Class variations in the incidence of alcoholism in the Lundby Study, Sweden.
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Biomedical subjects
Publications and source records attributed to J Lanke.
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In the present study a general population cohort of 3,563 persons has been observed concerning psychiatric attendance during a 25-year period, and the mortality experience among patients of different levels of psychiatric care has been studied. The relative overall death risk compared with that of the total Lundby population was found to be 1.9 in men and 1.5 in women with a background of any kind of psychiatric contact. Among former or present inpatients at mental hospitals the overall mortality rate in both sexes was about twice as high as that found in the total population. In men who had been inpatients at psychiatric departments the relative death risk from all causes of death was 4.8, whereas the corresponding risks among men and women who had only come into contact with psychiatric services as outpatients were 1.3 and 1.1, respectively. The relative violent death risk in men with a psychiatric contact was 4.6 compared with the total male population.
In the Lundby Study, all mental illnesses, treated as well as untreated, that occurred during a 25-year period in a geographically defined Swedish general population sample were evaluated. All forms of psychiatric services used by the population during the same period were registered. The present study investigates the mortality pattern of mentally ill persons who did not receive psychiatric specialist treatment. Men with a 'hidden' mental disorder showed a significantly increased mortality from non-violet causes (p less than 0.001). The relative somatic death risk in this group was even slightly higher than that found among mentally ill men who had received psychiatric specialist care. The somatic overmortality found among women with a hidden mental disorder did not reach statistical significance, while mentally ill women who had been treated showed a significant excess mortality from natural causes (p less than 0.05). The total number of violet deaths was small and calculations on violet death risks were performed only for men. Among men with a hidden mental disorder the age-standardized violent death risk was twice that of the total male population, but the increase did not reach statistical significance. Men with a treated mental disorder showed a significant over-mortality from violent causes (p less than 0.001).
Continuous exposure of young mongolian gerbils to trichloroethylene (230 ppm) was started at different times during the first month of life. The onset of exposure was accompanied by an increased number of deaths among the pups and by an immediate reduction in growth rate. The proportion of dead pups was greatest when exposure was started at birth, and decreased rapidly with increasing age at onset of exposure. Growth rate was partially restored approx. 1 week after the onset of exposure. After weaning the effect of the exposure on growth decreased, and the variation in the effect among different litters was considerably reduced. The enhanced sensitivity of the pups to trichloroethylene (TCE) exposure is believed to be due to a disturbance in the mother-offspring relationship.
The Lundby cohort consists of all inhabitants in a delimited area in Sweden studied in 1947 by Essen-Möller, then by Hagnell in 1957, and by Hagnell & Ojesjö in 1975. It has been claimed that depressive disorders have increased during the sixties and seventies. In order to examine this hypothesis on a normal population (the Lundby Study), comparisons were made of the incidence figures for depression during the periods 1947-57 and 1957-72, and during the five 5-year intervals within the period.
In the Lundby study, 3,563 persons from a geographically delimited area in Sweden have been examined by psychiatrists on repeated occasions during a 25-year period. Mental disorders, personality traits, social factors, etc., have been recorded. Great efforts have been made to get sufficient outside information about the living as well as the deceased. During the observation period 28 persons, 23 men and 5 women, committed suicide. More than half of the suicide individuals had had a depressive disorder. The male part of the cohort has been studied concerning changes over time of prevalence of depression and age standardized rates of completed suicide. When the first 10-year period 1947-1957 was compared with the last 15-year period 1957-1972, the prevalence of depression was found to have increased over time, while the suicide rates had decreased among men in the Lundby cohort.
There is an increased mortality among persons who are or who have been under psychiatric care. In any normal population many individuals suffer from mental disorders without coming into contact with psychiatric services, and our knowledge of the mortality pattern of these groups is limited. The Lundby cohort comprises 3,563 persons from a total population, followed concerning mental disorders during 15 and 25 years. In the present study we have investigated the mortality from nonviolent, natural causes among persons in the Lundby cohort with a history of mental disorders, irrespective of contact with psychiatrists or other physicians. The relative death rate from natural causes compared with the standard population was found to be 1.5 among men and 1.2 among women with backgrounds of mental disorders. Neurotics had no excess mortality in this study.
The purpose of the present study was to investigate the association between mental disorders and death from suicide and accident. The violent death group was drawn from a prospective psychiatric cohort study of 3,563 persons followed during 25 years (the Lundby Study). The deceased persons in the cohort had all been examined by psychiatrists on one or two occasions during their lives. Among men with a background of mental disorders, the age-standardized suicide rate was found to be about 4 times higher and the age-standardized accident rate about 2 1/2 times higher than that of the standard male population. When the immediate circumstances around the unnatural deaths were studied, mental as well as somatic disorders were found to have been present at the time of death in a high proportion of the cases. Neoplasms were found in 3 of the 28 suicide persons.
The annual age-standardized incidence rate of alcohol dependence among men in the Lundby community cohort prospectively observed during 1957-1972 (N = 2550) was 130 per 100,000 (including "alcohol abuse," 300 per 100,000). The individual expectancy of developing alcohol dependence in a lifetime was 8.6% (including "alcohol abuse," 19.3%). Of the cumulative probability, 78% was manifested by those under 40 years of age.
The influence of continuous inhalation of 150 ppm trichloroethylene (TCE) on body, liver, spleen, and kidney weights in rats, mice, and mongolian gerbils was tested. An age dependent decrease in body weight gain was observed in female rats exposed to TCE. All 3 species showed liver enlargement caused by the exposure. The effect was much more pronounced in mice, in which the increase was 60--80%, than in rats and gerbils where it was only 20--30%. After the end of the TCE-exposure the liver weights of the mice decreased rapidly. After 5 days of rehabilitation the weight was only 10--20% higher than that of the controls. This difference persisted for at least 25 days. The spleen weight appeared unaffected or somewhat smaller in TCE-exposed animals of all species. An increased kidney weight (15%) was observe din TCE-exposed gerbils. This effect was less pronounced in mice and rats. Effects on the liver have earlier been seen only after exposure to concentrations much higher than that used in the present study. This difference in results is proposed to be due to the different schedules used for the exposure.
2,550 persons from a geographically delimited area in Sweden were examined and described by a team of 4 psychiatrists in 1947. Mental disorders, personality traits, social factors, etc. were recorded for all but 1% of the population. 10 and 25 years later the same persons were examined in the same way irrespective of domicile. Great efforts were made to get sufficient outside information about the living as well as the deceased persons. The incidence of age psychoses was lower in the 15-year period 1957-1972 than in the 10-year period 1947-1957.
In the present investigation we have used a longitudinal psychiatric-epidemiological study of 3,563 persons who, at a certain date 1947 or 1957, were registered in a geographically well-defined area in Sweden, "Lundby". This population has been observed and psychiatrically evaluated for 25 and 15 years, respectively. During the observation period 23 men and 5 women committed suicide. In the total Lundby cohort the age-standardized male suicide rate was 51 per 100,000 person years. The corresponding rate in men without a psychiatric diagnosis was 8.3, among men who had suffered some kind of psychiatric disorder other than depression 83, and among men with depression 650. The study thus indicates that mental illness, especially depressive disorder, implies a considerably increased risk.
Mongolian gerbils (Meriones Unguiculatus) were continuously exposed to 320 ppm (1.72 g/m3) of trichloroethylene (TCE) for nine months. During this period the spatial memory of the animals was tested. No major differences were found between the TCE group and the air-exposed control group. Eleven days after the end of TCE exposure, the animals were again tested. Every second day during this test, they were exposed to 2,300 ppm (12.6 g/m3) of 1,1,1-trichloroethane for 6 h. It was found that, on days when exposed to 1,1,1-trichloroethane, the animals previously exposed to TCE made more correct choices in the maze than on days when not exposed, whereas the control group made less. This test was repeated 75 d after the end of TCE exposure. The results were predominantly the same as 11 d after TCE exposure. The results are interpreted as showing that irreversible effects on the central nervous system are caused by exposure to 320 ppm (1.72 g/m3) of TCE during nine months. The effects cannot be directly observed as changes in the behavior of the animals but can be revealed in almost every single animal by treatment with 1,1,1 trichloroethane. The possibility that covert toxicologic effects might exist in humans exposed to volatile solvents and that the effects may be unmasked by alcohol, stress, or age is discussed.
Two groups of Mongolian gerbils (Meriones unguiculatus) were continuously exposed to 150 ppm trichloroethylene (TCE) for 71 and 106 d, respectively. The behavior of the animals was tested in a symmetrical maze baited with sunflower seeds during a period of 23 d, beginning at the end of exposure. One additional group was exposed for 150 d and then allowed 40 d free from exposure before the start of the maze test. Comparisons between the TCE- and air-exposed animals showed differences in the number of correct choices and the number of seeds consumed in the maze, both after 71 and 106 d of exposure and at the end of the 40-d rehabilitation period that followed the 150-d exposure. The results were interpreted in terms of the "emotionality" of the animals.