Socioeconomic position at the age of 30 and the later risk of a mental disorder: a nationwide population-based register study

Hakulinen, Christian; Komulainen, Kaisla; Suokas, Kimmo; Pirkola, Sami; Pulkki-Råbäck, Laura; Lumme, Sonja; Elovainio, Marko; Böckerman, Petri

doi:10.1136/jech-2022-219674

Cited by 7 publications

(6 citation statements)

References 32 publications

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“…On the contrary, we found a positive bidirectional relationship of genetic liability to EA with schizophrenia and BD which only becomes apparent after adjusting for income. These findings are in line with a recent nationwide study in Finland supporting contributions of both social causation and health selection mechanisms to the risk of mental disorders 50 , and may contradict, at least in terms of genetic liability, widespread social causation vs health selection theories. 51 EA MVMR estimates were in agreement with previous positive genetic correlations with schizophrenia and bipolar disorder.…”

Section: Discussionsupporting

confidence: 90%

“…Despite the well-established relationship of socioeconomic status (SES) to mental disorders, 17,18 considerable debate remains about the causal links between key SES constituents income and education with SMD. 17,49,50 We used MVMR to address the potential influence of SES multidimensionality on mental disorders by analysing the independent effects of genetic liability to income and EA on three SMD. Our study revealed different patterns of bidirectional associations between SES constituents and the three SMD.…”

Section: Discussionmentioning

confidence: 99%

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Socioeconomic status and severe mental disorders: A Bidirectional Multivariable Mendelian Randomisation Study

Andreu-Bernabeu

González-Peñas

Arango

et al. 2023

Preprint

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Importance Despite the evidence supporting the relationship between socioeconomic status (SES) and severe mental disorders (SMD), the directionality of the associations between income or education and mental disorders is still poorly understood. Objective To investigate the potential bidirectional causal relationships between genetic liability to the two main components of SES (i.e., income and educational attainment (EA)) on three SMD: schizophrenia (SCZ), bipolar disorder (BD) and major depressive disorder (MDD) using multivariable Mendelian randomisation. Design, Setting, and Participants We performed a bidirectional, two-sample multivariable Mendelian randomisation (MVMR) study using summary statistics from the latest genome-wide associations studies (GWAS) of the Psychiatric Genomics Consortium (PGC), the UK biobank and the Social Science Genetic Association Consortium (SSGAC) to dissect the potential associations of income and EA with schizophrenia, BD and MDD including data for participants of European ancestry only. Data covered September 2022 to January 2023. Main Outcomes and Measures Socioeconomic status phenotypes (household income from the UK biobank, n=397,751, and EA based on the largest meta-analysis GWAS of individuals of European ancestry, n=766,345) and SMD from the PGC (schizophrenia, n=127,906; BD, n=51,710; and MDD n=500,119). Follow-up analyses were performed using the intelligence meta-analytical phenotype, n=269,867. Results GWAS data were derived from participants of European ancestry included in the UK Biobank, SSGAC and PGC consortiums (samples ranging from 766,345 to 51,710 individuals). Univariable MR (UVMR) showed that genetic liability to household income was associated with decreased risk of schizophrenia (IVW-ORSCZ=0.58 per-one-SD increase; P-value= 0.016) and MDD (IVW-ORMDD:0.66 P-value: 9.81e-08), with a smaller reverse effect of schizophrenia and MDD on income (IVW-βSCZ= -0.1147, P-value=7.55E-08; IVW-βDEP=-0.0356, P-value=8.70E-04). Direct effects (MVMR) after adjusting for EA were comparable. UVMR showed that genetic liability to EA was associated with lower risk of MDD and higher risk of BD, with no significant effects on schizophrenia. After accounting for income in the MMVR analyses, direct effects of genetic liability to EA was associated with increased risk of BD (MVMR-ORBIP: 2.69 per SD increase, P-value= 0.0000113) and schizophrenia (MVMR-ORSCZ: 2.09 per-SD-increase, P-value= 0.00108), but not with MDD. Effects for the association of EA with schizophrenia and BD were larger when including genetic liability to intelligence in the MVMR model, thus suggesting that they might reflect a non-cognitive component. Conclusions and Relevance The findings of this multivariable Mendelian randomisation analysis suggest an heterogenous pattern of causal links between SES and SMD. We found evidence for a negative bidirectional association between genetic liability to household income and the risk of schizophrenia and MDD. On the contrary, we found a positive bidirectional relationship of genetic liability to EA with schizophrenia and bipolar disorder, which only becomes apparent after adjusting for income. These findings shed light on the directional mechanisms between social determinants and mental disorders and may help to guide public mental health strategies addressing inequality and economic disadvantages.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Socioeconomic status and severe mental disorders: A Bidirectional Multivariable Mendelian Randomisation Study

Andreu-Bernabeu

González-Peñas

Arango

et al. 2023

Preprint

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“…Household income was a particularly strong cofactor in the models. This is not surprising, as income inequality and individual level low income and mental disorders have been strongly linked with complex bi-directional pathways (Pickett & Wilkinson, 2015;Hakulinen et al, 2020;Ridley et al, 2020;Suokas et al, 2020;Hakulinen et al, 2023). In the current study, we did not explore the causal pathways behind the mental disorders and income distribution.…”

Section: Discussionmentioning

confidence: 79%

Geographical variation in treated psychotic and other mental disorders in Finland by region and urbanicity

Suokas

Kurkela

Nevalainen

et al. 2023

Preprint

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Background: In Finland, prevalence of schizophrenia is higher in the eastern and northern regions and co-occurs with the distribution of schizophrenia polygenic risk scores. Both genetic and environmental factors have been hypothesized to contribute to this variation, but its reasons are not fully understood. We aimed to examine the prevalence of psychotic and other mental disorders by region and degree of urbanicity, and the impacts of socio-economic adjustments on these associations. Methods: Nationwide population registers from 2011 to 2017 and healthcare registers from 1975 to 2017. We used 19 administrative and three aggregate regions, and a seven-level urban-rural classification with 250 x 250 m resolution. Prevalence ratios (PRs) were calculated by Poisson regression models and adjusted for gender, age, and calendar year (basic adjustments), and origin, residential history, urbanicity, household income, economic activity, and physical comorbidity (additional adjustments) on an individual level. Average marginal effects were used to visualize interaction effects between region and urbanicity. Results: A total of 5 898 180 individuals were observed. All mental disorders were slightly more prevalent (PR 1.03 [95% CI, 1.02-1.03]), and psychotic disorders (1.11 [1.10-1.12]) and schizophrenia (1.19 [1.17-1.21]) considerably more prevalent in eastern and northern than in western coastal regions. After the additional adjustments, however, the PRs were 0.95 (0.95-0.96), 1.00 (0.99-1.01), and 1.03 (1.02-1.04), respectively. Urban residence was associated with increased prevalence of psychotic disorders across all regions (adjusted PR 1.21 [1.20-1.22]). Conclusions: Socioeconomic and sociodemographic factors modulate the within-country geographical distribution of mental disorders highlighting their truly contextual nature.

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“…Effective interventions and support systems are urgently needed to alleviate the burden of mental health issues in these crucial demographics. 48 , 49 These findings emphasize the importance of considering gender and age disparities when addressing the burden of mental disorders. Tailoring interventions and providing targeted support based on these differences can improve mental health outcomes and ensure more effective and equitable mental health care for individuals of all ages and genders.…”

Section: Discussionmentioning

confidence: 84%

Burden and Epidemiology of Mental Disorders in the Middle East and North Africa from 1990 to 2019: Findings from the Global Burden of Disease Study

Effatpanah,

Nakhostin-Ansari,

Gorgani

et al. 2024

Balkan Med J

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Background: Previous studies have mainly focused on individual mental disorders, and there is no study addressing the total burden of mental disorders in the Middle East and North Africa (MENA). Aims: To evaluate the burden of mental disorders in the MENA region from 1990 to 2019. Study Design: A cross-sectional study. Methods: We utilized global burden of disease data to examine the burden of 12 mental disorders from 1990 to 2019 across age groups, genders, and the 21 MENA countries. We collected data on prevalence, incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years (DALY), including both crude and age-standardized rates per 100,000 people. Results: The DALY rate of mental disorders in MENA countries increased by 13.88% from 1,747.92 per 100,000 people in 1990 to 1990.5 per 100,000 people in 2019. The highest percentage increases in the DALY rates of mental disorders were observed for bulimia nervosa (35.69%), other mental health disorders (34.58%), and schizophrenia (33.02%) from 1990 to 2019. However, the DALY rates for idiopathic developmental intellectual disability (-26.48%), conduct disorder (-23.91%), attention-deficit/ hyperactivity disorder (-16.46%), and autism spectrum disorders (-4.12%) decreased in the MENA region from 1990 to 2019. In 2019, the highest DALY rates for idiopathic developmental intellectual disability, anxiety disorders, and major depressive disorder were observed in age groups ≤ 4 years, 5-19 years, and ≥ 20 years, respectively. The age-standardized DALY rate of mental disorders was the highest in Palestine (2,396.9 per 100,000), Iran (2,295.8 per 100,000), and Lebanon (2,126.0 per 100,000) compared with other MENA countries in 2019. Conclusion: There has been a slight increase in the burden of mental disorders in the MENA region between 1990 and 2019. National policies should prioritize evidence-based preventive measures and ensure accessible treatment options for mental health disorders in the population, especially in the MENA region.

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Socioeconomic position at the age of 30 and the later risk of a mental disorder: a nationwide population-based register study

Cited by 7 publications

References 32 publications

Socioeconomic status and severe mental disorders: A Bidirectional Multivariable Mendelian Randomisation Study

Socioeconomic status and severe mental disorders: A Bidirectional Multivariable Mendelian Randomisation Study

Geographical variation in treated psychotic and other mental disorders in Finland by region and urbanicity

Burden and Epidemiology of Mental Disorders in the Middle East and North Africa from 1990 to 2019: Findings from the Global Burden of Disease Study

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