Background: Children’s cognitive development is influenced by dynamic interactions with the surrounding environment. Childhood adversity and air pollution have each been associated with poorer cognitive ability and school achievement. It is hypothesised that these exposures interact, such that cognitive ability in children experiencing high adversity is more vulnerable to the adverse effects of air pollution. However, this has not been examined at the population-level. Methods: We used data from the Danish Life Course (DANLIFE) cohort including information on 12 childhood adversities on all children born in Denmark during 1980-2001. The study population comprised 862,906 children with data on grade point average (GPA) from mandatory 9th-grade exit examinations. We used five previously established childhood adversity trajectory groups during ages 0-15: Low adversity, early life material deprivation, persistent material deprivation, loss or threat of loss, and high adversity. Annually modelled residential air pollution levels (PM2.5, PM10, and NO2) at a 1 km2 resolution during ages 0-15 were linked to each child. Using linear mixed-effects models (random intercept: school), we assessed interactions between childhood adversity groups and each air pollutant on GPA. Findings: Higher exposure to PM2.5 was significantly associated with lower GPA across all adversity groups, with the strongest association in the low adversity group (-0·81 [95% CI: -0·87;-0·74] GPA points per 5 µg/m3 increase in PM2.5) and the weakest in the high adversity group (-0·36 [-0·47;-0·24]). A similar but weaker pattern was observed for PM10, while NO2 showed heterogeneous patterns. Interpretation: Exposure to air pollution was associated with poorer school achievement across all childhood adversity groups. Contrary to our hypothesis, air pollution was most strongly associated with poorer school achievement in children experiencing low adversity. These findings suggest that, at the population-level, co-occurring social and environmental risks may not interact synergistically, reinforcing the importance of universal prevention strategies targeting both exposures.

Previous studies have identified associations between offspring birth weight (BW) and future maternal cardiovascular health, but many studies lack sufficient adjustment for confounders such as pregnancy complications, gestational age, maternal body mass index (BMI), and smoking. This study aimed to assess whether the association between term offspring BW and maternal cardiovascular risk is independent of these factors. We used data from the Copenhagen Perinatal Cohort (1959–1961). After excluding women with diabetes, preeclampsia, preterm births, and twin pregnancies, 5,766 women remained. Cardiovascular outcomes were obtained from Danish national registries with up to 45 years of follow-up. Hazard ratios (HR) with 95

AIM:The extant literature on type 2 diabetes and cognitive decline is based on short cognitive follow-ups and assessments of baseline cognitive ability after diagnosis. The objective was to investigate the influence of type 2 diabetes on cognitive decline over a period of on average 44 years. MATERIALS AND METHODS:This cohort study included 5,147 men from the Danish Aging and Cognition cohort consisting of a late mid-life (mean age 64.2 years) follow-up of men with intelligence test scores (IQ) available from statutory conscription board examinations in young adulthood (mean age 20.4 years). Follow-up included re-administration of the conscription board intelligence test and a comprehensive questionnaire. Exposure was self-reported but register-based type 2 diabetes and duration of disease were also calculated. Cognitive decline was defined as both IQ change (baseline-follow-up) and significant IQ decline based on the reliable change index (cut-off: 13.2 IQ-points). Associations were analyzed in linear and logistic regression models. RESULTS:Men having type 2 diabetes had a 1.81 IQ points (95%CI:1.14,2.49) larger decline compared to men without diabetes when adjusting for baseline IQ, years of education, follow-up age, retest interval, depression, and smoking status. Moreover, type 2 diabetes was associated with 1.42 times higher odds of a significant IQ decline and longer duration was associated with a larger, though not statistically significant, decline. The participation rate was 13.4%, and the participants were healthier and more well-educated than non-participants. To account for potential selection bias, inverse probability weights (IPW) were calculated based on baseline characteristics. The analyses applying these weights yielded similar estimates. CONCLUSION:Type 2 diabetes was associated with modestly greater cognitive decline and higher odds of a statistically significant (>13.2 IQ points) and clinically relevant decline. Finally, the alignment between main and IPW results indicates the findings are robust and likely generalizable.

Background Accumulation of β-amyloid (Aβ) in the brain is a hallmark of Alzheimer’s Disease (AD). Cerebral deposition of Aβ initiates deteriorating pathways which eventually can lead to AD. However, the exact mechanisms are not known. A possible pathway could be that Aβ affects the cerebral vessels, causing inadequate cerebrovascular function. In the present study, we examined if Aβ accumulation is associated with a reduced cerebral blood flow response (CBF) to neuronal activation by visual stimulation (DCBFVis.Act) in cognitively normal subjects from the Metropolit Danish Male Birth Cohort. Methods 64 subjects participated in the present study. DCBFVis.Act was measured using arterial spin labelling (ASL) combined with blood-oxygen-level-dependent (BOLD) MRI. Neuronal activation was obtained by visual stimulation by a flickering checkerboard presented on a screen in the MRI-scanner. Brain Aβ accumulation and cerebral glucose metabolism were assessed by PET imaging using the radiotracers [11C]Pittsburgh Compound-B (PiB) and [18F]Fluorodeoxyglucose (FDG), respectively. Cortical thickness was measured from structural MRI. Results DCBFVis.Act correlated negatively (\(\beta\) = -32.1 [95% confidence interval (CI): -60.2 ; -4.1], r = -0.30, p = 0.025) with PiB standardized uptake value ratio (SUVr) in the brain regions activated by visual stimulation. DCBFVis.Act did not correlate with FDG SUVr (\(\beta\) = 1.9 [CI: -23.8 ; 27.6], r = 0.02, p = 0.88) or cortical thickness (\(\beta\) = 10.3 [CI: -8.4 ; 29.0], r = 0.15, p = 0.27) in the activated brain regions. Resting CBF did not correlate with PiB SUVr neither in the regions activated by visual stimulation (\(\beta\) = -17.8 [CI:-71.9 ; 36.2], r = 0.09, p = 0.51) nor in the remaining cortex (\(\beta\) = 5.2 [CI:-3.9 ; 14.2], r = 0.15, p = 0.26). Conclusion We found a correlation between high PiB SUVr and reduced CBF response to neuronal activation, indicating a link between Aβ accumulation and impaired cerebrovascular function. The impairment was not associated with cortical thinning or hypometabolism, suggesting that Aβ accumulation affecting brain vessel function could be a very early pathology leading to neurodegenerative disease.

Culture significantly influences the understanding, presentation, diagnosis, and treatment of mental disorders, particularly among migrant patients. This observational study examines the frequency and timing of diagnostic changes among migrant patients in a specialized psychiatric outpatient clinic. Furthermore, the study includes a qualitative sub-study to provide insights into the diagnostic process. Out of the 119 migrant patients included in the study, 27.7% changed referral diagnoses during treatment. Diagnostic changes occurred in 15.7% of cases by the end of treatment, 13.4% at midterm, and 9.1% after the initial assessment. No significant associations were found between diagnostic changes and sociodemographic or treatment-related factors. While the qualitative sub-study primarily offered broader insights into the cultural aspects of treatment and the clinical encounter, rather than establishing causal effects on the diagnostic process, it revealed how acculturative stress and cultural identity influenced the presentation of symptoms. The study is conducted in a real-life clinical setting and, thus, reflects the everyday clinical practice of diagnostic changes at a specialized cultural psychiatric clinic. The findings from this study indicate that in addition to a culturally sensitive assessment, time is an important factor for diagnostic changes, which can be essential knowledge for clinical practice when planning diagnostic assessment and treatment. The findings underscore the need for enhancing clinicians' cultural competencies through targeted training, emphasizing cultural awareness in clinical practice.

BACKGROUND:Previous studies have found paternal occupation, childhood intelligence, and educational attainment to be important predictors of socioeconomic status (SES) later in life. However, these factors only explain part of the variance in SES and thus, it is important to identify other predictors of SES and trajectories of influence from early childhood to adulthood. OBJECTIVES:To analyze predictors of SES attainment during the life course from early childhood to midlife with special emphasis on identifying direct and indirect effects on midlife SES of early childhood, late childhood and young adult characteristics. METHODS:This study uses questionnaire and national registry data, including data on parental social background, intelligence, education, and midlife SES for 6,294 members of the Metropolit 1953 Danish Male Birth Cohort. The study sample included cohort members with information on intelligence at age 12 who were living in Denmark at age 50. Using structural equation modelling, direct and indirect mediated effects on midlife SES were estimated for early childhood, late childhood, and young adult characteristics. RESULTS:Educational attainment, intelligence, parental education, and father's occupational class had the strongest influences on midlife SES. A prediction model only including education and intelligence could only be slightly improved by the inclusion of other predictors, from 53.5% to 54.1% explained variance in midlife SES. Educational attainment was a particularly strong predictor of status attainment. Other early and late childhood factors had relatively weak direct effects, but significant indirect effects. Thus, it was possible to identify trajectories of influence from early childhood to midlife. CONCLUSION:Young adult education and intelligence were the strongest predictors of midlife SES. Early and late childhood factors influence young adult characteristics, but over the life course the direct effects of early life variables tend to decrease, and the effects on midlife SES become mediated and indirect.

BackgroundMost previous studies of effects of smoking on age-related cognitive decline have compared cognitive decline in current smokers, former smokers, and never smokers rather than investigating the effects of pack-years. The aim of the present study was to analyze the association between smoking and age-related cognitive decline in a sample of men administered the same intelligence test in young adulthood and late midlife, using pack-years between the two assessments as the primary measure of exposure to smoking.MethodsIn 5052 men, scores on a military intelligence test (BPP, Børge Priens Prøve) were available from young adulthood and a late midlife follow-up assessment including the same intelligence test and a comprehensive questionnaire on socio-demographic factors, lifestyle, and health. Information on smoking was self-reported at follow up for eight age periods, and pack-years were calculated from age 19 based on information on daily smoking and the duration of each age period. The differences in cognitive decline between adult-life smokers and non-smokers and the differences between light, moderate, and heavy smokers defined by pack-years were analyzed in linear regression models.ResultsAll smoking variables were only weakly associated with cognitive decline. Comparison of adult-life smokers and non-smokers showed less cognitive decline among smokers (1.12 IQ points, p < 0.001). Among smokers, analyses of pack-years suggested a weak dose-response relationship with more decline in heavy smokers than in light smokers (1.33 IQ points, p = 0.001). Independent of pack-years, current smoking was associated with larger cognitive decline than former smoking (1.73 IQ points, p < 0.001).ConclusionSmoking explained negligible fractions of the variance in cognitive decline, and thus our results did not indicate that smoking is a strong predictor of cognitive decline. The effects of pack-years suggest a relatively weak, possibly cumulative effect of smoking across the adult lifespan. The difference in decline between smokers and non-smokers may reflect participation bias and selective attrition at follow-up while the effects of current smoking may reflect either temporary effects of smoking or individual and life-style characteristics associated with continuation of smoking into late midlife.

Several studies conducted during the last 50 years have shown that lower intelligence is associated with a higher body mass index (BMI). During this period, the prevalence of obesity and overweight has increased considerably. We investigated whether this increase has altered the relation between intelligence and BMI by studying two cohorts of 419,319 conscripts, born 1939-1959 and 1983-2001, examined in the same geographical districts in Denmark. While the prevalence of obesity increased from 0.8% in the early to 6.7% in the late cohort, the two cohorts showed essentially the same pattern of relations between intelligence test scores (ITS), prevalence of obesity and overweight (including obesity), and BMI. The prevalence of obesity and overweight and BMI was higher at any ITS value in the late than in the early cohort, but inversely associated with ITS in both cohorts. The ITS displayed inverse J-shaped associations with BMI, with ITS peaking around a BMI of 20 kg/m2 and declining with higher BMI, although with a somewhat steeper decline in the early than in the late cohort. Thus, irrespective of the increase in prevalence of obesity and overweight and in BMI, the pattern of inverse relations between intelligence and higher BMI levels was maintained.

BACKGROUND:Given the high prevalence of trauma-related mental health problems in a growing population of refugees, identifying robust predictors of treatment outcome can optimize treatment strategies and resource allocation. The current study aimed to examine the robustness of predictors from seven previous predictor studies at the Competence Centre for Transcultural Psychiatry (CTP). METHODS:We studied if predictors from previous studies could be replicated in a sample of 219 refugees with PTSD who participated in a new distinct study conducted at CTP. We included all variables previously found to be significantly related to treatment response, as measured via the Harvard Trauma Questionnaire (HTQ) and the Hamilton Depression Scale (HAM-D). We categorised the variables as sociodemographic factors, CTP predictor index items, and baseline assessment scores. We performed regression analyses with one exposure variable at a time, controlling for baseline assessment scores corresponding to the dependent variable. We also conducted multiple linear regression analyses to examine the variance explained in total by the identified significant predictor variables. RESULTS:The study successfully replicated several predictors of treatment response for PTSD and depression, including a high understanding of therapy concepts, acceptability of psychological treatment, ability to reflect, motivation for active participation and cognitive resources, as well as low baseline pain levels. The findings replicated a U-shaped relationship between age and treatment response for depression, indicating better outcomes for younger participants and those over 60. Multiple regression analyses explained 28% and 39% of the variance in the PTSD (HTQ) and depression (HAM-D) treatment responses, respectively. CONCLUSIONS:This study contributes to the understanding of treatment response predictors in trauma-affected refugees by replicating findings from previous research in a new sample. It highlights the importance of modifiable factors, such as psychotherapy readiness, and underscores the necessity for tailored interventions to enhance treatment efficacy. As the global refugee crisis grows, the insights from this research can inform mental health strategies, ultimately improving care for this vulnerable population. Future research should continue to investigate modifiable predictors to further enhance treatment outcomes. TRIAL REGISTRATION:ClinicalTrials.gov NCT02761161.

Background Empirical evaluation of inverse probability weighting (IPW) for self-selection bias correction is inaccessible without the full source population. We aimed to: (i) investigate how self-selection biases frequency and association measures and (ii) assess self-selection bias correction using IPW in a cohort with register linkage.Methods The source population included 17 936 individuals invited to the Copenhagen Aging and Midlife Biobank during 2009-11 (ages 49-63 years). Participants counted 7185 (40.1%). Register data were obtained for every invited person from 7 years before invitation to the end of 2020. The association between education and mortality was estimated using Cox regression models among participants, IPW participants and the source population.Results Participants had higher socioeconomic position and fewer hospital contacts before baseline than the source population. Frequency measures of participants approached those of the source population after IPW. Compared with primary/lower secondary education, upper secondary, short tertiary, bachelor and master/doctoral were associated with reduced risk of death among participants (adjusted hazard ratio [95% CI]: 0.60 [0.46; 0.77], 0.68 [0.42; 1.11], 0.37 [0.25; 0.54], 0.28 [0.18; 0.46], respectively). IPW changed the estimates marginally (0.59 [0.45; 0.77], 0.57 [0.34; 0.93], 0.34 [0.23; 0.50], 0.24 [0.15; 0.39]) but not only towards those of the source population (0.57 [0.51; 0.64], 0.43 [0.32; 0.60], 0.38 [0.32; 0.47], 0.22 [0.16; 0.29]).Conclusions Frequency measures of study participants may not reflect the source population in the presence of self-selection, but the impact on association measures can be limited. IPW may be useful for (self-)selection bias correction, but the returned results can still reflect residual or other biases and random errors.

Individuals with schizophrenia (SZ) or bipolar disorder (BP) display cognitive impairments, while their firstdegree relatives perform at an intermediate level between the patient groups and controls. However, the environmental impact of having an ill relative likely varies with the type of kinship and some studies suggest that offspring may be particularly disadvantaged. The present study aimed to investigate the relationship between parent and child cognition in parents with SZ or BD and their 7-year-old offspring. A population-based cohort of 522 children (parental SZ, n = 202; parental BP, n = 120; controls, n = 200) and their parents underwent the same assessment battery covering a wide range of cognitive functions. We used Bayesian statistics to model performance. We found that performance on non-verbal tests was better in offspring than parents with SZ or BP, using the controls as reference. However, for verbal tests, there was little to no evidence for this pattern or even some evidence for the opposite in the BP group: relatively better performance in parents than offspring. The findings suggest that the offspring of parents with SZ or BP may be particularly disadvantaged in verbal abilities. Future studies will show whether this pattern persists throughout development.

Objective: To investigate a wide range of sociodemographic and clinical factors associated with treatment outcomes in older adults who initiated an SSRI for depression treatment in a real-world setting. Methods: This cohort study used Danish registry data covering all older adults (aged >65) who initiated SSRIs for depression from 2006 to 2017, first-time (since 1995). We followed the individuals for one year after their SSRI prescription. Six different outcomes were analyzed, including treatment discontinuation, switching, augmentation, psychiatric hospital contacts for depression, psychiatric hospital admission, and suicide attempt/self-harm. Association analyses employed Poisson regression, estimating incidence rate ratios with 95 % confidence intervals. Results: The study included 65,741 individuals with a mean age of 78.23 years, and 55.6 % were females. During follow-up, 40.1 % discontinued, 4.8 % switched, 20.3 % received augmentation, 3.0 % had psychiatric hospital contacts for depression, 3.2 % had psychiatric admission, and 0.1 % had suicide attempt/self-harm records. Differential treatment outcomes were observed based on sociodemographic and clinical factors. For example, being female, residing predominantly in rural areas, having psychiatric or somatic diagnoses, and using medications acting on blood/blood-forming organs, the cardiovascular system, or musculo-skeletal systems were linked to fewer unfavorable clinical outcomes. Conversely, marital status as being single or separated and the use of nervous system drugs were associated with a higher risk of unfavorable outcomes. Limitations: Confounding by indication might remain a problem, and depression severity data was not unavailable. Conclusions: Our findings emphasize considering patient characteristics in clinical decisions, as they can influence the clinical course of those undergoing depression treatment.

Background With aging populations worldwide, identification of predictors of age-related cognitive decline is becoming increasingly important. The Danish Aging and Cognition Cohort (DanACo) including more than 5000 Danish men was established to investigate predictors of age-related cognitive decline from young adulthood to late mid-life. Construction and content The DanACo cohort was established through two separate data collections with identical designs involving a follow-up examination in late mid-life of men for whom intelligence test scores were available from their mandatory conscription board examination. The cohort consists of 5,183 men born from 1949 through 1961, with a mean age of 20.4 years at baseline and a mean age of 64.4 years at follow-up. The baseline measures consisted of height, weight, intelligence test score and educational level collected at the conscription board examination. The follow-up assessment consisted of a re-administration of the same intelligence test and a comprehensive questionnaire covering socio-demographic factors, lifestyle, and health-related factors. The data were collected in test sessions with up to 24 participants per session. Using the unique personal identification number assigned to all Danes, the cohort has been linked to data from national administrative and health registers for prospectively collected data on socioeconomic and health-related factors. Utility and discussion The DanACo cohort has some major strengths compared to existing cognitive aging cohorts such as a large sample size ( n = 5,183 men), a validated global measure of cognitive ability, a long retest interval (mean 44.0 years) and the availability of prospectively collected data from registries as well as comprehensive questionnaire data. The main weakness is the low participation rate (14.3%) and that the cohort consists of men only. Conclusion Cognitive decline is a result of a summary of factors across the life-course. The DanACo cohort is characterized by a long retest interval and contains data on a wealth of factors across adult life which is essential to establish evidence on predictors of cognitive decline. Moreover, the size of the cohort ensures sufficient statistical power to identify even relatively weak predictors of cognitive decline.

OBJECTIVE:The authors investigated the clinical outcomes of commonly used antidepressants among older adults who initiated first-time antidepressants for depression by analyzing the 1-year risk of selected clinically relevant outcomes.METHODS:This cohort study used nationwide Danish registry data and included all older adults who redeemed a first-time (since 1995) antidepressant prescription with an indication of depression between 2006 and 2017. Only the 10 most frequently redeemed antidepressants were included in the analyses. Outcomes included discontinuation, switching, augmentation, psychiatric hospital contacts, suicide attempt or self-harm, fall-related injuries, cardiovascular events, and all-cause mortality. Incidence rate ratios (IRRs) and 95% confidence intervals were estimated using Poisson regression models, controlling for potential confounders.RESULTS:The study sample included 93,883 older adults (mean age, 78.0 years, SD=7.5 years; 56% female). The most frequently prescribed antidepressants were selective serotonin reuptake inhibitors (citalopram, 47.04%; escitalopram, 11.81%; fluoxetine, 0.55%; paroxetine, 0.52%; sertraline, 11.17%), serotonin-norepinephrine reuptake inhibitors (duloxetine, 0.71%; venlafaxine, 1.54%), a tricyclic antidepressant (amitriptyline, 1.86%), and two atypical antidepressants (mianserin, 1.93%; mirtazapine, 22.87%). Compared with users of sertraline (the reference drug in this analysis, as Danish guidelines recommend it as the first-choice treatment for depression), users of most of the other nine antidepressants had a significantly higher risk of discontinuation (e.g., mirtazapine: IRR=1.55, 95% CI=1.50-1.61; venlafaxine: IRR=1.22, 95% CI=1.12-1.32), switching (amitriptyline: IRR=1.45, 95% CI=1.15-1.81; venlafaxine: IRR=1.47, 95% CI=1.20-1.80), augmentation, cardiovascular events, and mortality. Overall, mirtazapine and venlafaxine users had the most adverse outcomes compared with sertraline users. These results remained consistent in analyses stratified by sex and age (≤75 years vs. >75 years).CONCLUSIONS:This real-world evidence suggests that clinical outcomes may vary among initiators of commonly used antidepressants in older adults, which may inform benefit-risk evaluation at treatment initiation, and highlights the importance of careful selection of antidepressant treatment.

Objectives: To investigate the influence of wine, beer, and spirits consumption, respectively, on non-pathological, age-related cognitive decline from young adulthood to late midlife in a large follow-up study of Danish men. Methods: The study includes 2456 middle-aged Danish men from the Lifestyle and Cognition Follow-up study 2015, with information on adult-life consumption (from age 26) of wine, beer, and spirits self-reported in late midlife and age-related cognitive decline assessed using the same validated intelligence test administered in young adulthood and late midlife. Associations were adjusted for consumption of other alcoholic beverages, year of birth, age at follow-up, retest interval, education, young adulthood intelligence, and personality. Results: Most of the men had wine (48%) or beer (42%) as their preferred beverage type. For all three alcoholic beverages, consumption of more than 14 units weekly was associated with a greater decline in unadjusted analyses, but this trend was only significant for wine. In contrast, adjusted models showed that moderate wine and spirits consumption was associated with less decline than abstention for these alcohol types (p = 0.03 for 8-14 units/week of wine and p = 0.03 for 1-7 units/week of spirits). Statistical tests suggested a difference between the estimated effects of consumption of 8-14 units/week of wine and beer on cognitive decline. Conclusions: While patterns of associations were similar across beverages, moderate wine and spirits consumption may mitigate cognitive decline, in contrast with beer. However, the results should be interpreted with caution due to inherent differences between men with different alcoholic beverage preferences.

Studies have shown a high prevalence of trauma and PTSD among patients with severe mental illness, but relatively few studies have examined the outcomes of PTSD treatment for this patient group. The aim of this case-series was to assess the feasibility of a Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) intervention for PTSD in people with psychosis. The study examined the possibilities and obstacles when treating this population within clinical settings. Patients were selected from four community mental health centers and were screened for traumatic experiences and symptoms of PTSD. A small group of eligible participants (n=7) received manualized TF-CBT adapted for patients with psychosis. Experienced therapists received training and supervision in the intervention. Symptoms of PTSD and psychosis were assessed at baseline and post-treatment along with quality of life, level of functioning, alliance, life events, engagement, suicidal ideation and adverse events. Treatment fidelity and the different combinations of treatment modules were monitored in regard to implementation. Three cases were selected as illustrative of the different treatment courses when implementing the TF-CBT intervention within this population. Detailed case descriptions were based on quantitative ratings and the therapists’ experiences with the therapy. Results from the case series highlighted issues regarding toleration of treatment, large variation in psychopathology and the task of matching treatment needs with appropriate therapeutic techniques. The complexity of the patient group may affect treatment and clinical research studies. Lessons learned from this case series can contribute to the future development implementation and evaluation of trauma treatment for patients with psychosis.

INTRODUCTION:Worldwide, more children than before survive preterm birth. Preterm birth can affect long-term cognitive outcomes. The aim of our study was to investigate the association between preterm birth and academic performance and intelligence in youth. MATERIAL AND METHODS:This cohort study included all liveborn children in Denmark from 1978 to 2000. We used uni- and multivariable logistic and linear regressions to analyze associations between gestational age and school graduation, grade point average (GPA), attending conscription, and male intelligence scores at conscription. We adjusted for a priori defined potential confounders. RESULTS:The study included 1 450 681 children and found an association between preterm birth and lower academic performance, with children born extremely preterm having the lowest odds of graduating from lower- and upper secondary education (LSE and USE) and appearing before the conscription board (odds ratios of 0.45 [0.38-0.54], 0.52 [0.46-0.59], and 0.47 [0.39-0.56] for LSE, USE, and conscription, respectively, compared to the term group). Statistically significant differences were observed in LSE for total GPA and core subject GPA with higher GPAs in the term group, which were considered clinically relevant for mathematics with a 0.71 higher grade point for the term compared to the extremely preterm. Conversely, USE differences were less evident, and in linear regression models we found that preterm birth was associated with higher GPAs in the adjusted analyses; however, this was not statistically significant. We demonstrated statistically significant differences in intelligence scores at conscription with lower scores in the three preterm groups (-5.13, -2.73, and - 0.76, respectively) compared to the term group. CONCLUSIONS:Low gestational age at birth was associated with not graduating from LSE and USE, achieving lower GPAs in LSE, not attending conscription, and lower intelligence scores in young adulthood. The findings remained significant after adjusting for potential confounders.

Dropout from mental health treatment is a substantial hindrance to relevant and effective treatment. Despite the high prevalence of PTSD among refugees, research into their treatment dropout has received limited attention. This study aimed to identify patterns and predictors of treatment dropout versus completion through different treatment stages. The sample included 940 patients with a refugee background undergoing outpatient treatment for PTSD in Denmark. All patients were offered 10 medical doctor sessions and 16-20 psychotherapy sessions. Dropout was analysed in three stages: (1) during the first six MD sessions, (2) during the first eight psychotherapy sessions upon completion of Stage 1, and (3) during psychotherapy sessions 9 to 16. A stepwise multiple regression analysis was conducted for each stage to identify predictors of stage-specific dropout. Counter to expectations, both early dropout and full completion were associated with better symptom outcomes, relative to late-treatment dropout. Key predictors varied by stage, with younger age predicting early dropout, whereas chronic pain and poor Danish proficiency predicted late dropout. Female gender and a clearly articulated motivation for active participation were predictors for full treatment completion. Practical advice is suggested to accommodate at-risk patients and to re-evaluate patient engagement after familiarisation with treatment.

Despite an increased focus on the impact of post-migratory factors on the health of trauma-affected refugees, research on the influence of residence permit is limited. This influence may manifest on the outcome of psychiatric treatment. Accordingly, the aim of this study was to examine the role of temporary residence permit on symptom severity and treatment outcome among trauma-affected refugees in PTSD treatment. The sample consisted of 897 patients, who were allocated into three groups based on their residence permit: temporary residence permit, permanent residence permit, and Danish citizenship. The outcome measures were symptoms of PTSD (Harvard Trauma Questionnaire), depression and anxiety (Hopkins Symptom Checklist-25 and Hamilton Depression and Anxiety Rating Scales), quality of life (WHO-5 Well-being Index), and functioning (The Sheehan Disability Scale), evaluated before and after psychiatric treatment. Temporary residents tended to have less severe symptoms prior to treatment. Overall, no significant differences were observed between the three groups on treatment outcome. However, Danish citizens had a poorer treatment outcome on Hamilton Depression Scale compared with temporary residents. This study is one of the first to investigate treatment implications of residence permit in a clinical setting. The interactions between mental health and individual post-migratory factors are complex. Further research is still needed to understand how residence status affects mental health and treatment outcomes for refugees.

BackgroundPeople with aphasia may be particularly vulnerable to a loss of quality of life after an acquired brain injury, but only a limited number of self-report measures have been adapted to people with aphasia.AimsTo investigate the psychometric properties of the Danish version of the Stroke and Aphasia Quality of Life Scale-39g (SAQOL-39gDK).Methods and proceduresThe questionnaire was administered to 72 participants admitted to inpatient neurorehabilitation after an acquired brain injury (65 with stroke) of which 22 had aphasia.Outcomes and resultsItems demonstrated an acceptable level of skewness, floor, and ceiling effects. Hypothesized associations between subscales and the total scale were generally confirmed. Test-retest reliability was acceptable, although wide confidence intervals suggested a positive change in quality of life during the test-retest interval. Acceptable levels of internal reliability were found of the total scale and subscales (Crohnbach's alpha = 0.84-0.94, omega total = 0.84-0.94). Inter-item correlations and worst-split half reliability indicated that not all subscales were unidimensional, and confirmatory factory analysis only supported a one-factor model for the communication subscale.ConclusionsThe reliability and validity of SAQOL-39gDK were found to be acceptable and comparable to other language versions of the scale according to criteria used in previous psychometric studies. The factor structure of the original scale could not be confirmed in the present study and should be investigated further in a larger sample of participants.