Using Danish national registry data to understand psychopathology following potentially traumatic experiences

Gradus, Jaimie L.; Rosellini, Anthony J.; Szentkúti, Péter; Horváth‐Puhó, Erzsébet; Smith, Meghan L.; Galatzer‐Levy, Isaac R.; Lash, Timothy L.; Galea, Sandro; Schnurr, Paula P.; Sørensen, Henrik Toft

doi:10.1002/jts.22777

Cited by 10 publications

(15 citation statements)

References 46 publications

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“…The study supports previous findings that adolescents who experience PTEs have an increased risk of psychopathology in adolescence compared to their peers with no PTE exposure, particularly when there has been exposure to several PTEs (Gradus et al., 2022; Lewis et al., 2019). In line with a recent Danish population‐based study (Gradus et al., 2022), we observed stronger associations between PTEs and certain diagnoses; however, the associations between PTEs and different diagnoses had a wider spread (standardized morbidity ratios = 1.9–5.2) in that study compared with ours. Even as both studies measured associations between diagnoses, they differ in that we measured the rate of PTEs within diagnostic categories, whereas Gradus et al.…”

Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 75%

“…To our knowledge, our study was the first to examine cumulative associations between PTEs and psychopathology in adolescence across the diagnostic spectrum by using national registry data. The heightened level of trauma exposure across several disorders supported the notion of PTEs as a transdiagnostic risk factor (Gradus et al., 2022). We did not investigate the potential mechanisms of this association in the current study, but there are several possible pathways between PTE exposure and psychopathology.…”

Section: Discussionmentioning

confidence: 84%

“…A critical question is whether PTE exposure represents a transdiagnostic risk factor for mental health problems in general or if PTEs selectively increase the risk for a circumscribed set of disorders. Recent research using Danish datasets has indicated that most PTEs, barring those related to pregnancy, are linked with all categories of psychiatric diagnoses (Gradus et al., 2022). This finding suggests that PTEs might be viewed as general risk determinants.…”

mentioning

confidence: 99%

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Using Norwegian National Patient Registry data to understand associations between potentially traumatic life experiences and mental health care use in adolescence

Skandsen,

Hysing,

Askeland

et al. 2023

Journal of Traumatic Stress

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Exposure to potentially traumatic experiences (PTEs) is common among children and adolescents and associated with an increased risk of psychiatric diagnoses. This study aimed to ascertain how the number of PTEs differed across adolescent psychiatric diagnoses. Data on PTE exposure were derived from the youth@hordaland survey, and Axis 1 data were from the linked Norwegian National Patient Registry (NPR). Among 10,257 total adolescents, 9,555 (age range: 16–19 years, 53.9% female) consented to register linkage, 8,845 of whom were included in the analyses. Having contact with Child and Adolescent Mental Health Services (CAMHS) predicted more PTEs (estimated marginal mean [EMM] = 1.04, SE = 0.05) and exposure to two or more PTEs compared to having no CAMHS contact (EMM = 0.60) after adjusting for age, ethnicity, sex, and parental education. Adolescents diagnosed with attention‐deficit/hyperactivity disorder, depression, trauma‐related disorders, conduct disorder, and anxiety experienced significantly more PTEs (EMMs = 0.90–1.63) than those with no CAMHS contact (EMM = 0.57, SE = 0.01). All diagnostic categories except psychosis, autism spectrum disorders, and eating disorders had a significantly higher rate of PTEs compared with adolescents with no CAMHS contact. The study highlights the potential role of exposure to multiple PTEs as a transdiagnostic risk factor, although the level of risk varies between diagnoses.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 84%

mentioning

confidence: 99%

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Using Norwegian National Patient Registry data to understand associations between potentially traumatic life experiences and mental health care use in adolescence

Skandsen,

Hysing,

Askeland

et al. 2023

Journal of Traumatic Stress

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“…Because instrument-based studies intrinsically have lower power, they more often rely on administrative data sets and may have less valid measures than confounder–control studies. For example, large data sets grounded in electronic health records offer promise for instrument-based stress and trauma research (Gradus et al, 2022; Weissman et al, 2020). Such records can include detailed psychopathology diagnoses, but they typically lack high-quality survey-based measures or screeners used to accurately identify symptoms and diagnoses among people not seen by mental health providers.…”

Section: Strengths and Limitations Of Instrumental Variable Approache...mentioning

confidence: 99%

Opportunities and challenges in using instrumental variables to study causal effects in nonrandomized stress and trauma research.

Matthay¹,

Smith²,

Glymour³

et al. 2023

Psychological Trauma: Theory, Research, Practice, and Policy

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Objective: Researchers are often interested in assessing the causal effect of an exposure on an outcome when randomization is not ethical or feasible. Estimating causal effects by controlling for confounders can be unconvincing because important potential confounders remain unmeasured. Study designs leveraging instrumental variables (IVs) offer alternatives to confounder–control methods but are rarely used in stress and trauma research. Method: We review the conceptual foundations and implementation of IV methods. We discuss strengths and limitations of IV approaches, contrasting with confounder–control methods, and illustrate the relevance of IVs for stress and trauma research. Results: IV approaches leverage an external or exogenous source of variation in the exposure. Instruments are variables that meet three conditions: relevance (variation in the IV is associated with variation in the chance of exposure), exclusion (the IV only affects the outcome through the exposure), and exchangeability (no unmeasured confounding of the IV–outcome relationship). Interpreting estimates from IV analyses requires an additional assumption, such as monotonicity (the instrument does not change the chance of exposure in different directions for any two individuals). Valid IVs circumvent the need to correctly identify, measure, and control for all confounders of the exposure–outcome relationship. The primary challenge is identifying a valid instrument. Conclusions: IV approaches have strengths and weaknesses compared with confounder–control approaches. IVs offers a promising complementary study design to improve evidence about the causal effects of exposures on outcomes relevant to stress and trauma. Collaboration with scientists who are experienced with identifying and analyzing IVs will support this work.

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Sex Differences in Psychopathology Following Potentially Traumatic Experiences

Kofman,

Selbe,

Szentkúti

et al. 2024

JAMA Netw Open

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ImportanceVarious psychopathology may follow trauma; however, sex differences in these ranging manifestations of posttraumatic psychopathology remain understudied.ObjectiveTo investigate sex-specific incidence of posttraumatic psychopathology.Design, Setting, and ParticipantsThis population-based cohort study of Danish national health registries included a cohort of individuals who experienced a potentially traumatic event (PTE) from 1994 to 2016. Individuals were further categorized by presence of any pretrauma psychopathology. A comparison group of individuals who experienced a nontraumatic stressor (nonsuicide death of a first-degree relative) was examined as a reference cohort.ExposuresAt least 1 of 8 PTEs (eg, physical assault, transportation accident) derived through health registry International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes, with additional qualifiers to improve classification accuracy.Main Outcomes and MeasuresIncidence of 9 categories of ICD-10 psychiatric disorders recorded in registries within 5 years of PTEs. The standardized morbidity ratios (SMRs) for psychopathology outcomes were also calculated to compare individuals experiencing PTEs with those experiencing a nontraumatic stressor.ResultsThis study included 1 398 026 individuals who had been exposed to trauma (475 280 males [34.0%]; 922 750 females [66.0%]). The group of males who had been exposed to trauma were evenly distributed across age, while most females in the trauma-exposed group were aged 16 to 39 years (592 385 [64.2%]). Males and females were equally distributed across income quartiles and predominantly single. Following PTEs, the most common diagnosis was substance use disorders for males (35 160 [7.4%]) and depressive disorders for females (29 255 [3.2%]); incidence proportions for these and other disorders were higher among males and females with any pretrauma psychopathology. Certain PTEs had elevated onset of various psychiatric disorders and some sex differences emerged. Following physical assault, associations were found with schizophrenia or psychotic disorders for males (SMR, 17.5; 95% CI, 15.9-19.3) and adult personality disorders for females (SMR, 16.3; 95% CI, 14.6-18.3). For noninterpersonal PTEs, males had larger SMRs for substance use, schizophrenia or psychotic disorders, and adult personality disorders (SMR, 43.4; 95% CI, 41.9-45.0), and females had larger SMRs for depressive disorders (SMR, 19.0; 95% CI, 18.6-19.4). Sex differences were also observed, particularly when considering pretrauma psychopathology. For example, among interpersonal PTEs, males were most likely to develop substance use disorders after physical assault, whereas females were more likely to develop various disorders, with stronger associations seen for females without pretrauma psychiatric diagnoses. Among noninterpersonal PTEs, exposure to toxic substance showed robust associations with psychopathology, particularly in those without pretrauma psychopathology, with sex-specific differences across psychiatric categories.Conclusions and RelevanceMental disorders after trauma were wide-ranging for males and females, and sex differences in patterns of posttraumatic psychopathology were more pronounced when accounting for pretrauma psychopathology. Findings provide new insights for sex-relevant PTEs and their mental health consequences. It also outlines future directions for advancing understanding of a constellation of posttraumatic psychopathology in males and females.

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Using Danish national registry data to understand psychopathology following potentially traumatic experiences

Cited by 10 publications

References 46 publications

Using Norwegian National Patient Registry data to understand associations between potentially traumatic life experiences and mental health care use in adolescence

Using Norwegian National Patient Registry data to understand associations between potentially traumatic life experiences and mental health care use in adolescence

Opportunities and challenges in using instrumental variables to study causal effects in nonrandomized stress and trauma research.

Sex Differences in Psychopathology Following Potentially Traumatic Experiences

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