title: Stress resilience in adolescence and subsequent antidepressant and anxiolytic medication in middle aged men: Swedish cohort study.
abstract: It is unclear whether psychological resilience to stress in adolescence represents a persistent characteristic relevant to the subsequent risk for depression and anxiety in later adulthood. We aimed to test whether low psychological stress resilience assessed in adolescence is associated with an increased risk of receiving medication for depression and anxiety in middle age. We utilized Swedish register-based cohort study. Men born between 1952 and 1956 (n = 175,699), who underwent compulsory assessment for military conscription in late adolescence were followed to examine subsequent risk of pharmaceutically-treated depression and anxiety in middle age, from 2006 to 2009 corresponding to ages between 50 and 58 years, using Cox regression. The associations of stress resilience with prescription of antidepressant and anxiolytics medication through potential mediating factors cognitive and physical function and adult socioeconomic factors were calculated. Low stress resilience was associated with elevated risks for antidepressant (hazard ratio (HR):1.5 (95% CI 1.4 1.6)) and anxiolytics (HR:2.4 (CI 2.0 2.7)) medication. Adjustment for measures of childhood living circumstances attenuated the associations somewhat. Around a third of association with low stress resilience, and a half of that with moderate resilience, was mediated through cognitive and physical function in adolescence and adult socioeconomic factors. The magnitude of the inverse association of higher cognitive function with antidepressant medication was eliminated among those with low stress resilience. These results indicate that low stress resilience in adolescence is associated with an increased risk for antidepressant and anxiolytics medication over 30 years later, in part mediated through developmental factors in adolescence and socioeconomic circumstances in adulthood, and low stress resilience can diminish or eliminate the inverse association of higher cognitive function with antidepressant medication.
authors.affiliation: Clinical Epidemiology and Biostatistics, Faculty of Medicine and Health, Örebro University, SE-701 82 Örebro, Sweden. Electronic address: Ayako.Hiyoshi@oru.se.
authors.forename: Ayako
authors.initials: A
authors.lastname: Hiyoshi
authors.affiliation: Clinical Epidemiology and Biostatistics, Faculty of Medicine and Health, Örebro University, SE-701 82 Örebro, Sweden. Electronic address: ruzan.udumyan@regionorebrolan.se.
authors.forename: Ruzan
authors.initials: R
authors.lastname: Udumyan
authors.affiliation: Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Norra Stationsgatan 69, SE-113 64 Stockholm, Sweden; Centre for Social Sustainability, CSS, Department of Neurobiology, Care Sciences and Society, SE-141 83 Huddinge, Sweden. Electronic address: walter.osika@ki.se.
authors.forename: Walter
authors.initials: W
authors.lastname: Osika
authors.affiliation: Swedish Institute for Social Research (SOFI), Stockholm University, SE-106 91 Stockholm, Sweden. Electronic address: erik.bihagen@sofi.su.se.
authors.forename: Erik
authors.initials: E
authors.lastname: Bihagen
authors.affiliation: Clinical Epidemiology and Biostatistics, Faculty of Medicine and Health, Örebro University, SE-701 82 Örebro, Sweden; Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, SE-171 76 Stockholm, Sweden. Electronic address: Katja.Fall@oru.se.
authors.forename: Katja
authors.initials: K
authors.lastname: Fall
authors.affiliation: Clinical Epidemiology and Biostatistics, Faculty of Medicine and Health, Örebro University, SE-701 82 Örebro, Sweden; Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, SE-171 76 Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, WC1E 6BT London, United Kingdom. Electronic address: scott.montgomery@regionorebrolan.se.
authors.forename: Scott
authors.initials: S
authors.lastname: Montgomery
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D014151:Anti-Anxiety Agents / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001007:Anxiety / Q000523:psychology; D003071:Cognition; D015331:Cohort Studies; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D008889:Military Personnel / Q000523:psychology; D055500:Resilience, Psychological; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000523:psychology; D013548:Sweden; D055815:Young Adult
chemical_list: D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents
keywords: Antidepressant; Anxiolytics; Medication; Register-based cohort study; Stress resilience; Sweden