Continuities and discontinuities in psychopathology between childhood and adult life

Development and validation of a risk calculator for major mood disorders among the offspring of bipolar parents using information collected in routine clinical practice

BACKGROUND

Family history is a significant risk factor for bipolar disorders (BD), but the magnitude of risk varies considerably between individuals within and across families. Accurate risk estimation may increase motivation to reduce modifiable risk exposures and identify individuals appropriate for monitoring over the peak risk period. Our objective was to develop and independently replicate an individual risk calculator for bipolar spectrum disorders among the offspring of BD parents using data collected in routine clinical practice.

METHODS

Data from the longitudinal Canadian High-Risk Offspring cohort study collected from 1996 to 2020 informed the development of a 5 and 10-year risk calculator using parametric time-to-event models with a cure fraction and a generalized gamma distribution. The calculator was then externally validated using data from the Lausanne-Geneva High-Risk Offspring cohort study collected from 1996 to 2020. A time-varying C-index by age in years was used to estimate the probability that the model correctly classified risk. Bias corrected estimates and 95% confidence limits were derived using a jackknife resampling approach.

FINDINGS

The primary outcome was age of onset of a major mood disorder. The risk calculator was most accurate at classifying risk in mid to late adolescence in the Canadian cohort (n = 285), and a similar pattern was replicated in the Swiss cohort (n = 128). Specifically, the time-varying C-index indicated that there was approximately a 70% chance that the model would correctly predict which of two 15-year-olds would be more likely to develop the outcome in the future. External validation within a smaller Swiss cohort showed mixed results.

INTERPRETATION

Findings suggest that this model may be a useful clinical tool in routine practice for improved individualized risk estimation of bipolar spectrum disorders among the adolescent offspring of a BD parent; however, risk estimation in younger high-risk offspring is less accurate, perhaps reflecting the evolving nature of psychopathology in early childhood. Based on external validation with a Swiss cohort, the risk calculator may not be as predictive in more heterogenous high-risk populations.

FUNDING

The Canadian High-Risk Study has been funded by consecutive operating grants from the Canadian Institutes for Health Research, currently CIHR PJT Grant 152796 he Lausanne-Geneva high-risk study was and is supported by five grants from the Swiss National Foundation (#3200-040,677, #32003B-105,969, #32003B-118,326, #3200-049,746 and #3200-061,974), three grants from the Swiss National Foundation for the National Centres of Competence in Research project "The Synaptic Bases of Mental Diseases" (#125,759, #158,776, and #51NF40 - 185,897), and a grant from GlaxoSmithKline Clinical Genetics.

ADHD and depression: investigating a causal explanation

BACKGROUND

Attention-deficit hyperactivity disorder (ADHD) is associated with later depression and there is considerable genetic overlap between them. This study investigated if ADHD and ADHD genetic liability are causally related to depression using two different methods.

METHODS

First, a longitudinal population cohort design was used to assess the association between childhood ADHD (age 7 years) and recurrent depression in young-adulthood (age 18-25 years) in N = 8310 individuals in the Avon Longitudinal Study of Parents and Children (ALSPAC). Second, two-sample Mendelian randomization (MR) analyses examined relationships between genetic liability for ADHD and depression utilising published Genome-Wide Association Study (GWAS) data.

RESULTS

Childhood ADHD was associated with an increased risk of recurrent depression in young-adulthood (OR 1.35, 95% CI 1.05-1.73). MR analyses suggested a causal effect of ADHD genetic liability on major depression (OR 1.21, 95% CI 1.12-1.31). MR findings using a broader definition of depression differed, showing a weak influence on depression (OR 1.07, 95% CI 1.02-1.13).

CONCLUSIONS

Our findings suggest that ADHD increases the risk of depression later in life and are consistent with a causal effect of ADHD genetic liability on subsequent major depression. However, findings were different for more broadly defined depression.

Mental disorders in referred 0-3-year-old children: a population-based study of incidence, comorbidity and perinatal risk factors

The epidemiology of mental disorders in early childhood is still under-researched. We aim to explore the incidence, comorbidities and risk factors of mental disorders in 0-3-year-olds referred to hospital settings. In a national cohort of 918,280 children born in 1997-2010, we calculated incidence rates per 1,000 person-years (IR) of first-time mental and developmental disorders diagnosed in hospitals before four years of age. Data were obtained from Danish population registries. We used logistic regression to analyse co-morbidity and Cox proportional hazard models to evaluate the influence of pre- and perinatal risk factors. A total of 16,164 children (1.76%) were diagnosed with a mental (0.90%) or developmental disorder (1.05%). Pervasive developmental disorders (PDD) and disorders of hyperactivity and inattention (ADHD) were increasingly diagnosed with age. Feeding and eating disorders and disorders of social functioning were most frequent among the youngest children. Comorbidity was found in 18%, e.g., between PDD and ADHD (OR 135.8; 95% CI 112.0-164.7) or between ADHD and disorders of social functioning (OR 148.0; 95% CI 106.4-205.7). Young maternal age, old paternal age, maternal smoking in pregnancy, boy sex, premature birth and being small for gestational age were associated with highly increased risk of mental and developmental disorders. Mental and developmental disorders diagnosed within the first four years of life show increasing incidence rates and a complex pattern of comorbidities. Study findings point to the need of clinical and research attention towards the manifestations of developmental psychopathology in very young children.

Callous-unemotional traits in Chinese preschool children with attention-deficit/hyperactivity disorder

BACKGROUND

Children with early onset of Callous-Unemotional (CU) traits are at a higher risk for long-term, persistent psychosocial problems. The current study aimed to explore the characteristics of CU in preschool children with Attention Deficit Hyperactivity Disorder (ADHD) and the diagnostic significance of CU traits in ADHD.

METHODS

A total of 176 preschool children (89 with ADHD and 87 Typically Developing Children [TDC]) aged 4-5 years old were recruited to the study. The participants were assessed for CU traits, emotional and behavioral problems, and how their executive functioning was associated with ADHD using multiple assessment scales. Multiple linear regression analysis was performed to assess the incremental validity of the Inventory of Callous-Unemotional Traits (ICU), adjusting for possible covariates by child's sex, conduct problems, and oppositional defiant symptoms.

RESULTS

The results showed that there was a significant difference of ICU scores between the ADHD and TDC groups (F = 30.12, P < 0.001). In terms of callousness, ADHD + Oppositional Defiant Disorder (ODD) group showed a significant high score, and the ADHD only group scored significantly higher than the TDC group (F = 20.42, P < 0.001). The ICU was negatively associated with the prosocial behaviour subscale (γ = - 0.57, P < 0.01) and showed low to moderate positive correlations with emotional and behavioural problems, as well as executive function (γ = 0.24-0.67, P < 0.05). The ICU scores explained 6% of the incremental validity in ADHD symptoms. The diagnostic value of the ICU for ADHD was medium and acceptable.

CONCLUSIONS

The current study indicated that early identification of CU traits may help clinicians better understand symptoms and behavioural problems in children with ADHD. CU traits therefore could be considered as a useful assessment tool for ADHD.

Childhood Maltreatment Experiences, Attachment, Sexual Offending: Testing a Theory

The aim of this study was to empirically examine the theoretical model proposed by Grady, Levenson, and Bolder used to explain the relationships between experiencing trauma, attachment styles, and risk factors associated with sexual offending. The specific risk factors tested were emotional, behavioral, and cognitive regulation deficits. The research questions were as follows: (1) What specific childhood traumatic experiences (physical and sexual abuse and/or other domestic trauma events) are associated with anxious-ambivalent and anxious-avoidant attachments? (2) Are anxious-ambivalent and anxious-avoidant attachment styles differentially linked to dysregulation outcomes (emotional, behavioral and cognitive shift, and inhibitions)? (3) Do insecure attachment styles explain why childhood trauma is associated with dysregulation? and (4) Do these early life experiences contribute to sexual offending behavior? The sample included 200 male youth adjudicated for either a sexual or nonsexual crime and living in the community or a residential facility. The average age of the youth was 17.17 years (SD = 1.81 years). Structural equation modeling was used to determine the direct and indirect relationships between abuse and traumatic experiences, anxious-avoidant and ambivalent-anxious attachment styles, and regulation deficits. Authors found a direct relationship between physical abuse and both of the attachment styles, separately. Both anxious-ambivalent and anxious-avoidant attachment styles related similarly to regulation deficits. Separately, anxious-ambivalent and anxious-avoidant attachment styles served as mediators between physical abuse and regulation deficits. Sexual abuse predicted the later commission of sexual crimes with no influence from attachment style. Finally, domestic trauma independently predicted regulation deficits in the model that included anxious-ambivalent attachment but had no effect on deficits in the model that included anxious-avoidant attachment. Implications for treatment include the need to consider using attachment-based interventions and prevention strategies, and a trauma-informed approach when working with justice involved youth. Suggestions for future research are also discussed.

Development, Psychopathology, and Ethnicity II: Psychiatric Disorders Among Young Adults

OBJECTIVE

To estimate the prevalence of psychiatric disorders and their continuity since childhood among young adults from the same ethnic group living in 2 low-income contexts.

METHOD

Young adults (N = 2,004; ages 15-29) were followed (82.8% retention) as part of the Boricua Youth Study, a study of Puerto Rican youths recruited at ages 5-13 in the South Bronx (SBx), New York, and Puerto Rico (PR). We estimated prevalence (lifetime; past year) of major depressive (MDD), mania, hypomania, generalized anxiety (GAD), tobacco dependence, and any other substance use disorders (SUD).

RESULTS

The prevalence of every disorder was higher among young women from the SBx compared with those from PR (eg, 9.2% versus 4.1% past-year SUD; 14% versus 6.8% for MDD/GAD). Among SBx young men, tobacco dependence and illicit SUD were elevated. Across both contexts, men had higher adjusted odds of illicit SUD than women, while women had higher GAD than men. MDD did not differ by gender. Young adulthood disorders (except for alcohol use disorder and GAD) followed childhood disorders. For example, childhood externalizing disorders preceded both MDD (young men and women) and illicit SUD (young women only).

CONCLUSION

Young women raised in a context where adversities like ethnic discrimination concentrate are at high risk for psychiatric disorders. In certain high-poverty contexts, young men may present with MDD as often as women. Interventions to prevent psychiatric disorders may need to address gender-specific processes and childhood disorders. However, SUD prevention among young men may need to address other factors.

The relationship of maternal anxiety, positive and negative affect schedule, and fatigue with neonatal psychological health upon childbirth

BACKGROUND

Exposure of mothers to negative moods and stress before childbirth leads to negative consequences for the infants. Given the importance of psychological health, this study aimed to examine the effect of these factors on the infants' psychological health.

METHOD

This cross-sectional study was conducted in Shiraz hospitals on 110 pregnant women selected with multistage random sampling. Research tools included The McGill Pain Questionnaire (MPQ) to measure fatigue with three criteria; The Positive and Negative Emotion Schedule (PANAS); and The Spielberger State-Trait Anxiety Inventory (STAI) were used to measure maternal mood and anxiety level. Also, neonatal psychological health was assessed by a checklist. Neonatal psychological health's correlation with maternal anxiety, fatigue, and mental state was assessed. Data were analyzed by SPSS-19 software using Pearson correlation coefficient and statistical regression at the significance level of 0.05.

RESULT

Although there was no significant relationship between maternal anxiety score and neonatal psychological health after birth (p = 0.231; r=-0.343), the relationship was significant immediately after birth with positive (P < 0.001; r = 0.343) and negative affect scores (P < 0.001; r=-0.357).

CONCLUSIONS

There was a statistically significant relationship between the neonatal psychological health and maternal fatigue (p ≤ 0.001; r = -0.357) and PANAS (p ≤ 0.001) of the mother; however, it had no significant relationship with maternal anxiety (p = 0.231; r=- 0.343). Therefore, nurses and midwives can reduce maternal anxiety and improve neonatal mental health by supporting mothers.

Poor glycaemic control is associated with increased risk of neurodevelopmental disorders in childhood-onset type 1 diabetes: a population-based cohort study

AIMS/HYPOTHESIS

The aim of this study was to investigate the effect of childhood-onset type 1 diabetes on the risk of subsequent neurodevelopmental disorders, and the role of glycaemic control in this association. We hypothesised that individuals with poor glycaemic control may be at a higher risk of neurodevelopmental disorders compared with the general population, as well as compared with individuals with type 1 diabetes with adequate glycaemic control.

METHODS

This Swedish population-based cohort study was conducted using data from health registers from 1973 to 2013. We identified 8430 patients with childhood-onset type 1 diabetes (diagnosed before age 18 years) with a median age of diabetes onset of 9.6 (IQR 5.9-12.9) and 84,300 reference individuals from the general population, matched for sex, birth year and birth county. Cox models were used to estimate the effect of HbA_1c on the risk of subsequent neurodevelopmental disorders, including attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorders (ASD) and intellectual disability.

RESULTS

During a median follow-up period of 5.6 years, 398 (4.7%) individuals with type 1 diabetes received a diagnosis of any neurodevelopmental disorder compared with 3066 (3.6%) in the general population, corresponding to an adjusted HR (HR_adjusted) of 1.31 (95% CI 1.18, 1.46) after additionally adjusting for other psychiatric morbidity prior to inclusion, parental psychiatric morbidity and parental highest education level. The risk of any neurodevelopmental disorder increased with HbA_1c levels and the highest risk was observed in patients with mean HbA_1c >8.6% (>70 mmol/mol) (HR_adjusted 1.90 [95% CI 1.51, 2.37]) compared with reference individuals without type 1 diabetes. In addition, when compared with patients with diabetes with HbA_1c <7.5% (<58 mmol/mol), patients with HbA_1c >8.6% (>70 mmol/mol) had the highest risk of any neurodevelopmental disorder (HR_adjusted 3.71 [95% CI 2.75, 5.02]) and of specific neurodevelopmental disorders including ADHD (HR_adjusted 4.16 [95% CI 2.92, 5.94]), ASD (HR_adjusted 2.84 [95% CI 1.52, 5.28]) and intellectual disability (HR_adjusted 3.93 [95% CI 1.38, 11.22]).

CONCLUSIONS/INTERPRETATION

Childhood-onset type 1 diabetes is associated with an increased risk of neurodevelopmental disorders, with the highest risk seen in individuals with poor glycaemic control. Routine neurodevelopmental follow-up visits should be considered in type 1 diabetes, especially in patients with poor glycaemic control.

The associations between maternal and child diet quality and child ADHD - findings from a large Norwegian pregnancy cohort study

BACKGROUND

Attention Deficit Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental disorder. Effective long-term treatment options are limited, which warrants increased focus on potential modifiable risk factors. The aim of this study was to investigate associations between maternal diet quality during pregnancy and child diet quality and child ADHD symptoms and ADHD diagnosis.

METHODS

This study is based on the Norwegian Mother, Father and Child Cohort Study (MoBa). We assessed maternal diet quality with the Prenatal Diet Quality Index (PDQI) and Ultra-Processed Food Index (UPFI) around mid-gestation, and child diet quality using the Diet Quality Index (CDQI) at 3 years. ADHD symptoms were assessed at child age 8 years using the Parent Rating Scale for Disruptive Behaviour Disorders. ADHD diagnoses were retrieved from the Norwegian Patient Registry.

RESULTS

In total, 77,768 mother-child pairs were eligible for studying ADHD diagnoses and 37,787 for ADHD symptoms. Means (SD) for the PDQI, UPFI and CDQI were 83.1 (9.3), 31.8 (9.7) and 60.3 (10.6), respectively. Mean (SD) ADHD symptom score was 8.4 (7.1) and ADHD diagnosis prevalence was 2.9% (male to female ratio 2.6:1). For one SD increase in maternal diet index scores, we saw a change in mean (percent) ADHD symptom score of - 0.28 (- 3.3%) (CI: - 0.41, - 0.14 (- 4.8, - 1.6%)) for PDQI scores and 0.25 (+ 3.0%) (CI: 0.13, 0.38 (1.5, 4.5%)) for UPFI scores. A one SD increase in PDQI score was associated with a relative risk of ADHD diagnosis of 0.87 (CI: 0.79, 0.97). We found no reliable associations with either outcomes for the CDQI, and no reliable change in risk of ADHD diagnosis for the UPFI.

CONCLUSIONS

We provide evidence that overall maternal diet quality during pregnancy is associated with a small decrease in ADHD symptom score at 8 years and lower risk for ADHD diagnosis, with more robust findings for the latter outcome. Consumption of ultra-processed foods was only associated with increased ADHD symptom score of similar magnitude as for overall maternal diet quality, and we found no associations between child diet quality and either outcome. No causal inferences should be made based on these results, due to potential unmeasured confounding.

Developmental Psychopathology and Ethnicity I: The Young Adulthood Assessment of the Boricua Youth Study

OBJECTIVE

Developmental psychopathology processes pertinent to underserved ethnically diverse youths may not always coincide with those relevant to youths from nondisadvantaged groups. This article reports on the young adulthood assessment (fourth wave; April 2013 to August 2017) of the Boricua Youth Study, which includes 2 population-based samples of children of Puerto Rican background (N = 2,491) aged 5-13 years (recruited in 2000), in the South Bronx, New York, and San Juan, Puerto Rico.

METHOD

Study procedures included intensive participant tracking and in-person interviews of young adults and, when possible, their parents. Study participation rates, measures, and weights are described.

RESULTS

At Boricua Youth Study wave 4 (on average 11.3 years since last wave of participation), we reassessed 2,004 young adults (mean age = 22.9 years, range = 15-29 years; 51% women; retention rate adjusted for ineligibility = 82.7%) and available parents (n = 1,180). Nonparticipation was due to inability to locate/contact participants (8.6%); refusal (4.7%); and ineligible status (2.8%) owing to cognitive impairment, incarceration, or death. Among participants originally from Puerto Rico, 91% stayed in Puerto Rico during young adulthood. Of participants from the South Bronx, 52.4% remained in the area (85.8% within 100 miles). Most study measures had good internal consistency (Cronbach α ≥ .70).

CONCLUSION

Our results support the viability of retaining a population-based cohort of children from the same ethnic group across 2 contexts during a life stage when individuals are likely to move. Longitudinal samples that are generalizable to underserved populations can elucidate developmental processes of relevance for curtailing the risk of psychopathology in disadvantaged contexts.

A Neurodevelopment Approach for a Transitional Model of Early Onset Schizophrenia

In the last decades, the conceptualization of schizophrenia has dramatically changed, moving from a neurodegenerative process occurring in early adult life to a neurodevelopmental disorder starting be-fore birth, showing a variety of premorbid and prodromal symptoms and, in relatively few cases, evolving in the full-blown psychotic syndrome. High rates of co-occurring different neurodevelopmental disorders such as Autism spectrum disorder and ADHD, predating the onset of SCZ, and neurobio-logical underpinning with significant similarities, support the notion of a pan-developmental disturbance consisting of impairments in neuromotor, receptive language, social and cognitive development. Con-sidering that many SCZ risk factors may be similar to symptoms of other neurodevelopmental psychi-atric disorders, transition processes from child & adolescent to adult systems of care should include both high risk people as well as subject with other neurodevelopmental psychiatric disorders with different levels of severity. This descriptive mini-review discuss the need of innovative clinical approaches, re-considering specific diagnostic categories, stimulating a careful analysis of risk factors and promoting the appropriate use of new and safer medications.

Identifying patterns of movement behaviours in relation to depressive symptoms during adolescence: A latent profile analysis approach

Movement behaviour guideline adherence has been associated with lower depressive symptoms during adolescence, yet no studies have used person-centered approaches to examine this relationship. The purpose of the present study was to identify whether unique adolescent movement behaviour profiles exist, evaluate predictors of profile membership, and determine whether profile membership was associated with differences in depressive symptoms cross sectionally and longitudinally. This study involved secondary analysis of the public-use data from Wave 1 and Wave 2 of the National Study of Adolescent Health. Adolescents (N = 6436; 48% male) in grades 7 to 12 (M_age = 16.03 ± 1.75) completed measures to assess moderate-to-vigorous physical activity (MVPA), recreational screen time (ST), and sleep - collectively known as movement behaviours - and depressive symptoms. Latent profile analysis identified four profiles that had similar sleep patterns and were thus characterized by different levels of MVPA and ST: high MVPA/low ST (29%), high MVPA/high ST (4%), low MVPA/low ST (53%), and low MVPA/high ST (14%). Several socio-demographic variables were found to influence profile membership. After adjusting for covariates, findings revealed depressive symptoms were lowest among the high MVPA/low ST profile and this trend was evident one year later. Engaging in high levels of either MVPA or ST alone did not provide additive benefits for depressive symptoms compared to those who engaged in low levels of both MVPA and ST. These findings suggest intervention efforts should take an integrative approach to improve mental health outcomes among adolescents by considering each of the movement behaviours concurrently.

Male fetus susceptibility to maternal inflammation: C-reactive protein and brain development

BACKGROUND

Maternal inflammation in early pregnancy has been identified epidemiologically as a prenatal pathogenic factor for the offspring's later mental illness. Early newborn manifestations of the effects of maternal inflammation on human fetal brain development are largely unknown.

METHODS

Maternal infection, depression, obesity, and other factors associated with inflammation were assessed at 16 weeks gestation, along with maternal C-reactive protein (CRP), cytokines, and serum choline. Cerebral inhibition was assessed by inhibitory P50 sensory gating at 1 month of age, and infant behavior was assessed by maternal ratings at 3 months of age.

RESULTS

Maternal CRP diminished the development of cerebral inhibition in newborn males but paradoxically increased inhibition in females. Similar sex-dependent effects were seen in mothers' assessment of their infant's self-regulatory behaviors at 3 months of age. Higher maternal choline levels partly mitigated the effect of CRP in male offspring.

CONCLUSIONS

The male fetal-placental unit appears to be more sensitive to maternal inflammation than females. Effects are particularly marked on cerebral inhibition. Deficits in cerebral inhibition 1 month after birth, similar to those observed in several mental illnesses, including schizophrenia, indicate fetal developmental pathways that may lead to later mental illness. Deficits in early infant behavior follow. Early intervention before birth, including prenatal vitamins, folate, and choline supplements, may help prevent fetal development of pathophysiological deficits that can have life-long consequences for mental health.

A Longitudinal Analysis of Social Skills and Adolescent Depression: A Multivariate Latent Growth Approach

Ample research has shown that the link between social skills and adolescent depression is significant. However, how the changes in different domains of social skills influence the change in depression from early to middle adolescence remains largely unknown. To address this gap in knowledge, the current research used longitudinal data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development (N = 1061) to examine the influences of the changes in cooperation, assertion, responsibility, and self-control on the change in depression from early to middle adolescence. Univariate latent growth modeling showed that, from early to middle adolescence, adolescents experience decreases in cooperation and assertion, increases in responsibility and depression, and stability in self-control. Multivariate latent growth modeling suggested that adolescents who had more increases in responsibility and self-control tended to experience a slower increase in depression from early to middle adolescence; while adolescents who had more decreases in cooperation and assertion tended to experience a faster increase in depression from early to middle adolescence. The results suggested that promoting adolescents social skills might be particularly salient for the prevention of adolescent depression.

Predicting externalizing behavior in toddlerhood from early individual differences in empathy

BACKGROUND

From middle childhood onward, there is often a negative link between empathy and externalizing behavior problems. Patterns at younger ages are still unclear, with mixed findings of no association, negative associations, and positive associations. This study examines links between empathy and externalizing problems, beginning in infancy.

METHODS

A community sample of infants (N = 165) was assessed for empathy at 3, 6, 12, 18, and 36 months, using behavioral observations. Externalizing problems were reported at 18 months (by mothers) and 36 months (by mothers and daycare teachers).

RESULTS

Boys showed more externalizing problems than girls. For boys, negative associations between empathy and externalizing appeared, particularly with teacher reports. For girls, there were positive associations between empathy and externalizing, which weakened with age. For both genders, empathy at ages 3, 6, and 18 months appeared to protect against increases in externalizing from 18 to 36 months.

CONCLUSIONS

The role of empathy in the development of early externalizing depends on both gender and age; toddler boys' externalizing may more typically stem from low empathy, whereas girls' early externalizing appears to be underlain by heightened sensitivity and unregulated or assertive approach attempts.

Girls' transition to adulthood and their later life socioeconomic attainment: Findings from the English longitudinal study of ageing

Transitions to adulthood represent a sensitive period for setting young people into particular life course trajectories, and the nature of these transitions have varied more for girls, historically, than for boys. We aim to investigate the long-term significance of different transitions out of full-time education for socioeconomic attainment in later life amongst postwar young women in England. Our data are from the English Longitudinal Study of Ageing for girls born during World War II and the post-war period (1939-1952, n = 1798). Using sequence analysis, we identified six types of transition out of full-time education between ages 14 and 26: Early-Work, Mid-Work, Late-Work, Early-Domestic, Late-Domestic, and Part-time Mixed. We used linear and multinomial regression models to examine associations between transition types and socioeconomic attainment outcomes from age 50, including individual income, household income and wealth, and occupational class. Our study found that later transitions into employment (Mid-Work and Late-Work) were associated with higher socioeconomic attainment after age 50 compared with women who made early transitions from education to employment (Early-Work); much of the advantage of making later transitions to employment was due to higher educational attainment. We also found that early transitions to domestic work (Early-Domestic) set young women onto trajectories of lower socioeconomic attainment than compared with those who made early transitions to employment, suggesting the nature of the transition from full-time education is as important as the timing, perhaps uniquely for women. A pathway of cumulative advantage/disadvantage is also evident in our study; results suggest a partial mediating role for educational attainment in associations between childhood social class and later life socioeconomic attainment.

The Effect of an Intervention Teaching Adolescents that People can Change on Depressive Symptoms, Cognitive Schemas, and Hypothalamic-Pituitary-Adrenal Axis Hormones

Interest is increasing in developing universal interventions to prevent depression in adolescents that are brief enough to be scaled up. The aim of this study was to test the effects on depressive symptoms, cognitive schemas, and Hypothalamic-Pituitary-Adrenal Axis Hormones of an intervention focused on teaching an element of an incremental theory of personality, namely, the belief that people can change. We also examined whether grade level moderated the effects of the intervention. A double-blind, randomized, controlled trial was conducted with 867 Spanish adolescent participants (51.9% boys, Grades 8-10) randomly assigned to an incremental theory intervention (n = 456) or an educational control intervention (n = 411). The adolescents completed measures of depressive symptoms and negative cognitive schemas at pretest, at 6-month follow-up, and at 12-month follow-up. A subsample of 503 adolescents provided salivary samples for cortisol and DHEA-S testing. In 8th grade, adolescents who received the incremental theory intervention displayed a greater decrease in depressive symptoms and cognitive schemas and a lower increase in DHEA-S. Moreover, in adolescents who received the intervention, the rate of adolescents with high depression scores decreased by almost 18% whereas in the control group, the rate increased by 37%. Surprisingly, the effects of the intervention were in the opposite direction among adolescents in 9th grade. These data indicate that a brief universal intervention could prevent depressive symptoms under some conditions, but developmental characteristics can moderate the effectiveness of this approach.

Patterns of the Diagnosis Prevalence of Psychiatric Disorders in the Population Aged 0-18 Years Based on the Nationwide Insurance Sample Data

Objectives

This study aimed to examine the trend in diagnostic prevalence of psychiatric disorders in children and adolescents.

Methods

Individuals aged 0–18 years were included in the study based on the National Health Insurance Claims Data. To investigate the trends in diagnosis and diagnostic prevalence of psychiatric disorders reflecting the decrease in the birth rate, data were analyzed from 2010 as a reference year to 2015.

Results

The number of patients diagnosed with psychiatric disorder decreased annually, from 23,412 on 2010 to 18,821 on 2015. The most common disorder was hyperkinetic disorder in male and depressive episode in female. Although there was no significant change in overall diagnostic prevalence rate of psychiatric disorders, age groups <10 years and some disorders had significant changes in prevalence rate. This study classified the diagnostic prevalence by age into two unique patterns: group in which the diagnosis rate increases with age and group in which the diagnosis rate peaks at a certain age and then decreases.

Conclusion

Diagnostic prevalence of psychiatric disorders was different according to age and sex. These patterns should be reflected in the formulation of policies related to mental health and in medical practice for pediatric patients. It is urgent to identify how these patterns change in young adults.

Complex Economic Behavior Patterns Are Constructed from Finite, Genetically Controlled Modules of Behavior

Complex ethological behaviors could be constructed from finite modules that are reproducible functional units of behavior. Here, we test this idea for foraging and develop methods to dissect rich behavior patterns in mice. We uncover discrete modules of foraging behavior reproducible across different strains and ages, as well as nonmodular behavioral sequences. Modules differ in terms of form, expression frequency, and expression timing and are expressed in a probabilistically determined order. Modules shape economic patterns of feeding, exposure, activity, and perseveration responses. The modular architecture of foraging changes developmentally, and different developmental, genetic, and parental effects are found to shape the expression of specific modules. Dissecting modules from complex patterns is powerful for phenotype analysis. We discover that both parental alleles of the imprinted Prader-Willi syndrome gene Magel2 are functional in mice but regulate different modules. Our study found that complex economic patterns are built from finite, genetically controlled modules.

The principles and mechanisms involved in constructing complex behavior patterns are not well defined. Stacher Hörndli et al. find that complex foraging patterns in mice are constructed from finite modules, defined as significantly reproducible behavioral sequences. Modules are expressed in a probabilistically defined order to construct complex patterns and controlled by genetic mechanisms.

Exposure to Parental Depressive Symptoms: A Longitudinal Analysis on the Association with Adolescents' Depressive Symptoms and Adjustment Problems

OBJECTIVE

Parental depressive symptoms have been associated with depressive symptoms and adjustment problems in adolescents. However, longitudinal studies assessing both mothers' and fathers' depressive symptoms over time and their association with adolescents' outcomes are sparse.

METHODS

Data were obtained from the Study of Early Child Care and Youth Development. A total of 1364 children and families were followed from the child's birth until the age of 15 years. Adolescents' depressive symptoms were evaluated via self-reported questionnaire at ages 11 to 15 years. Adjustment problems at 15 years of age were defined as high internalizing and/or externalizing problems. Parental depressive symptoms were assessed several times during the study period. Trajectories created using partitional clustering analyses were entered in logistic regression models to predict adolescents' outcomes.

RESULTS

After adjusting for sociodemographic variables, adolescents' outcomes were associated with every additional time point of reported maternal (depressive symptoms: odds ratio [OR] = 1.2, p = 0.001; adjustment problems: OR = 1.1, p = 0.003) and paternal depressive symptoms (adjustment problems: OR = 1.2, p = 0.027). When maternal and paternal depressive symptom trajectories were combined, we found adolescents' depressive symptoms to be significantly associated with mother elevated and stable subclinical father scores (OR = 3.3, p = 0.003) and girls (OR = 5.4, p < 0.001). Adjustment problems were associated with father elevated and stable subclinical mother (OR = 1.9, p = 0.003) and mother elevated and stable subclinical father (OR = 2.1, p = 0.001) trajectories.

CONCLUSION

Parental depressive symptoms are an important risk factor for adolescents' outcomes. This highlights the importance of continuously evaluating parents' mental status across child development. The cumulative effect of recurrent depressive symptoms and the combined parental trajectories are especially predictive for the development of adolescents' outcomes.

Screening for and Personalizing Prevention of Adolescent Depression

Depression is a prevalent, distressing, often recurrent, disorder. Adolescence represents a vulnerable developmental period when rates of depression surge and many experience their first episode. Some professional agencies now recommend universal screening starting at age 12. This paper advocates for a risk-based approach to screening for adolescent depression that can improve upon current approaches to screening and facilitate more seamless connections to enable personalizing prevention of depression based on risk group classification. Empirical examples are reviewed for screening based on established risk factors that predict later depression. Evidence is provided that risk groups can reliably and validly classify adolescents at risk for future development of depression based on cognitive and interpersonal vulnerabilities. These risk groups inform one approach to personalizing prevention of depression by matching youths' risk to established, evidence-based prevention programs (cognitive or interpersonal). Promising data from a randomized trial suggest that this personalized depression prevention strategy can reduce depression better than a "one size fits all" approach.

Individual Participant Data Meta-analysis: Impact of Conduct Problem Severity, Comorbid Attention-Deficit/Hyperactivity Disorder and Emotional Problems, and Maternal Depression on Parenting Program Effects

OBJECTIVE

There is concern whether established parenting programs for children's conduct problems meet the needs of families with severe and complex mental health problems. For example, many children with conduct problems show comorbid attention-deficit/hyperactivity disorder (ADHD) or emotional problems, or have parents who are depressed, but families with such complex mental health problems typically seen in real life are often underrepresented in evaluation trials. We tested whether children with more severe conduct problems, and those with more complex mental health problems, benefit less from the Incredible Years parenting program, using individual participant data meta-analysis of randomized trials in Europe.

METHOD

In 1,696 families from 13 children aged (child age 2-11 years; 37% girls; 58% low income; 30% ethnic minority; 98% mothers), we used moderator analysis within a multilevel model to test whether initial conduct problem severity, comorbid ADHD or emotional problems, and maternal depression would diminish intervention effects for children's conduct problems.

RESULTS

The Incredible Years program reduced children's conduct problems overall (Cohen's d = -0.35), but more so in children with more severe conduct problems. There was no evidence that children's comorbid ADHD and emotional problems changed the intervention benefits. Children of mothers with more depressive symptoms benefited more.

CONCLUSION

Children with more severe conduct problems derive greater, rather than lesser, benefits from a high-quality group parenting program, and comorbid ADHD and emotional problems do not reduce effects; maternal depression, rather than being linked to less child change, was associated with greater reductions in children's conduct problems.

Trajectories of internalising and externalising symptoms and inflammation in the general child population

BACKGROUND

Elevations in inflammatory marker levels have been shown to precede internalising and externalising problems in the general child population. One study has found the reverse, that elevations in inflammatory marker levels in childhood follow internalising and externalising problems. However, the authors did not explore the role of the course of these problems in childhood or adjust for a number of potential confounders including psychosocial stressors and prenatal and perinatal exposures.

AIMS

To investigate the association in childhood between the growth of internalising and externalising symptoms and levels of inflammatory markers, while accounting for potential confounders.

METHODS

Using data from the Avon Longitudinal Study of Parents and Children, we tested the association between the trajectories of internalising (emotional and social) and externalising (hyperactivity and conduct) problems, at ages 4, 6, 8 and 9 years, and levels of C-reactive protein (CRP) and interleukin 6 (IL-6) at age 9 years. We analysed data (n = 4525) using latent growth curve modelling and linear regression.

RESULTS

Children who had increasing levels of internalising symptoms over childhood were more likely to have higher levels of CRP and IL-6 at 9 years of age, even after adjustment for confounders. A one-unit increase in the rate of annual change of internalising symptoms was related to an increase of 12% and 8% in the level of CRP and IL-6, respectively. However, there was no evidence for an association between externalising symptoms and either inflammatory marker.

CONCLUSIONS

This study is the first step towards identifying a robust pathway, via increases in emotional and social difficulties, to elevated inflammation in healthy children. This association, if causal, suggests that effective interventions for children experiencing chronic emotional and social difficulties could also have physical health benefits.

The importance of a developmental perspective in Psychiatry: what do recent genetic-epidemiological findings show?

There is growing appreciation that a developmental perspective is helpful in Psychiatry. However, clinical practice and research, especially in an era of very large sample sizes, often ignore the developmental context. In this perspective piece, we discuss why a developmental view is important in Psychiatry and how recent genetic-epidemiological findings further highlight this. DSM-5 childhood neurodevelopmental disorders such as ADHD, typically onset in early childhood but can persist into adult life; the same ADHD genetic loading appears to contribute across the life course. However, recent longitudinal studies have observed that ADHD symptoms may emerge later during adolescence and adult life in some individuals although the etiology of this late-onset group is unclear. The epidemiology and genetics of depression do not appear to be the same in childhood, adolescence, and adult life. Recent genetic findings further highlight this. Autistic type problems and irritability also appear to show developmental variation in their genetic etiology. These findings raise the question of whether social communication and irritability have the same meaning at different ages. Schizophrenia typically onsets after adolescence. However, it is commonly preceded by childhood antecedents that do not resemble schizophrenia itself but do appear to index schizophrenia genetic liability. We conclude that there is a need for clinicians and scientists to adopt a developmental perspective in clinical practice and research by considering age-at-onset and changes over time as well as different developmental periods when interpreting clinical symptoms.

Interaction of maternal choline levels and prenatal Marijuana's effects on the offspring

BACKGROUND

This study investigated whether higher maternal choline levels mitigate effects of marijuana on fetal brain development. Choline transported into the amniotic fluid from the mother activates α7-nicotinic acetylcholine receptors on fetal cerebro-cortical inhibitory neurons, whose development is impeded by cannabis blockade of their cannabinoid-1(CB1) receptors.

METHODS

Marijuana use was assessed during pregnancy from women who later brought their newborns for study. Mothers were informed about choline and other nutrients, but not specifically for marijuana use. Maternal serum choline was measured at 16 weeks gestation.

RESULTS

Marijuana use for the first 10 weeks gestation or more by 15% of mothers decreased newborns' inhibition of evoked potentials to repeated sounds (d' = 0.55, p < 0.05). This effect was ameliorated if women had higher gestational choline (rs = -0.50, p = 0.011). At 3 months of age, children whose mothers continued marijuana use through their 10th gestational week or more had poorer self-regulation (d' = -0.79, p < 0.05). This effect was also ameliorated if mothers had higher gestational choline (rs = 0.54, p = 0.013). Maternal choline levels correlated with the children's improved duration of attention, cuddliness, and bonding with parents.

CONCLUSIONS

Prenatal marijuana use adversely affects fetal brain development and subsequent behavioral self-regulation, a precursor to later, more serious problems in childhood. Stopping marijuana use before 10 weeks gestational age prevented these effects. Many mothers refuse to cease use because of familiarity with marijuana and belief in its safety. Higher maternal choline mitigates some of marijuana's adverse effects on the fetus.

Continuity of psychiatric disorders between 6 and 11 years of age in the 2004 Pelotas Birth Cohort

Objective:

To investigate the incidence and homotypic and heterotypic continuity of psychiatric disorders between ages 6 and 11.

Methods:

In 2004, all live births in the city of Pelotas, Brazil, were recorded (n=4,231). Psychiatric disorders were assessed by the Strengths and Difficulties Questionnaire (SDQ). SDQ subscale scores (emotional symptoms, conduct problems, hyperactivity/inattention, and peer relationship problems) were categorized as normal or abnormal. To examine associations between problems over time, odds ratios were computed using logistic regression.

Results:

Any SDQ difficulty was observed in 350 children (10.4%, 95%CI 9.4-11.5) at age 6 and 476 (14.2%, 95%CI 13.0-15.4) at age 11, with a higher prevalence among boys at both ages. Between ages 6 and 11, there was a 50 and a 45% increase in the prevalence of emotional and hyperactivity/inattention symptoms, respectively. Among those who had any SDQ difficulty at age 6, that status persisted in 81% at age 11. We found homotypic continuity of emotional symptoms, conduct problems, hyperactivity/inattention, and peer relationship problems.

Conclusions:

Our results indicate an increasing incidence of psychiatric disorders in this age group, with rates of disorders and continuity patterns similar to those observed in other studies.

Identifying latent subgroups of children with developmental delay using Bayesian sequential updating and Dirichlet process mixture modelling

Identifying children who are at-risk for developmental delay, so that these children can have access to interventions as early as possible, is an important and challenging problem in developmental research. This research aimed to identify latent subgroups of children with developmental delay, by modelling and clustering developmental milestones. The main objectives were to (a) create a developmental profile for each child by modelling milestone achievements, from birth to three years of age, across multiple domains of development, and (b) cluster the profiles to identify groups of children who show similar deviations from typical development. The ensemble methodology used in this research consisted of three components: (1) Bayesian sequential updating was used to model the achievement of milestones, which allows for updated predictions of development to be made in real time; (2) a measure was created that indicated how far away each child deviated from typical development for each functional domain, by calculating the area between each child’s obtained sequence of posterior means and a sequence of posterior means representing typical development; and (3) Dirichlet process mixture modelling was used to cluster the obtained areas. The data used were 348 binary developmental milestone measurements, collected from birth to three years of age, from a small community sample of young children (N = 79). The model identified nine latent groups of children with similar features, ranging from no delays in all functional domains, to large delays in all domains. The performance of the Dirichlet process mixture model was validated with two simulation studies.

Intersectionality and Adolescent Mental Well-being: A Cross-Nationally Comparative Analysis of the Interplay Between Immigration Background, Socioeconomic Status and Gender

PURPOSE

Intersectionality theory highlights the importance of the interplay of multiple social group memberships in shaping individual mental well-being. This article investigates elements of adolescent mental well-being (life dissatisfaction and psychosomatic complaints) from an intersectional perspective. It tests mental well-being consequences of membership in combinations of multiple social groups and examines to what extent such intersectional effects depend on the national context (immigration and integration policies, national-level income, and gender equality).

METHODS

Using Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy, we assessed the role of the national context in shaping the interplay between immigration background, socioeconomic status, and gender, using data from 33 countries from the 2017/2018 Health Behaviour in School-aged Children survey.

RESULTS

We found no uniform intersectionality effects across all countries. However, when allowing the interplay to vary by national context, results did point toward some intersectional effects. Some aggravated negative effects were found for members of multiple disadvantaged social groups in countries with low levels of income equality and restrictive migration policies, whereas enhanced positive effects were found for members of multiple advantaged groups in these countries. Similarly, mitigated negative effects of membership in multiple disadvantaged groups were shown in countries with higher levels of income equality and more inclusive migration policies, whereas mitigated positive effects were found for multiply advantaged individuals. Although for national-level gender equality results pointed in a similar direction, girls' scores were counterintuitive. High national-level gender equality disproportionately benefitted groups of disadvantaged boys, whereas advantaged girls were doing worse than expected, and reversed effects were found for countries with low gender equality.

CONCLUSIONS

To fully understand social inequalities in adolescent mental well-being, the interplay between individual-level and national-level indicators must be explored.

Prevalence of depressive symptoms in primary school students in China: A systematic review and meta-analysis

BACKGROUNDS

Depression in children and adolescents is usually under-recognized. The findings of epidemiological studies on depressive symptoms in primary school students are inconsistent across studies. This study reports a systematic review and meta-analysis on the prevalence of depressive symptoms in primary school students in China.

METHODS

Literature search was performed in both international (PubMed, PsycINFO, EMBASE) and Chinese (China National Knowledge Internet, WANFANG Data and Chinese Biological Medical Literature) databases. The random-effects model was used to analyze data.

RESULTS

Twenty-seven studies involving 42,374 subjects were included. The pooled prevalence of depressive symptoms in Chinese primary school students was 17.2% (95% CI: 14.3%-20.5%). Subgroup analyses found that the prevalence significantly varied between geographic regions, with western China reporting the highest prevalence. Meta-regression analyses found that year of survey and study quality were significantly associated with the prevalence of depressive symptoms.

CONCLUSIONS

Given the high prevalence of depressive symptoms and its negative health outcomes, preventive measures, regular screening and effective treatments need to be implemented for this population.

Predicting mental health problems in adolescence using machine learning techniques

BACKGROUND

Predicting which children will go on to develop mental health symptoms as adolescents is critical for early intervention and preventing future, severe negative outcomes. Although many aspects of a child's life, personality, and symptoms have been flagged as indicators, there is currently no model created to screen the general population for the risk of developing mental health problems. Additionally, the advent of machine learning techniques represents an exciting way to potentially improve upon the standard prediction modelling technique, logistic regression. Therefore, we aimed to I.) develop a model that can predict mental health problems in mid-adolescence II.) investigate if machine learning techniques (random forest, support vector machines, neural network, and XGBoost) will outperform logistic regression.

METHODS

In 7,638 twins from the Child and Adolescent Twin Study in Sweden we used 474 predictors derived from parental report and register data. The outcome, mental health problems, was determined by the Strengths and Difficulties Questionnaire. Model performance was determined by the area under the receiver operating characteristic curve (AUC).

RESULTS

Although model performance varied somewhat, the confidence interval overlapped for each model indicating non-significant superiority for the random forest model (AUC = 0.739, 95% CI 0.708-0.769), followed closely by support vector machines (AUC = 0.735, 95% CI 0.707-0.764).

CONCLUSION

Ultimately, our top performing model would not be suitable for clinical use, however it lays important groundwork for future models seeking to predict general mental health outcomes. Future studies should make use of parent-rated assessments when possible. Additionally, it may not be necessary for similar studies to forgo logistic regression in favor of other more complex methods.

Severity and Frequency of Antisocial Behaviors: Late Adolescence/Young Adulthood Antisocial Behavior Index

OBJECTIVES

An Antisocial Behavior index (ASB-I) for children (ages 5 to 15) was previously developed by obtaining clinician ratings of the seriousness or severity of various behaviors with the goal of improving assessment of antisocial behaviors (ASB) longitudinally. We extend the instrument for use in late adolescence/young adulthood, as socially unacceptable conduct manifests differently across developmental stages. As in the original study, this extension (the ASB-I YA) is based on independent ratings of ASB seriousness/severity during late adolescence/young adulthood (16 to 28 years) made by nine experienced clinicians.

METHODS

The items rated were drawn from the Oppositional Defiant Disorder and Conduct Disorder schedules of the NIMH Diagnostic Interview Schedule for Children (DISC-IV) and the Elliott Delinquency scales, plus new or modified items developmentally appropriate for late adolescence/young adulthood. Specific ratings were based on the developmental stage and reported frequency of the behaviors. The study also describes the distribution of ASB-I YA scores in the Boricua Youth Study.

RESULTS

Reliability was substantial for the average ratings of each subscale and for the total score [ICC(3,9): .88 to .95]. Certain items were rated as more severe when occurring in late adolescence/young adulthood compared to childhood/early adolescence (e.g., hitting someone on purpose); however, most ratings were similar across developmental periods. Most importantly, raters reliably and consistently rated the items describing ASB in young adulthood, allowing the computation of the ASB-I YA score.

CONCLUSIONS

Together with the ASB-I, the ASB-I YA can further advance the study of ASB progression from childhood into young adulthood.

Prevention and early intervention in youth mental health: is it time for a multidisciplinary and trans-diagnostic model for care?

BACKGROUND

Similar to other health care sectors, mental health has moved towards the secondary prevention, with the effort to detect and treat mental disorders as early as possible. However, converging evidence sheds new light on the potential of primary preventive and promotion strategies for mental health of young people. We aimed to reappraise such evidence.

METHODS

We reviewed the current state of knowledge on delivering promotion and preventive interventions addressing youth mental health.

RESULTS

Half of all mental disorders start by 14 years and are usually preceded by non-specific psychosocial disturbances potentially evolving in any major mental disorder and accounting for 45% of the global burden of disease across the 0-25 age span. While some action has been taken to promote the implementation of services dedicated to young people, mental health needs during this critical period are still largely unmet. This urges redesigning preventive strategies in a youth-focused multidisciplinary and trans-diagnostic framework which might early modify possible psychopathological trajectories.

CONCLUSIONS

Evidence suggests that it would be unrealistic to consider promotion and prevention in mental health responsibility of mental health professionals alone. Integrated and multidisciplinary services are needed to increase the range of possible interventions and limit the risk of poor long-term outcome, with also potential benefits in terms of healthcare system costs. However, mental health professionals have the scientific, ethical, and moral responsibility to indicate the direction to all social, political, and other health care bodies involved in the process of meeting mental health needs during youth years.

Evaluation of a Longitudinal Family Stress Model in a Population-Based Cohort

The Family Stress Model (FSM) is an influential family process model that posits that socioeconomic disadvantage impacts child outcomes via its effects on parents. Existing evaluations of the FSM are constrained by limited measures of socioeconomic disadvantage, cross-sectional research designs, and reliance on non-population-based samples. The current study tested the FSM in a subsample of the Fragile Families and Child Wellbeing Study (N = 2,918), a large population-based study of children followed from birth through age 9. We employed a longitudinal framework and used measures of socioeconomic disadvantage beyond economic resources. Although the hypothesized FSM pathways were identified in the longitudinal model (e.g., economic pressure at age 1 was associated with maternal distress at age 3, maternal distress at age 3 was associated with parenting behaviors at age 5), the effects of socioeconomic disadvantage at childbirth on youth socioemotional outcomes at age 9 did not operate through all of the hypothesized mediators. In longitudinal change models that accounted for the stability in constructs, multiple indicators of socioeconomic disadvantage at childbirth were indirectly associated with youth externalizing behaviors at age 9 via either economic pressure at age 1 or changes in maternal warmth from ages 3 to 5. Greater economic pressure at age 1, increases in maternal distress from ages 1 to 3, and decreases/increases in maternal warmth/harshness from ages 3 to 5 were also directly associated with increases in externalizing behaviors from ages 5 to 9. Results provide partial support for the FSM across the first decade of life.

Longitudinal associations between parental incarceration and children's emotional and behavioural development: Results from a population cohort study

BACKGROUND

Parental incarceration (PI) is associated with adverse developmental outcomes for children affected. However, research in this area often reports conflicting results with few studies following children across time in non-U.S.

POPULATIONS

Additionally, more research is called for using multi-informant perspectives rather than relying on adult reports of child outcomes alone.

METHODS

This study used data from the first two waves of a nationally representative cohort study of 8,568 children aged 9 years and followed up at age 13 living in the Republic of Ireland (2007-2012). Propensity score matching was used to match children who had experienced PI by the age of nine to children who had not experienced PI by sociodemographics and experience of other stressful events. Mental health, as measured by self-concept (Piers-Harris II) and externalizing and internalizing difficulties (strength and difficulties questionnaire), was compared across both groups.

RESULTS

Fifty of the 8,568 children (weighted percentage 0.9%) reported experiencing PI by the age of nine. These children came from more socially disadvantaged homes and were more likely to have experienced other potentially stressful life events. In comparison to a matched sample of children not affected by PI, children affected by PI reported higher levels of anxiety at age nine. Longitudinal analysis indicated these children affected by PI also reported lower levels of happiness at age 13 with higher levels of emotional difficulties reported by their primary caregiver.

CONCLUSIONS

Children of incarcerated parents face a greater array of life challenges. PI had an association with child-reported levels of anxiety at age nine. PI also had a medium-term association on caregiver assessments of emotional difficulties of children affected as well child-reported levels of happiness over time.

Emotional disorder and absence from school: findings from the 2004 British Child and Adolescent Mental Health Survey

Emotional disorder may be associated with absence from school, but the existing evidence is methodologically weak. We studied the relationships between anxiety, depression and emotional difficulties, and school absence (total, authorised and unauthorised) using data from the 2004 British Child and Adolescent Mental Health Survey (BCAMHS). The BCAMHS was a cross-sectional, community survey of 7977 5- to 16-year-olds. Emotional disorder was assessed using the Development and Wellbeing Assessment (DAWBA), and emotional difficulties using the Strengths and Difficulties Questionnaire (SDQ) completed by teachers and parents. Teachers reported days absent in the previous school term. Multivariable negative binomial regression was used to examine the impact of emotional disorder and difficulties on absence. Age, gender and general health were explored as moderators. Anxiety, depression and emotional difficulties were associated with higher rates of all types of absence [rate ratios for total absence: anxiety 1.69 (1.39-2.06) p < 0.001; depression 3.40 (2.46-4.69) p < 0.001; parent-reported emotional difficulties 1.07 (1.05-1.10) p < 0.001; teacher-reported emotional difficulties 1.10 (1.08-1.13) p < 0.001]. The strongest association was observed for depression and unauthorised absence. Relationships were stronger for secondary compared to primary school children. Health and educational professionals should be aware that children with poor attendance may be experiencing emotional ill health, regardless of absence type. The absence may provide a useful tool to identify those who require additional mental health support. Findings highlight the widespread burden of emotional disorder and the need to support those with emotional ill health in continuing to access education.

A study protocol for a randomised trial of adjunct computerised memory specificity training (c-MeST) for major depression in youth: targeting cognitive mechanisms to enhance usual care outcomes in mental health settings

Background

Youth depression is highly prevalent and is related to impairments in academic, social and behavioural functioning. Evidence-based treatments are available, but many young people do not respond or sufficiently recover with first-line options, and a significant proportion experience relapse. Consequently, there is clear scope to enhance intervention in this critical period of early-onset depression. Memory specificity training (MeST) is a low-intensity intervention for depression that targets reduced specificity when recalling memories of the past, a common cognitive vulnerability in depression. This randomised controlled trial will assess the efficacy of adding a computerised version of MeST (c-MeST) to usual care for youth depression.

Methods/design

Young people aged 15–25 years with a major depressive episode (MDE) will be recruited and randomised to have immediate access to the seven session online c-MeST program in addition to usual care, or to usual care and wait-list for c-MeST. The primary outcomes will be diagnostic status of an MDE and self-reported depressive symptoms assessed at baseline, 1-, 3- and 6-month intervals. Autobiographical memory specificity and other variables thought to contribute to the maintenance of reduced memory specificity and depression will be assessed as mediators of change.

Discussion

Online provision of c-MeST provides a simple, low-intensity option for targeting a cognitive vulnerability that predicts the persistence of depressive symptoms. If found to be efficacious as an adjunct to usual care for depressed youth, it could be suitable for broader roll-out, as c-MeST is highly accessible and implementation requires only minimal resources due to the online and automated nature of intervention.

Trial registration

Australian New Zealand Clinical Trials Registry, ACTRN12619000234112p. Registered on the 18 February 2019. All items from the WHO Trial Registration Data Set can be found within the protocol.

Protocol version

1.0

Categorical and Dimensional Approaches to Examining the Joint Effect of Autism and Schizotypal Personality Disorder on Sustained Attention

INTRODUCTION

Accumulating evidence for the co-occurrence autism spectrum disorder (ASD) and schizotypal personality disorder (SPD) at both the diagnostic and symptom levels raises important questions about the nature of their association and the effect of their co-occurrence on the individual's phenotype and functional outcome. Research comparing adults with ASD and SPD, as well as the impact of their co-occurrence on outcomes is extremely limited. We investigated executive functioning in terms of response inhibition and sustained attention, candidate endophenotypes of both conditions, in adults with ASD, SPD, comorbid ASD and SPD, and neurotypical adults using both categorical and dimensional approaches.

METHODS

A total of 88 adults (Mean Age = 37.54; SD = 10.17): ASD (n = 26; M/F = 20/6); SPD (n = 20; M/F = 14/6); comorbid ASD and SPD (n=9; M/F=6/3) and neurotypicals (n=33; M/F=23/10) completed the Sustained Attention to Response Task (SART) in both its fixed and random forms. Positive and autistic symptom severity was assessed with the positive subscale of the Positive and Negative Syndrome Scale (PANSSpos) and the PANSS Autism Severity Score (PAUSS), respectively.

RESULTS

Controlling for full scale IQ, working memory and medication dosage, group analyses revealed that the comorbid group committed fewer omission errors than the ASD group on the fixed SART, and fewer omission errors than the ASD and SPD groups on the random SART. The individual difference analyses of the entire sample revealed that the PANSSpos and PAUSS interactively reduced omission errors in both the fixed and random SARTs, as well as increased d' scores, indicative of improved overall performance. We observed no significant results for commission errors or reaction time.

CONCLUSIONS

Concurrent elevated levels of autistic and positive psychotic symptoms seem to be associated with improved sustained attention abilities (reduced omission errors) but not inhibition (commission errors). Our findings highlight the importance of investigating the concurrent effect of ASD and SPD at both the symptom and diagnostic levels, and raise important questions for future research regarding the clinical and behavioral phenotypes of adults with dual diagnosis and, more generally, about the nature of the relationship between ASD and SPD.

Psychological Comorbidities in Autism Spectrum Disorder

Autism spectrum disorder (ASD) is characterized by impairment in behavior, communication, and social interaction. Thus, accurate identification, regular behavioral and other nonmedical interventions would improve the diagnosis, management, and treatment of this condition.In this chapter, we investigate the importance of diagnosing and identifying comorbid psychiatric disorders that occur with ASD as these conditions can often complicate treatment, and failure to recognize them can result in deficits that can persist into adolescence and adulthood. In addition, we explore the impact of comprehensive psychological intervention in ASD patients with comorbid psychiatric disorders with the ultimate goal of improving overall quality of life.

Using Genetics to Examine a General Liability to Childhood Psychopathology

Psychiatric disorders show phenotypic as well as genetic overlaps. There are however also marked developmental changes throughout childhood. We investigated the extent to which, for a full range of early childhood psychopathology, a general “p” factor was explained by genetic liability, as indexed by multiple different psychiatric polygenic risk scores (PRS) and whether these relationships altered with age. The sample was a UK, prospective, population-based cohort with psychopathology data at age 7 (N = 8161) and age 13 (N = 7017). PRS were generated from large published genome-wide association studies. At both ages, we found evidence for a childhood “p” factor as well as for specific factors. Schizophrenia and attention-deficit/hyperactivity disorder (ADHD) PRS were associated with this general “p” factor at both ages but depression and autism spectrum disorder (ASD) PRS were not. We also found some evidence of associations between schizophrenia, ADHD and depression PRS with specific factors, but these were less robust and there was evidence for developmental changes.

Effects of Childhood Life Events on Adjustment Problems in Adolescence: A Longitudinal Study

OBJECTIVES

Stressful life events (SLEs) have been associated with adjustment problems in adolescence (APA) in cross-sectional studies. Using a longitudinal cohort, we examined the influence of these events and predefined covariates on APA and compared internalizing and externalizing trajectories among children with many versus few SLEs.

METHODS

Data were obtained from the Study of Early Child Care and Youth Development. One thousand three hundred sixty-four children and their families were followed from child's birth until age 15 years. Adjustment problems at age 15 years were defined as high (>60 T-score) internalizing and/or externalizing problems on the Youth Self-Report and Child Behavior Checklist. Stressful life events were evaluated at 54 months, and third and fifth grade. Categories created by mixture model analyses for covariates were used in logistic regressions to predict adjustment problems.

RESULTS

Mothers reported higher rates of adjustment problems than adolescents (21.1% vs 16.3%; p < 0.0001). Adjustment problems were associated with more SLEs (odds ratio [OR] = 1.7; p = 0.0042), male sex (OR = 1.9; p = 0.001), child's high emotional reactivity (OR = 1.6; p = 0.01), and paternal depression (OR = 2.1; p = 0.0165). Analysis using the mother's report of adjustment problems showed the same predictors, as well as lower maternal education level (OR = 3.5; p = 0.0003), and child's friendship quality (OR = 0.4; p = 0.005). Higher internalizing and externalizing T-scores were apparent in children with more SLEs from 2 years of age onward (ps < 0.0001).

CONCLUSION

After adjusting for multiple covariates, SLEs during childhood predicted adjustment problems. Our results suggest that emotional reactivity and paternal depression play a role in the development of APA.

General psychopathology, internalising and externalising in children and functional outcomes in late adolescence

BACKGROUND

Internalising and externalising problems commonly co-occur in childhood. Yet, few developmental models describing the structure of child psychopathology appropriately account for this comorbidity. We evaluate a model of childhood psychopathology that separates the unique and shared contribution of individual psychological symptoms into specific internalising, externalising and general psychopathology factors and assess how these general and specific factors predict long-term outcomes concerning criminal behaviour, academic achievement and affective symptoms in three independent cohorts.

METHODS

Data were drawn from independent birth cohorts (Avon Longitudinal Study of Parents and Children (ALSPAC), N = 11,612; Generation R, N = 7,946; Maternal Adversity, Vulnerability and Neurodevelopment (MAVAN), N = 408). Child psychopathology was assessed between 4 and 8 years using a range of diagnostic and questionnaire-based measures, and multiple informants. First, structural equation models were used to assess the fit of hypothesised models of shared and unique components of psychopathology in all cohorts. Once the model was chosen, linear/logistic regressions were used to investigate whether these factors were associated with important outcomes such as criminal behaviour, academic achievement and well-being from late adolescence/early adulthood.

RESULTS

The model that included specific factors for internalising/externalising and a general psychopathology factor capturing variance shared between symptoms regardless of their classification fits well for all of the cohorts. As hypothesised, general psychopathology factor scores were predictive of all outcomes of later functioning, while specific internalising factor scores predicted later internalising outcomes. Specific externalising factor scores, capturing variance not shared by any other psychological symptoms, were not predictive of later outcomes.

CONCLUSIONS

Early symptoms of psychopathology carry information that is syndrome-specific as well as indicative of general vulnerability and the informant reporting on the child. The 'general psychopathology factor' might be more relevant for long-term outcomes than specific symptoms. These findings emphasise the importance of considering the co-occurrence of common internalising and externalising problems in childhood when considering long-term impact.

Estimating the Strength of Associations Between Prenatal Diet Quality and Child Developmental Outcomes: Results From a Large Prospective Pregnancy Cohort Study

Our aim in this study was to estimate the strength of associations between prenatal diet quality and child behavioral, language, and motor functions in the Norwegian Mother and Child Cohort Study (1999-2008). We created a prenatal diet quality index (PDQI) based on adherence to Norwegian dietary guidelines. Child outcomes were defined as sum scores on the Child Behavior Checklist, the Ages and Stages Questionnaire, and the Child Development Index at ages 18, 36, and 60 months. Using a longitudinal cohort study design and Bayesian hierarchical modeling, we estimated association strengths using inverse probability weighting to account for selection bias. In total, 27,529 mother-child pairs were eligible for inclusion. A 1-standard-deviation increase in PDQI score was associated with an absolute reduction in outcome sum scores of 0.02-0.21 and a 3%-7% relative decrease, with larger decreases seen for language and motor functions than for behavioral functions. PDQI scores were inversely associated with all child functions, but the estimated strength of each association was low. The results indicate that the observed variations in PDQI scores in an industrialized Western society may not profoundly influence the child functions studied.

Chronotypes and its association with psychological morbidity and childhood parasomnias

BACKGROUND

The relationship between chronotypes and sleeping problems is not clear. The objective of the study was to identify the relative occurrence of chronotypes among college students and to explore adult psychological morbidity and childhood sleeping problems across chronotypes.

MATERIALS AND METHODS

One hundred and fifty undergraduate medical students were assigned into different chronotypes by Morningness-Eveningness Questionnaire and they were further assessed using Self-Reporting Questionnaire, Parasomnia Questionnaire (adapted from the Adult Sleep Disorders Questionnaire), and Pittsburgh Sleep Quality Index.

RESULTS

Intermediate chronotype was the most common, seen in 87 (58%) students, followed by evening type in 34 (22.7%). Evening types have more difficulties in making a decision, becoming exhausted more easily and feeling worthless than other chronotypes. Evening-oriented students showed a significantly higher frequency of initial insomnia and poorer overall sleep quality than the other groups. The current bedwetting was more in evening types; there was no difference in any other current and childhood parasomnias.

CONCLUSIONS

Evening chronotypes had greater difficulty in decision-making, and they were more vulnerable to feel worthless. No significant association was found between childhood parasomnias and chronotypes except persistent bedwetting during adulthood in evening types.

The temporal sequence of depressive symptoms, peer victimization, and self-esteem across adolescence: Evidence for an integrated self-perception driven model

Depression is associated with a multiplicity of adverse outcomes in adolescence, including peer victimization and low self-esteem. Depressive symptoms, peer victimization, and self-esteem are linked in cross-sectional studies, but no longitudinal study has been conducted assessing their developmental pathways in one integrated model across adolescence. We explored their temporal sequencing in a normative sample of 612 Canadian adolescents (54% girls) assessed annually over 5 years (Grade 7 to Grade 11). Potential confounders such as biological sex, ethnicity/race, and parent income and education were statistically controlled. We found evidence for the vulnerability model (self-esteem predicting depression) and the symptoms-driven model (depression predicting peer victimization). Our findings also supported the integration of these pathways into a self-perception driven model characterized by the indirect effect of self-esteem on later peer victimization via depressive symptoms. Specifically, poor self-esteem initiated a developmental cascade that led to poor mood and poor peer relations. These results highlight the importance of helping youth form a healthy identity that promotes positive mental health and peer relations, and the need to intervene with depressed, victimized, and at-risk adolescents to instill positive self-regard. Our results also emphasize the central role that self-perceptions play in the onset and maintenance of poor outcomes.