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      Association of Primary Humoral Immunodeficiencies With Psychiatric Disorders and Suicidal Behavior and the Role of Autoimmune Diseases

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          Abstract

          This cohort study assesses whether primary humoral immunodeficiencies that affect antibody level and function are associated with lifetime psychiatric disorders and suicidal behavior, and whether this association is explained by the co-occurrence of autoimmune diseases among adults in Sweden.

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          External review and validation of the Swedish national inpatient register

          Jonas F. Ludvigsson, Eva Andersson, Anders Ekbom … (2011)
          Background The Swedish National Inpatient Register (IPR), also called the Hospital Discharge Register, is a principal source of data for numerous research projects. The IPR is part of the National Patient Register. The Swedish IPR was launched in 1964 (psychiatric diagnoses from 1973) but complete coverage did not begin until 1987. Currently, more than 99% of all somatic (including surgery) and psychiatric hospital discharges are registered in the IPR. A previous validation of the IPR by the National Board of Health and Welfare showed that 85-95% of all diagnoses in the IPR are valid. The current paper describes the history, structure, coverage and quality of the Swedish IPR. Methods and results In January 2010, we searched the medical databases, Medline and HighWire, using the search algorithm "validat* (inpatient or hospital discharge) Sweden". We also contacted 218 members of the Swedish Society of Epidemiology and an additional 201 medical researchers to identify papers that had validated the IPR. In total, 132 papers were reviewed. The positive predictive value (PPV) was found to differ between diagnoses in the IPR, but is generally 85-95%. Conclusions In conclusion, the validity of the Swedish IPR is high for many but not all diagnoses. The long follow-up makes the register particularly suitable for large-scale population-based research, but for certain research areas the use of other health registers, such as the Swedish Cancer Register, may be more suitable.
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            From inflammation to sickness and depression: when the immune system subjugates the brain.

            Robert Dantzer, Jason O'Connor, Gregory Freund … (2008)
            In response to a peripheral infection, innate immune cells produce pro-inflammatory cytokines that act on the brain to cause sickness behaviour. When activation of the peripheral immune system continues unabated, such as during systemic infections, cancer or autoimmune diseases, the ensuing immune signalling to the brain can lead to an exacerbation of sickness and the development of symptoms of depression in vulnerable individuals. These phenomena might account for the increased prevalence of clinical depression in physically ill people. Inflammation is therefore an important biological event that might increase the risk of major depressive episodes, much like the more traditional psychosocial factors.
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              The Swedish personal identity number: possibilities and pitfalls in healthcare and medical research

              Jonas F. Ludvigsson, Petra Otterblad Olausson, Birgitta Pettersson … (2009)
              Swedish health care and national health registers are dependent on the presence of a unique identifier. This paper describes the Swedish personal identity number (PIN) and explores ethical issues of its use in medical research. A ten-digit-PIN is maintained by the National Tax Board for all individuals that have resided in Sweden since 1947. Until January 2008, an estimated 75,638 individuals have changed PIN. The most common reasons for change of PIN are incorrect recording of date of birth or sex among immigrants or newborns. Although uncommon, change of sex always leads to change of PIN since the PIN is sex-specific. The most common reasons for re-use of PIN (n = 15,887), is when immigrants are assigned a PIN that has previously been assigned to someone else. This is sometimes necessary since there is a shortage of certain PIN combinations referring to dates of birth in the 1950s and 1960s. Several ethical issues can be raised pro and con the use of PIN in medical research. The Swedish PIN is a useful tool for linkages between medical registers and allows for virtually 100% coverage of the Swedish health care system. We suggest that matching of registers through PIN and matching of national health registers without the explicit approval of the individual patient is to the benefit for both the individual patient and for society.
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                Author and article information

                Journal
                Title: JAMA Psychiatry
                Abbreviated Title: JAMA Psychiatry
                Publisher: American Medical Association (AMA)
                ISSN (Print): 2168-622X
                Publication date (Electronic): June 10 2020
                Affiliations
                [1 ]Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
                [2 ]Department of Psychiatry, Massachusetts General Hospital, Boston
                [3 ]Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
                [4 ]Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
                [5 ]School of Medical Sciences, Örebro University, Örebro, Sweden
                Article
                DOI: 10.1001/jamapsychiatry.2020.1260
                SO-VID: 30cf49d7-e6a6-47c7-9c6f-b4a18c7effcb
                Copyright © © 2020
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