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Dhara S, Thakur J, Pandey N, Mozumdar A, Roy S. Prevalence of major depressive disorder and its determinants among young married women and unmarried girls: Findings from the second round of UDAYA survey. PLoS One 2024; 19:e0306071. [PMID: 38954722 PMCID: PMC11218953 DOI: 10.1371/journal.pone.0306071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 06/11/2024] [Indexed: 07/04/2024] Open
Abstract
INTRODUCTION Depression is a prevalent and debilitating mental illness affecting young women worldwide. This study aimed to identify psychosocial determinants of major depressive disorder (MDD) among young women in Bihar and Uttar Pradesh, India. METHODS Data from "Understanding the Lives of Adolescents and Young Adults" (UDAYA) study (2018-19) for young women aged 12-23 years, both married and unmarried was used for this paper. MDD was evaluated using the Patient Health Questionnaire PHQ-9 with a cut-off score of ≤10. The determinants of MDD were identified through multilevel binary logistic regression analysis. RESULTS The prevalence of MDD was 13.6% (95% CL 12.2-15.2) and 5.1% (95% CL 4.2-6.1) for young married women and unmarried girls, respectively. Among the young married women, community-level variables like dowry-related humiliation (1.74, 95% CI 1.15-2.64), and sexual assaults (2.15, 95% CI 1.24-3.73) were significantly associated with MDD. For unmarried girls, reporting of family violence <10% of participants (0.45, 95% CI 0.24-0.85), family violence (≥10% of participants) % (0.35 95% CI 0.19-0.68) and interpartner violence (>25% of participants) (0.42; 95% CI 0.23-0.74) remain significant predictors of MDD. At individual level, for both the groups, age, participation in decision making (on education), social capital (currently attending school/educational course and number of friends), self-efficacy, telephonic harassment, and physical activity were associated with MDD. Wealth index, job seeking, participation in decision making (on health-seeking), parental interactions and physical abuse (for unmarried girls only) and education, reported last sexual intercourse, pressure from the in-laws' to conceive (for young married women only) were associated with MDD. CONCLUSIONS For young married women, community level targeted interventions should focus on the social ecology to foster a sense of safe community environment. For unmarried girls, additionally, interventions should aim to optimize their family environment for effective mental health outcomes.
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Affiliation(s)
- Shromona Dhara
- Department of Anthropology, University of Calcutta, Kolkata, West Bengal, India
| | | | | | | | - Subho Roy
- Biological Anthropology Unit, Indian Statistical Institute, Kolkata, India
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Baradwan S, Tawfiq A, Hakeem GF, Alkaff A, Hafedh B, Faden Y, Khadawardi K, Abdulghani SH, Althagafi H, Abu-Zaid A. The effects of low-dose aspirin on preterm birth: a systematic review and meta-analysis of randomized controlled trials. Arch Gynecol Obstet 2024; 309:1775-1786. [PMID: 38372754 DOI: 10.1007/s00404-024-07373-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/02/2024] [Indexed: 02/20/2024]
Abstract
AIM To conduct a systematic review and meta-analysis of all randomized controlled trials (RCTs) that evaluated the efficacy of low-dose aspirin (LDA, ≤ 160 mg/day) on preventing preterm birth (PB). METHODS Five databases were screened from inception until June 25, 2023. The RCTs were assessed for quality according to Cochrane's risk of bias tool. The endpoints were summarized as risk ratio (RR) with 95% confidence interval (CI). RESULTS Overall, 40 RCTs were analyzed. LDA significantly decreased the risk of PB < 37 weeks (RR: 0.91, 95% CI 0.87, 0.96, p < 0.001, moderate certainty of evidence) with low between-study heterogeneity (I2 = 23.2%, p = 0.11), and PB < 34 weeks (RR: 0.78, 95% CI 0.61, 0.99, p = 0.04, low certainty of evidence) with high between-study heterogeneity (I2 = 58.3%, p = 0.01). There were no significant differences between both groups regarding the risk of spontaneous (RR: 0.94, 95% CI 0.83, 1.07, p = 0.37) and medically indicated (RR: 1.28, 95% CI 0.87, 1.88, p = 0.21) BP < 37 weeks. Sensitivity analysis revealed robustness for all outcomes, except for the risk of PB < 34 weeks. For PB < 37 weeks and PB < 34 weeks, publication bias was detected based on visual inspection of funnel plots for asymmetry and statistical significance for Egger's test (p = 0.009 and p = 0.0012, respectively). CONCLUSION LDA can significantly reduce the risk of PB < 37 and < 34 weeks. Nevertheless, further high-quality RCTs conducted in diverse populations, while accounting for potential confounding factors, are imperative to elucidate the optimal aspirin dosage, timing of initiation, and treatment duration for preventing preterm birth and to arrive at definitive conclusions.
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Affiliation(s)
- Saeed Baradwan
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Afaf Tawfiq
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Ghaidaa Farouk Hakeem
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Alya Alkaff
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Bandr Hafedh
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Yaser Faden
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Khalid Khadawardi
- Department of Obstetrics and Gynecology, College of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Sahar H Abdulghani
- Department of Obstetrics and Gynecology, Security Forces Hospital Program, Riyadh, Saudi Arabia
| | - Hanin Althagafi
- Department of Obstetrics and Gynecology, Faculty of Medicine at Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed Abu-Zaid
- Department of Obstetrics and Gynecology, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
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Bitsko RH, Holbrook JR, O'Masta B, Maher B, Cerles A, Saadeh K, Mahmooth Z, MacMillan LM, Rush M, Kaminski JW. A Systematic Review and Meta-analysis of Prenatal, Birth, and Postnatal Factors Associated with Attention-Deficit/Hyperactivity Disorder in Children. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:203-224. [PMID: 35303250 PMCID: PMC9482663 DOI: 10.1007/s11121-022-01359-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 12/17/2022]
Abstract
Previous studies have shown mixed results on the relationship between prenatal, birth, and postnatal ("pregnancy-related") risk factors and attention-deficit/hyperactivity disorder (ADHD). We conducted meta-analyses to identify potentially modifiable pregnancy-related factors associated with ADHD. A comprehensive search of PubMed, Web of Science, and EMBASE in 2014, followed by an updated search in January 2021, identified 69 articles published in English on pregnancy-related risk factors and ADHD for inclusion. Risk factors were included in the meta-analysis if at least three effect sizes with clear pregnancy-related risk factor exposure were identified. Pooled effect sizes were calculated for ADHD overall, ADHD diagnosis, inattention, and hyperactivity/impulsivity. Odds ratios (OR) were calculated for dichotomous measures and correlation coefficients (CC) for continuous measures. Prenatal factors (pre-pregnancy weight, preeclampsia, pregnancy complications, elevated testosterone exposure), and postnatal factors (Apgar score, neonatal illness, no breastfeeding) were positively associated with ADHD overall; the findings for ADHD diagnosis were similar with the exception that there were too few effect sizes available to examine pre-pregnancy weight and lack of breastfeeding. Prenatal testosterone was significantly associated with inattention and hyperactivity/impulsivity. Effect sizes were generally small (range 1.1-1.6 ORs, -0.16-0.11 CCs). Risk factors occurring at the time of birth (perinatal asphyxia, labor complications, mode of delivery) were not significantly associated with ADHD. A better understanding of factors that are consistently associated with ADHD may inform future prevention strategies. The findings reported here suggest that prenatal and postnatal factors may serve as potential targets for preventing or mitigating the symptoms of ADHD.
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Affiliation(s)
- Rebecca H Bitsko
- Division of Human Development and Disability, National Center On Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Joseph R Holbrook
- Division of Human Development and Disability, National Center On Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Brion Maher
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | | | | | - Jennifer W Kaminski
- Division of Human Development and Disability, National Center On Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention, Atlanta, GA, USA
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Gill R, Karim ME, Puyat JH, Guhn M, Janus M, Gagné Petteni M, Forer B, Gadermann AM. Childhood poverty and school readiness: Differences by poverty type and immigration background. SSM Popul Health 2024; 25:101563. [PMID: 38144443 PMCID: PMC10746556 DOI: 10.1016/j.ssmph.2023.101563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 11/09/2023] [Accepted: 11/17/2023] [Indexed: 12/26/2023] Open
Abstract
Objectives Poverty exposes children to adverse conditions that negatively impact development. However, there is limited understanding on how different types of poverty may affect children of various immigration backgrounds differently in outcomes such as school readiness. This study examined these relationships between household and/or neighbourhood poverty, poverty timing, and immigration background with school readiness outcomes at kindergarten. Methods This study utilized a retrospective, population-based cohort of administrative records linked with surveys completed by kindergarten teachers for 15 369 children born in British Columbia, Canada. The exposures investigated were neighbourhood poverty (residing in a neighbourhood in the lowest income-quintile) and/or household poverty (receiving a health insurance subsidy due to low household income). Experiencing both neighbourhood and household poverty simultaneously was defined as "combined" household and neighbourhood poverty. The outcome of vulnerability on school readiness domains was assessed at kindergarten (47.8% female; mean age = 6.01 years) using teacher ratings on the Early Development Instrument (EDI). Results Children exposed to combined poverty between age 0 and 2 had greater odds of being vulnerable in two or more domains of school readiness than children not exposed to any poverty during this period (adjusted odds ratio (aOR) = 2.07, 95% CI: [1.74; 2.47], p < 0.001). The effect of combined poverty was larger than household poverty only (aOR = 1.54, 95% CI: [1.31; 1.82], p < 0.001) or neighbourhood poverty only (aOR = 1.49, 95% CI: [1.30; 1.70], p < 0.001). Combined poverty was associated with negative outcomes regardless of timing. Both non-immigrants (aOR = 2.40, 95% CI: [1.92; 3.00], p < 0.001) and second-generation immigrants (aOR = 1.63, 95% CI: [1.22; 2.17], p < 0.001) experiencing combined poverty scored lower on school readiness. Conclusions Children who experienced combined poverty had lower levels of school readiness at kindergarten, regardless of timing and immigration background.
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Affiliation(s)
- Randip Gill
- Human Early Learning Partnership, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada
| | - Mohammad Ehsanul Karim
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada
- Centre for Advancing Health Outcomes, Providence Health Care Research Institute, 570-1081 Burrard Street, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Joseph H. Puyat
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada
- Centre for Advancing Health Outcomes, Providence Health Care Research Institute, 570-1081 Burrard Street, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Martin Guhn
- Human Early Learning Partnership, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada
| | - Magdalena Janus
- Human Early Learning Partnership, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, Hamilton, Canada
| | - Monique Gagné Petteni
- Human Early Learning Partnership, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada
- Centre for Advancing Health Outcomes, Providence Health Care Research Institute, 570-1081 Burrard Street, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Barry Forer
- Human Early Learning Partnership, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada
| | - Anne M. Gadermann
- Human Early Learning Partnership, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada
- Centre for Advancing Health Outcomes, Providence Health Care Research Institute, 570-1081 Burrard Street, St. Paul’s Hospital, Vancouver, BC, Canada
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Svraka B, Álvarez C, Szücs D. Anxiety predicts math achievement in kindergarten children. Front Psychol 2024; 15:1335952. [PMID: 38476390 PMCID: PMC10927750 DOI: 10.3389/fpsyg.2024.1335952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/16/2024] [Indexed: 03/14/2024] Open
Abstract
Introduction Math anxiety (MA) is an academic anxiety about learning, doing, and evaluating mathematics, usually studied in school populations and adults. However, MA likely has its origins before children go to school. For example, studies have shown that general anxiety (GA) for everyday events is less separable from MA in primary than in early secondary school. This suggests that GA may be a precursor of MA. For this reason, here, we have examined whether GA is already associated with math achievement at the end of kindergarten. Methods We tested 488 Hungarian kindergarten children aged 5.7 to 6.9 years (55% girls) and analyzed the effect of GA, sex, and family SES on math achievement in kindergarten children. Results Strikingly, confirming results from primary school children, we found that GA negatively correlated with math achievement already in this preschool population. Higher GA levels had a stronger negative effect on girls' than boys' math achievement. However, there were no significant sex differences in math achievement in kindergarten. Additionally, family socioeconomic status was the strongest predictor of math achievement. Discussion We speculate that high GA in preschool is a plausible early precursor of later high MA. Early interventions could aim to control GA levels before children start formal schooling.
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Affiliation(s)
- Bernadett Svraka
- Department of Education, Faculty of Primary and Pre-School Education, ELTE, Eötvös Loránd University, Budapest, Hungary
- Doctoral School of Mental Health Sciences, Semmelweis University, Budapest, Hungary
- MTA-SZTE Metacognition Research Group, Szeged, Hungary
- National Laboratory for Social Innovation, Budapest, Hungary
| | - Carolina Álvarez
- Centre for Neuroscience in Education, Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | - Dénes Szücs
- Centre for Neuroscience in Education, Department of Psychology, University of Cambridge, Cambridge, United Kingdom
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Vanzella-Yang A, Vergunst F, Domond P, Vitaro F, Tremblay RE, Bégin V, Côté S. Childhood behavioral problems are associated with the intergenerational transmission of low education: a 16-year population-based study. Eur Child Adolesc Psychiatry 2024; 33:595-603. [PMID: 36932229 DOI: 10.1007/s00787-023-02193-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 03/08/2023] [Indexed: 03/19/2023]
Abstract
The intergenerational transmission of low educational attainment is well-documented, but little is known about how behavioral problems in childhood explain this association. Drawing upon a population-based cohort study (n = 3020) linked to administrative records, we investigated the extent to which inattentive, internalizing, externalizing, and prosocial behaviors at child ages 6-8 years accounted for associations between parental education and child's risk of failing to graduate from high school. We adjusted for economic, demographic, cognitive, and perinatal factors, as well as parental mental health. Using logistic regressions and the Karlson-Holm-Breen decomposition method, we found that childhood behaviors together explained 19.5% of the association between mother's education and child's high school graduation status at age 22/23, and 13.7% of the association between father's education and this same outcome. Inattentive behaviors were most strongly associated with failure to graduate from high school, while the role of other behaviors was modest or negligible. Inattentive behaviors may represent a mediational pathway between parental education and child education. Early interventions targeting inattentive behaviors could potentially enhance the prospects of intergenerational educational mobility.
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Affiliation(s)
- Adam Vanzella-Yang
- School of Public Health, University of Montreal, Montreal, Canada.
- Sainte-Justine Hospital Research Center, University of Montreal, 3175 Côte Sainte-Catherine, Montreal, QC, H3T 1C5, Canada.
| | - Francis Vergunst
- School of Public Health, University of Montreal, Montreal, Canada
- Sainte-Justine Hospital Research Center, University of Montreal, 3175 Côte Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
- Special Needs Education, University of Oslo, Oslo, Norway
| | - Pascale Domond
- School of Public Health, University of Montreal, Montreal, Canada
- Sainte-Justine Hospital Research Center, University of Montreal, 3175 Côte Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
| | - Frank Vitaro
- Sainte-Justine Hospital Research Center, University of Montreal, 3175 Côte Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
- School of Psychoeducation, University of Montreal, Montreal, Canada
| | - Richard E Tremblay
- Sainte-Justine Hospital Research Center, University of Montreal, 3175 Côte Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
- Department of Pediatrics and Department of Psychology, University of Montreal, Montreal, Canada
- School of Public Health, Physiotherapy and Sport Science, University College Dublin, Dublin, Ireland
| | - Vincent Bégin
- Department of Psychoeducation, University of Sherbrooke, Sherbrooke, Canada
| | - Sylvana Côté
- School of Public Health, University of Montreal, Montreal, Canada
- Sainte-Justine Hospital Research Center, University of Montreal, 3175 Côte Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
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Galbally M, Watson SJ, Newnham J, White S, Watkins A, Lewis AJ. The Relationship Between Early Term Birth and the Risk of Later Childhood Mental Disorders Within a Pregnancy Cohort. Child Psychiatry Hum Dev 2024:10.1007/s10578-023-01643-5. [PMID: 38165581 DOI: 10.1007/s10578-023-01643-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2023] [Indexed: 01/04/2024]
Abstract
This study examines whether gestational age, birth weight, and early term birth is associated with childhood mental disorders in 342 pregnant women recruited at less than 20 weeks gestation and were then followed up until 4 years postpartum, including 93 children born at early term. Women were assessed at recruitment using the Structured Clinical Interview for DSM. At 4 years of age their children were assessed using the Preschool Age Psychiatric Assessment (PAPA) and the Child Behavior Checklist (CBCL). This study found earlier birth predicted an increased risk for anxiety disorders and demonstrated a significant interaction between gestational age and lower birthweight. The risk for ADHD increased with lower gestational age independent of birthweight. In contrast, gestational age was not associated with Oppositional Defiant Disorder, Conduct Disorder, internalizing or externalizing symptoms. These findings highlight the important differences in the association of early term birth and vulnerability for specific mental disorders.
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Affiliation(s)
- Megan Galbally
- School of Clinical Sciences, Monash University, Clayton, VIC, 3168, Australia.
- Health Futures Institute, Murdoch University, Perth, Australia.
| | - Stuart J Watson
- School of Clinical Sciences, Monash University, Clayton, VIC, 3168, Australia
- Health Futures Institute, Murdoch University, Perth, Australia
| | - John Newnham
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Australia
| | - Scott White
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Australia
| | | | - Andrew J Lewis
- Institute of Health and Wellbeing, Federation University, Ballarat, Australia
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Zhao YV, Gibson JL. Evidence for Protective Effects of Peer Play in the Early Years: Better Peer Play Ability at Age 3 Years Predicts Lower Risks of Externalising and Internalising Problems at Age 7 Years in a Longitudinal Cohort Analysis. Child Psychiatry Hum Dev 2023; 54:1807-1822. [PMID: 35697892 PMCID: PMC10581935 DOI: 10.1007/s10578-022-01368-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/16/2022] [Indexed: 11/28/2022]
Abstract
Peer play ability may be a protective factor against childhood mental health difficulties but there is lack of empirical evidence to support this hypothesis. We conducted longitudinal structural equation modelling study over a population cohort (N = 1676) to examine the effect of age 3 peer play ability on children's age 7 mental health outcomes (measured by the Strengths and Difficulties Questionnaire subscales). We modelled effects for the entire population and two sub-groups at high-risk for mental health problems based on age 3 temperament. Controlling for demographic variables, temperament, maternal distress, play with parents and number of siblings, better peer play ability at age 3 years predicted lower risk of problems on all 4 SDQ subscales at age 7 years for the general population. For the low-persistence subgroup, better peer play ability at age 3 predicted lower risk of age 7 hyperactivity, emotional and peer problems, whereas better peer play ability at age 3 predicted only lower risk of age 7 hyperactivity for the high-reactivity group. Taken together our results provide evidence that supports the hypothesis that early peer play ability may be a protective factor against later mental health difficulties. We conclude that further research aimed at establishing causation is worth pursuing.
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Affiliation(s)
- Yiran Vicky Zhao
- Play and Communication Lab, Centre for Research on Play in Education, Development and Learning, Faculty of Education, University of Cambridge, 184 Hills Road, Cambridge, CB2 8PQ, UK
| | - Jenny Louise Gibson
- Play and Communication Lab, Centre for Research on Play in Education, Development and Learning, Faculty of Education, University of Cambridge, 184 Hills Road, Cambridge, CB2 8PQ, UK.
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Ahmad S, Peterson ER, Waldie KE, Morton SMB. Proximal Processes and Contextual Factors Associated with Early Socio-emotional Competence Development. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01591-0. [PMID: 37717222 DOI: 10.1007/s10578-023-01591-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2023] [Indexed: 09/19/2023]
Abstract
There is growing interest in child socio-emotional competence from parents, educators, employers and policy makers, with emphasis on developing it as early as possible. The aim of the present study was to examine contextual and proximal factors that influence socio-emotional competence development across the first five years of a child's life. We used data from 3200 mothers and their children drawn mostly from four major data collection waves (antenatal, 9 months, 2 years and 4.5 years) of the population-based longitudinal study, Growing Up in New Zealand. Regression analyses were carried out to identify the predictors of socio-emotional competence after controlling for demographics and prior score(s) of socio-emotional competence. We found that specific maternal behaviours, such as playing games and playing with toys with children, singing songs or telling stories to them, reading books with them, having rules around viewing TV, DVDs and videos, and praising children have a positive effect on socio-emotional competence. Parental relationship warmth and less family stress at 9 months also made positive contributions to socio-emotional competence at 9 months and 2 years. In contrast, attending childcare and having more siblings at home negatively predicted socio-emotional competence at 9 months. Mother's unemployment, living in neighbourhoods perceived as negative and being in contact with family and social services were negatively associated with concurrent socio-emotional competence at 2 years. Overall, more and/or stronger contemporaneous effects were found suggesting that negative effects of contextual factors may not have lasting impact on socio-emotional competence. In addition, the results showed that maternal behaviours need to be practised regularly to have positive impact on child's socio-emotional development.
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Affiliation(s)
- Sahrish Ahmad
- School of Psychology, Faculty of Science, The University of Auckland, Auckland, New Zealand.
| | - Elizabeth R Peterson
- School of Psychology, Faculty of Science, The University of Auckland, Auckland, New Zealand
- Growing Up in New Zealand, Centre for Longitudinal Research-He Ara ki Mua, The University of Auckland, Auckland, New Zealand
| | - Karen E Waldie
- School of Psychology, Faculty of Science, The University of Auckland, Auckland, New Zealand
- Growing Up in New Zealand, Centre for Longitudinal Research-He Ara ki Mua, The University of Auckland, Auckland, New Zealand
| | - Susan M B Morton
- Growing Up in New Zealand, Centre for Longitudinal Research-He Ara ki Mua, The University of Auckland, Auckland, New Zealand
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Tall J, Biel M. The Effects of Social Determinants of Health on Child and Family Mental Health: Implications of the COVID-19 Pandemic and Beyond. Curr Psychiatry Rep 2023; 25:387-394. [PMID: 37470927 DOI: 10.1007/s11920-023-01436-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 07/21/2023]
Abstract
PURPOSE OF REVIEW This review aims to expand understanding of the effect of SDOH on youth and family mental health outcomes. The review highlights significant findings from recent literature across SDOH categories (Economic Stability, Education Access/Quality, Health Care Access/Quality, Neighborhood/Built Environment, and Social/Community Context). This review also aims to demonstrate how the COVID-19 pandemic influences these effects. RECENT FINDINGS Economic instability (i.e., poverty, food insecurity) is associated with poorer MH outcomes. The COVID-19 pandemic limited access to mental health resources, including reduced opportunities for school-based mental health services and insurance barriers. Systemic factors, such as community violence and racism, exacerbate MH disparities. Policy decisions, especially those addressing poverty, can help youth and family exposures to SDOH, ACEs, and TS, which can help improve youth mental health outcomes at the population level. Findings on negative consequences of SDOH factors should be balanced with reporting findings of resiliency and other associated protective factors.
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Affiliation(s)
- Jasmine Tall
- The Chicago School of Professional Psychology, 901 15th St NW, 20005, Washington, DC, USA.
| | - Matthew Biel
- Georgetown University Medical Center, MedStar Georgetown University Hospital, Washington, DC, USA
- Early Childhood Innovation Network, Washington, DC, USA
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Acker J, Aghaee S, Mujahid M, Deardorff J, Kubo A. Structural Racism and Adolescent Mental Health Disparities in Northern California. JAMA Netw Open 2023; 6:e2329825. [PMID: 37594761 PMCID: PMC10439477 DOI: 10.1001/jamanetworkopen.2023.29825] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/12/2023] [Indexed: 08/19/2023] Open
Abstract
Importance Understanding how structural racism is associated with adolescent mental health is critical to advance health equity. Objective To assess associations between neighborhood privilege, measured by the Index of Concentration at the Extremes (ICE) and adolescent depressive symptoms, suicidality, and related racial and ethnic disparities. Design, Setting, and Participants This was a retrospective cohort study using electronic health records of adolescents aged 12 to 16 years who attended well-teen visits between 2017 and 2021. Kaiser Permanente Northern California is an integrated health care delivery system serving 4.6 million members. The cohort included 34 252 individuals born singleton at an affiliated facility from January 1, 2005, to December 31, 2009, and who had completed at least 1 mental health screener during a well-teen visit by November 23, 2021. Exposures American Community Survey 2016 to 2021 5-year estimates were used to calculate ICE scores for adolescents' residential census tract at ages 10 to 11. Three ICE measures were used as proxies of structural racism: racial privilege (ICE-race and ethnicity; hereinafter ICE-race), economic privilege (ICE-income), and combined economic and racial privilege (ICE-income plus race and ethnicity; herinafter ICE-income plus race). ICE scores were categorized into quintiles based on California statewide distributions. Main Outcomes and Measures Depressive symptoms and suicidality were assessed through self-report screeners during well-teen visits. Depressive symptoms were considered to be present if patients had a score on the Patient Health Questionnaire-2 of 3 or higher (the tool uses a Likert scale to determine the frequency [0 = not at all; 3 = nearly every day] that they had depressed mood and lack of pleasure in usual activities in the past 2 weeks; responses were summed and dichotomized). Results Analyses included 34 252 adolescents (12-16 years of age; mean [SD] age, 13.7 [0.8] years; 17 557 [51.3%] male, 7284 [21.3%] Asian or Pacific Islander, 2587 [7.6%] Black], 9061 [26.5%] Hispanic, 75 [0.2%] American Indian or Indigenous, 12 176 [35.5%] White, and 3069 [9%] other or unknown). Risks of depressive symptoms and suicidality generally increased with each level of declining neighborhood privilege. Adjusted risk ratios comparing adolescents from neighborhoods with the least to most racial and economic privilege were 1.37 (95% CI, 1.20-1.55) for depressive symptoms and 1.59 (95% CI, 1.23-2.05) for suicidality. Racial disparities between Black and White youth and Hispanic and White youth decreased after adjusting for each ICE measure, and became nonsignificant in models adjusting for ICE-race and ICE-income plus race. Conclusions and Relevance In this cohort study, lower neighborhood privilege was associated with greater risks of adolescent depressive symptoms and suicidality. Furthermore, adjusting for neighborhood privilege reduced mental health disparities affecting Black and Hispanic adolescents. These findings suggest that efforts to promote equity in adolescent mental health should extend beyond the clinical setting and consider the inequitable neighborhood contexts that are shaped by structural racism.
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Affiliation(s)
- Julia Acker
- School of Public Health, University of California, Berkeley
| | - Sara Aghaee
- Kaiser Permanente Northern California Division of Research, Oakland
| | | | | | - Ai Kubo
- Kaiser Permanente Northern California Division of Research, Oakland
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Kopp M, Lindauer M, Garthus-Niegel S. Association between maternal employment and the child´s mental health: a systematic review with meta-analysis. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02164-1. [PMID: 36780025 PMCID: PMC9924214 DOI: 10.1007/s00787-023-02164-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 02/05/2023] [Indexed: 02/14/2023]
Abstract
The recent rise in maternal workforce participation has led to more research regarding the role of maternal employment for (early) childhood mental health. This systematic review with meta-analysis covers new evidence on the association of both variables. A systematic literature search was conducted. Studies had to compare children 0-7 years of age on the basis of their mothers' employment status, working amount, employment duration, i.e., how long the mother had been back at work after birth, or timing of return to work. Child mental health was operationalized as behavior problems and prosocial behavior. Narrative and meta-analytic syntheses of evidence were conducted. Maternal employment was associated with more conduct problems but less internalizing behavior problems and anxious/depressed behavior in children; full-time employment was linked to more externalizing behavior problems and more hyperactivity/inattention. Longer employment duration was related to less (internalizing) behavior problems and more prosocial behavior but also more externalizing behavior problems. Narrative syntheses indicated early maternal return to work to be associated with more child externalizing behavior problems and less prosocial behavior. Whether maternal employment is associated with child mental health strongly depends on both variables' operationalization. Especially part-time employment, longer employment duration, and return to work only after the first year postpartum may be beneficial for child mental health. Practical implications pertain to an expanded offer of family leave and the endorsement of maternal employment after the first year postpartum. Here, factors that may buffer the negative associations with full-time employment warrant consideration.
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Affiliation(s)
- Marie Kopp
- Faculty of Medicine Carl Gustav Carus, Institute and Policlinic of Occupational and Social Medicine, Technische Universität Dresden, Dresden, Germany
| | - Marina Lindauer
- Faculty of Medicine Carl Gustav Carus, Institute and Policlinic of Occupational and Social Medicine, Technische Universität Dresden, Dresden, Germany
| | - Susan Garthus-Niegel
- Faculty of Medicine Carl Gustav Carus, Institute and Policlinic of Occupational and Social Medicine, Technische Universität Dresden, Dresden, Germany.
- Institute for Systems Medicine (ISM) and Faculty of Medicine, Medical School Hamburg, Hamburg, Germany.
- Department of Childhood and Families, Norwegian Institute of Public Health, Oslo, Norway.
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Albanese CM, Oberle E, Sutherland JM, Janus M, Schonert-Reichl KA, Georgiades K, Guhn M, Gagné Petteni M, Gadermann A. A cross-sectional study of organized activity participation and emotional wellbeing among non-immigrant and immigrant-origin children in British Columbia, Canada. Prev Med Rep 2022; 31:102052. [PMID: 36820384 PMCID: PMC9938338 DOI: 10.1016/j.pmedr.2022.102052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 11/07/2022] [Accepted: 11/13/2022] [Indexed: 11/16/2022] Open
Abstract
Organized activity participation has been linked to children's emotional wellbeing. However, a scarcity of literature considers the role of immigrant background. This study's primary objective was to measure the association between organized activity participation and emotional wellbeing among a population-based sample of Grade 7 children in British Columbia, Canada. We also examined whether this relationship depended on immigration background. Our sample included 14,406 children (47.8% female; mean age = 12.0 years). 9,393 (65.2%) children were of non-immigrant origin (48.9% female; mean age = 12.1 years). 5,013 children (34.8%) were of immigrant origin (45.8% female; mean age = 12.0 years; 40.8% first-generation). Participants completed the Middle Years Development Instrument, a self-report survey measuring children's wellbeing and assets. We used odds ratios and the χ2 test to compare the organized activity participation of non-immigrant and immigrant-origin children. We used multiple linear regression to measure associations between participation and indicators of emotional wellbeing and assessed whether associations varied based on immigrant background, controlling for demographic factors and peer belonging. Participation in any activity was similar among non-immigrant and immigrant-origin children (OR1st-gen=1.06, p=0.37; OR2nd-gen=0.97, p=0.62). Immigrant generation status modified the relationship between participation and emotional wellbeing (χSWL 2=3.69, p=0.03; χDep 2=12.31, p<0.01). Beneficial associations between participation and both life satisfaction and depressive symptoms were observed among non-immigrant children only, although associations were small. We conclude that immigrant background modestly modified the association between organized activity participation and emotional wellbeing.
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Key Words
- BC, British Columbia
- Depressive symptoms
- ICC, Intraclass correlation coefficient
- Immigration
- LRT, Likelihood ratio test
- MDI, Middle Years Development Instrument
- MLR, Multiple linear regression
- MOH, Ministry of Health
- MSP, Medical Services Plan
- Middle Years Development Instrument
- Middle childhood
- OR, Odds ratio
- Organized activities
- SES, Socioeconomic status
- SWL, Satisfaction with life
- Satisfaction with life
- US, United States
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Affiliation(s)
- Carmela Melina Albanese
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario M5T 3M7, Canada,Corresponding author.
| | - Eva Oberle
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
| | - Jason M. Sutherland
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada,Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia V6Z 1Y6, Canada
| | - Magdalena Janus
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada,Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario L8S 4K1, Canada
| | | | - Katholiki Georgiades
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario L8S 4K1, Canada
| | - Martin Guhn
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada
| | - Monique Gagné Petteni
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada,Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia V6Z 1Y6, Canada
| | - Anne Gadermann
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia V6T 1Z3, Canada,Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia V6Z 1Y6, Canada
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14
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Cao M, Li L, Raat H, Van Grieken A, Wang X, Lin L, Chen Q, Jing J. Socioeconomic factors and autism among 16- to 30-month-old children: Evidence from a national survey of China. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022:13623613221132743. [DOI: 10.1177/13623613221132743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We examined the association of socioeconomic status with the diagnosis of autism during 16–30 months of age. Using data from a national survey in China, we included 6049 children (55.6% male) in the final analysis, among which 71 of them were clinically diagnosed with autism. Adjusted for covariates, the odds ratios for having the diagnosis of autism (2.46, 95% confidence interval: [1.32, 4.59]) among children whose mother’s level is “junior middle school or below” were significantly higher than children whose mother’s level is “college or above.” Among children of lower educated mothers, there is a higher risk of being diagnosed with autism at a young age. We recommend more support for families with a low socioeconomic status to early detect, diagnose, and manage autism. Lay abstract Does being born in a family of high socioeconomic status mean a higher risk of being diagnosed with autism? The evidence from the Asian area is lacking. This research was conducted among 6049 toddlers who went through an evaluation–diagnose procedure of autism and whose parents were surveyed during the national survey of China, 2016–2017. Parents reported their education levels, occupations, family income, and ethnic background. We recruited the toddlers and parents from kindergartens, communities, and hospitals in five geographically representative areas of China. On average, these toddlers were 23 months of age. We found toddlers whose mothers had less than 9 years of education (junior middle school or below) had 2.46 times the chance to get a diagnosis of autism, compared with toddlers whose mothers had more than 15 years of education (college or above). We also found that 1.17 toddlers could be diagnosed with autism in each 100 Chinese toddlers. These findings have important implications for providing support to families that have low socioeconomic status, especially families with a mother who did not complete 9 years of education. Early detection programs focused on children from low socioeconomic backgrounds should be promoted.
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Affiliation(s)
| | - Li Li
- Maternity and Children Health Care Hospital of Luohu District, China
| | - Hein Raat
- Erasmus University Medical Centre, The Netherlands
| | | | | | | | - Qiang Chen
- Zhuhai Women and Children’s Hospital, China
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15
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Neighbourhood context and diagnosed mental health conditions among immigrant and non-immigrant youth: a population-based cohort study in British Columbia, Canada. Soc Psychiatry Psychiatr Epidemiol 2022; 58:693-709. [PMID: 35695905 DOI: 10.1007/s00127-022-02301-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 05/05/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Evidence from systematic reviews suggests that adult immigrants living in areas of higher immigrant density (areas with a higher proportion of foreign-born residents) tend to experience fewer mental health problems-likely through less discrimination, greater access to culturally/linguistically appropriate services, and greater social support. Less is known about how such contexts are associated with mental health during childhood-a key period in the onset and development of many mental health challenges. This study examined associations between neighbourhood immigrant density and youth mental health conditions in British Columbia (BC; Canada). METHODS Census-derived neighbourhood characteristics were linked to medical records for youth present in ten of BC's largest school districts from age 5 through 19 over the study period (1995-2016; n = 138,090). Occurrence of physician assessed diagnoses of mood and/or anxiety disorders, attention deficit hyperactivity disorder (ADHD), and conduct disorder was inferred through International Classification of Diseases (ICD) diagnostic codes in universal public health insurance records. Multi-level logistic regression was used to model associations between neighbourhood characteristics and odds of diagnoses for each condition; models were stratified by generation status (first-generation: foreign-born; second-generation: Canadian-born to a foreign-born parent; non-immigrant). RESULTS Higher neighbourhood immigrant density was associated with lower odds of disorders among first-generation immigrant youth (e.g., adjusted odds of mood-anxiety disorders for those in neighbourhoods with the highest immigrant density were 0.67 times lower (95% CI: 0.49, 0.92) than those in neighbourhoods with the lowest immigrant density). Such protective associations generally extended to second-generation and non-immigrant youth, but were-for some disorders-stronger for first-generation than second-generation or non-immigrant youth. CONCLUSIONS Findings suggest there may be protective mechanisms associated with higher neighbourhood immigrant density for mental health conditions in immigrant and non-immigrant youth. It is important that future work examines potential pathways by which contextual factors impact immigrant and non-immigrant youth mental health.
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Smith TA, Kievit RA, Astle DE. Maternal mental health mediates links between socioeconomic status and child development. CURRENT PSYCHOLOGY 2022; 42:21967-21978. [PMID: 37692883 PMCID: PMC10482759 DOI: 10.1007/s12144-022-03181-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2022] [Indexed: 11/27/2022]
Abstract
The impact of socioeconomic status (SES) on early child development is well-established, but the mediating role of parental mental health is poorly understood. Data were obtained from The Avon Longitudinal Study of Parents and Children (ALSPAC; n = 13,855), including measures of early SES (age 8 months), key aspects of development during mid-late childhood (ages 7-8 years), and maternal mental health during early childhood (ages 0-3 years). In the first year of life, better maternal mental health was shown to weaken the negative association between SES and child mental health. Better maternal mental health was additionally shown to weaken the association between SES and child cognitive ability. These findings highlight the variability and complexity of the mediating role of parental mental health on child development. They further emphasise the importance of proximal factors in the first year of life, such as parental mental health, in mediating key developmental outcomes.
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Affiliation(s)
- Tess A. Smith
- MRC Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge, UK
| | - Rogier A. Kievit
- MRC Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge, UK
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, Netherlands
| | - Duncan E. Astle
- MRC Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge, UK
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17
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Jarvis I, Sbihi H, Davis Z, Brauer M, Czekajlo A, Davies HW, Gergel SE, Guhn M, Jerrett M, Koehoorn M, Nesbitt L, Oberlander TF, Su J, van den Bosch M. The influence of early-life residential exposure to different vegetation types and paved surfaces on early childhood development: A population-based birth cohort study. ENVIRONMENT INTERNATIONAL 2022; 163:107196. [PMID: 35339041 DOI: 10.1016/j.envint.2022.107196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/23/2022] [Accepted: 03/17/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Growing evidence suggests that exposure to green space is associated with improved childhood health and development, but the influence of different green space types remains relatively unexplored. In the present study, we investigated the association between early-life residential exposure to vegetation and early childhood development and evaluated whether associations differed according to land cover types, including paved land. METHODS Early childhood development was assessed via kindergarten teacher-ratings on the Early Development Instrument (EDI) in a large population-based birth cohort (n = 27,539) in Metro Vancouver, Canada. The residential surrounding environment was characterized using a high spatial resolution land cover map that was linked to children by six-digit residential postal codes. Early-life residential exposure (from birth to time of EDI assessment, mean age = 5.6 years) was calculated as the mean of annual percentage values of different land cover classes (i.e., total vegetation, tree cover, grass cover, paved surfaces) within a 250 m buffer zone of postal code centroids. Multilevel models were used to analyze associations between respective land cover classes and early childhood development. RESULTS In adjusted models, one interquartile range increase in total vegetation percentage was associated with a 0.33 increase in total EDI score (95% CI: 0.21, 0.45). Similar positive associations were observed for tree cover (β-coefficient: 0.26, 95% CI: 0.15, 0.37) and grass cover (β-coefficient: 0.12, 95% CI: 0.02, 0.22), while negative associations were observed for paved surfaces (β-coefficient: -0.35, 95% CI: -0.47, -0.23). CONCLUSIONS Our findings indicate that increased early-life residential exposure to vegetation is positively associated with early childhood developmental outcomes, and that associations may be stronger for residential exposure to tree cover relative to grass cover. Our results further indicate that childhood development may be negatively associated with residential exposure to paved surfaces. These findings can inform urban planning to support early childhood developmental health.
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Affiliation(s)
- Ingrid Jarvis
- Department of Forest and Conservation Sciences, Faculty of Forestry, The University of British Columbia, 2424 Main Mall, Vancouver, British Columbia, Canada
| | - Hind Sbihi
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, 2206 East Mall, Vancouver, British Columbia, Canada; BC Centre for Disease Control, 655 West 12(th) Avenue, Vancouver, British Columbia, Canada
| | - Zoë Davis
- Department of Forest and Conservation Sciences, Faculty of Forestry, The University of British Columbia, 2424 Main Mall, Vancouver, British Columbia, Canada
| | - Michael Brauer
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, 2206 East Mall, Vancouver, British Columbia, Canada
| | - Agatha Czekajlo
- Department of Forest Resources Management, Faculty of Forestry, The University of British Columbia, 2424 Mail Mall, Vancouver, British Columbia, Canada
| | - Hugh W Davies
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, 2206 East Mall, Vancouver, British Columbia, Canada
| | - Sarah E Gergel
- Department of Forest and Conservation Sciences, Faculty of Forestry, The University of British Columbia, 2424 Main Mall, Vancouver, British Columbia, Canada
| | - Martin Guhn
- Human Early Learning Partnership, School of Population and Public Health, The University of British Columbia, 2206 East Mall, Vancouver, British Columbia, Canada
| | - Michael Jerrett
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California at Los Angeles, 650 Charles E. Young Drive South, Los Angeles, CA, the United States; Center for Occupational and Environmental Health, Fielding School of Public Health, University of California at Los Angeles, 650 Charles E. Young Drive South, Los Angeles, CA, the United States
| | - Mieke Koehoorn
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, 2206 East Mall, Vancouver, British Columbia, Canada
| | - Lorien Nesbitt
- Department of Forest Resources Management, Faculty of Forestry, The University of British Columbia, 2424 Mail Mall, Vancouver, British Columbia, Canada
| | - Tim F Oberlander
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, 2206 East Mall, Vancouver, British Columbia, Canada; Department of Pediatrics, Faculty of Medicine, The University of British Columbia, 4480 Oak Street, Vancouver, British Columbia, Canada
| | - Jason Su
- Division of Environmental Health Sciences, School of Public Health, University of California Berkeley, 2121 Berkeley Way West, Berkeley, CA, the United States
| | - Matilda van den Bosch
- Department of Forest and Conservation Sciences, Faculty of Forestry, The University of British Columbia, 2424 Main Mall, Vancouver, British Columbia, Canada; School of Population and Public Health, Faculty of Medicine, The University of British Columbia, 2206 East Mall, Vancouver, British Columbia, Canada; ISGlobal, Parc de Recerca Biomèdica de Barcelona, Doctor Aiguader 88 08003 Barcelona, Spain; Universitat Pompeu Fabra, Plaça de la Mercè, 10-12, 08002 Barcelona, Spain; Centro de Investigación Biomédica en Red Instituto de Salud Carlos III, Calle de Melchor, Fernández Almagro, 3, 28029 Madrid, Spain.
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18
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Ståhlberg T, Upadhyaya S, Khanal P, Sucksdorff M, Luntamo T, Suominen A, Sourander A. Preterm birth, poor foetal growth and anxiety disorders in a Finnish nationwide register sample. Acta Paediatr 2022; 111:1556-1565. [PMID: 35488484 PMCID: PMC9545468 DOI: 10.1111/apa.16377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/20/2022] [Accepted: 04/27/2022] [Indexed: 11/28/2022]
Abstract
Aim We examined the associations between preterm birth, poor foetal growth and anxiety disorders among children and adolescents. Additionally, we examined the impact of common comorbidities and specific anxiety disorders separately. Methods Three Finnish registers provided data on a nationwide birth cohort of 22,181 cases with anxiety disorders and 74,726 controls. Conditional logistic regression was used to examine the associations. Results Extremely very preterm birth and moderate‐late preterm birth were associated with increased adjusted odds ratios (aOR) for anxiety disorders (aOR 1.39, 95% CI 1.11–1.75 and aOR 1.13, 95% CI 1.03–1.23, respectively). Weight for gestational age of less than −2SD (aOR 1.29, 95% CI 1.17–1.42) and −2SD to −1SD (aOR 1.08, 95% CI 1.03–1.14) were associated with increased odds ratios for anxiety disorders. When comorbidities were considered, the associations became statistically insignificant for pure anxiety disorders, but remained significant in the groups with comorbid depressive or neurodevelopmental disorders. Conclusion Preterm birth and poor foetal growth increased the odds for anxiety disorders. However, the associations seem to be explained by the conditions of comorbid depressive and neurodevelopmental disorders. Comorbidities should be considered when examining and treating child and adolescent anxiety disorders.
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Affiliation(s)
- Tiia Ståhlberg
- University of Turku Turku Finland
- INVEST Research Flagship Center University of Turku Turku Finland
| | - Subina Upadhyaya
- University of Turku Turku Finland
- INVEST Research Flagship Center University of Turku Turku Finland
| | - Prakash Khanal
- University of Turku Turku Finland
- INVEST Research Flagship Center University of Turku Turku Finland
| | - Minna Sucksdorff
- University of Turku Turku Finland
- INVEST Research Flagship Center University of Turku Turku Finland
- Department of Pediatrics Turku University Hospital Turku Finland
| | - Terhi Luntamo
- University of Turku Turku Finland
- INVEST Research Flagship Center University of Turku Turku Finland
- Department of Child Psychiatry Turku University Hospital Turku Finland
| | - Auli Suominen
- University of Turku Turku Finland
- INVEST Research Flagship Center University of Turku Turku Finland
| | - Andre Sourander
- University of Turku Turku Finland
- INVEST Research Flagship Center University of Turku Turku Finland
- Department of Child Psychiatry Turku University Hospital Turku Finland
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Zhao X, Jiang M, Zhang W. The Impact of Environmental Pollution and Economic Growth on Public Health: Evidence From China. Front Public Health 2022; 10:861157. [PMID: 35419328 PMCID: PMC8995792 DOI: 10.3389/fpubh.2022.861157] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 02/11/2022] [Indexed: 12/22/2022] Open
Abstract
A comprehensive understanding of the impact of economic growth and environmental pollution on public health is crucial to the sustainable development of public health. In this paper, an individual fixed effect model is used to analyze the impact of environmental pollution and economic growth on public health, based on the panel data of 30 provinces in China from 2007 to 2018. The research finds that: First, the health status of China's four regions is not only affected by economic growth and environmental pollution, but also affected by the per capita disposable income and urbanization rate. Second, there is a long-term balanced relationship between China's economic growth, environmental pollution and public health. Third, environmental pollution harms children's health and significantly increases the perinatal mortality, while economic growth helps to reduce the perinatal mortality. Fourth, environmental pollution plays a regulatory role between economic growth and public health. Fifth, there are significant regional differences in the impact of environmental pollution and economic growth on public health. Among them, the degree of harm caused by sulfur dioxide emissions on mortality in northeastern China is significantly higher than that of the eastern China, eastern China is higher than that of the western China, and western China is higher than that of the central China. Finally, in order to reduce the adverse consequences of environmental pollution on public health in the process of economic development, this study puts forward relevant policy suggestions.
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Affiliation(s)
- Xiaochun Zhao
- School of Management, Anhui University, Hefei, China
| | - Mei Jiang
- School of Management, Anhui University, Hefei, China
| | - Wei Zhang
- School of Public Administration, Sichuan University, Chengdu, China
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20
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Emerson SD, Gagné Petteni M, Guhn M, Oberle E, Georgiades K, Milbrath C, Janus M, Schonert-Reichl KA, Gadermann AM. Social context factors and refugee children's emotional health. Soc Psychiatry Psychiatr Epidemiol 2022; 57:829-841. [PMID: 34562109 DOI: 10.1007/s00127-021-02173-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 09/06/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Refugee children face numerous challenges associated with pre-migration trauma and post-migration adaptation. Much research pertaining to refugee children's well-being focuses on psychiatric symptoms. Relatively few studies have examined how social context factors-such as perceptions of peer belonging, and support from adults at home and at school-contribute to the emotional health of refugee children. Informed by social-ecological theories emphasizing dynamic interactions between the contexts in which children develop, we examined associations between social context factors and emotional health in refugee children. METHODS Data were drawn from a population-based data linkage in British Columbia, Canada. The analytic sample included 682 grade 4 students (Mage 9.2 years; 46.3% female) with a refugee background who responded to the Middle Years Development Instrument (MDI) during the 2010/2011-2016/2017 school years. The MDI is a self-report survey of children's social and emotional competencies and social context factors completed at school. Regression analyses were used to examine associations of social context factors (school climate, supportive adults at school and at home, and peer belonging) with indicators of emotional health (life satisfaction, self-concept, optimism, and sadness). Refugee generation status (first/second) was considered through stratification and testing of interactions with social context factors. RESULTS Perceived supportive school climate, support from adults in school and at home, and peer belonging were each independently associated with better emotional health. Results were similar for first- and second-generation children. CONCLUSION Taken together, results suggest a unique role of the school context to refugee children's emotional health. School-based programming that promotes positive school climate can be considered as an important approach to support newcomer refugee children and their families.
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Affiliation(s)
- Scott D Emerson
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, Canada.
| | - Monique Gagné Petteni
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Martin Guhn
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Eva Oberle
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Katholiki Georgiades
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Constance Milbrath
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Magdalena Janus
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, Canada.,Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Kimberly A Schonert-Reichl
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, Canada.,Department of Psychology, University of Illinois at Chicago, Chicago, USA
| | - Anne M Gadermann
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, Canada.,Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, Canada
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21
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Khanal P, Ståhlberg T, Luntamo T, Gyllenberg D, Kronström K, Suominen A, Sourander A. Time trends in treated incidence, sociodemographic risk factors and comorbidities: a Finnish nationwide study on anxiety disorders. BMC Psychiatry 2022; 22:144. [PMID: 35193518 PMCID: PMC8864838 DOI: 10.1186/s12888-022-03743-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 01/27/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND There has been a lack of research about the time trends and socio-demographic risk factors for children and adolescents who receive treatment for anxiety disorders. This study aimed to fill these gaps in our knowledge by examining a nationwide sample of Finnish children and adolescents diagnosed in specialized healthcare settings. METHODS This study comprised national register data of all singleton children born in Finland from 1992-2006 who were diagnosed with anxiety disorders from 1998-2012. The changes in time trends in incidence were studied by dividing the study sample into three cohorts by birth years: 1992-1996, 1997-2001 and 2002-2006, who were followed up until the age of 20, 15 and 10 years, respectively. The 22,388 individuals with anxiety disorders were age and gender matched with 76,139 controls from the general population. Logistic regression was used to examine the socio-demographic risk factors and anxiety disorders in the entire sample. Comorbid disorders were examined in the oldest birth cohort (1992-1996 born). RESULTS Comparing the 1992-1996 and 2002-2006 cohorts showed that the cumulative incidence of treated anxiety disorders at the age of 10 increased from 0.3 to 1.2% among females and 0.46 to 1.9% among males. Subjects had higher likelihood for being diagnosed with an anxiety disorder if their mothers had low maternal socio-economic status class at birth (OR 1.53, 95% CI 1.45-1.61) compared to higher SES class, and marital status was single at the time of birth (OR 2.02, 95% CI 1.87-2.17) compared to married or in a relationship. They had lower risk of anxiety disorders diagnosis if born in rural (OR 0.82, 95% CI 0.79-0.86) or semi-urban areas (OR 0.79, 95% CI 0.76-0.82) when compared to urban residence. There was a wide range of psychiatric comorbidities, and unipolar depression was the most common (31.2%). CONCLUSION Anxiety disorders diagnosed by specialized Finnish services increased from 1998-2012 in both genders. This could indicate a real increase in overall anxiety disorders or an increase in treatment seeking. The findings on maternal socioeconomic status and single parenting improve the recognition of the environmental risk factors for anxiety disorders among children and adolescents.
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Affiliation(s)
- Prakash Khanal
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland.
- INVEST Research Flagship Center, University of Turku, Turku, Finland.
| | - Tiia Ståhlberg
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
- INVEST Research Flagship Center, University of Turku, Turku, Finland
- Department of Adolescent Psychiatry, Turku University Hospital, Turku, Finland
| | - Terhi Luntamo
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
- INVEST Research Flagship Center, University of Turku, Turku, Finland
- Department of Child Psychiatry, Turku University Hospital, Turku, Finland
| | - David Gyllenberg
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
- INVEST Research Flagship Center, University of Turku, Turku, Finland
- National Institute of Health and Welfare, Helsinki, Finland
- Department of Adolescent Psychiatry, Helsinki University and Helsinki University Central Hospital, Helsinki, Finland
| | - Kim Kronström
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
- Department of Adolescent Psychiatry, Turku University Hospital, Turku, Finland
| | - Auli Suominen
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
- INVEST Research Flagship Center, University of Turku, Turku, Finland
| | - Andre Sourander
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland
- INVEST Research Flagship Center, University of Turku, Turku, Finland
- Department of Child Psychiatry, Turku University Hospital, Turku, Finland
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22
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Ståhlberg T, Upadhyaya S, Polo-Kantola P, Khanal P, Luntamo T, Hinkka-Yli-Salomäki S, Sourander A. Associations Between Delivery Modes, Birth Outcomes and Offspring Anxiety Disorders in a Population-Based Birth Cohort of Children and Adolescents. Front Psychiatry 2022; 13:917299. [PMID: 35911234 PMCID: PMC9326080 DOI: 10.3389/fpsyt.2022.917299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Mode of delivery and well-being markers for newborn infants have been associated with later psychiatric problems in children and adolescents. However, only few studies have examined the association between birth outcomes and anxiety disorders and the results have been contradictory. METHODS This study was a Finnish population-based register study, which comprised 22,181 children and adolescents with anxiety disorders and 74,726 controls. Three national registers were used to collect the data on exposures, confounders and outcomes. Mode of delivery, the 1-min Apgar score, umbilical artery pH and neonatal monitoring were studied as exposure variables for anxiety disorders and for specific anxiety disorders. Conditional logistic regression was used to examine these associations. RESULTS Unplanned and planned cesarean sections increased the odds for anxiety disorders in children and adolescents (adjusted OR 1.08, 95% CI 1.02-1.15 and aOR 1.12, 95% CI 1.05-1.19, respectively). After an additional adjustment for maternal diagnoses, unplanned cesarean sections remained statistically significant (aOR 1.11, 95% CI 1.04-1.18). For specific anxiety disorders, planned cesarean sections and the need for neonatal monitoring increased the odds for specific phobia (aOR 1.21, 95% CI 1.01-1.44 and aOR 1.28, 95% CI 1.07-1.52, respectively). CONCLUSIONS Birth by cesarean section increased the odds for later anxiety disorders in children and adolescents and unplanned cesarean sections showed an independent association. Further studies are needed to examine the mechanisms behind these associations.
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Affiliation(s)
- Tiia Ståhlberg
- Research Center for Child Psychiatry, INVEST Flagship, University of Turku, Turku, Finland
| | - Subina Upadhyaya
- Research Center for Child Psychiatry, INVEST Flagship, University of Turku, Turku, Finland
| | - Päivi Polo-Kantola
- Department of Obstetrics and Gynecology, Turku University Hospital and University of Turku, Turku, Finland
| | - Prakash Khanal
- Research Center for Child Psychiatry, INVEST Flagship, University of Turku, Turku, Finland
| | - Terhi Luntamo
- Research Center for Child Psychiatry, INVEST Flagship, University of Turku, Turku, Finland.,Department of Child Psychiatry, Turku University Hospital, Turku, Finland
| | | | - Andre Sourander
- Research Center for Child Psychiatry, INVEST Flagship, University of Turku, Turku, Finland.,Department of Child Psychiatry, Turku University Hospital, Turku, Finland
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23
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Huang Y, Huang J, Wang T, Xu S, Li J. The Impact of the Corona Virus Disease 2019 Pandemic on Chinese Middle School Students' Self-Perceived Emotional States: A Wuhan Perspective. Front Psychol 2021; 12:740879. [PMID: 34803821 PMCID: PMC8602185 DOI: 10.3389/fpsyg.2021.740879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/12/2021] [Indexed: 11/15/2022] Open
Abstract
This mixed-methods study examined the impact of the COVID-19 pandemic on 1493 Grades 7, 8, and 9 students’ self-perceived emotional states in Wuhan, China when it was locked down for the pandemic on January 23, 2020 and when the lockdown was lifted on April 8, 2020, as well as the changes of their emotional states over the 1-year period after the lockdown was lifted. A five-point Likert scale survey was administered to the participants between March 1 and April 1, 2020 when Wuhan was blocked down; and three focus group interviews were conducted between May 1 and May 31, 2021, 1 year after the lockdown was lifted. The results showed that these students in Wuhan experienced feelings of loss of control and negative emotions when the city was locked down and they were home quarantined; furthermore, there were significant differences for their self-perceived feelings of loss of control and negative emotions across demographic variables of gender, grade level, physical activity, social economic status, and family cohesion; finally, their emotional states changed substantially at different time nodes during this pandemic. Implications for students, parents, and schools are discussed.
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Affiliation(s)
- Yan Huang
- Educational Economics and Management, Law and Business School, Wuhan Institute of Technology, Wuhan, China
| | - Jinyan Huang
- The Research Institute for Educational Assessment and Research Methodology, School of Teacher Education, Jiangsu University, Zhenjiang, China
| | - Tingting Wang
- Educational Economics and Management, Law and Business School, Wuhan Institute of Technology, Wuhan, China
| | - Siying Xu
- Logistics Management and Engineering, School of Management, Wuhan Textile University, Wuhan, China
| | - Jialing Li
- Educational Economics and Management, Law and Business School, Wuhan Institute of Technology, Wuhan, China
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24
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Jarvis I, Davis Z, Sbihi H, Brauer M, Czekajlo A, Davies HW, Gergel SE, Guhn M, Jerrett M, Koehoorn M, Oberlander TF, Su J, van den Bosch M. Assessing the association between lifetime exposure to greenspace and early childhood development and the mediation effects of air pollution and noise in Canada: a population-based birth cohort study. Lancet Planet Health 2021; 5:e709-e717. [PMID: 34627475 DOI: 10.1016/s2542-5196(21)00235-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Exposure to greenspace is associated with improved childhood development, but the pathways behind this relationship are insufficiently understood. Therefore, we aimed to investigate the association between lifetime residential exposure to greenspace and early childhood development and evaluate the extent to which this association is mediated by reductions in traffic-related air pollution and noise. METHODS This population-based birth cohort study comprised singleton births in Metro Vancouver, BC, Canada, between April 1, 2000, and Dec 31, 2005. Children and mothers had to be registered with the mandatory provincial health insurance programme, Medical Services Plan, and have lived within the study area from the child's birth to the time of outcome assessment. Early childhood development was assessed via teacher ratings on the Early Development Instrument (EDI), and we used the total EDI score as the primary outcome variable. We estimated greenspace using percentage vegetation derived from spectral unmixing of annual Landsat satellite image composites. Lifetime residential exposure to greenspace was estimated as the mean of annual percentage vegetation values within 250 m of participants' residential postal codes. Multilevel modelling, adjusted for eight covariates, was used to investigate associations between greenspace exposure and EDI scores. We estimated the mediation effects of nitrogen dioxide (NO2), fine particulate matter (PM2·5), and noise levels using causal mediation analyses. FINDINGS Of the 37 745 children born in Metro Vancouver between April 1, 2000, and Dec 31, 2005, 27 372 were included in our final study sample. In the adjusted model, 1 IQR increase in percentage vegetation was associated with a 0·16 (95% CI 0·04-0·28; p=0·0073) increase in total EDI score, indicating small improvements in early childhood development. We estimated that 97·1% (95% CI 43·0-396·0), 29·5% (12·0-117·0), and 35·2% (17·9-139·0) of the association was mediated through reductions in NO2, PM2·5, and noise, respectively. INTERPRETATION Increased exposure to residential greenspace might improve childhood development by reducing the adverse developmental effects of traffic-related exposures, especially NO2 air pollution. Our study supports the implementation of healthy urban planning and green infrastructure interventions. FUNDING Canadian Institutes of Health Research.
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Affiliation(s)
- Ingrid Jarvis
- Department of Forest and Conservation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Zoë Davis
- Department of Forest and Conservation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Hind Sbihi
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Michael Brauer
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Agatha Czekajlo
- Department of Forest Resources Management, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Hugh W Davies
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Sarah E Gergel
- Department of Forest and Conservation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Martin Guhn
- Faculty of Forestry, and Human Early Learning Partnership, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Michael Jerrett
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA, USA; Center for Occupational and Environmental Health, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA, USA
| | - Mieke Koehoorn
- Department of Forest and Conservation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Tim F Oberlander
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jason Su
- Division of Environmental Health Sciences, School of Public Health, University of California at Berkeley, Berkeley, CA, USA
| | - Matilda van den Bosch
- Department of Forest and Conservation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; ISGlobal, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain; Barcelona, Spain; Centro de Investigación Biomédica en Red Instituto de Salud Carlos 3, Madrid, Spain.
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25
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Guez A, Peyre H, Williams C, Labouret G, Ramus F. The epidemiology of cognitive development. Cognition 2021; 213:104690. [PMID: 33931198 DOI: 10.1016/j.cognition.2021.104690] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 03/12/2021] [Accepted: 03/17/2021] [Indexed: 12/26/2022]
Abstract
The epidemiology of cognitive development is an approach essentially based on large observational studies, which examines individual differences in cognitive abilities throughout childhood and their determinants. Although different in terms of methodology and main interests from developmental psychology, cognitive epidemiology offers complementary viewpoints on cognitive development and addresses fundamental research questions of interest to developmental psychologists. The present paper depicts the contributions of the epidemiological approach to the field of cognitive development and highlights the methodological advances that have made such contributions possible. We discuss the stability and developmental trajectories of cognitive functions, their main predictors, the complex interplay between environmental and genetic predictors, and the relationships between the different domains of cognition from birth to adulthood.
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Affiliation(s)
- Ava Guez
- Laboratoire de sciences cognitives et psycholinguistique, ENS, EHESS, PSL University, CNRS, Paris, France.
| | - Hugo Peyre
- Laboratoire de sciences cognitives et psycholinguistique, ENS, EHESS, PSL University, CNRS, Paris, France; Neurodiderot. INSERM UMR 1141, Paris Diderot University, Paris, France; Department of Child and Adolescent Psychiatry, Robert Debré Hospital, APHP, France
| | - Camille Williams
- Laboratoire de sciences cognitives et psycholinguistique, ENS, EHESS, PSL University, CNRS, Paris, France
| | - Ghislaine Labouret
- Laboratoire de sciences cognitives et psycholinguistique, ENS, EHESS, PSL University, CNRS, Paris, France
| | - Franck Ramus
- Laboratoire de sciences cognitives et psycholinguistique, ENS, EHESS, PSL University, CNRS, Paris, France.
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26
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Population-Level Data on Child Development at School Entry Reflecting Social Determinants of Health: A Narrative Review of Studies Using the Early Development Instrument. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073397. [PMID: 33805965 PMCID: PMC8037511 DOI: 10.3390/ijerph18073397] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/18/2021] [Accepted: 03/20/2021] [Indexed: 12/27/2022]
Abstract
Background: The Early Development Instrument (EDI) was developed as a population-level assessment of children’s developmental health at school entry. EDI data collection has created unprecedented opportunities for population-level studies on children’s developmental outcomes. The goal of this narrative review was to synthesize research using the EDI to describe how it contributes to expanding the understanding of the impacts of social determinants on child development and how it applies to special populations. Methods: Select studies published in peer-reviewed scientific journals between 2015 and 2020 and incorporating the social determinants of health perspectives were chosen to highlight the capability of the EDI to monitor children’s developmental health and contribute knowledge in the area of early childhood development. Results: A number of studies have examined the association between several social determinants of health and children’s developmental outcomes, including hard-to-reach and low-frequency populations of children. The EDI has also been used to evaluate programs and interventions in different countries. Conclusions: The ability of the EDI to monitor children’s developmental outcomes in various populations has been consistently demonstrated. The EDI, by virtue of its comprehensive breadth and census-like collection, widens the scope of research relating to early childhood development and its social determinants of health.
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27
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Vaillancourt T, Szatmari P, Georgiades K, Krygsman A. The impact of COVID-19 on the mental health of Canadian children and youth. Facets (Ott) 2021. [DOI: 10.1139/facets-2021-0078] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Children and youth flourish in environments that are predictable, safe, and structured. The COVID-19 pandemic has disrupted these protective factors making it difficult for children and youth to adapt and thrive. Pandemic-related school closures, family stress, and trauma have led to increases in mental health problems in some children and youth, an area of health that was already in crisis well before COVID-19 was declared a global pandemic. Because mental health problems early in life are associated with significant impairment across family, social, and academic domains, immediate measures are needed to mitigate the potential for long-term sequalae. Now more than ever, Canada needs a national mental health strategy that is delivered in the context in which children and youth are most easily accessible—schools. This strategy should provide coordinated care across sectors in a stepped care framework and across a full continuum of mental health supports spanning promotion, prevention, early intervention, and treatment. In parallel, we must invest in a comprehensive population-based follow-up of Statistics Canada’s Canadian Health Survey on Children and Youth so that accurate information about how the pandemic is affecting all Canadian children and youth can be obtained. It is time the Canadian government prioritizes the mental health of children and youth in its management of the pandemic and beyond.
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Affiliation(s)
- Tracy Vaillancourt
- University of Ottawa, Ottawa, Ontario, Canada
- Royal Society of Canada, Working Group on Children and Schools
| | - Peter Szatmari
- Royal Society of Canada, Working Group on Children and Schools
- Cundill Centre for Child and Youth Depression at Centre for Addiction and Mental Health, Hospital for Sick Children, Toronto, Ontario
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28
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Ding X, Wang J, Li N, Su W, Wang H, Song Q, Guo X, Liang M, Qin Q, Sun L, Chen M, Sun Y. Individual, Prenatal, Perinatal, and Family Factors for Anxiety Symptoms Among Preschool Children. Front Psychiatry 2021; 12:778291. [PMID: 34987428 PMCID: PMC8721098 DOI: 10.3389/fpsyt.2021.778291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/19/2021] [Indexed: 01/21/2023] Open
Abstract
Anxiety is one of the most common psychological disorders among children. Few studies have investigated the prevalence and comprehensive factors for anxiety among preschool children in China. This study aimed to assess the prevalence of anxiety and explore influential factors at multiple levels including individual, prenatal and perinatal, and family factors, associated with anxiety symptoms among preschool children. The multisite cross-sectional study was conducted in Anhui Province and included 3,636 preschool children aged 3-6 years. Anxiety symptoms of children were assessed using the Chinese version of the Spence Preschool Anxiety Scale. Logistic regression analyses were performed to explore associations between factors at multiple levels and significant anxiety symptoms, and the model was validated internally using 10-fold cross-validation. Among the participants, 9.1% of children had significant anxiety symptoms. Girls reported more significant anxiety symptoms. Children's poor dietary habits, sleep disturbances, autistic tendencies, and left-behind experience; maternal poor prenatal emotional symptoms; and more caregivers' anxiety symptoms were significantly associated with anxiety symptoms among children. The result of 10-fold cross-validation indicated that the mean area under the curve, sensitivity, specificity, and accuracy were 0.78, 70.45%, 78.18%, and 71.15%, respectively. These factors were slightly different among different subtypes of anxiety symptoms. The results of this study suggested that anxiety symptoms in preschool children were prevalent, particularly in girls. Understanding early-life risk factors for anxiety is crucial, and efficient prevention and intervention strategies should be implemented in early childhood even pregnancy.
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Affiliation(s)
- Xiuxiu Ding
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Jun Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, China.,Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Ning Li
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Wanying Su
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Hao Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Qiuxia Song
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Xianwei Guo
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Mingming Liang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Qirong Qin
- Ma'anshan Center for Disease Control and Prevention, Ma'anshan, China
| | - Liang Sun
- Fuyang Center for Disease Control and Prevention, Fuyang, China
| | - Mingchun Chen
- Changfeng Center for Disease Control and Prevention, Changfeng, China
| | - Yehuan Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei, China
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29
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Brandt V, Patalay P, Kerner Auch Koerner J. Predicting ADHD symptoms and diagnosis at age 14 from objective activity levels at age 7 in a large UK cohort. Eur Child Adolesc Psychiatry 2021; 30:877-884. [PMID: 32506264 PMCID: PMC8140967 DOI: 10.1007/s00787-020-01566-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 05/01/2020] [Indexed: 12/16/2022]
Abstract
Hyperactivity is one of the three core symptoms in children with attention deficit hyperactivity disorder (ADHD). Diagnosing ADHD typically involves self-report, third party report and observations. Objective activity data can make a valuable contribution to the diagnostic process. Small actigraphy studies in clinical samples have shown that children with ADHD move more than children without ADHD. However, differences in physical activity between children with and without ADHD have not been assessed in large community samples or longitudinally. This study used data from the Millennium Cohort Study to test whether symptoms of ADHD (parent-rating Strengths and Difficulties Questionnaire) and ADHD diagnosis at age 14 (reported by parents) could be predicted from objective activity data (measured with actigraphs) at age 7 in N = 6675 children (final N = 5251). Regressions showed that less sedentary behavior at age 7 predicted more ADHD symptoms at age 14 (β = - 0.002, CI - 0.004 to - 0.001). The result remained significant when controlled for ADHD symptoms at age 7, sex, BMI, month of birth, SES and ethnicity (β = - 0.001, CI - 0.003 to - 0.0003). ADHD diagnosis at age 14 was also significantly predicted by less sedentary behavior at age 7 (β = - 0.008). Our findings show that symptoms of ADHD can be predicted by objective activity data 5 years in advance and suggest that actigraphy could be a useful instrument aiding an ADHD diagnosis. Interestingly, the results indicate that the key difference between children with and without ADHD lies in reduced sedentary activity, i.e., times of rest.
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Affiliation(s)
- Valerie Brandt
- Department of Psychology, Center for Innovation in Mental Health, University of Southampton, Southampton, Hampshire, UK
| | - Praveetha Patalay
- Centre for Longitudinal Studies, Institute of Social Research, UCL, London, UK
- Faculty of Population Health Sciences, MRC Unit of Lifelong Health and Ageing, UCL, London, UK
| | - Julia Kerner Auch Koerner
- Educational Psychology, Helmut-Schmidt-University Hamburg, Holstenhofweg 85, 22043, Hamburg, Germany.
- Center for Individual Development and Adaptive Education of Children at Risk (IDeA), Frankfurt, Germany.
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30
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Ståhlberg T, Khanal P, Chudal R, Luntamo T, Kronström K, Sourander A. Prenatal and perinatal risk factors for anxiety disorders among children and adolescents: A systematic review. J Affect Disord 2020; 277:85-93. [PMID: 32799108 DOI: 10.1016/j.jad.2020.08.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Prenatal and perinatal risk factors for anxiety disorders have rarely been studied, even though they are highly prevalent in children and adolescents. It is important to identify the common risk factors, so that targeted preventive care and early interventions can be provided. METHODS A systematic review of the PubMed and PsycInfo databases was conducted to 25 October 2019, according to the Preferred Reporting Items of Systematic Reviews and Meta-analyses guidelines. The protocol was registered on the Prospective Register of Systematic Reviews and the quality assessment was carried out using the Joanna Briggs tools. RESULTS The review identified 31 studies from eight countries, including three register studies. Cohort sizes ranged from 69 to 89,404 and diagnoses cases ranged from 4 to 7867. Although various risk factors had been researched, only few of them had been repeatedly studied and the findings were highly inconsistent. The associations between the different risk factors and anxiety disorders seemed weak compared to many other psychiatric disorders, but preterm birth and maternal somatic illnesses may increase the risk for anxiety disorders in offspring. LIMITATIONS The studies varied considerably by study design, risk factors and anxiety disorders studied, sample sizes and follow up periods. CONCLUSIONS Prenatal and perinatal risk factors for anxiety disorders have been under-researched, compared to other psychiatric disorders. Our systematic review found weak links to prenatal events, but flagged up preterm birth and maternal somatic illnesses as possible avenues for future research.
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Affiliation(s)
- Tiia Ståhlberg
- Research Centre for Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori 3. floor, 20014 Turku, Finland.
| | - Prakash Khanal
- Research Centre for Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori 3. floor, 20014 Turku, Finland
| | - Roshan Chudal
- Research Centre for Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori 3. floor, 20014 Turku, Finland
| | - Terhi Luntamo
- Research Centre for Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori 3. floor, 20014 Turku, Finland
| | - Kim Kronström
- Research Centre for Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori 3. floor, 20014 Turku, Finland; Department of Adolescent Psychiatry, Turku University Hospital, Turku, Finland
| | - Andre Sourander
- Research Centre for Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori 3. floor, 20014 Turku, Finland; Turku University Hospital, Turku, Finland; INVEST Research Flagship, University of Turku, (Principal Investigator), Turku, Finland
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31
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Abstract
We review basic science research on neural mechanisms underlying emotional processing in individuals of differing socioeconomic status (SES). We summarise SES differences in response to positive and negative stimuli in limbic and cortical regions associated with emotion and emotion regulation. We discuss the possible relevance of neuroscience to understanding the link between mental health and SES. We hope to provide insights into future neuroscience research on the etiology and pathophysiology of mental disorders relating to SES.
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Affiliation(s)
- Yu Hao
- Center for Neuroscience & Society, University of Pennsylvania, USA
| | - Martha J Farah
- Center for Neuroscience & Society, University of Pennsylvania, USA
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32
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Georg S, Bosle C, Fischer JE, De Bock F. Psychometric properties and contextual appropriateness of the German version of the Early Development Instrument. BMC Pediatr 2020; 20:339. [PMID: 32646399 PMCID: PMC7346437 DOI: 10.1186/s12887-020-02191-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 06/02/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Assessing the early development of children at a population level in educational settings, may be useful for public health and policy decision making. In this study, we evaluated the psychometric properties and the contextual appropriateness of a German language version of the Early Development Instrument (EDI), a survey-based instrument originally developed in Canada, which assesses developmental vulnerability for children in preschool settings. METHODS Sixty preschool teachers from six preschool organizations (22% of organizations contacted) in three cities in southwest Germany participated. They administered a German version of the EDI (GEDI) to 225 children (51% of eligible children). We assessed internal consistency, test-retest and interrater reliability. Preschool teachers assisted in determining face-validity by reviewing item coverage and comprehensibility. Exploratory factor analysis (EFA) was used to evaluate convergent validity. Concurrent validity was measured using correlations and agreements (Bland-Altman plots) between GEDI and other validated instrument scores. Additionally, we compared associations between GEDI domain scores and sociodemographic characteristics with similar associations in EDI studies worldwide. RESULTS GEDI domains showed good to excellent internal consistency (0.73 < α > 0.99) and moderate to good test-retest and interrater reliability (0.50 to 0.81 and 0.48 to 0.71, respectively [p-value < 0.05]). Face validity was considered acceptable. EFA showed a factor structure similar to the original EDI. Correlations (range: 0.32 to 0.67) and agreements between GEDI scores and other German language instruments suggested good external reliability. Scoring within the lowest 10th percentile was strongly associated with age. CONCLUSIONS Our psychometric assessment suggests good reliability and consistency of the GEDI. Differences in the age distribution of children, pedagogical objectives and educational system features of German preschools require future work to determine score thresholds indicative of vulnerability. Aside from dropping selected items from the original EDI that were inconsistent with features of the German educational system, the distribution of values in the language and cognitive development domain also suggested that context-specific cut-offs must be established for the German version. Such efforts are needed to account for relevant contextual differences between the educational systems.
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Affiliation(s)
- Sabine Georg
- Mannheim Institute of Public Health, Social and Preventive Medicin, Medical Faculty Mannheim of the Ruprecht-Karls-University Heidelberg, Ludolf-Krehl-Straße 7-11, 68167 Mannheim, Germany
| | - Catherin Bosle
- Mannheim Institute of Public Health, Social and Preventive Medicin, Medical Faculty Mannheim of the Ruprecht-Karls-University Heidelberg, Ludolf-Krehl-Straße 7-11, 68167 Mannheim, Germany
| | - Joachim E. Fischer
- Mannheim Institute of Public Health, Social and Preventive Medicin, Medical Faculty Mannheim of the Ruprecht-Karls-University Heidelberg, Ludolf-Krehl-Straße 7-11, 68167 Mannheim, Germany
| | - Freia De Bock
- Mannheim Institute of Public Health, Social and Preventive Medicin, Medical Faculty Mannheim of the Ruprecht-Karls-University Heidelberg, Ludolf-Krehl-Straße 7-11, 68167 Mannheim, Germany
- Federal Centre for Health Education, Maarweg 149-161, 50625 Cologne, Germany
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33
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Lloyd JEV, Boonstra J, Forer B, Hershler R, Milbrath C, Poon BT, Razaz N, Rowcliffe P, Schonert-Reichl K. Robust Confidence Intervals for the Population Mean Alternatives to the Student-t Confidence Interval. JOURNAL OF MODERN APPLIED STATISTICAL METHODS 2020. [DOI: 10.22237/jmasm/1556670060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Population-based, person-specific, longitudinal child and youth health and developmental data linkages involve connecting combinations of specially-collected data and administrative data for longitudinal population research purposes. This glossary provides definitions of key terms and concepts related to their theoretical basis, research infrastructure, research methodology, statistical analysis, and knowledge translation.
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Canney M, Induruwage D, Sahota A, McCrory C, Hladunewich MA, Gill J, Barbour SJ. Socioeconomic Position and Incidence of Glomerular Diseases. Clin J Am Soc Nephrol 2020; 15:367-374. [PMID: 32079609 PMCID: PMC7057310 DOI: 10.2215/cjn.08060719] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 01/14/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Social deprivation is a recognized risk factor for undifferentiated CKD; however, its association with glomerular disease is less well understood. We sought to investigate the relationship between socioeconomic position and the population-level incidence of biopsy-proven glomerular diseases. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS In this retrospective cohort study, a provincial kidney pathology database (2000-2012) was used to capture all incident cases of membranous nephropathy (n=392), IgA nephropathy (n=818), FSGS (n=375), ANCA-related GN (ANCA-GN, n=387), and lupus nephritis (n=389) in British Columbia, Canada. Quintiles of area-level household income were used as a proxy for socioeconomic position, accounting for regional differences in living costs. Incidence rates were direct standardized to the provincial population using census data for age and sex and were used to generate standardized rate ratios. For lupus nephritis, age standardization was performed separately in men and women. RESULTS A graded increase in standardized incidence with lower income was observed for lupus nephritis (P<0.001 for trend in both sexes) and ANCA-GN (P=0.04 for trend). For example, compared with the highest quintile, the lowest income quintile had a standardized rate ratio of 1.7 (95% confidence interval, 1.19 to 2.42) in women with lupus nephritis and a standardized rate ratio of 1.5 (95% confidence interval, 1.09 to 2.06) in ANCA-GN. The association between income and FSGS was less consistent, in that only the lowest income quintile was associated with a higher incidence of disease (standardized rate ratio, 1.55; 95% confidence interval, 1.13 to 2.13). No significant associations were demonstrated for IgA nephropathy or membranous nephropathy. CONCLUSIONS Using population-level data and a centralized pathology database, we observed an inverse association between socioeconomic position and the standardized incidence of lupus nephritis and ANCA-GN.
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Affiliation(s)
- Mark Canney
- Division of Nephrology and
- BC Renal, Provincial Health Services Authority, British Columbia, Canada
| | | | - Anahat Sahota
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cathal McCrory
- Department of Gerontology, Trinity College Dublin, Dublin, Ireland; and
| | - Michelle A Hladunewich
- Division of Nephrology, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Jagbir Gill
- Division of Nephrology and
- BC Renal, Provincial Health Services Authority, British Columbia, Canada
| | - Sean J Barbour
- Division of Nephrology and
- BC Renal, Provincial Health Services Authority, British Columbia, Canada
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