Low muscle strength in adolescence linked to increased risk of early death

Contact: Stephanie Burns
BMJ-British Medical Journal

Effect similar to classic risk factors such as weight and blood pressure

Research: Muscular strength in male adolescents and premature death: cohort study of one million participants

Low muscle strength in adolescence is strongly associated with a greater risk of early death from several major causes, suggests a large study published on bmj.com today.

The effect is similar to well established risk factors for early death like being overweight or having high blood pressure, leading the authors to call for young people, particularly those with very low strength, to engage in regular physical activity to boost their muscular fitness.

High body mass index (BMI) and high blood pressure at a young age are known risk factors for premature death, but whether muscular strength in childhood or adolescence can predict mortality is unclear.

So a team of researchers, led by Professor Finn Rasmussen at the Karolinska Institutet in Sweden, tracked more than one million Swedish male adolescents aged 16 to 19 years over a period of 24 years.

Participants underwent three reliable muscular strength tests at the start of the study (knee extension strength, handgrip strength and elbow flexion strength). BMI and blood pressure were also measured. Premature death was defined as death before age 55 years.

During the follow-up period, 26,145 participants (2.3% of the group) died. Suicide was the most common cause of death (22.3%) compared with cardiovascular diseases (7.8%) or cancer (14.9%).

High muscular strength was associated with a 20-35% lower risk of early death from any cause and also from cardiovascular diseases, independently of BMI or blood pressure. No association was seen with cancer deaths.

Stronger adolescents also had a 20-30% lower risk of early death from suicide and were up to 65% less likely to have any psychiatric diagnosis, such as schizophrenia and mood disorders. These results suggest that physically weaker individuals might be more mentally vulnerable, say the authors.

In contrast, male adolescents with the lowest level of muscular strength showed the greatest all-cause mortality and also the greatest mortality in cardiovascular disease and suicide before age 55 years.

Death rates from any cause (per 100,000 person years) ranged between 122.3 and 86.9 for weakest and strongest adolescents respectively. Rates for cardiovascular diseases were 9.5 and 5.6 and for suicide were 24.6 and 16.9.

The authors say that low muscular strength in adolescents “is an emerging risk factor for major causes of death in young adulthood, such as suicide and cardiovascular diseases.” The effect sizes of these associations “are similar to classic risk factors such as body mass index and blood pressure,” they add.

They suggest that muscular strength tests, in particular handgrip strength, could be assessed with good reliability in almost any place, including clinical settings, schools and workplaces.

They also support the need for regular physical activity in childhood and adolescence, saying: “People at increased risk of long term mortality, because of lower muscular strength, should be encouraged to engage in exercise programmes and other forms of physical activity.”

Medication cuts crime rate among ADHD sufferers: results suggested that encouraging more ADHD sufferers to take medication could help to reduce crime and re-offending rates

Wed, 21 Nov 2012 22:00 GMT


* Study of 25,000 people found ADHD drugs cut crime rates

* Ritalin and other stimulants can help patients to focus

* Experts say medication decisions must be personal choice

By Kate Kelland

LONDON, Nov 21 (Reuters) – Criminal behaviour in adults with attention deficit hyperactivity disorder (ADHD) drops sharply when they take stimulant drugs like Ritalin to help them to control impulses, scientists said on Wednesday.

A study of more than 25,000 people with ADHD found the number of crimes committed was about a third or more lower in those taking medication, suggesting that encouraging ADHD patients to stay on the pills could cut the risk of crime.

Past international studies show up to two-thirds of young offenders and half the adult prison population screen positively for childhood ADHD, and many may still have symptoms as adults.

British and Swedish researchers who conducted the new study found that patients who went through periods on and off ADHD drugs had a significantly reduced risk of engaging in criminal activity when they were medicated.

“The bottom line is that medication led to a 32 percent reduction in crime rates in men and a 41 percent reduction in crime rates in women,” said Seena Fazel, a forensic psychiatrist at Britain’s Oxford University who presented the findings at a briefing in London

Paul Lichtenstein of Sweden’s Karolinska Institute, who worked with Fazel and colleagues, said the results suggested that encouraging more ADHD sufferers to take medication could help to reduce crime and re-offending rates.

“It’s said that roughly 30 to 40 percent of long-serving criminals have ADHD. If their chances of recidivism can be reduced by 30 percent, it would clearly affect total crime numbers in many societies, he said in a statement.

Some 5 percent of school-age children and around half as many adults worldwide have ADHD, a disorder characterised by distractedness and impulsive and sometimes violent behaviour.

In the United States, it is one of the most common childhood disorders with an average of 9 percent of children between the ages of five and 17 are diagnosed with it each year.

Previous studies have shown that people with ADHD have on average less education and lower incomes, higher rates of unemployment, divorce and substance abuse, and are more likely to enter a life of crime. But until now health experts were not clear how medication might be affecting the crime risk.

“We’ve shown that ADHD medication very probably reduces the risk of crime,” said Henrik Larsson of the Karolinska Institute. “However … most medical treatments can have adverse side effects, so risks must be weighed up against benefits.”

Ritalin, known generically as methylphenidate, is sold by the Swiss drugmaker Novartis and is widely used in developed countries to help people with ADHD to concentrate better and control impulsiveness. Other ADHD drugs include Johnson & Johnson’s Concerta, Shire’s Adderall and Vyvanse and Eli Lilly’s Strattera.

Philip Asherson, an ADHD expert from Britain’s Institute of Psychiatry who was not involved in this research but was speaking at the London briefing, said the findings could point to a cost-effective way to help patients stay out of trouble.

In Britain for example, a month’s supply of ADHD medication costs around 300 pounds per patient, he said – a fraction of the cost to society of keeping someone in prison.

Asherson stressed however that decisions about medication should be a personal choice.

The study was published in the New England Journal of Medicine on Wednesday.


Link between creativity and mental illness confirmed

Simon Kyaga

[PRESS RELEASE 16 October 2012]

People in creative professions are treated more often for mental illness than the general population, there being a particularly salient connection between writing and schizophrenia. This according to researchers at Karolinska Institutet, whose large-scale Swedish registry study is the most comprehensive ever in its field.

Last year, the team showed that artists and scientists were more common amongst families where  bipolar disorder and schizophrenia is present, compared to the population at large. They subsequently expanded their study to many more psychiatric diagnoses – such as schizoaffective disorder, depression, anxiety syndrome, alcohol abuse, drug abuse, autism, ADHD, anorexia nervosa and suicide – and to include people in outpatient care rather than exclusively hospital patients.


The present study tracked almost 1.2 million patients and their relatives, identified down to second-cousin level. Since all were matched with healthy controls, the study incorporated much of the Swedish population from the most recent decades. All data was anonymized and cannot be linked to any individuals.


The results confirmed those of their previous study: certain mental illness – bipolar disorder – is more prevalent in the entire group of people with artistic or scientific professions, such as dancers, researchers, photographers and authors. Authors specifically also were more common among most of the other psychiatric diseases (including schizophrenia, depression, anxiety syndrome and substance abuse) and were almost 50 per cent more likely to commit suicide than the general population.


The researchers also observed that creative professions were more common in the relatives of patients with schizophrenia, bipolar disorder, anorexia nervosa and, to some extent, autism. According to Simon Kyaga, consultant in psychiatry and doctoral student at the Department of Medical Epidemiology and Biostatistics, the results give cause to reconsider approaches to mental illness.


“If one takes the view that certain phenomena associated with the patients illness are beneficial, it opens the way for a new approach to treatment,” he says. “In that case, the doctor and patient must come to an agreement on what is to be treated, and at what cost. In psychiatry and medicine generally there has been a tradition to see the disease in black-and-white terms and to endeavour to treat the patient by removing everything regarded as morbid.”


The study was financed with grants from the Swedish Research Council, the Swedish Psychiatry Foundation, the Bror Gadelius Foundation, the Stockholm Centre for Psychiatric Research and the Swedish Council for Working Life and Social Research