title: Future marginalisation and mortality in young Swedish men with non-psychotic psychiatric disorders and the resilience effect of cognitive ability: a prospective, population-based study.
abstract: Large-scale studies examining future trajectories of marginalisation and health in adolescents with mental illness are scarce. The aim of this study was to examine if non-psychotic psychiatric disorders (NPDs) were associated with future indicators of marginalisation and mortality. We also aimed to determine whether these associations might be mediated by education level and attenuated by high cognitive ability.
  
  
  
  This is a prospective cohort study with baseline data from the Swedish Conscription register.
  
  
  
  The study was carried out in Sweden from 1969 to 2005.
  
  
  
  All of the participants were 18-year-old men at mandatory conscription in Sweden between 1969 and 2005 (n=1 609 690).
  
  
  
  NPDs were clinically diagnosed at conscription. Cognitive ability was measured by a standardised IQ test at conscription. National register data covered information on welfare support, long-term unemployment, disability pension (DP) and mortality over a period of 1-36 years.
  
  
  
  NPD at the age of 18 years was a predictor of future welfare support, OR 3.73 (95% CI 3.65 to 3.80); long-term unemployment, OR 1.97 (95% CI 1.94 to 2.01); DP, HR 2.95 (95% CI 2.89 to 3.02); and mortality, HR 2.45 (2.33-2.52). The adjusted models suggested that these associations were not confounded by fathers' educational level, cognitive ability had only a minor attenuating effect on most associations and the mediating effect of own educational level was small.
  
  
  
  The present study underlines a higher prevalence of future adversities in young men experiencing NPDs at the age of 18 years. It also indicates that higher cognitive ability may work as a potential resilience factor against future marginalisation and mortality.
authors: Section for Social Medicine and Epidemiology, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
authors: J
authors: J
authors: Löve
authors: Section for Social Medicine and Epidemiology, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
authors: G
authors: G
authors: Hensing
authors: Occupational and Environmental Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
authors: M
authors: M
authors: Söderberg
authors: Occupational and Environmental Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
authors: K
authors: K
authors: Torén
authors: Department of Psychiatry and Neurochemistry, Neuropsychiatric Epidemiology Unit, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.
authors: M
authors: M
authors: Waern
authors: Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden Department of Primary Health Care, Institute of Medicine, All at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors: M
authors: M
authors: Åberg
mesh_terms: D000293:Adolescent; D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology / Q000523:psychology; D003071:Cognition; D015331:Cohort Studies; D003866:Depressive Disorder / Q000453:epidemiology / Q000523:psychology; D005500:Follow-Up Studies; D006801:Humans; D007360:Intelligence; D007361:Intelligence Tests; D016015:Logistic Models; D008297:Male; D008571:Men; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology; D008875:Middle Aged; D009026:Mortality; D016017:Odds Ratio; D010415:Pensions / Q000706:statistics & numerical data; D010554:Personality Disorders / Q000453:epidemiology / Q000523:psychology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011632:Public Assistance / Q000706:statistics & numerical data*; D055500:Resilience, Psychological; D062487:Social Marginalization / Q000523:psychology; D012943:Social Security / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology; D013548:Sweden / Q000453:epidemiology; D014478:Unemployment / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: EPIDEMIOLOGY; MENTAL HEALTH