title: Nonpsychotic Mental Disorders in Teenage Males and Risk of Early Stroke: A Population-Based Study.
abstract: OBJECTIVE
  Although the incidence of stroke is on the decline worldwide, this is not the case for early stroke. We aimed to determine whether nonpsychotic mental disorder at the age of 18 years is a risk factor for early stroke, and if adolescent cardiovascular fitness and intelligence quotient might attenuate the risk.
  
  
  METHODS
  Population-based Swedish cohort study of conscripts (n=1 163 845) who enlisted during 1968 to 2005. At conscription, 45 064 males were diagnosed with nonpsychotic mental disorder. Risk of stroke during follow-up (5-42 years) was calculated with Cox proportional hazards models. Objective baseline measures of fitness and cognition were included in the models in a second set of analyses.
  
  
  RESULTS
  There were 7770 first-time stroke events. In adjusted models, increased risk for stroke was observed in men diagnosed with depressive/neurotic disorders (hazard ratio [HR], 1.23; 95% confidence interval [CI], 1.11-1.37), personality disorders (HR, 1.52; 95% CI, 1.29-1.78), and alcohol/substance use disorders (HR, 1.61; 95% CI, 1.41-1.83) at conscription. Corresponding figures for fatal stroke were HR, 1.38; 95% CI, 1.06 to 1.79; HR, 2.26; 95% CI, 1.60 to 3.19; and HR, 2.20; 95% CI, 1.63 to 2.96. HRs for stroke were attenuated when fitness level and intelligence quotient were introduced. Associations remained significant for personality disorders and alcohol/substance use in the fully adjusted models. The interaction term was statistically significant for fitness but not for intelligence quotient.
  
  
  CONCLUSIONS
  Our findings suggest that fitness may modify associations between nonpsychotic disorders and stroke. It remains to be clarified whether interventions designed to improve fitness in mentally ill youth can influence future risk of early stroke.
authors: From the Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology (M.A.I.Å., M.N., M.H., H.G.K., J.N.), Department of Primary Health Care (M.A.I.Å., M.H.), Occupational and Environmental Medicine (K.T.), Departments of Molecular and Clinical Medicine (A.R.), Department of Internal Medicine (N.D.Å.), Institute of Medicine, Neuropsychiatric Epidemiology Unit, and Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology (M.W.) Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; and Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia (M.N.). maria.aberg@gu.se.
authors: Maria A I
authors: MA
authors: Åberg
authors: From the Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology (M.A.I.Å., M.N., M.H., H.G.K., J.N.), Department of Primary Health Care (M.A.I.Å., M.H.), Occupational and Environmental Medicine (K.T.), Departments of Molecular and Clinical Medicine (A.R.), Department of Internal Medicine (N.D.Å.), Institute of Medicine, Neuropsychiatric Epidemiology Unit, and Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology (M.W.) Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; and Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia (M.N.).
authors: Kjell
authors: K
authors: Torén
authors: From the Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology (M.A.I.Å., M.N., M.H., H.G.K., J.N.), Department of Primary Health Care (M.A.I.Å., M.H.), Occupational and Environmental Medicine (K.T.), Departments of Molecular and Clinical Medicine (A.R.), Department of Internal Medicine (N.D.Å.), Institute of Medicine, Neuropsychiatric Epidemiology Unit, and Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology (M.W.) Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; and Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia (M.N.).
authors: Michael
authors: M
authors: Nilsson
authors: From the Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology (M.A.I.Å., M.N., M.H., H.G.K., J.N.), Department of Primary Health Care (M.A.I.Å., M.H.), Occupational and Environmental Medicine (K.T.), Departments of Molecular and Clinical Medicine (A.R.), Department of Internal Medicine (N.D.Å.), Institute of Medicine, Neuropsychiatric Epidemiology Unit, and Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology (M.W.) Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; and Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia (M.N.).
authors: Malin
authors: M
authors: Henriksson
authors: From the Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology (M.A.I.Å., M.N., M.H., H.G.K., J.N.), Department of Primary Health Care (M.A.I.Å., M.H.), Occupational and Environmental Medicine (K.T.), Departments of Molecular and Clinical Medicine (A.R.), Department of Internal Medicine (N.D.Å.), Institute of Medicine, Neuropsychiatric Epidemiology Unit, and Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology (M.W.) Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; and Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia (M.N.).
authors: H Georg
authors: HG
authors: Kuhn
authors: From the Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology (M.A.I.Å., M.N., M.H., H.G.K., J.N.), Department of Primary Health Care (M.A.I.Å., M.H.), Occupational and Environmental Medicine (K.T.), Departments of Molecular and Clinical Medicine (A.R.), Department of Internal Medicine (N.D.Å.), Institute of Medicine, Neuropsychiatric Epidemiology Unit, and Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology (M.W.) Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; and Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia (M.N.).
authors: Jenny
authors: J
authors: Nyberg
authors: From the Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology (M.A.I.Å., M.N., M.H., H.G.K., J.N.), Department of Primary Health Care (M.A.I.Å., M.H.), Occupational and Environmental Medicine (K.T.), Departments of Molecular and Clinical Medicine (A.R.), Department of Internal Medicine (N.D.Å.), Institute of Medicine, Neuropsychiatric Epidemiology Unit, and Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology (M.W.) Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; and Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia (M.N.).
authors: Annika
authors: A
authors: Rosengren
authors: From the Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology (M.A.I.Å., M.N., M.H., H.G.K., J.N.), Department of Primary Health Care (M.A.I.Å., M.H.), Occupational and Environmental Medicine (K.T.), Departments of Molecular and Clinical Medicine (A.R.), Department of Internal Medicine (N.D.Å.), Institute of Medicine, Neuropsychiatric Epidemiology Unit, and Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology (M.W.) Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; and Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia (M.N.).
authors: N David
authors: ND
authors: Åberg
authors: From the Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology (M.A.I.Å., M.N., M.H., H.G.K., J.N.), Department of Primary Health Care (M.A.I.Å., M.H.), Occupational and Environmental Medicine (K.T.), Departments of Molecular and Clinical Medicine (A.R.), Department of Internal Medicine (N.D.Å.), Institute of Medicine, Neuropsychiatric Epidemiology Unit, and Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology (M.W.) Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; and Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia (M.N.).
authors: Margda
authors: M
authors: Waern
mesh_terms: D000293:Adolescent; D000367:Age Factors; D015331:Cohort Studies; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D011159:Population Surveillance / Q000379:methods; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D013548:Sweden / Q000453:epidemiology
keywords: adolescent; exercise; mental disorders; population; stroke