Objective To determine the association between parental mental illness and the risk of injuries among offspring. Design Retrospective cohort study. Setting Swedish population based registers. Participants 1 542 000 children born in 1996-2011 linked to 893 334 mothers and 873 935 fathers. Exposures Maternal or paternal mental illness (non-affective psychosis, affective psychosis, alcohol or drug misuse, mood disorders, anxiety and stress related disorders, eating disorders, personality disorders) identified through linkage to inpatient or outpatient healthcare registers. Main outcome measures Risk of injuries (transport injury, fall, burn, drowning and suffocation, poisoning, violence) at ages 0-1, 2-5, 6-9, 10-12, and 13-17 years, comparing children of parents with mental illness and children of parents without mental illness, calculated as the rate difference and rate ratio adjusted for confounders. Results Children with parental mental illness contributed to 201 670.5 person years of follow-up, while children without parental mental illness contributed to 2 434 161.5 person years. Children of parents with mental illness had higher rates of injuries than children of parents without mental illness (for any injury at age 0-1, these children had an additional 2088 injuries per 100 000 person years; number of injuries for children with and without parental mental illness was 10 235 and 72 723, respectively). At age 0-1, the rate differences ranged from 18 additional transport injuries to 1716 additional fall injuries per 100 000 person years among children with parental mental illness compared with children without parental mental illness. A higher adjusted rate ratio for injuries was observed from birth through adolescence and the risk was highest during the first year of life (adjusted rate ratio at age 0-1 for the overall association between any parental mental illness that has been recorded in the registers and injuries 1.30, 95% confidence interval 1.26 to 1.33). Adjusted rate ratios at age 0-1 ranged from 1.28 (1.24 to 1.32) for fall injuries to 3.54 (2.28 to 5.48) for violence related injuries. Common and serious maternal and paternal mental illness was associated with increased risk of injuries in children, and estimates were slightly higher for common mental disorders. Conclusions Parental mental illness is associated with increased risk of injuries among offspring, particularly during the first years of the child’s life. Efforts to increase access to parental support for parents with mental illness, and to recognise and treat perinatal mental morbidity in parents in secondary care might prevent child injury.

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. MethodsWe 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 betweenJan 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.

BackgroundPrevious studies on the effect of zolpidem or zopiclone use on the risk of road traffic crashes (RTCs) have shown mixed results.ObjectiveOur objective was to determine the association between zolpidem or zopiclone use (as separate drugs or combined) and the occurrence of injurious RTCs among older adult drivers.MethodsThis was a population-based matched case–control and case–crossover study based on secondary data linked together from Swedish national registers. Cases were drivers aged 50–80 years involved in a vehicle crash resulting in injuries between January 2006 and December 2009 for the case–control study (n = 27,096) and from February 2006 to December 2009 for the case–crossover study (n = 26,586). For the first design, four controls were matched to each case by sex, age, and residential area, and exposure was categorized into new, occasional, and frequent use of zolpidem only, zopiclone only, and combined zolpidem and zopiclone. For the case–crossover study, newly dispensed zolpidem or zopiclone users were assessed during the 28 days prior to the crash and compared with an equally long control period using a 12-week washout period. Matched adjusted odds ratios (OR) were computed using conditional logistic regression.ResultsIncreased ORs for all users were observed. In the case–control study, the highest odds were seen among newly initiated zolpidem-only users involved in single-vehicle crashes (adjusted OR 2.27; 95% confidence interval [CI] 1.21–4.24), followed by frequent combined zolpidem and zopiclone users [adjusted OR 2.20; CI 1.21–4.00]. In the case–crossover, newly initiated treatment with zolpidem or zopiclone showed an increased risk that was highest in the 2 weeks after the start of the treatment (OR 2.66; 95% CI 1.04–6.81).ConclusionsThese results provide more compelling evidence for the role of zolpidem or zopiclone in the occurrence of RTCs among older adults, not only in frequent users, but also at the beginning of treatment.Electronic supplementary materialThe online version of this article (doi:10.1007/s40263-017-0445-9) contains supplementary material, which is available to authorized users.

Background Previous studies assessing the relationship between depression and diabetes mellitus did not consider the severity of depression. In the present study we assessed the risk of developing type 2 diabetes mellitus (T2DM) among people with various severity of depression. Methods This prospective longitudinal cohort study included 9,936 individuals residing in Stockholm County, Sweden who responded to the baseline questionnaire in 1998–2000. The participants were followed from 1 year after the baseline up to 2015 for the occurrence of T2DM, using the National Patient Register, Swedish Prescribed Drug Registers, and Cause of Death Register. Depression and anxious distress were assessed using psychiatric rating scales and defined according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Results Depression was associated with a statistically significant increased risk of T2DM after adjusting for potential confounders (OR 1.48, CI 1.10, 1.99). The strongest association was observed for severe depression (OR 1.72, CI 1.15, 2.59). Further, those with depression, regardless of severity, and with concurrent moderate/severe anxious distress had an increased risk of T2DM (OR 1.73, CI 1.13, 2.63) compared to those with neither depression nor anxious distress. Conclusions The study adds evidence that depression is associated with a higher risk for developing T2DM , and the association is stronger among people with severe depression. Electronic supplementary material The online version of this article (10.1186/s12889-019-7322-z) contains supplementary material, which is available to authorized users.

ObjectivesDespite much focus on the health impact of road traffic injury (RTI) on life, there is a lack of knowledge of the dynamic process of return to work following RTI and its related factors. The aim of this study was to identify longitudinal patterns of sickness absence (SA) following RTI, to examine the patterns’ interplay with health-related quality of life (HRQoL) and to determine if there are differences, regarding the patterns and interplay, according to injury severity.DesignA register-based prospective cohort study.SettingAdministrative data on RTI in Sweden from the Swedish Traffic Accident Data Acquisition System (STRADA) and Swedish Social Insurance data.ParticipantsIndividuals suffering an RTI (total n=4761) were identified in STRADA between 1 January 2007 and 31 December 2009. A total of 903 of these met the inclusion criteria for the current study and were included.Primary and secondary outcome measuresThe primary outcome measure was SA following RTI. The secondary outcome measure was HRQoL.ResultsThree distinct patterns of SA were identified; ‘Stable’, ‘Quick decrease’ and ‘Gradual decrease’. The patterns differed in the number of initial SA days and the rate of reduction of SA days. After 3 years, all three patterns had almost the same level of SA. Higher injury severity and a higher number of SA days had a negative interplay with HRQoL. Participants who initially had a higher number of SA days were more likely to report a low HRQoL, indicating that people with a slower return to work are more vulnerable.ConclusionThe study highlights the heterogeneity of return to work after an RTI. People with a more severe injury and slower pace of return to work seem to be more vulnerable with regards to HRQoL loss following RTI.