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Risk and protective factors for mental disorders beyond genetics: an evidence-based atlas
Hosp Gen Univ Gregorio Maranon, Spain; Univ Complutense Madrid, Spain; Biomed Res Ctr Mental Hlth CIBERSAM, Spain.
Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.ORCID iD: 0000-0001-9019-4125
Kings Coll London, England; Univ Padua, Italy; Univ Ottawa, Canada; Ottawa Hosp, Canada.
Univ Southampton, England; Univ Southampton, England; Univ Nottingham, England; NYU Langone, NY USA.
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2021 (English)In: World Psychiatry, ISSN 1723-8617, E-ISSN 2051-5545, Vol. 20, no 3, p. 417-436Article in journal (Refereed) Published
Abstract [en]

Decades of research have revealed numerous risk factors for mental disorders beyond genetics, but their consistency and magnitude remain uncer-tain. We conducted a "meta-umbrella" systematic synthesis of umbrella reviews, which are systematic reviews of meta-analyses of individual studies, by searching international databases from inception to January 1, 2021. We included umbrella reviews on non-purely genetic risk or protective factors for any ICD/DSM mental disorders, applying an established classification of the credibility of the evidence: class I (convincing), class II (highly suggestive), class III (suggestive), class IV (weak). Sensitivity analyses were conducted on prospective studies to test for temporality (reverse causation), TRANSD criteria were applied to test transdiagnosticity of factors, and A Measurement Tool to Assess Systematic Reviews (AMSTAR) was employed to address the quality of meta-analyses. Fourteen eligible umbrella reviews were retrieved, summarizing 390 meta-analyses and 1,180 associations between putative risk or protective factors and mental disorders. We included 176 class I to III evidence associations, relating to 142 risk/protective factors. The most robust risk factors (class I or II, from prospective designs) were 21. For dementia, they included type 2 diabetes mellitus (risk ratio, RR from 1.54 to 2.28), depression (RR from 1.65 to 1.99) and low frequency of social contacts (RR=1.57). For opioid use disorders, the most robust risk factor was tobacco smoking (odds ratio, OR=3.07). For non-organic psychotic disorders, the most robust risk factors were clinical high risk state for psychosis (OR=9.32), cannabis use (OR=3.90), and childhood adversities (OR=2.80). For depressive disorders, they were widowhood (RR=5.59), sexual dysfunction (OR=2.71), three (OR=1.99) or four-five (OR=2.06) metabolic factors, childhood physical (OR=1.98) and sexual (OR=2.42) abuse, job strain (OR=1.77), obesity (OR=1.35), and sleep disturbances (RR=1.92). For autism spectrum disorder, the most robust risk factor was maternal overweight pre/during pregnancy (RR=1.28). For attention-deficit/hyperactivity disorder (ADHD), they were maternal pre-pregnancy obesity (OR=1.63), maternal smoking during pregnancy (OR=1.60), and maternal overweight pre/during pregnancy (OR=1.28). Only one robust protective factor was detected: high physical activity (hazard ratio, HR=0.62) for Alzheimers disease. In all, 32.9% of the associations were of high quality, 48.9% of medium quality, and 18.2% of low quality. Transdiagnostic class I-III risk/protective factors were mostly involved in the early neurodevelopmental period. The evidence-based atlas of key risk and protective factors identified in this study represents a benchmark for advancing clinical characterization and research, and for expanding early intervention and preventive strategies for mental disorders.

Place, publisher, year, edition, pages
John Wiley & Sons, 2021. Vol. 20, no 3, p. 417-436
Keywords [en]
Risk factors; protective factors; mental disorders; dementia; psychotic disorders; mood disorders; autism spectrum disorder; attention-deficit; hyperactivity disorder; early intervention; preventive strategies
National Category
Psychiatry
Identifiers
URN: urn:nbn:se:liu:diva-179834DOI: 10.1002/wps.20894ISI: 000694412400021PubMedID: 34505386OAI: oai:DiVA.org:liu-179834DiVA, id: diva2:1600481
Available from: 2021-10-05 Created: 2021-10-05 Last updated: 2021-10-29

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