University of Oulu

Miika Nietola, Tanja Nordström, Jouko Miettunen, Jyrki Korkeila, Erika Jääskeläinen, Effects of gender and psychiatric comorbidity on the age of illness onset and the outcome of psychotic depression—A birth cohort study, Journal of Affective Disorders, Volume 296, 2022, Pages 587-592, ISSN 0165-0327,

Effects of gender and psychiatric comorbidity on the age of illness onset and the outcome of psychotic depression : a birth cohort study

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Author: Nietola, Miika1; Nordström, Tanja2,3,4; Miettunen, Jouko2,3;
Organizations: 1Psychiatric department, University of Turku and the Hospital District of Southwest Finland, Kunnallissairaalantie 20, building 9, 3. floor, 20700 Turku, Finland
2Center for Life Course Health Research, University of Oulu, Oulu, Finland
3Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
4Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland
5Psychiatric Department, University of Turku and Satakunta Hospital District, Finland
6Department of Psychiatry, Oulu University Hospital, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.6 MB)
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Language: English
Published: Elsevier, 2022
Publish Date: 2021-12-17


Background: Psychotic depression (PD) is an under-researched disorder with severe symptoms and course of illness. Little is known about gender differences relating to this condition and possible variation of prognosis based on comorbid pathology. Our aim was to analyze the effects of gender and psychiatric comorbidities on the age of illness onset and on the outcome of psychotic depression.

Methods: The study was carried out in the Northern Finland Birth Cohort 1966. We utilized register data to acquire information about lifetime psychiatric diagnoses, hospitalization, age of illness onset, rate of disability pensions and mortality. The PD group (n = 58) was defined based on a lifetime register diagnosis. We compared outcome variables in sub-groups based on gender and comorbid alcohol use or personality disorder.

Results: The prevalence of comorbid personality disorders was 38% (22/58) and comorbid alcohol use disorders 41% (24/58). PD patients with a personality disorder diagnosis had an earlier onset age (p<0.01) and a higher mortality rate (p = 0.03). Male gender (p = 0.03), comorbid alcohol use disorder (p%lt;0.01) and personality disorder (p %lt; 0.01) were all associated with more psychiatric hospitalization. Comorbid alcohol use disorder was more common among men (males: 61%; females: 29%; p = 0.03).

Limitations: National registers were the main source of diagnostic information.

Conclusions: Gender and psychiatric comorbidity have significant implications for the course of illness in PD in naturalistic settings, which is an important message for all clinicians. More research into the heterogeneity of PD is needed in order to guide research and clinical practice.

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Series: Journal of affective disorders
ISSN: 0165-0327
ISSN-E: 1573-2517
ISSN-L: 0165-0327
Volume: 296
Pages: 587 - 592
DOI: 10.1016/j.jad.2021.09.077
Type of Publication: A1 Journal article – refereed
Field of Science: 3124 Neurology and psychiatry
Funding: This study was supported by Turku University Foundation, Doctoral Programme in Clinical Research (DPCR), The Psychiatric Clinic of University of Turku, Juho Vainio Foundation, Yrjö Jahnsson Foundation and the Finnish Medical Foundation. The funders did not participate in the study or in the preparation of the manuscript in any way.
Copyright information: © 2021 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY license (