Associations apparent for any, exclusive, and cumulative (at least 1 year) breastfeeding

Breastfeeding may lower mothers’ later life risks of depression and anxiety for up to 10 years after pregnancy, suggest the findings of a small observational study, published in the open access journal BMJ Open.

The observed associations were apparent for any, exclusive, and cumulative (at least 12  months) breastfeeding, the study shows.

Breastfeeding is associated with lower risks of postnatal depression and anxiety, but it’s not clear if these lowered risks might persist in the longer term, say the researchers.

To find out, they tracked the breastfeeding behaviour and health of 168 second time mothers who were originally part of the ROLO Longitudinal Birth Cohort Study for 10 years.

All the women had given birth to a child weighing under 4 kg and they and their children had check-ups 3 and 6 months, and 2, 5, and 10 years after birth by which time the mothers’ average age was 42.

At each check-up, the mothers completed a detailed health history questionnaire. This asked whether they had been diagnosed with, and treated for, depression/anxiety. They also provided information on potentially influential factors, including diet and physical activity levels.

At the check-ups, the mothers provided information on: whether they had ever breastfed or expressed milk for 1 day or more; total number of weeks of exclusive breastfeeding; total number of weeks of any breastfeeding; and cumulative periods of breastfeeding of less or more than 12 months.

Nearly three quarters of the women (73%; 122) reported having breastfed at some point. The average period of exclusive breastfeeding lasted 5.5 weeks and that of any breastfeeding for 30.5 weeks. More than a third (37.5%; 63) reported cumulative periods of breastfeeding adding up to at least 12 months.

Twenty two (13%) of the women reported depression/anxiety at  the 10-year check-up, with a further 35 (21%) reporting depression or anxiety at any time point.

Those reporting depression/anxiety at the 10 year check-up were younger,  less physically active, and had lower wellbeing scores at the start of the study than those who didn’t report this. Those women reporting depression and anxiety at any time point differed only by age at the start of the study.

Analysis of the data showed that women experiencing depression and anxiety 10 years after pregnancy were less likely to have breastfed and had shorter periods of any or exclusive breastfeeding over their lifetime.

Each week of lifetime exclusive breastfeeding was associated with a 2% lower likelihood of reporting depression and anxiety, after accounting for potentially influential factors, including alcohol intake.

This is an observational study, and as such, no firm conclusions can be drawn about cause and effect. And the researchers acknowledge that participants were relatively few in number, not ethnically or socially diverse, and that the study relied on personal recall rather than objective measures of depression/anxiety.

Nevertheless, they write: “We suggest there also may be a protective effect of successful breastfeeding on postpartum depression and anxiety, which in turn lowers the risk of maternal depression and anxiety in the longer term.”

They explain: “The likelihood is that the association is multifactorial, as many socioeconomic and cultural factors influence both breastfeeding and mental health in addition to the impact of health history.  Additionally, women with a prior history of depression and anxiety are at risk of lower breastfeeding success, compounding the association but in the reverse direction.”

They conclude: “We know that improving breastfeeding rates and duration can improve lifetime health outcomes, reducing population level disease burden and resulting in significant healthcare savings.

“The possibility that breastfeeding could further reduce the huge burden of depression on individuals, families, healthcare systems and economies only adds to the argument for policymakers to improve breastfeeding support.”

08/01/2025

Notes for editors
Research: Breastfeeding and later depression and anxiety in mothers in Ireland: a 10- year prospective observational study Doi: 10.1136/bmjopen-2024-097323
Journal: BMJ Open

External funding: Health Research Board, Ireland; Health Research Centre for Health and Diet Research; National Maternity Hospital Medical Fund; European Commission Seventh Framework Programme; Children’s Health Ireland

Link to Academy of Medical Sciences press release labelling system http://press.psprings.co.uk/AMSlabels.pdf  

About the journal
BMJ Open is one of 70 journals published by BMJ Group.
https://bmjopen.bmj.com

Externally peer reviewed? Yes
Evidence type: Observational
Subjects: Mothers

The post Breastfeeding may lower mums’ later life depression/anxiety risks for up to 10 years after pregnancy first appeared on BMJ Group.

Study contributes to ongoing debate about England’s clock change policy

The week after the autumn clock change is associated with a reduction in demand for NHS services for sleep disorders, cardiovascular disease, anxiety, depression, and psychiatric conditions in England, finds a study in the Christmas issue of The BMJ.

However, there is little evidence that the spring clock change has any short term effect on the number of health conditions, say the researchers.

Daylight saving time was introduced during the first world war and involves moving the clocks one hour forward in spring and one hour back in autumn. It operates in around 70 countries and affects a quarter of the world’s population.

Yet some studies (mainly outside the UK) have suggested that the clock changes, particularly the spring clock change, have a detrimental effect on health, leading to calls for them to be abolished.

To obtain a clearer picture, researchers set out to explore the short term (acute) effects of the clock changes on people’s mental and physical health in England.

Their findings are based on linked primary and secondary care records for 683,809 people with at least one of eight health events in the weeks surrounding the spring or autumn clock changes from 2008 to 2019.

The health events analysed were anxiety, major acute cardiovascular disease, depression, eating disorder, road traffic injury, self-harm, or sleep disorder in primary or secondary care or a psychiatric condition in accident and emergency.

The mean daily number of events (per year, per region) in the first week after the clock changes were compared with those in the control period (four weeks before the changes and weeks 2-4 after).

In the week after the autumn clock change, five health conditions had fewer events: anxiety (a 3% reduction from 17.3 events per day to 16.7), acute cardiovascular disease (a 2% reduction from 50 events per day to 48.9), depression (a 4% reduction from 44.6 to 42.7), psychiatric conditions (a 6% reduction from 3.5 to 3.3), and sleep disorders (an 8% reduction from 5.4 to 4.9).

Little evidence was found of reductions in eating disorder diagnoses, road traffic injuries, or self-harm or of changes after the spring clock change.

This is an observational study, so no firm conclusions can be drawn about cause and effect, and the authors note that health records contain only events for which the individual seeks medical help, and the date that a health event is recorded by a clinician, which is not necessarily the date of symptom onset.

However, they say the results are based on 12 years of broadly representative general practice and hospital data, giving a more complete picture of the effect of the clock changes on demand for health services than previous studies.

They suggest that the extra sleep over the Autumn clock change and the abrupt increase in morning sunlight exposure after the transition may be beneficial to health.

And they conclude: “Our study contributes to the ongoing debate about England’s clock change policy. Future research should explore the mechanisms underlying the reduction in health events that we observed after the autumn clock change.”

17/12/2025

Notes for editors
Research: Acute effects of daylight saving time clock changes on mental and physical health in England: population based retrospective cohort study doi: 10.1136/bmj-2024-085962
Journal: The BMJ

External funding: Wellcome

Link to Academy of Medical Sciences press release labelling system: http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Observational
Subjects: People 

The post Autumn clock change linked to reduction in certain health conditions first appeared on BMJ Group.

Interaction of these 2 factors contributes 17% of overall risk, study findings suggest 

Concurrent physical frailty and depression likely boost the risk of dementia in older people, with the interaction of these 2 factors alone contributing around 17% of the overall risk, suggest the findings of a large international study, published in the open access journal General Psychiatry.

Globally, some 57 million people are living with dementia—a figure that is expected to triple by 2050, note the researchers.

Previously published research has primarily focused on the individual associations between physical frailty or depression and dementia risk, despite the fact that both have physiological and pathological factors in common, they explain.

To explore the potential interaction between these two factors on dementia risk in older adults,  the researchers tracked the diagnosis of any type of dementia in 220,947 participants (average age: 64; 53% women) from 3 large study groups.

These were the UK Biobank, the English Longitudinal Study of Ageing (ELSA), and the Health and Retirement Study.

Physical frailty was assessed using modified versions of the Fried frailty criteria, in which a person is considered to be frail if they have 3 or more of the following indicators: unintentional weight loss; self-reported exhaustion; low physical activity; slow walking speed; and weak grip strength.

Depression was evaluated through responses to mental health questionnaires or combined with hospital admission records.

Compared with those in good physical health, frail participants across all 3 groups were older, more likely to be female, weigh more, have more long term conditions and lower educational attainment.

During an average tracking period of nearly 13 years, 9088 people (7605 in the UK Biobank, 1207 in the Health Retirement Study and 276 in the ELSA) were diagnosed with dementia of any type.

Analysis of the data revealed that compared with those in good physical health, those who were frail were more than 2.5 times as likely to be diagnosed with dementia, while depression was associated with a 59% heightened risk.

And participants who were both physically frail and depressed were more than 3 times as likely to be diagnosed with dementia as those in good physical and mental health.

What’s more, a significant additional interaction between physical frailty and depression was observed, with around 17% of the overall dementia risk attributable to these two factors combined.

“These results underscore the complex relationship between frailty, depression, and cognitive function,” write the researchers.

“Lower levels of frailty may allow the health system to partially offset the cognitive burden of depression and, similarly, lower levels of depression may enable the system to mitigate the burden of frailty,” they suggest.

“However, once both factors exceed a certain threshold, this compensatory ability may be compromised, leading to a sharp increase in the risk of dementia,” they add.

This is an observational study, and as such, no firm conclusions can be drawn about cause and effect. And the researchers sound a note of caution in the interpretation of the findings, primarily because the definitions of physical frailty, depression, and dementia varied across the three cohorts.

Nevertheless, the researchers conclude: “Given that physical frailty and depression are modifiable, concurrent interventions targeting these conditions could significantly reduce dementia risk.”

16/12/2025

Notes for editors
Research: Associations of physical frailty, depression and their interaction with incident all- cause dementia among older adults: evidence from three prospective cohorts Doi: 10.1136/ gpsych-2025-102172
Journal: General Psychiatry

External funding: National Key Research and Development Program of China

Link to Academy of Medical Sciences press release labelling system
http://press.psprings.co.uk/AMSlabels.pdf 

About the journal
General Psychiatry is one of 70 journals published by BMJ Group. The title is owned by the Shanghai Mental Health Center.
https://gpsych.bmj.com/

Externally peer reviewed? Yes
Evidence type: Observational
Subjects: People

The post Concurrent frailty + depression likely boost dementia risk in older people first appeared on BMJ Group.

No significant variation in risk by type of disorder or timing of child’s exposure
Include dedicated support for these disorders in maternal healthcare, say researchers

Eating disorders in mums-to-be are linked to a heightened risk of asthma and wheezing in their children, irrespective of the type of disorder, presence of co-existing depression/anxiety, or the timing of their child’s exposure, finds research published online in the journal Thorax.

The findings prompt the researchers to call for the inclusion of dedicated support in the healthcare of pregnant women with eating disorders to improve the respiratory health of their children.

To date, research on the effects of maternal mental health on children’s respiratory health has focused predominantly on depression, anxiety, and broadly defined stress, with limited evidence on less common conditions like eating disorders, note the researchers.

And while the evidence on the consequences of maternal eating disorders has consistently reported on their children’s cognitive, social, emotional, behavioural and eating behaviours, the evidence is less consistent for physical health outcomes.

To strengthen the evidence base, the researchers analysed data from 131,495 mother and child pairs from 7 distinct European birth cohorts in the EU Child Cohort Network (EUCCN), looking at potential associations between maternal eating disorders before pregnancy and their children’s preschool wheezing and school age asthma.

They subsequently explored potential associations between women who didn’t have depression or anxiety by type of eating disorder (anorexia or bulimia) and period of exposure (pregnancy or after birth).

The prevalence of maternal eating disorders before pregnancy ranged from nearly 1% to 17% across the 7 cohorts. And the prevalence of co-existing depression/anxiety among women with eating disorders ranged from 11% to 75%.

The prevalence of preschool wheezing ranged from 21% to nearly 50%, while that of school age asthma ranged from just over 2% to nearly 17.5%.

An eating disorder before pregnancy was associated with an overall 25% heightened risk of preschool wheeze, although this varied considerably in each cohort, and with a 26% heightened risk of school age asthma, which was much more consistent across the cohorts.

These heightened risks weakened slightly after excluding mothers who had depression/anxiety.

Similar associations with childhood asthma were found for anorexia and bulimia, while preschool wheezing was associated with bulimia only.

Although the observed associations differed slightly across exposure periods (before, during, or after pregnancy), no distinct window of susceptibility emerged.

This is an observational study, and as such, no firm conclusions can be drawn about cause and effect, and the prevalence of eating and respiratory disorders varied widely across the cohorts.

“Although this may make some of the findings less comparable, the direction and the magnitude of the associations were relatively stable in all the analyses,” explain the researchers.

But they add: “The mechanisms underlying the associations between maternal mental health and childhood respiratory outcomes remain unclear.”

They suggest that mental ill health and associated stress may activate the hypothalamic-pituitary-adrenal axis, disrupting the baby’s lung development during pregnancy and maturation of the child’s immune system, thereby increasing susceptibility to immune mediated conditions, including asthma.

“Children born to mothers with [eating disorders] are at an increased risk of foetal growth restriction, prematurity, Caesarean delivery and low birth weight. These are also well-known risk factors for respiratory morbidity, suggesting multiple possible mediating pathways in the link between maternal [eating disorders] and childhood respiratory outcomes,” they point out.

“In addition, research has shown that both mental health disorders and asthma involve dysregulation in immune response and inflammatory pathways, suggesting a common genetic basis that may contribute to both conditions,” they add.

They conclude: “There is a need to include maternal [eating disorders] in research on early- life respiratory risk factors and to integrate [eating disorder] screening and support into maternal healthcare to improve respiratory outcomes in offspring.”

02/12/2025

Notes for editors
Research: Maternal eating disorders and respiratory outcomes in childhood: findings from the EU Child Cohort Network Doi: 10.1136/thorax-2025-223718
Journal: Thorax

About the journal
Thorax is one of 70 journals published by BMJ Group. The title is co-owned with the British Thoracic Society.
https://thorax.bmj.com

External funding: EU Horizon 2020 research and innovation programme

Link to Academy of Medical Sciences Press Release labelling system
http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Observational
Subjects: People

The post Eating disorders in mums-to-be linked to heightened risk of asthma and wheezing in their kids first appeared on BMJ Group.

Major psychiatric disorders associated with shorter telomeres, indicative of cellular ageing
3-4 cups linked to longer telomeres, equal to 5 extra ‘biological’ years, say researchers
But no such effects observed beyond this daily amount

Drinking a maximum of 3-4 cups of coffee a day may slow the ‘biological’ ageing of people with severe mental illness, by lengthening their telomeres—indicators of cellular ageing—and giving them the equivalent of 5 extra biological years, compared with non-coffee drinkers, finds research published in the open access journal BMJ Mental Health.

But no such effects were observed beyond this quota, which is the maximum daily intake recommended by several international health authorities, including the NHS and the US Food and Drug Administration.

Telomeres sit on the end of chromosomes and perform a role similar to the plastic tips on the end of shoelaces.  While telomere shortening is a natural part of the ageing process, it seems to be accelerated in those with major psychiatric disorders, such as psychosis, schizophrenia, and bipolar disorder, note the researchers.

Telomeres are sensitive to environmental factors, including, possibly, diet. And coffee, when drunk in moderation, has been associated with various health benefits, prompting the researchers to explore whether it might influence the rate at which telomeres shorten in people with major mental ill health.

They included 436 adult participants from the Norwegian Thematically Organised Psychosis (TOP) study, recruited between 2007 and 2018: 259 had schizophrenia; the rest (177) had affective disorders, including bipolar disorder and major depressive disorder with psychosis.

Participants were asked how much coffee they drank every day and were grouped into 4 categories: zero (44); 1–2 cups; 3–4 cups (110); and 5 or more cups. And they were asked whether they smoked, and if so, for how long they had done so.

Participants who drank 5+ cups a day were significantly older than those who drank none or 1–2 cups a day. And those with schizophrenia drank significantly more coffee than those with an affective disorder.

Smoking is associated with faster caffeine metabolism. And around three quarters of participants (77%; 337) smoked, and had done so, on average, for 9 years. And those drinking 5+ cups a day had smoked for significantly longer than any of the other groups.

Telomere length was measured from white blood cells (leucocytes) extracted from blood samples, and this revealed a significant difference among the 4 groups, forming a J shaped curve.

Compared with those drinking no coffee, drinking up to 3–4 cups a day was associated with longer telomeres, but not in those participants drinking 5 or more every day.

Those participants getting a daily 4-cup caffeine hit had telomere lengths comparable to a biological age 5 years younger than that of non-coffee drinkers after adjusting for age, sex, ethnicity, tobacco use, type of mental ill health, and drug treatment.

This is an observational study, and, as such, no firm conclusions can be drawn about cause and effect. And the researchers acknowledge that they had no information on potentially influential factors, including the type and timing of the coffee consumed, actual caffeine levels, or other sources of caffeinated drinks.

But there are plausible biological explanations for their findings, they suggest. These include the powerful antioxidant and anti-inflammatory compounds found in coffee.

“Telomeres are highly sensitive to both oxidative stress and inflammation, further highlighting how coffee intake could help preserve cellular ageing in a population whose pathophysiology may be predisposing them to an accelerated rate of ageing,” they explain.

Coffee is popular worldwide, with an estimated 10.56 billion kilos consumed around the globe in 2021-2 alone, they point out.

But despite its potential benefits, “consuming more than the daily recommended amount of coffee may also cause cellular damage and [telomere] shortening through the formation of reactive oxygen species,” they caution, emphasising that international health authorities recommend limiting caffeine intake to a maximum of 400 mg/day (4 cups of coffee).

Notes for editors
Research: Coffee intake is associated with telomere length in severe mental disorders Doi: 10.1136/bmjment-2025-301700
Journal: BMJ Mental Health

External funding: Medical Research Council; Research Council of Norway

Link to Academy of Medical Sciences press release labelling system http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Observational
Subjects: People

The post Daily coffee drinking may slow biological ageing of people with major mental illness first appeared on BMJ Group.

Risks highest within first 12 months, but remain high for years afterwards
Findings highlight need for integrated health service provision and continued monitoring

The health impacts of eating disorders, such as anorexia, bulimia, and binge eating, are not only complex, affecting many different organ systems, but long-lasting, finds a large tracking study, published in the open access journal BMJ Medicine.

The risks of serious conditions, such as diabetes, renal and liver failure, fractures, and premature death, are particularly high within the first 12 months of diagnosis. But these heightened risks persist for years, highlighting the need for timely integrated multidisciplinary health services and continued monitoring to improve outcomes, conclude the researchers.

UK rates of eating disorders have risen significantly since the COVID-19 pandemic restrictions, note the researchers. But while the detrimental mental and physical consequences are well known, the long term effects are less well understood, they add.

To strengthen the evidence base, the researchers scrutinised anonymised medical records in the Clinical Practice Research Datalink, linked to Hospital Episode Statistics and death certification data for people across England over a 20 year period (1998 to 2018 inclusive).

Some 24,709 people, aged 10-44, with a diagnosed eating disorder, were matched for age, sex, and GP practice with up to 20 others without these disorders (493,001 in total), and their mental and physical health tracked for 10 years.

Most (89%) of the entire sample was female. And among those with eating disorders, 14.5% (3577) had anorexia; 20.5% (5085) had bulimia; 5% (1215) had a binge eating disorder; and in 60% (14,832), the eating disorder was unspecified.

Analysis of the data revealed that eating disorders were associated with substantially higher risks of poor physical and mental health, and premature death.

Within the first year of diagnosis, people with eating disorders were 6 times more likely to be diagnosed with renal failure and nearly 7 times more likely to be diagnosed with liver disease, as well as being at significantly heightened risks of osteoporosis (6 times as high), heart failure (twice as high), and diabetes (3 times as high).

The risks of renal failure and liver disease were still 2.5 to nearly 4 times higher after 5 years, with 110 and 26 more cases than would be expected, respectively, per 10,000 people at 10 years.

Similarly, the risks of poor mental health were significantly higher 12 months after an eating disorder diagnosis: the risks of depression were 7 times higher, with 596 additional cases per 10,000 people, while those of self-harm were more than 9 times as high, with an additional 309 cases/10,000. And although they were lower, these heightened risks persisted after 5 years.

The risk of death from any cause within the first 12 months of diagnosis was also more than 4 times as high, and for unnatural deaths, including suicide, it was 5 times as high. After 5 years, these risks were still 2 and 3 times higher, corresponding to 43/10,000 extra deaths from all causes and 184/100,000 extra deaths from unnatural causes.

And 10 years after diagnosis, the equivalent figures for additional deaths amounted to 95/10,000 and 341/100,000, respectively. The risk of suicide was nearly 14 times higher in the first year but was still nearly 3 times higher after 10 years, accounting for 169 additional deaths/100,000 people.

The researchers acknowledge that the medical records data didn’t include the severity of the eating disorder, making it impossible to link severity to worse outcomes.

But they say: “Our data describe the substantial long term effects of eating disorders and emphasise the potential opportunity for primary care to have a greater role in offering support and long term monitoring for individuals who are recovering from an eating disorder.”

They suggest: “A closer and more cohesive management approach in primary and specialist care may also be needed, for both physical (nephrology, cardiology, and endocrinology) and mental health services to provide this support.”

They add: “A potential gap exists in provision where patients’ difficulties are too complex for low intensity brief interventions, but not complex enough for specialist teams.”

And they conclude:”Raising awareness among healthcare providers about the lasting effects of eating disorders and the need for ongoing support in managing current symptoms and recovery is essential.”

In a linked editorial, Dr Jennifer Couturier and Ethan Nella of McMaster University, Ontario, Canada, point out that despite the high prevalence of eating disorders, “their consequences are under-recognised.”

They add: “Earlier studies have illustrated the limited education given during medical training on the topic of eating disorders, and the current study emphasises the importance of disseminating this knowledge to all healthcare professionals.

“Medical education should place greater emphasis on the recognition and management of eating disorders, to equip primary care providers, specialists, and allied health professionals with the tools to identify early warning signs and monitor ongoing risks associated with eating disorders.”

They conclude: “Multiple organ systems are affected by eating disorders, which then requires an integration of care to adequately treat patients. This situation places primary care providers in an ideal position for leading and coordinating [their] care, and suggests that primary care settings would be apt for early and ongoing intervention.”

18/11/2025

Notes for editors
Research: Adverse outcomes in patients with a diagnosis of an eating disorder: primary care cohort study with linked secondary care and mortality records Doi: 10.1136/bmjmed-2025-001438
Editorial: Time to recognise the risks to patients after an eating disorder diagnosis Doi: 10.1136/bmjmed-2025-002261

Journal: BMJ Medicine

External funding: National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Research Collaboration (research)

Link to Academy of Medical Sciences press release labelling system
http://press.psprings.co.uk/AMSlabels.pdf 

Externally peer reviewed? Yes (research); No (editorial)
Evidence type: Observational data analysis; Opinion
Subjects: People

The post Health impacts of eating disorders complex and long-lasting first appeared on BMJ Group.

Study provides broader understanding of the mental health benefits of green space

Higher levels of greenness are associated with lower risks of hospital admissions for mental disorders, finds an analysis of data from seven countries over two decades, published in The BMJ’s climate issue today.

The results suggest that this protective effect increases with greater exposure to greenness, with no clear threshold – evidence that can inform urban design and health policy to better protect mental health, say the researchers.

Mental wellbeing remains a global challenge. It’s estimated that 1.1 billion people had mental disorders in 2021, contributing to 14% of the global disease burden with associated economic and societal costs.

Growing evidence suggests that exposure to greenness might reduce the risk of mental disorders, but most previous studies are limited to single countries, short term exposures, or specific mental health outcomes.

To address these gaps, researchers analysed 11.4 million hospital admissions for mental disorders from 6,842 locations in seven countries (Australia, Brazil, Canada, Chile, New Zealand, South Korea, and Thailand) from 2000 to 2019.

They included all cause mental disorders and six specific categories (psychotic disorders, substance use disorders, mood disorders, behavioural disorders, dementia, and anxiety).

Greenness was measured by the normalised difference vegetation index (NDVI), a widely used and reliable satellite derived metric for assessing vegetation levels in a given area.

Factors including population levels, weather conditions, air pollutants, socioeconomic indicators and seasonality were taken into account and models were stratified by sex, age, urbanisation, and season.

The results show that local greenness was associated with a 7% reduction in hospital admissions for all cause mental disorders, with stronger associations for substance use disorders (9%), psychotic disorders (7%), and dementia (6%).

However, associations varied across countries and disorders. For example, Brazil, Chile, and Thailand showed consistent protective associations across most disorders, while in Australia and Canada, greenness was associated with modestly increased risks for all cause mental disorders and for several specific disorders.

Overall, protective associations were strongest in urban areas, where an estimated 7,712 hospital admissions for mental disorders annually were potentially preventable through greater exposure to greenness.

Seasonal patterns were also found in urban areas, suggesting that climate and weather conditions play a crucial role in how green spaces are used and perceived, say the authors.

Further analysis in urban areas suggested that a 10% increase in greenness was associated with fewer hospital admissions for mental disorders ranging from around 1 per 100,000 in South Korea to approximately 1,000 per 100,000 in New Zealand.

This is an observational study so no firm conclusions can be drawn about cause and effect and the authors acknowledge the uncertainties of using hospital admission data from multiple countries. They also point out that their results only capture severe disorders requiring inpatient care so underestimate the full burden of mental health.

Nevertheless, they say this study suggests “a considerable proportion or rate of hospital admissions for mental disorders may be associated with exposure to greenness and could potentially be reduced through greening interventions under realistic scenarios.”

“These mental health benefits may also bring broader economic and social advantages, including reduced healthcare costs, less strain on health systems, improved workplace productivity, and enhanced community wellbeing.”

Future research should aim to explore the differential effects of various types of green spaces, such as parks or forests, on mental health outcomes, and focus on assessing the quality and accessibility of green spaces, they add.

05/11/2025

Notes for editors
Research: Greenness and hospital admissions for cause specific mental disorders: multicountry time series study doi: 10.1136/bmj-2025-084618
Journal: The BMJ

External funding: Australian Research Council and Australian National Health and Medical Research Council

Link to Academy of Medical Sciences press release labelling system: http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Observational
Subjects: People

The post Greenness linked to fewer hospital stays for mental health conditions first appeared on BMJ Group.

But sex, age, family history, co-existing conditions not specific risk factors
Impact on risk of death from any cause even greater than it is in others of same age 

The survival rates of people with early onset dementia—diagnosed before the age of 65—vary considerably by clinical type, but sex, age, family history and co-existing conditions aren’t specific risk factors, finds research published online in the Journal of Neurology Neurosurgery & Psychiatry.

Although the survival of those afflicted by dementia in older age is shorter, the overall impact on the risk of death from any cause is even greater in those with early onset disease than it is in others of comparable age, say the researchers.

Around 5% of dementia cases globally are categorised as early onset. But while dementia is widely recognised as a life-limiting condition among elderly people, few studies have assessed survival times and the factors associated with prognosis in those with early onset disease, explain the researchers.

To explore this further and help inform the treatment and care provision of those diagnosed with early onset dementia, the researchers reviewed and reassessed all 12,490 visits made to dementia outpatient clinics in two university hospital districts in Finland between 2010 and 2021.

Some 794 confirmed cases of early onset dementia were identified, to include Alzheimer’s disease, frontotemporal dementia, alpha-synucleinopathies (in particular, Lewy body dementia), and ‘other’ and ‘mixed’ dementia, which included vascular cognitive impairment.

The survival times of each of these cases was compared with those of 10 people without neurodegenerative disease, but matched for age, sex, and geographical region, from general population data registers (7930 people in total).

During the study period, 215 people with early onset dementia died. Their average survival time was nearly 9 years, but varied according to disease subtype.

The shortest survival time of nearly 7 years was seen among those with frontotemporal dementia or Lewy body dementia (7 years), although those with both frontotemporal dementia and motor neurone disease (ALS) lived for just over 2 years, on average.

Those with Alzheimer’s disease lived for nearly 10 years, on average, while those with vascular cognitive impairment lived the longest—over 10 years, on average.

Compared with those without neurodegenerative disease, the death rate from any cause among those with early onset dementia was more than 6.5 times higher. But when categorised by disease subtype, it was nearly 14 times as high in those with frontotemporal dementia, and more than 4 times as high among those with vascular cognitive impairment, for example.

Male sex, older age, several co-existing conditions, and lower educational attainment were all universally associated with an increased risk of death, but they weren’t specific to early onset dementia. It was the diagnosis of early onset dementia itself that was most strongly and independently associated with survival time, say the researchers.

Only diabetes, which is a known risk factor for dementia, was associated with shorter survival time among those with early onset dementia.

“Overall, although the survival time in years appears shorter in older patients, the impact of dementia diagnosis on all-cause mortality is more significant in the [early onset dementia] age group than in the late onset patients when compared with the general population,” comment the researchers.

This is an observational study, and no definitive conclusions can be drawn about cause and effect. The researchers also acknowledge various limitations to their findings, including that most of the study participants had no genetic or neuropathological confirmation of their dementia. And the numbers in each clinical subgroup were small.

“Our study provides up-to-date [early onset dementia] survival rates in a validated population-based [early onset dementia] cohort, and highlights the substantial effect caused by [its] diagnosis on patients’ mortality,” conclude the researchers.

“Accurate up-to-date data on the survival and mortality rates of [early onset dementia] are crucial in designing healthcare structures, comprehensive patient care, and clinical trials,” they add.

04/11/2025

Notes for editors
Research:  Survival and mortality rates in early onset dementia Doi: 10.1136/jnnp-2025-336805
Journal: Journal of Neurology Neurosurgery & Psychiatry

External funding: Jane and Aatos Erkko Foundation; Wihuri Research Institute; Uulo Arhio Memorial Foundation; Päivikki and Sakari Sohlberg Foundation; Research Council of Finland; Roche; Sigrid Jusélius Foundation; Finnish Brain Foundation; Finnish Cultural Foundation; Finnish Medical Foundation; Finnish Parkinson Foundation

Link to Academy of Medical Sciences Press Release labelling system
http://press.psprings.co.uk/AMSlabels.pdf

About the journal
The Journal of Neurology Neurosurgery & Psychiatry is one of 70  journals published by BMJ Group.
https://jnnp.bmj.com

Externally peer reviewed? Yes
Evidence type: Observational
Subjects: People

The post Significant variations in survival times of early onset dementia by clinical subtype first appeared on BMJ Group.

Even light drinking is unlikely to be protective; risk rises in tandem with quantity consumed

Drinking any amount of alcohol likely increases the risk of dementia, suggests the largest combined observational and genetic study to date, published online in BMJ Evidence Based Medicine.

Even light drinking—generally thought to be protective, based on observational studies—is unlikely to lower the risk, which rises in tandem with the quantity of alcohol consumed, the research indicates.

Current thinking suggests that there might be an ‘optimal dose’ of alcohol for brain health, but most of these studies have focused on older people and/or didn’t differentiate between former and lifelong non-drinkers, complicating efforts to infer causality, note the researchers.

To try and circumnavigate these issues and strengthen the evidence base, the researchers drew on observational data and genetic methods (Mendelian randomisation) from two large biological databanks for the entire ‘dose’ range of alcohol consumption.

These were the US Million Veteran Program (MVP), which includes people of European, African, and Latin American ancestry, and the UK Biobank (UKB), which includes people of predominantly European ancestry.

Participants who were aged 56–72 at baseline, were monitored from recruitment until their first dementia diagnosis, death, or the date of last follow-up (December 2019 for MVP and January 2022 for UKB), whichever came first. The average monitoring period was 4 years for the US group, and 12 for the UK group.

Alcohol consumption was derived from questionnaire responses—over 90% of participants said they drank alcohol—and the Alcohol Use Disorders Identification Test (AUDIT-C) clinical screening tool. This screens for hazardous drinking patterns, including the frequency of binge drinking (6 or more drinks at a time).

In all, 559,559 participants from both groups were included in observational analyses, 14,540 of whom developed dementia of any type during the monitoring period:10,564 in the US group; and 3976 in the UK group. And 48,034 died: 28,738 in the US group and 19,296 in the UK group.

Observational analyses revealed U-shaped associations between alcohol and dementia risk: compared with light drinkers (fewer than 7 drinks a week) a 41% higher risk was observed among non-drinkers and heavy drinkers consuming 40 or more drinks a week, rising to a 51% higher risk among those who were alcohol dependent.

Mendelian randomisation genetic analyses drew on key data from multiple large individual genome-wide association studies (GWAS) of dementia, involving a total of 2.4 million participants to ascertain lifetime (rather than current) genetically predicted risks.

Mendelian randomisation leverages genetic data, minimising the impact of other potentially influential factors, to estimate causal effects: genomic risk for a trait (in this case, alcohol consumption) essentially stands in for the trait itself.

Three genetic measures related to alcohol use were used as different exposures, to study the impact on dementia risk of alcohol quantity, as well as problematic and dependent drinking.

These exposures were: self-reported weekly drinks (641 independent genetic variants);  problematic ‘risky’ drinking (80 genetic variants); and alcohol dependency (66 genetic variants).

Higher genetic risk for all 3 exposure levels was associated with an increased risk of dementia, with a linear increase in dementia risk the higher the alcohol consumption.

For example, an extra 1-3 drinks a week was associated with a 15% higher risk. And a doubling in the genetic risk of alcohol dependency was associated with a 16% increase in dementia risk.

But no U-shaped association was found between alcohol intake and dementia, and no protective effects of low levels of alcohol intake were observed. Instead, dementia risk steadily increased with more genetically predicted drinking.

What’s more, those who went on to develop dementia typically drank less over time in the years preceding their diagnosis, suggesting that reverse causation—whereby early cognitive decline leads to reduced alcohol consumption—underlies the supposed protective effects of alcohol found in previous observational studies, say the researchers.

They acknowledge that a principal limitation of their findings is that the strongest statistical associations were found in people of European ancestry, because of the numbers of participants of this ethnic heritage studied. Mendelian randomisation also relies on assumptions that can’t be verified, they add.

Nevertheless, they suggest that their findings “challenge the notion that low levels of alcohol are neuroprotective.”

And they conclude: “Our study findings support a detrimental effect of all types of alcohol consumption on dementia risk, with no evidence supporting the previously suggested protective effect of moderate drinking.

“The pattern of reduced alcohol use before dementia diagnosis observed in our study underscores the complexity of inferring causality from observational data, especially in ageing populations.

“Our findings highlight the importance of considering reverse causation and residual confounding in studies of alcohol and dementia, and they suggest that reducing alcohol consumption may be an important strategy for dementia prevention.”

23/09/2025

Notes for editors
Research: Alcohol use and risk of dementia in diverse populations: evidence from cohort, case–control and Mendelian randomisation approaches Doi:10.1136/bmjebm2025-113913
Journal: BMJ Evidence Based Medicine

External funding: Department of Veterans Affairs Office of Research and Development, Million Veteran Program; VA Cooperative Studies Program

Link to Academy of Medical Sciences press release labelling system
http://press.psprings.co.uk/AMSlabels.pdf 

Externally peer reviewed? Yes
Evidence type: Observational + Mendelian randomisation study
Subjects: People

The post Drinking any amount of alcohol likely increases dementia risk first appeared on BMJ Group.

Increasing from twice as high for one disorder to 11 times as high for four or more
In particular, concurrent mood + anxiety disorder linked to odds of up to 90% for dementia

The odds of developing dementia are strongly linked to the number of co-existing mental health disorders, rising from twice as high for one disorder to 11 times as high for four or more, finds research published in the open access journal BMJ Mental Health.

In particular, the combination of concurrent mood and anxiety disorders is linked to odds of  dementia of up to 90%, the findings indicate.

Psychiatric disorders, such as depression, anxiety, and bipolar disorder, have been individually associated with an increased risk of dementia. But the existing body of research hasn’t assessed the impact of multiple co-existing psychiatric disorders, say the researchers.

In a bid to plug this knowledge gap, they drew on information extracted from the clinical database of the psychiatry department of Bicêtre Hospital, Paris.

They included 3688 patients aged at least 45 and diagnosed with one or more of the most common psychiatric disorders—depression, anxiety, psychosis, substance misuse, personality disorder and bipolar disorder—between August 2009 and October 2023. And they included every type of dementia and cognitive impairment.

The average age of the entire group  was 67: 70 in those with dementia, and 66 in those without. And the average delay between diagnosis of the first psychiatric disorder and dementia diagnosis was 18 months, but ranged from 7 to 13 years.

Nearly 71% (2608) of the patients had one psychiatric disorder; 21.5% (789) had two; 6% (226) had three; and 2% (65) had four or more.

After adjusting for age, sex, and cardiovascular risk factors, the odds of dementia rose in tandem with the number of psychiatric disorders.

Compared with those with one psychiatric disorder, those with two, were twice as likely to be diagnosed with dementia, while those with three, were more than 4 times as likely to do so.

And those with four or more, were 11 times as likely to have dementia.

In particular, the combination of concurrent mood and anxiety disorders was linked to odds of dementia of up to 90%.

The effect of concurrent psychiatric disorders seems to be specific to dementia and suggests they may be early warning signs of it, because further in-depth analysis testing the potential effects on the likelihood of other disease—in this case renal failure–failed to show any link, note the researchers.

This is an observational study, and as such, no firm conclusions can be drawn about cause and effect. And the researchers caution that dementia diagnoses may have been delayed, and, without clinical confirmation, misclassification may have occurred.

All the study participants were also drawn from just one psychiatric department, so may not be representative of all patients with mental health disorders, added to which, information on several potentially influential factors, including socioeconomic status, family history, duration of psychiatric disorder, treatment and brain scans, wasn’t available, the researchers add.

Nevertheless, they conclude:“The findings of this study highlight the strong association between the co-occurrence of psychiatric disorders and an increased posterior probability of developing dementia, particularly for patterns with anxiety and mood disorders.

“Recent advancements in dementia diagnoses, such as the development of biomarkers in blood and cerebrospinal fluid, as well as the use of positron emission tomography, encourage earlier and more accurate detection of dementia.

“Integrating these tools into clinical practice for high-risk individuals, especially those with specific psychiatric comorbidities identified in this study, could significantly enhance their care management, given the recent advancements in dementia treatment.”

09/09/2025

Notes for editors
Research: Strong association between psychiatric disorders co-occurrence and dementia: a Bayesian approach on a 14-year clinical data warehouse  Doi:10.1136/bmjment-2025- 301651
Journal: BMJ Mental Health

Link to Academy of Medical Sciences press release labelling system http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Observational
Subjects: People

The post Odds of dementia strongly linked to number of co-existing mental health disorders first appeared on BMJ Group.