BACKGROUND:Anorexia nervosa has potential to influence the development and function of the gastrointestinal system. We assessed the association between maternal anorexia nervosa and risk of gastrointestinal morbidity in offspring. METHODS:We analyzed a longitudinal cohort of 1,269,370 children born in Quebec, Canada, between 2006 and 2022. The exposure was maternal anorexia nervosa. The outcome was hospitalization for pediatric gastrointestinal disorders, including hypertrophic pyloric stenosis, inflammatory bowel disease, and other digestive morbidity. Follow-up ranged from 1 to 17 years. We used adjusted Cox regression models to obtain hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between maternal anorexia nervosa and pediatric gastrointestinal disorders. RESULTS:A total of 2,447 children (0.2%) had a mother with anorexia nervosa. By age 17 years, the cumulative incidence of gastrointestinal disorders was higher among children whose mothers had anorexia nervosa than other children (165.7 vs. 129.4 per 1,000). Compared with no anorexia, maternal anorexia nervosa was associated with a greater risk of any childhood gastrointestinal disorder (HR: 1.42, 95% CI: 1.26-1.61), particularly hypertrophic pyloric stenosis (HR: 2.51, 95% CI: 1.35-4.66), inflammatory bowel disease (HR: 2.46, 95% CI: 1.67-3.64), and rectal hemorrhage (HR: 3.46, 95% CI: 1.97-6.09). Children whose mothers developed anorexia nervosa after age 20 years or were hospitalized more than once for anorexia had the greatest risk of gastrointestinal morbidity. The associations were not explained by digestive birth defects. CONCLUSION:Maternal anorexia nervosa is associated with pediatric gastrointestinal disorders that could potentially be mitigated with psychosocial support, nutritional rehabilitation, and breastfeeding.

OBJECTIVE:To determine the extent to which anorexia nervosa is associated with premature mortality. METHOD:We carried out a matched cohort study of 7332 male and female patients with anorexia nervosa and 73,215 patient controls who were admitted between 1989 and 2023 in hospital centers of Quebec, Canada. We tracked the patients longitudinally over time to identify premature deaths before age 75 years and determined the cause of death. We used stratified Cox regression models adjusted for patient characteristics to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between anorexia nervosa and premature mortality. RESULTS:Overall, 186 (2.5%) patients with anorexia nervosa and 615 (0.8%) matched controls died before age 75 years. Compared with no anorexia, anorexia nervosa was associated with 3.02 times the risk of premature mortality among females (95% CI 2.50-3.65) and 2.23 times the risk among males (95% CI 1.35-3.70). Patients with a first anorexia nervosa admission between age 20 and 29 years were most at risk of premature mortality (HR 8.00, 95% CI 4.30-14.88), as were patients hospitalized ≥ 3 times for anorexia nervosa (HR 4.72, 95% CI 3.25-6.84). Anorexia nervosa was associated with premature mortality due to metabolic and other endocrine disorders, suicide, and a range of other causes. DISCUSSION:Anorexia nervosa is associated with an elevated risk of premature mortality from metabolic disorders, suicide, and other causes. Patients who are female, hospitalized as young adults, or have repeated admissions for anorexia nervosa are most at risk.

BACKGROUND:The relationship between induced abortion and long-term mental health is not clear. We assessed whether having an induced abortion was associated with an increase in the long-term risk of mental health hospitalization. METHODS:We carried out a retrospective cohort study of 28,721 induced abortions and 1,228,807 births in hospitals of Quebec, Canada, between 2006 and 2022. The exposure was induced abortion compared with other pregnancies, and the outcome was hospitalization for a psychiatric disorder, substance use disorder, or suicide attempt over time. We followed patients up to 17 years after the end of pregnancy to identify mental health-related hospitalizations. We calculated hazard ratios (HR) and 95 % confidence intervals (CI) for the association between induced abortion and mental health hospitalization, adjusted for pregnancy characteristics. RESULTS:Rates of mental health-related hospitalization were higher following induced abortions than other pregnancies (104.0 vs. 42.0 per 10,000 person-years). Abortion was associated with hospitalization for psychiatric disorders (HR 1.81, 95 % CI 1.72-1.90), substance use disorders (HR 2.57, 95 % CI 2.41-2.75), and suicide attempts (HR 2.16, 95 % CI 1.91-2.43) compared with other pregnancies. The associations were greater for patients who had preexisting mental illness or were aged less than 25 years at the time of the abortion. Abortion was strongly associated with mental health hospitalization within five years but risks waned over time. CONCLUSION:Induced abortion is associated with an increased risk of mental health-related hospitalization in the long term but the association weakens with time.

BACKGROUND:Anorexia nervosa has the potential to affect fetal neurodevelopment. We examined the association between maternal anorexia nervosa and mental, substance-related, and neurodevelopmental morbidity in offspring. METHODS:We conducted a retrospective cohort study of 1,269,370 children in Quebec, Canada, between 2006 and 2022. The main exposure was maternal anorexia nervosa requiring admission. The outcome was childhood hospitalization for mental, substance-related, or neurodevelopmental disorders between birth and age 17 years, with follow-up ending in 2023. We estimated hazard ratios (HR) and 95% confidence intervals (CI) for the association between maternal anorexia nervosa and child outcomes using Cox regression models adjusted for patient characteristics. RESULTS:In total, 2,447 (0.2%) children had a mother admitted for anorexia nervosa. Children of mothers with anorexia nervosa had higher hospitalization rates for mental, substance-related, and neurodevelopmental morbidity than other children (104.7 vs. 51.4 per 1,000 by age 17 years). Children whose mothers had anorexia nervosa were particularly at risk of mental health hospitalization (HR 2.30, 95% CI 1.52-3.49), especially for anorexia nervosa (HR 10.62, 95% CI 5.06-22.29) and anxiety and stress disorders (HR 1.84, 95% CI 1.09-3.08), compared with unexposed children. Maternal anorexia nervosa was associated with substance-related (HR 2.01, 95% CI 1.26-3.21) and neurodevelopmental morbidity in children (HR 1.55, 95% CI 1.19-2.01). CONCLUSION:Maternal anorexia nervosa is associated with childhood hospitalization for mental health, substance-related, and neurodevelopmental morbidity, although results should be interpreted with caution owing to potential confounders. Mothers with anorexia nervosa may benefit from psychosocial support to prevent mental and neurodevelopmental morbidity in offspring.

BACKGROUND:Anorexia nervosa is associated with an increased risk of fracture in women, but the association is unclear in men. We assessed the association between anorexia nervosa and the later risk of fracture hospitalization for men and women separately. METHODS:We performed a longitudinal cohort study of 7,332 patients with anorexia nervosa in Quebec, Canada, matched with 73,215 healthy controls between 1989 and 2023. The exposure was anorexia nervosa requiring inpatient treatment. Outcomes included severe fractures requiring admission for surgical reduction or fixation anytime after the anorexia nervosa admission. We used adjusted Cox regression models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association of anorexia nervosa with risk of fracture hospitalization stratified by sex. RESULTS:Patients with anorexia nervosa had higher fracture rates than controls, including men (74.0 vs. 39.9 per 10,000 person-years) and women (47.6 vs. 21.0 per 10,000 person-years). Compared with matched controls, men with anorexia nervosa were 1.86 times more likely to be hospitalized for fractures (95% CI 1.34-2.58), while women were 2.26 times more likely (95% CI 2.02-2.51). Anorexia nervosa was associated with fractures of the femur, humerus, and thoracic/shoulder/pelvic bones. Anorexia nervosa was strongly associated with osteoporotic fractures (HR 7.50, 95% CI 5.62-10.01). CONCLUSION:Anorexia nervosa is associated with an increased risk of pathologic fractures up to 34 years later. The association is present for both men and women.

Adolescent mental health was a major problem during the COVID-19 pandemic. We determined the extent to which adolescents with a history of adversity were at risk of mental health hospitalization during the pandemic. We conducted a longitudinal cohort study of 303,378 adolescents from Quebec, Canada, who were age 10-14 years at the start of the pandemic. The main exposure was early life adversity, which included childhood adversity as well as maternal history of adversity or mental illness. The main outcome was hospitalization for a psychiatric disorder, substance use disorder, or suicide attempt between March 2020 and March 2023. We used Cox regression models to compute adjusted hazard ratios (HR) and 95% confidence intervals (CI) for the association of adversity with risk of mental health admission during the pandemic. Adolescents with a history of childhood adversity were 6-9 times more likely to be admitted for a psychiatric disorder (HR 5.79, 95% CI 4.82-6.95), substance use disorder (HR 8.89, 95% CI 6.36-12.43), or suicide attempt (HR 6.93, 95% CI 4.85-9.90) during the pandemic, compared with other adolescents. Adolescents whose mothers experienced adversity or whose mothers had mental illness were 2-6 times more likely to be admitted for mental disorders. Associations were present for both sexes, although adversity was particularly associated with substance use disorders among males. Having a history of childhood or maternal adversity was a strong risk factor for mental health hospitalization among adolescents during the pandemic.

Background The endocannabinoid (eCB) system and the serotonin (5-HT) are both implicated in the severity of the depression. 5-HT is synthesized from the amino acid tryptophan (Trp), which is also a precursor for kynurenine (Kyn) whose production is increased at the expense of 5-HT in depressed patients. No clinical studies have investigated the crosstalk between the eCB system and the Trp/5-HT/Kyn pathways. Here, we hypothesized that the eCB system is associated with an enhanced Kyn production in relation to the severity of depressive symptoms. Methods Eighty-two subjects (51 patients with a diagnosis of depressive disorder (DSM-5) and 31 healthy volunteers), were assessed with the Montgomery-Åsberg Depression Rating Scale (MADRS), Beck Depression Scale, and Global Clinical Impression. Serum concentrations of eCBs ( N -arachidonoylethanolamine (AEA) and 2-arachidonoylglycerol (2-AG)); structurally related fatty acyl compounds 2-oleoylglycerol (2-OG), oleoylethanolamide (OEA), and palmitoylethanolamide (PEA); Trp, Kyn, Kyn/Trp ratio (an index of Trp degradation into Kyn) and 5-HT were also determined. Results Following a principal component analysis including the severity of depression, Kyn and the Kyn/Trp ratio appear to be directly associated with 2-AG, AEA, and PEA. Interestingly, these biomarkers also permitted to distinguish the population into two main clusters: one of individuals having mild/severe depressive symptoms and the other with an absence of depressive symptoms. Using parametric analysis, higher serum levels of 2-AG, Kyn, and the ratio Kyn/Trp and lower levels of Trp and 5-HT were found in individuals with mild/severe depressive symptoms than in those without depressive symptoms. While in asymptomatic people, PEA was directly associated to Trp, and OEA indirectly linked to 5-HT, in individuals with depressive symptoms, these correlations were lost, and instead, positive correlations between AEA and 2-AG, PEA and AEA, and PEA vs 2-AG and OEA concentrations were found. Conclusions Parametric and non-parametric analyses suggest a possible association between eCBs, tryptophan/kynurenine biomarkers, and severity of depression, confirming a likely interplay among inflammation, stress, and depression. The enhanced relationships among the biomarkers of the 2-AG and AEA pathways and related lipids seen in individuals with depressive symptoms, but not in asymptomatics, suggest an altered metabolism of the eCB system in depression.

OBJECTIVE:To determine the association between burns and hospitalization for mental health disorders up to 3 decades later. BACKGROUND:Burns are associated with pain, disability, and scarring, but the long-term impact on mental health is unclear. METHODS:We analyzed a cohort of 23,726 patients with burns aged ≥10 years who were matched to 223,626 controls from Quebec, Canada, between 1989 and 2022. The main exposure was admission for a burn. We followed patients during 3,642,206 person-years of follow-up to identify future hospitalizations for psychiatric disorders, substance use disorders, and suicide attempts. We estimated adjusted hazard ratios (HRs) with 95% CIs for the association between burns and subsequent mental health hospitalization using Cox proportional hazards regression. RESULTS:Patients with burns had a 1.76 times greater risk of mental health hospitalization over time (95% CI: 1.72-1.81), compared with controls. Associations were present regardless of burn site, but were greatest for burns covering ≥50% of the body (HR: 3.29, 95% CI: 2.61-4.15), third-degree burns (HR: 2.04, 95% CI: 1.94-2.14), and burns requiring skin grafts (HR: 2.00, 95% CI: 1.90-2.10). Compared with controls, patients with burns had more than two times the risk of hospitalization for eating disorders (HR: 3.14, 95% CI: 2.50-3.95), psychoactive substance use disorders (HR: 2.27, 95% CI: 2.17-2.39), and suicide attempts (HR: 2.42, 95% CI: 2.23-2.62). Risks were particularly elevated within 5 years of the burn but persisted throughout follow-up. CONCLUSIONS:Burns are associated with an increased risk of hospitalization for mental health disorders up to 30 years later.

Objective: To determine the association between burns and hospitalization for mental health disorders up to three decades later. Summary Background Data: Burns are associated with pain, disability, and scarring, but the long-term impact on mental health is unclear. Methods: We analyzed a cohort of 23,726 burn patients aged ≥10 years who were matched to 223,626 controls from Quebec, Canada, between 1989 and 2022. The main exposure was admission for a burn. We followed patients during 3,642,206 person-years of follow-up to identify future hospitalizations for psychiatric disorders, substance use disorders, and suicide attempts. We estimated adjusted hazard ratios (HR) with 95% confidence intervals (CI) for the association between burns and subsequent mental health hospitalization using Cox proportional hazards regression. Results: Burn patients had 1.76 times greater risk of mental health hospitalization over time (95% CI 1.72-1.81), compared with controls. Associations were present regardless of burn site, but were greatest for burns covering ≥50% of the body (HR 3.29, 95% CI 2.61-4.15), third degree burns (HR 2.04, 95% CI 1.94-2.14), and burns requiring skin grafts (HR 2.00, 95% CI 1.90-2.10). Compared with controls, burn patients had more than two times the risk of hospitalization for eating disorders (HR 3.14, 95% CI 2.50-3.95), psychoactive substance use disorders (HR 2.27, 95% CI 2.17-2.39), and suicide attempts (HR 2.42, 95% CI 2.23-2.62). Risks were particularly elevated within 5 years of the burn, but persisted throughout follow-up. Conclusions: Burns are associated with an increased risk of hospitalization for mental health disorders up to 30 years later.

We studied the effect of the Covid-19 pandemic on child eating disorder hospitalizations in Quebec, Canada. Quebec had one of the strictest lockdown measures targeting young people in North America. We analyzed eating disorder hospitalizations in children aged 10–19 years before and during the pandemic. We used interrupted time series regression to assess trends in the monthly number of hospitalizations for anorexia nervosa, bulimia nervosa, and other eating disorders before the pandemic (April 2006 to February 2020), and during the first (March to August 2020) and second waves (September 2020 to March 2021). We determined the types of eating disorders requiring hospital treatment and identified the age, sex and socioeconomic subgroups that were most affected. Hospitalization rates for eating disorders increased during the first (6.5 per 10,000) and second waves (12.8 per 10,000) compared with the period before the pandemic (5.8 per 10,000). The increase occurred for anorexia nervosa as well as other types of eating disorders. The number of girls and boys aged 10–14 years admitted for eating disorders increased during wave 1. Wave 2 triggered an increase in eating disorder admissions among girls aged 15–19 years. Hospitalization rates increased earlier for advantaged than disadvantaged youth. The Covid-19 pandemic affected hospitalizations for anorexia nervosa as well as other eating disorders, beginning with girls aged 10–14 years during wave 1, followed by girls aged 15–19 years during wave 2. Boys aged 10–14 years were also affected, as well as both advantaged and disadvantaged youth.

Background Maternal suicide attempts are associated with adverse psychosocial outcomes in children, but the association with chronic morbidity is poorly understood. We examined the relationship between maternal suicide attempt and risk of hospitalization for potentially preventable conditions in offspring. Methods We analyzed a longitudinal cohort of 1 032 210 children born in Quebec, Canada between 2006 and 2019. The main exposure measure was maternal suicide attempt before or during pregnancy. Outcomes included child hospitalizations for potentially preventable conditions, including infectious diseases, dental caries, atopy, and injury up to 14 years after birth. We used adjusted Cox proportional hazards regression models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association of maternal suicide attempt with risk of hospitalization for these outcomes. Results Compared with no suicide attempt, children whose mothers attempted suicide had an increased risk of hospitalization for infectious diseases (HR 1.11, 95% CI 1.06-1.16), dental caries (HR 1.31, 95% CI 1.15-1.48), and injury (HR 1.16, 95% CI 1.03-1.31). Risk of hospitalization for any of these outcomes was greater if mothers attempted suicide by hanging (HR 1.46, 95% CI 1.22-1.75), had their first attempt between the age of 25 and 34 years (HR 1.27, 95% CI 1.13-1.42), and had 3 or more attempts (HR 1.56, 95% CI 1.27-1.91). Maternal suicide attempts were more strongly associated with child hospitalization before 10 years of age. Conclusions Children whose mothers have a history of suicide attempt have an elevated risk of hospitalization for potentially preventable conditions.

Purpose: To determine if suicide attempts increased during the first year of the pandemic among young adolescents in Quebec, Canada.Methods: We analyzed children aged 10-14 years who were hospitalized for a suicide attempt between January 2000 and March 2021. We calculated age-specific and sex-specific suicide attempt rates and the proportion of hospitalizations for suicide attempts before and during the pandemic and compared rates with patients aged 15-19 years. We used interrupted time series regression to measure changes in rates during the first (March 2020 to August 2020) and second (September 2020 to March 2021) waves and difference-in-difference analysis to determine if the pandemic had a greater impact on girls than boys.Results: Suicide attempt rates decreased for children aged 10-14 years during the first wave. However, rates increased sharply during the second wave for girls, without changing for boys. Girls aged 10-14 years had an excess of 5.1 suicide attempts per 10,000 at the start of wave 2, with rates continuing to increase by 0.6 per 10,000 every month thereafter. Compared with the prepandemic period, the increase in the proportion of girls aged 10-14 years hospitalized for a suicide attempt was 2.2% greater than that of boys during wave 2. The pattern seen in girls aged 10-14 years was not present in girls aged 15-19 years.Discussion: Hospitalizations for suicide attempts among girls aged 10-14 years increased considerably during the second wave of the pandemic, compared with boys and older girls. Young adolescent girls may benefit from screening and targeted interventions to address suicidal behavior.(c) 2023 Society for Adolescent Health and Medicine. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

OBJECTIVE:To determine the association between adolescent hospitalization for suicide attempts and the subsequent risk of eating disorder hospitalization. METHOD:This was a cohort study of 162,398 adolescent girls in Quebec, Canada, including 7741 with suicide attempts before 20 years of age, matched to 154,657 adolescents with no attempt between 1989 and 2019. The main exposure measure was suicide attempt hospitalization. The main outcome measure was hospitalization for an eating disorder up to 31 years later, including anorexia nervosa, bulimia nervosa, and other eating disorders. We used adjusted Cox regression models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between adolescent suicide attempts and eating disorder hospitalization. RESULTS:Adolescent girls admitted for a suicide attempt had 5.55 times the risk of eating disorder hospitalization over time (95% CI 3.74-8.23), compared with matched controls. Suicide attempt was associated with anorexia nervosa (HR 3.57, 95% CI 1.78-7.17) and bulimia nervosa and other eating disorders (HR 8.55, 95% CI 5.48-13.32). Associations were pronounced in girls with repeated suicide attempts. Girls who attempted suicide through self-poisoning had an elevated risk of anorexia nervosa, whereas girls who used violent methods such as cutting or piercing had a greater risk of bulimia nervosa and other eating disorders. Suicide attempt was strongly associated with eating disorder hospitalization in the year following the attempt, but associations persisted throughout follow-up. DISCUSSION:Suicide attempt admission is associated with the long-term risk of eating disorder hospitalization in adolescent girls. PUBLIC SIGNIFICANCE:This study of adolescent girls suggests that suicide attempt admission is associated with the long-term risk of hospitalization for eating disorders. The risk is greatest in the year after the attempt, but persists over time. Adolescents who present with a suicide attempt may benefit from screening for eating disorders and long-term follow-up to help prevent the exacerbation or development of eating disorders.

BACKGROUND:We studied the effect of the Covid-19 pandemic on child eating disorder hospitalizations in Quebec, Canada. Quebec had one of the strictest lockdown measures targeting young people in North America.METHODS:We analyzed eating disorder hospitalizations in children aged 10-19 years before and during the pandemic. We used interrupted time series regression to assess trends in the monthly number of hospitalizations for anorexia nervosa, bulimia nervosa, and other eating disorders before the pandemic (April 2006 to February 2020), and during the first (March to August 2020) and second waves (September 2020 to March 2021). We determined the types of eating disorders requiring hospital treatment and identified the age, sex and socioeconomic subgroups that were most affected.RESULTS:Hospitalization rates for eating disorders increased during the first (6.5 per 10,000) and second waves (12.8 per 10,000) compared with the period before the pandemic (5.8 per 10,000). The increase occurred for anorexia nervosa as well as other types of eating disorders. The number of girls and boys aged 10-14 years admitted for eating disorders increased during wave 1. Wave 2 triggered an increase in eating disorder admissions among girls aged 15-19 years. Hospitalization rates increased earlier for advantaged than disadvantaged youth.CONCLUSIONS:The Covid-19 pandemic affected hospitalizations for anorexia nervosa as well as other eating disorders, beginning with girls aged 10-14 years during wave 1, followed by girls aged 15-19 years during wave 2. Boys aged 10-14 years were also affected, as well as both advantaged and disadvantaged youth.

•Duration of untreated illness (DUI) varies between mood disorders.•Longer DUI is associated with lower incidence rate of psychiatric hospitalizations.•Longer DUI is associated with lower incidence rate of comorbid disorders.•Age of onset and sex moderate some of the associations between DUI and outcomes.

Childhood and adolescence are sensitive periods in health development. Teens who attempt suicide may face psychosocial and biophysical vulnerability, increasing their risk of chronic morbidity later in life. We examined the association between suicide attempts before 20 years of age with the risk of morbidity later in life among adolescent women.

Pregnancy outcomes of women with serious injuries due to violence receive limited attention. We examined the association of assault before and during pregnancy with maternal and infant outcomes at delivery. We performed a retrospective cohort study of 2,193,711 births in Quebec, Canada between 1989 and 2016. We identified women who were hospitalized for physical assault, sexual assault, and assault with documented intimate partner violence before and during pregnancy. We examined adverse outcomes at delivery, including preeclampsia, placental abruption, antepartum hemorrhage, stillbirth, preterm birth, low birthweight, and other disorders. In log-binomial regression models, we estimated risk ratios (RR) and 95% confidence intervals (CI) for the association between violence hospitalization and adverse birth outcomes, adjusted for potential confounders. Compared with no exposure, violence before or during pregnancy was associated with the future risk of placental abruption (RR 1.49, 95% CI 1.23–1.82), antepartum hemorrhage (RR 1.43, 95% CI 1.19–1.71), stillbirth (RR 1.83, 95% CI 1.27–2.63), preterm birth (RR 1.70, 95% CI 1.54–1.87), and low birthweight (RR 1.78, 95% CI 1.58–2.00). Physical assault, sexual assault, and assault with documented intimate partner violence were all associated with adverse outcomes. The risk of adverse outcomes was elevated regardless of timing and number of violence admissions, although associations were stronger for women hospitalized twice or more. Physical assault, sexual assault, and intimate partner violence are important risk factors for adverse pregnancy outcomes. Screening for violence in women of childbearing age and closer follow-up during pregnancy may help improve birth outcomes.