Development of a scale to measure symptoms of anxiety and depression in the general UK population: the psychiatric symptom frequency scale

The suicidal ideation attributes scale (SIDAS): Community-based validation study of a new scale for the measurement of suicidal ideation

While suicide prevention efforts are increasingly being delivered using technology, no scales have been developed specifically for web-based use. The Suicidal Ideation Attributes Scale (SIDAS) was developed and validated as a brief, web-based measure for severity of suicidal ideation, using an online survey of Australian adults (n = 1,352). The SIDAS demonstrated high internal consistency and good convergent validity. Frequency and controllability of thoughts were more strongly associated with suicide plans and attempts than other attributes assessed. Scores ≥ 21 indicated high risk of suicide behavior. The SIDAS appears to be a valid web-based measure for severity of suicidal ideation.

Temporal effects of separation on suicidal thoughts and behaviours

Divorce has been identified as a risk factor for suicide. However, little research has been conducted on the time trajectory of the influence of relationship separation on suicidal outcomes. This study aimed to assess the effects over time of relationship breakdown and separation on suicidality. Data were drawn from 6616 Australian adults participating in the PATH through Life Project, a population-based longitudinal study. Suicidal ideation was reported by 406 participants (6.1%), and 99 (1.5%) reported a suicide plan or attempt in the past year. The effects of separation on suicidality were strongest soon after separation, with a nearly three-fold increase in ideation (adjusted OR = 2.73, p < 0.001) and an eight-fold increase in plans/attempts (adjusted OR = 7.75, p < 0.001) in the two years following separation, gradually diminishing subsequently. The period up to four years before a separation was also found to be a time of increased risk for suicidal thoughts and behaviours, while marriage was protective. Separation is a strong risk factor for suicidality and mental health services should target recently separated individuals.

Lifetime affect and midlife cognitive function: prospective birth cohort study

BACKGROUND

Recurrent affective problems are predictive of cognitive impairment, but the timing and directionality, and the nature of the cognitive impairment, are unclear.

AIMS

To test prospective associations between life-course affective symptoms and cognitive function in late middle age.

METHOD

A total of 1668 men and women were drawn from the Medical Research Council National Survey of Health and Development (the British 1946 birth cohort). Longitudinal affective symptoms spanning age 13-53 years served as predictors; outcomes consisted of self-reported memory problems at 60-64 years and decline in memory and information processing from age 53 to 60-64 years.

RESULTS

Regression analyses revealed no clear pattern of association between longitudinal affective symptoms and decline in cognitive test scores, after adjusting for gender, childhood cognitive ability, education and midlife socioeconomic status. In contrast, affective symptoms were strongly, diffusely and independently associated with self-reported memory problems.

CONCLUSIONS

Affective symptoms are more clearly associated with self-reported memory problems in late midlife than with objectively measured cognitive performance.

The GoodNight study--online CBT for insomnia for the indicated prevention of depression: study protocol for a randomised controlled trial

BACKGROUND

Cognitive Behaviour Therapy for Insomnia (CBT-I) delivered through the Internet is effective as a treatment in reducing insomnia in individuals seeking help for insomnia. CBT-I also lowers levels of depression in this group. However, it is not known if targeting insomnia using CBT-I will lower depressive symptoms, and thus reduce the risk of major depressive episode onset, in those specifically at risk for depression. Therefore, this study aims to examine whether Internet delivery of fully automated self-help CBT-I designed to reduce insomnia will prevent depression.

METHOD/DESIGN

A sample of 1,600 community-dwelling adults (aged 18-64), who screen positive for both subclinical levels of depressive symptoms and insomnia, will be recruited via various media and randomised to either a 9-week online insomnia treatment programme, Sleep Healthy Using The internet (SHUTi), or an online attention-matched control group (HealthWatch). The primary outcome variable will be depression symptom levels at the 6-month post-intervention on the Patient Heath Questionnaire-9 (PHQ-9). A secondary outcome will be onset of major depressive episodes assessed at the 6-month post-intervention using 'current' and 'time from intervention' criteria from the Mini International Neuropsychiatric Interview.

DISCUSSION

This trial is the first randomised controlled trial of an Internet-based insomnia intervention as an indicated preventative programme for depression. If effective, online provision of a depression prevention programme will facilitate dissemination.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ANZCTR), Registration number: ACTRN12611000121965.

Does resilience predict suicidality? A lifespan analysis

In this article, we examine the association between resilience and suicidality across the lifespan. Participants (n = 7485) from the Personality and Total Health (PATH) Through Life Project, a population sample from Canberra and Queanbeyan, Australia, were stratified into three age cohorts (20-24, 40-44, 60-64 years of age). Binary Logistic regression explored the association between resilience and suicidality. Across age cohorts, low resilience was associated with an increased risk for suicidality. However, this effect was subsequently made redundant in models that fully adjusted for other risk factors for suicidality among young and old adults. Resilience is associated with suicidality across the lifespan, but only those in midlife continued to report increased likelihood of suicidality in fully-adjusted models.

Anxiety symptoms as precursors of major depression and suicidal ideation

BACKGROUND

Relative to depression symptoms, the role of anxiety symptoms in the development of depression and suicidal ideation has not been well established. This study aimed to identify the anxiety and depression symptoms that confer the greatest amount of risk for depression and suicidal ideation at the population level.

METHOD

The PATH through Life study is an Australian community-based longitudinal cohort study of 7,485 younger, middle-aged, and older adults. Adjusted population attributable risk (PAR) for incident depression and suicidal ideation after 4 years was assessed for 18 symptoms of anxiety and depression.

RESULTS

Anxiety symptoms contributed greater risk overall to both depression (45%) and suicidal ideation (23%) incidence than depression symptoms (35% and 16%, respectively). Anxiety symptoms had largest PARs among younger age groups.

CONCLUSIONS

Prevention programs for depression and suicide should aim to reduce anxiety symptoms in addition to depression symptoms, and target individuals reporting symptoms such as worrying or irritability.

A test of the Interpersonal Theory of Suicide in a large community-based cohort

BACKGROUND

Joiner's Interpersonal Theory of Suicide (Van Orden et al., 2010; Joiner, 2005) predicts that suicide ideation is strongest in those experiencing both high perceived burdensomeness and thwarted belongingness, and that the combination of suicide ideation and acquired capability for suicide is critical in the development of suicide plans and attempts. However, few datasets exist which allow the examination of these predictions. The present study aimed to test predictions from the model in a population-based cohort.

METHODS

a survey was completed by 6133 participants from the PATH Through Life Project. Scales measuring perceived burdensomeness, thwarted belongingness, hopelessness, capability to self-injure, ideation, plans and attempts were developed using existing items. Regression models were used to predict the outcomes of ideation and of plans/attempts.

RESULTS

consistent with the Interpersonal Theory, interactions were found between perceived burdensomeness and thwarted belongingness predicting ideation, and interactions of capability and ideation for plans/attempts. However, some predictions of the theory were not fulfilled. Nevertheless, the Interpersonal Theory explained more variance than epidemiological models using mental disorders as predictors. Age differences were evident, with models of older cohorts accounting for less variance. Gender models suggested thwarted belongingness was a stronger predictor of ideation in males than females.

LIMITATIONS

while the fit of the factors assessing the Interpersonal Theory was adequate, the findings will need to be confirmed using previously developed scales of these constructs.

CONCLUSIONS

predictive models of suicide need to take into account multiple risk factors, gender differences and changes in associations over the life span.

Longitudinal risk profiling for suicidal thoughts and behaviours in a community cohort using decision trees

BACKGROUND

While associations between specific risk factors and subsequent suicidal thoughts or behaviours have been widely examined, there is limited understanding of the interplay between risk factors in the development of suicide risk. This study used a decision tree approach to develop individual models of suicide risk and identify the risk factors for suicidality that are important for different subpopulations.

METHODS

In a population cohort of 6656 Australian adults, the study examined whether measures of mental health, physical health, personality, substance use, social support, social stressors and background characteristics were associated with suicidal ideation and suicidal behaviours after four-year follow-up.

RESULTS

Previous suicidality, anxiety symptoms, depression symptoms, neuroticism and rumination were the strongest predictors of suicidal ideation and behaviour after four years. However, divergent factors were predictive of suicidal thoughts and behaviours across the spectrum of mental health. In particular, substance use was only associated with suicidal thoughts and behaviours in those with moderate levels of anxiety or depression.

LIMITATIONS

Most of the measurements were based on self-report. Further research is required to assess whether changes in risk factors lead to changes in suicidality.

CONCLUSIONS

Examining suicide risk factors using decision trees is a promising approach for developing individualised assessments of suicide risk and tailored intervention programs.

The role of lifestyle behaviors on 20-year cognitive decline

This study examined the association between smoking, physical activity and dietary choice at 36 and 43 years, and change in these lifestyle behaviors between these ages, and decline in verbal memory and visual search speed between 43 and 60-64 years in 1018 participants from MRC National Survey of Health and Development (NSHD, the British 1946 birth cohort). ANCOVA models were adjusted for sex, social class of origin, childhood cognition, educational attainment, adult social class, and depression; then the lifestyle behaviors were additionally mutually adjusted. Results showed that healthy dietary choice and physical activity were associated, respectively, with slower memory and visual search speed decline over 20 years, with evidence that increasing physical activity was important. Adopting positive health behaviors from early midlife may be beneficial in reducing the rate of cognitive decline and ultimately reducing the risk of dementia.

Prevalence of suicidal behaviours in two Australian general population surveys: methodological considerations when comparing across studies

PURPOSE

To investigate whether methodological differences between two Australian general population surveys have the capacity to affect the apparent prevalence rates of suicidal ideation and suicide attempts.

METHODS

609 Wave 1 of the Personality and Total Health (PATH) Through Life Project participants, and 83 participants derived from the 1997 National Survey of Mental Health and Wellbeing (NSMHWB) met the criteria for inclusion (suicidal ideation/suicide attempt). Analysis involved Chi-square and binary logistic regression.

RESULTS

Twelve-month prevalence rates for suicidal ideation and suicide attempt were 8.2%, (95% CI = 7.6-8.8) and 0.8% (95% CI = 0.6-1.0) for PATH (N = 7,485), and contrast with 2.9% (95% CI = 2.6-3.2) and 0.3% (95% CI = 0.2-0.5) for NSMHWB (N = 10,641) samples, respectively. While notable discrepancies are apparent between the prevalence statistics, both sets of statistics are within the bounds of other Australian and international studies. Parallel rate disparities for suicidal ideation are found across age-by-gender groups. Aside from differences in the basic prevalence rates, surveys have analogous age-by-gender profiles for suicidal ideation.

CONCLUSIONS

While it is possible that samples are representative of the populations from which they are derived, 12-month prevalence rate discrepancies between PATH and NSMHWB surveys are likely to originate from demographic and survey methodology differences. Where investigations employ different methodologies, especially in relation to modes of survey administration and the assessment items utilised, a cautious approach should be taken when comparing findings.

Self-reported sleep difficulty during the menopausal transition: results from a prospective cohort study

OBJECTIVE

The aim of this study was to examine the relationship between menopausal transition status and self-reported sleep difficulty.

METHODS

With the use of data on women participating in the Medical Research Council National Survey of Health and Development who have been followed up from birth in March 1946 (n = 962), relationships between menopausal transition status and self-reported sleep difficulty were assessed annually in women between ages 48 and 54 years.

RESULTS

Menopausal transition status was related to severe self-reported sleep difficulty. The odds of reporting severe self-reported sleep difficulty were increased approximately by 2- to 3.5-fold (95% CI ranges from 1.08-3.27 to 1.99-6.04) for women in most menopausal transition statuses compared with women who remained premenopausal. After adjustment for current psychological, vasomotor, and somatic symptoms and waking frequently at night to use the toilet, only women who had a hysterectomy remained at an increased risk for moderate sleep difficulty.

CONCLUSIONS

The modest relationship between menopausal transition status and moderate sleep difficulty may be related to greater variation in individual definitions of moderate difficulty. Attention to the level of sleep difficulty in this group of women will assist in the decision to address current health symptoms versus sleep itself. Women without prior health problems may experience severe self-reported sleeping difficulty during the menopausal transition and require tailored care from health professionals.

Symptoms of depression and anxiety, and change in body mass index from adolescence to adulthood: results from a British birth cohort

BACKGROUND

Depression and anxiety have been shown to be associated with obesity and underweight, but little is known about how the relationship varies across the life course, from adolescence through adulthood. We aimed to investigate the association between adolescent- and adult-onset affective symptoms and body mass index (BMI) change from age 15 to 53 years.

METHOD

We used data from a British birth cohort born in 1946 and followed up ever since. The relationship between affective symptom profiles, distinguishing adolescent-onset and adult-onset symptoms, and BMI change from adolescence to age 53 years was investigated using multilevel models.

RESULTS

Women with adolescent-onset symptoms had lower mean BMI at age 15 years, faster rates of increase across adulthood, and higher BMI at age 53 years than those with no symptoms. Men with adolescent-onset symptoms had lower BMI at all ages from 15 to 53 years. The BMI trajectories of men and women with adult-onset symptoms did not differ from those with absence of symptoms at all ages.

CONCLUSIONS

The relationship between affective symptoms and change in BMI varies by sex and age at onset of symptoms. Adolescence may be an important period for the development of the association between affective symptoms and weight gain in girls. Intervention to prevent increases in BMI across adult life in women with adolescent-onset symptoms, even if they are not overweight at this age, should be considered.

Baseline factors predictive of serious suicidality at follow-up: findings focussing on age and gender from a community-based study

BACKGROUND

Although often providing more reliable and informative findings relative to other study designs, longitudinal investigations of prevalence and predictors of suicidal behaviour remain uncommon. This paper compares 12-month prevalence rates for suicidal ideation and suicide attempt at baseline and follow-up; identifies new cases and remissions; and assesses the capacity of baseline data to predict serious suicidality at follow-up, focusing on age and gender differences.

METHODS

6,666 participants aged 20-29, 40-49 and 60-69 years were drawn from the first (1999-2001) and second (2003-2006) waves of a general population survey. Analyses involved multivariate logistic regression.

RESULTS

At follow-up, prevalence of suicidal ideation and suicide attempt had decreased (8.2%-6.1%, and 0.8%-0.5%, respectively). However, over one quarter of those reporting serious suicidality at baseline still experienced it four years later. Females aged 20-29 never married or diagnosed with a physical illness at follow-up were at greater risk of serious suicidality (OR = 4.17, 95% CI = 3.11-5.23; OR = 3.18, 95% CI = 2.09-4.26, respectively). Males aged 40-49 not in the labour force had increased odds of serious suicidality (OR = 4.08, 95% CI = 1.6-6.48) compared to their equivalently-aged and employed counterparts. Depressed/anxious females aged 60-69 were nearly 30% more likely to be seriously suicidal.

CONCLUSIONS

There are age and gender differentials in the risk factors for suicidality. Life-circumstances contribute substantially to the onset of serious suicidality, in addition to symptoms of depression and anxiety. These findings are particularly pertinent to the development of effective population-based suicide prevention strategies.

Patterns in trouble sleeping among women at mid-life: results from a British prospective cohort study

BACKGROUND

Although trouble sleeping is a common problem among women at mid-life, patterns in trouble sleeping relating to social and health-related risk factors are unclear. This analysis describes the dynamics of trouble sleeping among women at mid-life.

METHODS

The National Survey of Health and Development is a nationally representative study of births in 1946 in England, Scotland, and Wales followed up through mid-life. Multistate life table analysis utilised 893 women interviewed annually between ages 48 to 54 years.

RESULTS

Women spent an average of 2.6 years with trouble sleeping, and the average length of a continuous episode of trouble sleeping was 2.4 years. Among women who reported at least one episode, the average number of episodes was 1.5. Health-related risk factors at age 43 of number of physical conditions, anxiety and depression symptoms, use of prescription medication, and current or past trouble sleeping were related to increased total and per episode duration of trouble sleeping over the 7-year study interval and increased duration per episode. Differences associated with these risk factors ranged from 1.2 to 1.8 years for duration over the study interval and 0.5 to 0.8 years per episode. There was no association between average number of episodes per woman reporting at least one episode and these health-related risk factors at age 43.

CONCLUSIONS

This study provides support for association between increased duration of trouble sleeping, in total and per episode, and health risk factors at age 43, suggesting a long-term relationship between risk factors and sleep.

Appraisals of stressors and common mental disorder from early to mid-adulthood in the 1946 British birth cohort

BACKGROUND

We examined the extent to which perceived life change following experiences of stressful life events, differentiated by type of stressor, influenced mental health during adulthood.

METHODS

The analytic sample of 2073 cohort members was drawn from the MRC National Survey of Health and Development, a sample followed since their birth in March 1946. Logistic regression was used to assess the relationship between stressors reported at 36 and 43 years and common mental disorder at 36, 43, and 53 years. Common mental disorder was measured using the Present State Exam at 36 years, the Psychiatric Symptom Frequency at 43 years, and the 28-item General Health Questionnaire at 53 years.

RESULTS

Data spanning across nearly 20 years suggest that stressors perceived to have contributed to a notable life change increased the likelihood of scoring above the cut off score for common mental disorder in comparison to stressors experienced without subsequent life change. Models were adjusted for gender, educational attainment, social class, relationship status, and past episodes of common mental disorder. This relationship appears to be most evident for proximal family and economic stressors and distal interpersonal relationship stressors experienced by close friends and relatives.

LIMITATIONS

All study information is based on self-reports and details about the nature of the life change or cognitive attribution style were not available.

CONCLUSIONS

Appraisals of changes following stressful life events may be more important than the occurrence of stressors alone in assessing the impact of stressful life events on adult mental health.

The relationship between fatigue and psychiatric disorders: evidence for the concept of neurasthenia

OBJECTIVE

Fatigue and psychiatric disorders frequently occur comorbidly and share similar phenomenological features. There has been debate as to whether chronic fatigue, or neurasthenia, should be considered an independent syndrome distinct from psychiatric disorders. We aimed to establish whether persistent fatigue can occur independently from psychiatric disorders and to test the hypothesis that fatigue without comorbid psychiatric symptoms has unique premorbid risk factors. We also aimed to investigate the psychological outcome of any individuals with fatigue.

METHODS

The MRC National Survey of Health and Development was used to prospectively follow 5362 participants from birth. A sample of nonfatigued individuals without psychiatric disorder was selected at age 36 and followed until age 43 years (n=2714). At age 43, the presence of new onset fatigue and/or psychiatric disorder was assessed. Information on a number of potential premorbid risk factors was collected between ages 0 and 36 years. Individuals with fatigue but no comorbid psychiatric disorder were then followed up at age 53 years.

RESULTS

At age 43 years, 201 (7.4%) participants reported significant levels of new onset fatigue in the absence of comorbid psychiatric disorder. Despite the absence of case level psychiatric disorder, these individuals did report increased levels of some psychological symptoms. Excessive childhood energy (adjusted OR 2.63, 95% CI 1.55-4.48, P<.001) and being overweight at age 36 (adjusted OR 1.62, 95% CI 1.05-2.49, P=.03) were specific risk factors for fatigue without psychiatric disorder but not fatigue with comorbid psychiatric illness. Neuroticism was a risk factor for fatigue both with and without comorbid psychiatric disorder. Negative life events and a family history of psychiatric illness were only risk factors for fatigue when it occurred comorbidly with psychiatric illness.

CONCLUSIONS

A significant proportion of the adult population will suffer from fatigue without comorbid psychiatric disorder. While fatigue and psychiatric disorders share some risk factors, excessive energy in childhood and being overweight as an adult appear to be specific risk factors for fatigue. Our results confirm the significant overlap between fatigue and psychiatric disorders, while also providing evidence for neurasthenia as a separate diagnosis.

Is suicidality distinguishable from depression? Evidence from a community-based sample

OBJECTIVE

Suicidal behaviour is often considered in the context of depression. Taking an empirical, dimensional and population-based approach, this investigation examines two issues: first, whether it is justifiable to regard suicidality as a symptom of depression or an independent construct. Second, although suicidal behaviour has been shown to decline with increasing age and differ across gender, little is known about the stability of the underlying construct across the lifespan and between genders.

METHOD

Data were derived from a community-based sample consisting of 7485 people aged 20-24, 40-44 or 60-64 years. Confirmatory factor analysis was used to assess the adequacy of model fit and measurement invariance across gender and then age groups.

RESULTS

The data fitted a two-factor model of depression and suicidality better than a single-factor model. Multi-group analysis indicated strict measurement invariance for both gender and age groups, indicating no significant differences between groups in measurement model fit.

CONCLUSIONS

These analyses establish that suicidality is distinguishable from depression, although the factors are substantially correlated. Results suggest that the underlying factorial relationship between suicidality and depression appears not to vary considerably between genders or across cohorts aged 20-24, 40-44 and 60-64 years. Finally, the analyses also highlight the necessity of inventories with scales identifying symptoms of suicidality independent of depression symptoms.

Factors associated with antidepressant, anxiolytic and hypnotic use over 17 years in a national cohort

BACKGROUND

In the general population, most individuals with mental disorders are not treated with psychotropic medications. The objective of this study was to identify factors associated with psychotropic medication use over a 17 year period in a birth cohort.

METHOD

Members of the 1946 British birth cohort (n=2,928 in 1999) reported psychotropic medication use in 1982 at age 36, in 1989 at age 43, and in 1999 at age 53. At each of the three time points, several factors were investigated for their association with antidepressant, anxiolytic or hypnotic medication use.

RESULTS

After adjusting for severity of symptoms of depression and anxiety, clinical factors such as suicidal ideation, sleep difficulty and poor physical health were strongly associated with antidepressant, anxiolytic or hypnotic medication use in 1982 and 1989, but not in 1999. Non-clinical factors were infrequently associated with antidepressant, anxiolytic or hypnotic medication use in 1982 and 1989 after adjusting for severity of symptoms, however several non-clinical factors were associated with antidepressant, anxiolytic or hypnotic medication use in 1999 including being female (OR=1.4, 95% CI: 1.0, 1.9), unemployment (OR=2.9, 95% CI: 2.1, 4.1), living alone (OR=2.6, 95% CI: 1.7, 3.9), and being divorced, separated or widowed (OR=1.5, 95% CI: 1.1, 2.3).

LIMITATIONS

Data were not available on help-seeking behaviour.

CONCLUSIONS

Treatment of mental disorder with psychotropic medications is strongly associated with clinical factors. However, non-clinical factors continue to be significant, and may influence both treatment-seeking and prescribing behaviour.

Psychiatric outcomes 10 years after treatment with antidepressants or anxiolytics

BACKGROUND

Antidepressants and anxiolytics have demonstrated short-term efficacy; however, little is known about the long-term effectiveness of these drugs.

AIMS

To investigate long-term psychiatric outcomes following antidepressant and/or anxiolytic use during an episode of mental disorder in mid-life.

METHOD

Members of the 1946 British birth cohort were assessed for symptoms of depression and anxiety at age 43. Among 157 with mental disorder, those using antidepressants and/or anxiolytics were compared with those not using medications on psychiatric outcomes at age 53.

RESULTS

Use of antidepressants or anxiolytics was associated with a lower prevalence of mental disorder at age 53 (odds ratio (OR)=0.3, 95% CI 0.1-1.0) after adjustment for eight variables in a propensity-for-treatment analysis. Only 24% of those being treated with medications at age 43 were still using them at 53.

CONCLUSIONS

Use of antidepressants or anxiolytics during an episode of mental disorder may have long-term beneficial effects on mental health. This may be because of a demonstrated willingness to seek help rather than long-term maintenance therapy.

A systematic review of the relationship between rumination and suicidality

Rumination has been persistently implicated in the etiology of hopelessness and depression, which are proximal predictors of suicidality. As a result, researchers have started to examine the role of rumination in suicidality. This systematic review provides a concise synopsis of the current progress in examining the relationship between rumination and suicidality, and highlights areas for future research. A search of the international literature was conducted using the three main psychological and medical databases. Eleven studies were identified providing evidence, with one exception, of a relationship between rumination and suicidality. This review also highlights the considerable dearth of studies on this area of concern, specifically of case-control and prospective, clinical studies, in the worldwide literature.

The relationship between early personality and midlife psychological well-being: evidence from a UK birth cohort study

BACKGROUND

Individual differences in personality influence the occurrence, reporting and outcome of mental health problems across the life course, but little is known about the effects on adult psychological well-being. The aim of this study was to examine long range associations between Eysenck's personality dimensions and psychological well-being in midlife.

METHODS

The study sample comprised 1,134 women from the 1946 British birth cohort. Extraversion and neuroticism were assessed using the Maudsley Personality Inventory in adolescence (age 16 years) and early adulthood (age 26). Psychological well-being was assessed at age 52 with a 42-item version of Ryff's Psychological Well-being Scale. Analyses were undertaken within a structural equation modelling framework that allowed for an ordinal treatment of well-being and personality items, and latent variable modelling of longitudinal data on emotional adjustment. The contribution of mental health problems in linking personality variations to later well-being was assessed using a summary measure of mental health (emotional adjustment) created from multiple time-point assessments.

RESULTS

Women who were more socially outgoing (extravert) reported higher well-being on all dimensions. Neuroticism was associated with lower well-being on all dimensions. The effect of early neuroticism on midlife well-being was almost entirely mediated through emotional adjustment defined in terms of continuities in psychological/ psychiatric distress. The effect of extraversion was not mediated by emotional adjustment, nor attenuated after adjustment for neuroticism.

CONCLUSIONS

Individual differences in extraversion and neuroticism in early adult life influence levels of well-being reported in midlife.

The relationship between prior psychiatric disorder and chronic fatigue: evidence from a national birth cohort study

BACKGROUND

Increased rates of psychiatric disorder have previously been reported in those diagnosed with chronic fatigue syndrome (CFS) or myalgic encephalomyelitis (ME), although the direction of causation in this relationship has not been established. We aimed to test the hypothesis that individuals with self-reported CFS/ME have increased levels of psychiatric disorder prior to the onset of their fatigue symptoms.

METHOD

A total of 5,362 participants were prospectively followed with various measures of personality, psychiatric disorder and fatigue levels collected over the first 43 years of their life. CFS/ME was identified through self-report during a semi-structured interview at age 53 years.

RESULTS

Thirty-four (1.1%) of the 3,035 subjects assessed at age 53 years reported a diagnosis of CFS/ME. CFS/ME was more common among females, but there was no association between CFS/ME and either social class, social mobility or educational level. Those with psychiatric illness between the ages of 15 and 36 years were more likely to report CFS/ME later in life with an odds ratio (OR, adjusted for sex) of 2.65 [95% confidence interval (CI) 1.26-5.57, p=0.01]. Increased levels of psychiatric illness, in particular depression and anxiety, were present prior to the occurrence of fatigue symptoms. There was a dose-response relationship between the severity of psychiatric symptoms and the likelihood of later CFS/ME. Personality factors were not associated with a self-reported diagnosis of CFS/ME.

CONCLUSIONS

This temporal, dose-response relationship suggests that psychiatric disorders, or shared risk factors for psychiatric disorders, are likely to have an aetiological role in some cases of CFS/ME.

Etiology of chronic fatigue syndrome: testing popular hypotheses using a national birth cohort study

OBJECTIVE

To review the etiology of chronic fatigue syndrome (CFS) and test hypotheses relating to immune system dysfunction, physical deconditioning, exercise avoidance, and childhood illness experiences, using a large prospective birth cohort.

METHODS

A total of 4779 participants from the Medical Research Council's National Survey of Health and Development were prospectively followed for the first 53 years of their life with >20 separate data collections. Information was collected on childhood and parental health, atopic illness, levels of physical activity, fatigue, and participant's weight and height at multiple time points. CFS was identified through self-report during a semistructured interview at age 53 years with additional case notes review.

RESULTS

Of 2983 participants assessed at age 53 years, 34 (1.1%, 95% Confidence Interval 0.8-1.5) reported a diagnosis of CFS. Those who reported CFS were no more likely to have suffered from childhood illness or atopy. Increased levels of exercise throughout childhood and early adult life and a lower body mass index were associated with an increased risk of later CFS. Participants who later reported CFS continued to exercise more frequently even after they began to experience early symptoms of fatigue.

CONCLUSIONS

Individuals who exercise frequently are more likely to report a diagnosis of CFS in later life. This may be due to the direct effects of this behavior or associated personality factors. Continuing to be active despite increasing fatigue may be a crucial step in the development of CFS.

A longitudinal typology of symptoms of depression and anxiety over the life course

BACKGROUND

Little is known about long-term profiles of depressive and anxious symptomatology over the life course and about the developmental determinants of different trajectories. The objective of this study was to identify a novel typology of symptoms of depression and anxiety over the life course and examine its neurodevelopmental antecedents in an epidemiological sample.

METHODS

A longitudinal latent variable analysis was conducted on measures of anxious and depressive symptoms at ages 13, 15, 36, 43, and 53 years among 4627 members of the Medical Research Council National Survey of Health & Development (the British 1946 birth cohort). Early life predictors of class membership were studied with ordinal logistic regression.

RESULTS

We identified six distinct profiles up to age 53: absence of symptoms (44.8% of sample); repeated moderate symptoms (33.6%); adult-onset moderate symptoms (11.3%); adolescent symptoms with good adult outcome (5.8%); adult-onset severe symptoms (2.9%); and repeated severe symptoms over the life course (1.7%). Heavier babies had lower likelihood of depressive and anxious symptoms (odds ratio [OR] = .92; 95% confidence interval [CI] .85-.99), whereas delay in first standing (OR = 1.19; 95% CI 1.11-1.28) and walking (OR = 1.22; 95% CI 1.14-1.31) was associated with subsequent higher likelihood of symptoms, controlling for social circumstances and stressful life events during childhood.

CONCLUSIONS

There was evidence of distinct profiles of depressive and anxious symptomatology over the life course and associations with markers of neurodevelopment. This suggests very early factors are associated with long-term experience of symptoms of depression and anxiety.

Age and gender differences among Australian suicide ideators: prevalence and correlates

We investigated the prevalence and correlates of suicidal ideation in an Australian population sample at three stages of adulthood. Random sampling of a community acquired 7485 participants. Cohorts were 20 to 24, 40 to 44, or 60 to 64 years old. Twelve-month prevalence of suicidal ideation was 8.2%. Suicidal ideation was highest among the youngest cohort. Males with chronic physical illness were more prone to suicidal ideation, as were those aged 20 to 24 and 60 to 64. Furthermore, under-employed subjects 60 to 64 years old were seven times more likely to experience suicidal ideation than their counterparts working full-time. Childhood adversity and rumination had positive associations with suicidality; however, considering oneself more masterful was linked with lower levels of suicidal ideation. Contrary to clinical and popular views, our results highlight that proximal non-mental health variables such as employment, physical health, social factors, and personality are equally important to experiencing suicidal ideation as symptoms of psychological distress.

Three decades of antidepressant, anxiolytic and hypnotic use in a national population birth cohort

BACKGROUND

Psychotropic medication use is common and increasing. Use of such drugs at the individual level over long periods has not been reported.

AIMS

To describe antidepressant, anxiolytic and hypnotic drug use, and associations between such medication use and common mental disorder, over a 22-year period.

METHOD

Questions about psychotropic medication use and symptoms of common mental disorder were asked of more than 3000 members of the 1946 British birth cohort at multiple time points between ages 31 and 53 years.

RESULTS

Prevalence of any antidepressant, anxiolytic or hypnotic use increased significantly from 1977 (30.6 per 1000) to 1999 (59.1 per 1000) as the cohort aged. Less than 30% with mental disorder used antidepressants, anxiolytics or hypnotics. Previous use of antidepressant, anxiolytic or hypnotic was a strong predictor of future use during an episode of mental disorder (odds ratios 3.0-8.4); this association became weaker over time.

CONCLUSIONS

Pharmacotherapy is infrequently used by individuals with common mental disorder in Britain; this has not changed in the past three decades.

Do treated psychiatric patients become later community cases? A prospective cohort study

BACKGROUND

There have been few attempts to link two aspects of psychiatric epidemiology, severe disorder and milder 'common' mental disorder, by ascertaining whether subjects who have received psychiatric treatment for major disorders are identified later in epidemiological community surveys.

METHODS

Subjects were from a national birth cohort study and had been followed prospectively from childhood to middle age, with concurrent information on treatment from psychiatric facilities. In two successive prevalence surveys of milder disorder at 36 and 43 years, the association between earlier treatment and being a later community case was examined

RESULTS

Among 102 subjects who had been treated patients up to age 35 years, 52 (51%) were identified as definite community cases (36, 35%) or subthreshold cases (16, 16%) at either one or both later points. The proportion of community subjects who were previous psychiatric patients increased systematically from community non-cases, through subthreshold cases on one or both occasions, definite cases on one occasion, to definite cases on both occasions.

CONCLUSIONS

About half of subjects who have received treatment from psychiatric facilities remain with persistent symptoms such as to identify them as definite or subthreshold cases of milder common mental disorder some years later.

Parent-child relationships and health problems in adulthood in three UK national birth cohort studies

BACKGROUND

Event-based measures suggest that emotional adversity in childhood has a long-term health impact, but less attention has been paid to chronic emotional stressors such as family conflict, harsh discipline or lack of affection. This study aimed to assess the impact of the latter on health problems and illness in adulthood.

METHODS

Logistic regression and multinomial logistic regression analyses of data collected in three UK national birth cohort studies at ages 43 and 16 years covering subjective report of relationship quality from the 'child', and number of health problems and illnesses reported in adulthood at ages 43, 33 and 26 years adjusted for social class, sex and, in 1946 and 1970 cohorts, for symptoms of mental illness.

RESULTS

Reports of abuse and neglect (1946 cohort), poor quality relationship with mother and father (1958 cohort), and a range of negative relationship descriptors (1970 cohort) predicted reports of three or more illnesses or health problems in adulthood. Results were inconsistent with respect to one or two illnesses or health problems. Adjustment for sex, social class and poor mental health attenuated the odds of poor health, but measures of relationship quality retained a significant independent effect.

CONCLUSIONS

Poor quality parent-child relationships could be a remediable risk factor for poor health in adulthood.

Social and environmental conditions across the life course and age at menopause in a British birth cohort study

OBJECTIVE

To assess whether socio-economic status, environmental stress and hardship throughout the life course are associated with age at menopause.

DESIGN

Birth cohort study.

SETTING

England, Scotland, Wales.

SAMPLE

A total of 1515 women from a stratified sample of all births in one week in 1946.

METHODS

Age at menopause was collected using annual postal questionnaires from age 47 to 53 years. Information on socio-economic conditions and hardship were collected at contacts throughout life from age 2 to 43 years. Socio-economic indicator variables were defined to represent cumulative exposure to hardship in childhood and in adulthood.

MAIN OUTCOME MEASURES

Age at menopause.

RESULTS

Cox's proportional hazard models indicated that women whose fathers were in a manual social class occupation at three time points during her childhood had an earlier age at menopause than those whose fathers were in non-manual occupations at all three (HR: 1.51; 95% CI: 0.93-2.47). Similar findings were seen for household crowding. These socio-economic gradients could not be explained by adult socio-economic status, behaviour and lifestyle or by psychological health and stress, but were attenuated by other early life factors. Women who experienced parental divorce early in life (before five years of age) had double the rate of menopause of those whose parents did not divorce (HR: 2.14; 95% CI: 1.33-3.42). There were no consistent findings with adult socio-economic indicators.

CONCLUSIONS

There is some evidence of a cumulative effect of socio-economic circumstances in childhood, but not in adulthood, on age at menopause. Childhood nutrition, cognition and emotional stress possibly underlie the social gradient.

ALCOHOL CONSUMPTION AND MIDLIFE COGNITIVE CHANGE IN THE BRITISH 1946 BIRTH COHORT STUDY

AIMS

Cross-sectional studies suggest that alcohol consumption benefits cognitive function. However, more longitudinal studies are required to confirm that alcohol has an effect on cognitive change and to rule out the possibility that those of higher ability engage in a lifestyle that protects against cognitive decline.

METHODS

We investigated the association between self-reported alcohol consumption and change in memory, speed and concentration in midlife, in 903 men and 861 women enrolled in the MRC National Survey of Health and Development (the British 1946 birth cohort).

RESULTS

After controlling for educational attainment, occupational social class and general cognitive ability, it was found that alcohol consumption was associated with a slower memory decline from 43 to 53 years in men, but a more rapid decline in visual search speed for the same interval in women. These effects were not explained by a further control for health status (body water weight, smoking, exercise, cardio-respiratory disease and affective state).

CONCLUSIONS

Our data suggest that alcohol consumption is associated with a slower memory decline. However, the negative association between alcohol and psychomotor function in women is a potential cause for concern.

A population survey found an association between self-reports of traumatic brain injury and increased psychiatric symptoms

OBJECTIVE

This study determined whether self-reported Traumatic Brain Injury (TBI), identified in a community sample and occurring up to 60 years previously, is associated with current psychiatric symptoms, suicidality, and psychologic well-being.

STUDY DESIGN AND SETTING

Three age cohorts (20-24, 40-44, 60-64) were randomly sampled from the cities of Canberra and Queanbeyan, Australia, yielding a total of 7,485 participants. The samples were administered scales measuring anxiety, depression, suicidality, positive and negative affect, personality traits, and physical health status.

RESULTS

Of the total sample, 5.7% reported history of TBI involving loss of consciousness for at least 15 min, occurring an average of 22 years previously. History of TBI was associated with increased symptoms of depression, anxiety, negative affect, and suicidal ideation.

CONCLUSION

History of TBI is a risk factor for psychiatric morbidity. The effect is greatest in young adults, and occurs up to several decades subsequent to the occurrence of TBI.

Sexual orientation and mental health: results from a community survey of young and middle-aged adults

BACKGROUND

Community surveys have reported a higher rate of mental health problems in combined groups of homosexual and bisexual participants, but have not separated these two groups.

AIMS

To assess separately the mental health of homosexual and bisexual groups compared with heterosexuals.

METHOD

A community survey of 4824 adults was carried out in Canberra, Australia. Measures covered anxiety, depression, suicidality, alcohol misuse, positive and negative affect and a range of risk factors for poorer mental health.

RESULTS

The bisexual group was highest on measures of anxiety, depression and negative affect, with the homosexual group falling between the other two groups. Both the bisexual and homosexual groups were high on suicidality. Bisexuals also had more current adverse life events, greater childhood adversity, less positive support from family, more negative support from friends and a higher frequency of financial problems. Homosexuals reported greater childhood adversity and less positive support from family.

CONCLUSIONS

The bisexual group had the worst mental health, although homosexual participants also tended to report more distress.

Anxiety in cataract surgery: pilot study

PURPOSE

To quantify the anxiety provoked by cataract surgery and establish whether the preoperative stage, the day of surgery, or the outcome was associated with unduly high anxiety.

SETTING

Moorfields Eye Hospital, London, United Kingdom.

METHODS

A cross-sectional survey of adult patients having cataract surgery under local anesthesia was done. The Hospital Anxiety and Depression (HAD) scale and a Visual Analog Scale (VAS) were used to quantify the patients' anxiety. Of the 108 patients enrolled, 38 were surveyed at the preassessment clinic, 36 at the day ward (operation day), and 34 at the postoperative clinic. For each stage, the patients were divided into groups: first-eye cataract surgery, second-eye cataract surgery, and combined (first- and second-surgery patients).

RESULTS

The average patient in the combined group found the preassessment stage to be more anxiety provoking than the operation day or the postoperative visit. The median HAD scale scores were 5, 4, and 2, respectively, and the median VAS anxiety scores, 4, 2, and 1.75. The HAD anxiety scores in the combined group were significantly different between the operation day and the postoperative visit (P <.05, Mann-Whitney U) but not between the preassessment and operation day. The VAS scores showed no significant differences among the 3 stages of treatment in the combined group. Different anxiety trends were found between the first- and second-surgery groups.

CONCLUSION

The average patient was not unduly anxious about cataract surgery.

Neuroticism, life events and mental health: evidence for person-environment correlation

BACKGROUND

There is some evidence that genetic effects on the likelihood of experiencing stressful life events (SLEs) are mediated by heritable traits such as cognitive ability (CA) and neuroticism (N).

AIMS

To examine whether the association between CA, N and mental ill-health is driven in part by a predisposition to experience depressogenic SLEs.

METHOD

Childhood measures of N and CA were available in a birth cohort of 5362 individuals. At ages 36 and 43 years, mental state and occurrence of SLEs in the previous year were assessed. Using a path-analytic approach, models with and without a hypothesised influence of N and CA on the occurrence of SLEs were compared.

RESULTS

The fit of the model with childhood N having a direct influence on SLEs was good with chi 2 = 5.72, d.f. = 4, P = 0.22 at age 36 years and chi 2 = 3.50, d.f. = 5, P = 0.62 at age 43. The fit of the model was significantly worse without this path at both ages (36 years: chi 2 = 42.5, d.f. = 1, P < 0.001; 43 years chi 2 = 15.3, d.f. = 1, P < 0.001). No consistent differences were seen in comparisons of models with CA.

CONCLUSIONS

The results are congruent with the suggestion that genetic effects on SLEs are mediated by personal characteristics. Part of the well-established association between N and minor psychiatric disorder may be mediated by an indirect effect of N on the likelihood of experiencing SLEs.

Is "somatisation" a defense against the acknowledgment of psychiatric disorder?

OBJECTIVE

To determine whether experiencing physical symptoms is associated with a denial of psychological distress in individuals with probable psychiatric disorder.

METHODS

A nested case-control study was performed using data from a national birth cohort study. All subjects who scored above threshold on a case-finding questionnaire of psychiatric disorder were identified. Those who in a separate question endorsed the presence of psychiatric disorder ("acknowledgers") were compared with those who did not.

RESULTS

Acknowledgers were more likely to be female, better educated and have more severe current and past psychiatric disorder. They were also more likely to report multiple physical symptoms, even when potential confounders and severity of psychiatric disorder were controlled.

CONCLUSION

There is no evidence that experiencing multiple physical symptoms helps the individual deny the presence of psychiatric disorder.

Predictive validity of the BRASS index in screening patients with post-discharge problems. Blaylock Risk Assessment Screening Score

RATIONALE

Discharge planning is a nursing intervention that aims to ensure continuity of care; it consists of several steps of which selecting patients in need of it is the first one. The Blaylock Risk Assessment Screening Score (BRASS) index is a risk screening instrument which can be used early after admission to identify those patients in need of discharge planning.

AIM

To test the predictive validity of the BRASS index in screening patients with post-discharge problems.

DESIGN

Prospective longitudinal design with prediction instrument measured at admission, and outcomes measured at discharge and 7 and 30 days after discharge.

OUTCOME MEASURES

length of stay, discharge destination, status after discharge.

INSTRUMENTS

BRASS index, Problems after discharge Questionnaire, Nottingham Health Profile, COOP/WONCA charts.

RESEARCH METHOD

503 elderly patients were screened at admission with the BRASS index. Length of stay and discharge destination were measured at discharge in these same patients. Outcomes after discharge were gathered only in patients who were discharged home and with length of stay of more than 3 days (n=226); outcomes were measured by postal questionnaires at day 7 and day 30 after discharge.

RESULTS

patients identified by the BRASS index as high risk are frequently not discharged home and have a longer length of stay. The BRASS scores correlate significantly with the outcome scores after discharge: the higher the BRASS score, the higher the difficulty score after discharge on all domains. However, the sensitivity of the BRASS index is rather low.

CONCLUSION

This study demonstrates that the BRASS index is a good predictor instrument for indicating patients who are not discharged home, that the BRASS scores correlate significantly with problems experienced after discharge and that it has high specificity to predict patients with problems after discharge. Clinical use, however, is limited due to the low sensitivity. The BRASS index is a promising case-finding instrument for discharge planning, but needs further development.

Temporal relationships between physical symptoms and psychiatric disorder. Results from a national birth cohort

BACKGROUND

Physical symptoms and psychiatric disorder are associated. We aimed to investigate which comes first.

METHODS

Data from the Medical Research Council National Survey of Health and Development, a population-based birth cohort study were used at two time points: 36 and 43 years. Six physical symptoms were reported at both time points. The Present State Examination and Psychiatric Symptom Frequency interviews were administered at 36 and 43 years respectively. Odds ratios corrected for a variety of confounders were used to describe the associations between physical symptoms and psychiatric disorder across these two time points.

RESULTS

Psychiatric disorder increased the odds of reporting symptoms 3-7-fold. The relationship strengthened when the outcome was defined as suffering from multiple symptoms. Population attributable risk of psychiatric disorder and subsyndromal disorder in causing multiple somatic symptoms was 40.3%. Prospectively, psychiatric disorder at 36 years was a predictor for five of the six physical symptoms. Three physical symptoms at 36 years predicted new onset of psychiatric symptoms at 43 years.

CONCLUSIONS

Psychiatric disorder is strongly related to physical symptoms. The direction of causality may operate in both directions. Assuming a causal relationship, psychiatric disorder (including sub-threshold disorders) could account for at most 40% of cases of multiple physical symptoms.