10.1016/j.jad.2019.07.077 (DOI)000482176400004 ()31382102 (PubMedID)
Funder
Swedish Research Council, 2014-10092Forte, Swedish Research Council for Health, Working Life and WelfareSwedish Research Council FormasVinnova
Available from: 2019-09-30 Created: 2019-09-30 Last updated: 2019-09-30Bibliographically approved
Alaie, I., Philipson, A., Ssegonja, R., Hagberg, L., Feldman, I., Sampaio, F., . . . Jonsson, U. (2019). Uppsala Longitudinal Adolescent Depression Study (ULADS). BMJ Open, 9(3), Article ID e024939.
Open this publication in new window or tab >>Uppsala Longitudinal Adolescent Depression Study (ULADS)
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2019 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 3, article id e024939Article in journal (Refereed) Published
Abstract [en]

Purpose: To present the Uppsala Longitudinal Adolescent Depression Study, initiated in Uppsala, Sweden, in the early 1990s. The initial aim of this epidemiological investigation was to study the prevalence, characteristics and correlates of adolescent depression, and has subsequently expanded to include a broad range of social, economic and health-related long-term outcomes and cost-of-illness analyses.

Participants: The source population was first-year students (aged 16-17) in upper-secondary schools in Uppsala during 1991-1992, of which 2300 (93%) were screened for depression. Adolescents with positive screening and sex/age-matched peers were invited to a comprehensive assessment. A total of 631 adolescents (78% females) completed this assessment, and 409 subsequently completed a 15year follow-up assessment. At both occasions, extensive information was collected on mental disorders, personality and psychosocial situation. Detailed social, economic and health-related data from 1993 onwards have recently been obtained from the Swedish national registries for 576 of the original participants and an age-matched reference population (N=200 000).

Findings to date: The adolescent lifetime prevalence of a major depressive episode was estimated to be 11.4%. Recurrence in young adulthood was reported by the majority, with a particularly poor prognosis for those with a persistent depressive disorder or multiple somatic symptoms. Adolescent depression was also associated with an increased risk of other adversities in adulthood, including additional mental health conditions, low educational attainment and problems related to intimate relationships.

Future plans: Longitudinal studies of adolescent depression are rare and must be responsibly managed and utilised. We therefore intend to follow the cohort continuously by means of registries. Currently, the participants are approaching mid-adulthood. At this stage, we are focusing on the overall long-term burden of adolescent depression. For this purpose, the research group has incorporated expertise in health economics. We would also welcome extended collaboration with researchers managing similar datasets.

National Category
Psychiatry Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-389609 (URN)10.1136/bmjopen-2018-024939 (DOI)000471144900167 ()30826765 (PubMedID)
Funder
Swedish Research Council, 2014-10092Forte, Swedish Research Council for Health, Working Life and WelfareStiftelsen Söderström - Königska sjukhemmet
Available from: 2019-07-22 Created: 2019-07-22 Last updated: 2019-07-22Bibliographically approved
Päären, A., Bohman, H., von Knorring, L., Olsson, G., von Knorring, A.-L. & Jonsson, U. (2017). Early risk factors for adult bipolar disorder in adolescents with mood disorders: a 15-year follow-up of a community sample. Paper presented at 19th Annual Conference of the International-Society-for-Bipolar-Disorders, MAY 04-07, 2017, Washington, DC. Bipolar Disorders, 19(S1), 63-63
Open this publication in new window or tab >>Early risk factors for adult bipolar disorder in adolescents with mood disorders: a 15-year follow-up of a community sample
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2017 (English)In: Bipolar Disorders, ISSN 1398-5647, E-ISSN 1399-5618, Vol. 19, no S1, p. 63-63Article in journal, Meeting abstract (Other academic) Published
National Category
Psychiatry
Identifiers
urn:nbn:se:uu:diva-331816 (URN)10.1111/bdi.12479 (DOI)000401266200142 ()
Conference
19th Annual Conference of the International-Society-for-Bipolar-Disorders, MAY 04-07, 2017, Washington, DC
Available from: 2017-10-18 Created: 2017-10-18 Last updated: 2017-10-18Bibliographically approved
Hultcrantz, E. & von Knorring, A.-L. (2014). Barn med uppgivenhetssyndrom behöver läkarintyg omgående. Läkartidningen (04/01)
Open this publication in new window or tab >>Barn med uppgivenhetssyndrom behöver läkarintyg omgående
2014 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, no 04/01Article in journal, Editorial material (Other (popular science, discussion, etc.)) Published
National Category
Medical and Health Sciences
Research subject
Child and Youth Psychiatry
Identifiers
urn:nbn:se:uu:diva-244782 (URN)
Available from: 2015-02-20 Created: 2015-02-20 Last updated: 2017-12-04Bibliographically approved
Päären, A., Bohman, H., von Knorring, L., Olsson, G., von Knorring, A.-L. & Jonsson, U. (2014). Early risk factors for adult bipolar disorder in adolescents with mood disorders: A 15-year follow-up of a community sample. BMC Psychiatry, 14(1), 363
Open this publication in new window or tab >>Early risk factors for adult bipolar disorder in adolescents with mood disorders: A 15-year follow-up of a community sample
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2014 (English)In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 14, no 1, p. 363-Article in journal (Refereed) Published
Abstract [en]

Background:  We aimed to outline the early risk factors for adult bipolar disorder (BPD) in adolescents with mood disorders.

Methods: Adolescents (16-17 years old) with mood disorders (n=287; 90 participants with hypomania spectrum episodes and 197 with major depressive disorder [MDD]) were identified from a community sample. Fifteen years later (at 30-33 years of age), mood episodes were assessed (n=194). The risk of developing BPD (n=22), compared with MDD (n=104) or no mood episodes in adulthood (n=68), was estimated via logistic regression. Adolescent mood symptoms, non-mood disorders, and family characteristics were assessed as potential risk factors.

Results: Among the adolescents with mood disorders, a family history of BPD was the strongest predictor of developing BPD compared with having no mood episodes in adulthood (OR=5.94; 95% CI=1.11-31.73), whereas disruptive disorders significantly increased the risk of developing BPD compared with developing MDD (OR=2.94; CI=1.06-8.12). The risk that adolescents with MDD would develop adult BPD, versus having no mood episodes in adulthood, was elevated among those with an early disruptive disorder (OR=3.62; CI=1.09-12.07) or multiple somatic symptoms (OR=6.60; CI=1.70-25.67). Only disruptive disorders significantly predicted adult BPD among adolescents with MDD versus continued MDD in adulthood (OR=3.59; CI=1.17-10.97). Only a few adolescents with hypomania spectrum episodes continued to have BPD as adults, and anxiety disorders appeared to increase this risk.

Conclusions: Although most of the identified potential risk factors are likely general predictors of continued mood disorders, disruptive disorders emerged as specific predictors of developing adult BPD among adolescents with MDD.

Keywords
adolescent mood disorders, bipolar disorder, predictors, long-term follow-up assessment
National Category
Psychiatry
Research subject
Psychiatry
Identifiers
urn:nbn:se:uu:diva-239832 (URN)10.1186/s12888-014-0363-z (DOI)000348156400001 ()25539591 (PubMedID)
Projects
adolescents with mood disorders: A 15-year follow-up of a community sample
Available from: 2015-01-02 Created: 2015-01-02 Last updated: 2017-12-05Bibliographically approved
Päären, A., Bohman, H., von Knorring, A.-L., von Knorring, L., Olsson, G. & Jonsson, U. (2014). Hypomania spectrum disorder in adolescence: a 15-year follow-up of non-mood morbidity in adulthood. BMC Psychiatry, 14, 9
Open this publication in new window or tab >>Hypomania spectrum disorder in adolescence: a 15-year follow-up of non-mood morbidity in adulthood
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2014 (English)In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 14, p. 9-Article in journal (Refereed) Published
Abstract [en]

Background:

We investigated whether adolescents with hypomania spectrum episodes have an excess risk of mental and physical morbidity in adulthood, as compared with adolescents exclusively reporting major depressive disorder (MDD) and controls without a history of adolescent mood disorders.

Methods:

A community sample of adolescents (N = 2 300) in the town of Uppsala, Sweden, was screened for depressive symptoms. Both participants with positive screening and matched controls (in total 631) were diagnostically interviewed. Ninety participants reported hypomania spectrum episodes (40 full-syndromal, 18 with brief episode, and 32 subsyndromal), while another 197 fulfilled the criteria for MDD without a history of a hypomania spectrum episode. A follow up after 15 years included a blinded diagnostic interview, a self-assessment of personality disorders, and national register data on prescription drugs and health services use. The participation rate at the follow-up interview was 71% (64/90) for the hypomania spectrum group, and 65.9% (130/197) for the MDD group. Multiple imputation was used to handle missing data.

Results:

The outcomes of the hypomania spectrum group and the MDD group were similar regarding subsequent non-mood Axis I disorders in adulthood (present in 53 vs. 57%). A personality disorder was reported by 29% of the hypomania spectrum group and by 20% of the MDD group, but a statistically significant difference was reached only for obsessive-compulsive personality disorder (24 vs. 14%). In both groups, the risk of Axis I disorders and personality disorders in adulthood correlated with continuation of mood disorder. Prescription drugs and health service use in adulthood was similar in the two groups. Compared with adolescents without mood disorders, both groups had a higher subsequent risk of psychiatric morbidity, used more mental health care, and received more psychotropic drugs.

Conclusions:

Although adolescents with hypomania spectrum episodes and adolescents with MDD do not differ substantially in health outcomes, both groups are at increased risk for subsequent mental health problems. Thus, it is important to identify and treat children and adolescents with mood disorders, and carefully follow the continuing course.

Keywords
Adolescence, Hypomania spectrum, Follow up, Comorbidity
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-218944 (URN)10.1186/1471-244X-14-9 (DOI)000330075000002 ()
Available from: 2014-02-27 Created: 2014-02-20 Last updated: 2017-12-05Bibliographically approved
Päären, A., von Knorring, A.-L., Olsson, G., von Knorring, L., Bohman, H. & Jonsson, U. (2013). Hypomania spectrum disorders from adolescence to adulthood: A 15-year follow-up of a community sample. Journal of Affective Disorders, 145(2), 190-199
Open this publication in new window or tab >>Hypomania spectrum disorders from adolescence to adulthood: A 15-year follow-up of a community sample
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2013 (English)In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 145, no 2, p. 190-199Article in journal (Refereed) Published
Abstract [en]

Background: There is a lack of scientific knowledge about the broader spectrum of hypomania in adolescence and the course over time. To investigate this, we used longitudinal data spanning from adolescence to age 31 years.

Method: A community sample of adolescents (N=2300) was screened for depressive symptoms. Adolescents (16-17 years) with a positive screening and matched controls were interviewed with a structured diagnostic interview. A blinded follow-up assessment was conducted 15 years later, with a structured diagnostic interview covering the age span 19-31 years. Questions about treatment and family history were included.

Results: Ninety adolescents (16-17 years) with a lifetime hypomania spectrum episode (3.9% of the total sample) were identified: 40 with fullsyndromal, 18 with brief-episode (<4 day), and 32 with subsyndromal (1-2 main symptoms and 1-2 additional symptoms) hypomania. The hypomania symptoms reported by the fullsyndromal and the brief-episode groups were similar, whereas the subsyndromal group per definition reported fewer symptoms. Of the 90 adolescents with a hypomania spectrum episode, 64 (71%) participated in the follow-up interview. Mania in adulthood was reported by 2 (3%), hypomania by an additional 4 (6%), and major depression by 38 (59%). Incidence of mood episodes in adulthood did not differ between the subgroups of hypomania spectrum.

Limitations: 29% of the participants with hypomania spectrum were lost to follow-up.

Conclusion: The results indicate that only a small proportion of adolescents with hypomania spectrum episodes continue to have (hypo)mania in adulthood. Thus, maintenance or prophylactic treatment does not seem warranted for this group.

Keywords
Child and adolescent hypomania, Mood disorders, Long-term follow-up
National Category
Psychiatry
Research subject
Psychiatry
Identifiers
urn:nbn:se:uu:diva-196000 (URN)10.1016/j.jad.2012.07.031 (DOI)000314092100007 ()
Available from: 2013-03-04 Created: 2013-03-04 Last updated: 2017-12-06Bibliographically approved
Bahmanyar, S., Sundstrom, A., Kaijser, M., von Knorring, A.-L. & Kieler, H. (2013). Pharmacological treatment and demographic characteristics of pediatric patients with Attention Deficit Hyperactivity Disorder, Sweden. European Neuropsychopharmacology, 23(12), 1732-1738
Open this publication in new window or tab >>Pharmacological treatment and demographic characteristics of pediatric patients with Attention Deficit Hyperactivity Disorder, Sweden
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2013 (English)In: European Neuropsychopharmacology, ISSN 0924-977X, E-ISSN 1873-7862, Vol. 23, no 12, p. 1732-1738Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to describe the pediatric population with ADHD and their pharmacological treatment. Using the Swedish National Patient Register and the Prescribed Drug Register we identified individuals below 19 years of age who were diagnosed or medically treated for ADHD for the first time 2006-2007. The unique patient identifiers were used to link information from the two registers to describe demographic characteristics, hospital care and drug treatments. Logistic regression model estimated the association between age, sex, frequency of hospitalization, diagnosis or treatment for other mental disorders and risk of gap in the treatment. Totally the study included 7931 patients of whom 74% were males. The mean age at first diagnosis was 12 years. Some 84% were medically treated for ADHD and approximately 90% received methylphenidate as the first substance. Combination therapy was rare and the most common combination was methylphenidate and atomoxetine. More than 55% of the patients, which could be followed up for two years after start of treatment, had at least one treatment gap of six months. Older age at diagnosis, lower number of hospitalizations and comorbidity with other mental disorders increased risks of gaps in medication. Approximately one fifth of the patients recorded in the National Patient Register as diagnosed with ADHD did not receive pharmacological treatment. Medication adherence seems to be low, when measured as gaps in treatment.

Keywords
Attention Deficit Disorder with Hyperactivity, Methylphenidate, Atomoxetine, Amphetamine, Dextroamphetamine, Pediatrics, Cohort study
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-213907 (URN)10.1016/j.euroneuro.2013.07.009 (DOI)000327921900008 ()
Available from: 2014-01-06 Created: 2014-01-05 Last updated: 2017-12-06Bibliographically approved
Hultcrantz, E. & von Knorring, A.-L. (2012). Apatiska barn finns: och de har rätt till vård. Läkartidningen, 109(43), 1932-1933
Open this publication in new window or tab >>Apatiska barn finns: och de har rätt till vård
2012 (English)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 109, no 43, p. 1932-1933Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-184926 (URN)
Available from: 2012-11-19 Created: 2012-11-15 Last updated: 2017-12-07Bibliographically approved
von Knorring, A.-L. (2012). Barnpsykiatri (2 revideraded.). In: Lars Olsson och Anna Josephson (Ed.), Hjärnan: (pp. 239-256). Stockholm: Karolinska Institutet University Press
Open this publication in new window or tab >>Barnpsykiatri
2012 (Swedish)In: Hjärnan / [ed] Lars Olsson och Anna Josephson, Stockholm: Karolinska Institutet University Press , 2012, 2 reviderad, p. 239-256Chapter in book (Other (popular science, discussion, etc.))
Place, publisher, year, edition, pages
Stockholm: Karolinska Institutet University Press, 2012 Edition: 2 reviderad
Keywords
Brain
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-190543 (URN)978-91-85565-59-7 (ISBN)
Available from: 2013-01-08 Created: 2013-01-08 Last updated: 2017-10-18Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-3975-0063

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