Christina Dalman

Schizophrenia and related psychoses are associated with obstetric complications but whether these associations are causal is yet to be explored. This study investigates the relationship between specific complications (e.g. preterm birth, growth restriction, hypoxia), genetic predisposition, and schizophrenia risk using a comprehensive approach integrating large-scale register-based cohort studies, genetically-informed designs, individual genotypes, and detailed familial health data.This is finally possible since we are updating our register linkage, Psychiatry Sweden, to include follow-up data until 2022, thereby enhancing our power (N=25 000 individuals with schizophrenia spectrum disorders). This presents an opportunity to combine a total-population cohort study with genetically-informed designs, such as sibling- and cousin-comparison studies, and pedigree-based family psychiatric history risk scores using familial health records in up to third degree relatives, to enhance the robustness of our causal inference. Finally, we have now genotyped a sub-set of 3000 individuals with schizophrenia and 2500 controls. Integrating  individual genotype data with health registers, we will examine the joint influence of genetics and obstetric complications on schizophrenia risk using polygenic risk scores and tentatively pathway analyses.Together these studies will add to the etiological knowledge about schizophrenia but also whether maternity care could constitute a way of prevention.

The discussion on how to support the possibly increasing group of adolescents with mental health problems sometimes becomes polarized due to our fragmentary knowledge of the actual needs and numbers. This project will, for the first time, systematically assess:the proportions of adolescents in Sweden with different levels of mental health problems, ranging from emotional distress (which does not fulfill diagnostic criteria) to mental disorders (fulfilling criteria, for, e.g., depression or anxiety), andtheir need and utilization of support and care, taking a broad view of potential support structures beyond, but including, the health care system.The study is based on computer assisted assessments of 6,000 eligible 14- and 17-year-olds in schools and their parents online. Emotional distress will be measured with validated symptom scales (GAD-7 and PHQ-A) and mental disorders using a well-established diagnostic instrument (DAWBA). Information on the frequency, severity, and duration of symptoms and their impact on function will be integrated into Children’s Global Assessment Scale (CGAS) ratings. All together these measures form a solid ground for experienced psychiatrists to appraise  levels of emotional distress and diagnosed mental disorders as well as need of support. Information on self-reported need of a wide range of support functions will be compared with professionals’ assessments of need. Health care data from registers in combination with self-reported utilization of support and care will be compared with professionals’ judgement of need, to estimate hidden proportions of those who are not in contact with care despite an existing need or identify potential “overutilization”. Key demographic and socioeconomic information will be linked from registers to understand how the prevalence of emotional distress and mental disorders varies among different populations, as well as the degree to which needs for support are met in different groups.  The main applicant is responsible for the project, supported by a senior researcher as academic coordinator and a fulltime project leader for practical tasks. Questions on self-reported needs and utilization will be developed in collaboration with e.g. adolescents, NGOs, school health care. The budget is estimated to total 6.9 million over four years.Not until we have the facts can we appropriately act and lay the ground for a broader perspective on support for mental health for adolescents in Sweden.