Expanding conceptual frameworks: life course risk modelling for mental disorders

Risk Factors for the Mental Health of Adolescents from the Parental Perspective: Photo-Voice in Rural Communities of Ecuador

Mental health in adolescence is a very important topic worldwide, especially in rural areas. The implementation of Participatory Action Research (PAR) through the photo-voice method was a way to encourage adults to recognize problematic situations (at personal, family or community levels) that threaten the well-being of adolescents, but that in everyday life may go unnoticed by parents and caregivers. Our study aimed to identify risk factors for mental health in adolescents living in rural communities of Ecuador from the parental perspective through photographs and focus group discussions. The study sought to raise awareness of this issue at the family and community levels. The photo-voice method was conducted with the participation of 29 parents. The photographs and the collaborative construction of meanings allowed parents to have a better understanding about the importance of mental health and its benefit for adolescents. The principal risk factors mentioned by parents were stress, sleep deprivation, tiredness, poverty, difficulties in continuing education and alcohol consumption. In conclusion, we point out the importance of this intervention to explore the knowledge and understanding of the topic by parents as well as to communicate information that demystifies false beliefs around mental health.

Data-Driven Model Building for Life-Course Epidemiology

Life-course epidemiology is useful for describing and analyzing complex etiological mechanisms for disease development, but existing statistical methods are essentially confirmatory, because they rely on a priori model specification. This limits the scope of causal inquiries that can be made, because these methods are suited mostly to examine well-known hypotheses that do not question our established view of health, which could lead to confirmation bias. We propose an exploratory alternative. Instead of specifying a life-course model prior to data analysis, our method infers the life-course model directly from the data. Our proposed method extends the well-known Peter-Clark (PC) algorithm (named after its authors) for causal discovery, and it facilitates including temporal information for inferring a model from observational data. The extended algorithm is called temporal PC. The obtained life-course model can afterward be perused for interesting causal hypotheses. Our method complements classical confirmatory methods and guides researchers in expanding their models in new directions. We showcase the method using a data set encompassing almost 3,000 Danish men followed from birth until age 65 years. Using this data set, we inferred life-course models for the role of socioeconomic and health-related factors on development of depression.

A developmental perspective on personality and psychopathology across the life span

Taking a developmental perspective, guided by core principles of developmental science and developmental psychopathology, is necessary to move the fields of personality science and psychopathology forward. Personality and psychopathology can be delineated using hierarchical models of individual differences, as evidenced by decades of converging evidence across community and psychiatric samples, countries and cultures, and ages and developmental periods. A large body of empirical research likewise documents associations between personality and various forms of psychopathology. Cross-sectional investigations of personality-psychopathology links in samples of adults now yield diminishing returns. Prospective, longitudinal investigations that assess personality, psychopathology, and their co-development across the life span are needed to determine their temporal ordering, capture dynamic associations over time and development, and elucidate causal origins and underlying mechanisms. We lay out a developmental framework that integrates across the developmental, personality, and psychopathology literatures in order to further understanding and guide future investigations of the nature of personality-psychopathology links.

Socioeconomic disadvantage across the life-course and oral health in older age: findings from a longitudinal study of older British men

Background

The influence of life-course socioeconomic disadvantage on oral health at older ages is not well-established. We examined the influence of socioeconomic factors in childhood, middle-age and older age on oral health at older ages, and tested conceptual life-course models (sensitive period, accumulation of risk, social mobility) to determine which best described observed associations.

Methods

A representative cohort of British men aged 71-92 in 2010-12 included socioeconomic factors in childhood, middle-age and older age. Oral health assessment at 71-92 years (n = 1622) included tooth count, periodontal disease and self-rated oral health (excellent/good, fair/poor) (n = 2147). Life-course models (adjusted for age and town of residence) were compared with a saturated model using Likelihood-ratio tests.

Results

Socioeconomic disadvantage in childhood, middle-age and older age was associated with complete tooth loss at 71-92 years-age and town adjusted odds ratios (95% CI) were 1.39 (1.02-1.90), 2.26 (1.70-3.01), 1.83 (1.35-2.49), respectively. Socioeconomic disadvantage in childhood and middle-age was associated with poor self-rated oral health; adjusted odds ratios (95% CI) were 1.48 (1.19-1.85) and 1.45 (1.18-1.78), respectively. A sensitive period for socioeconomic disadvantage in middle-age provided the best model fit for tooth loss, while accumulation of risk model was the strongest for poor self-rated oral health. None of the life-course models were significant for periodontal disease measures.

Conclusion

Socioeconomic disadvantage in middle-age has a particularly strong influence on tooth loss in older age. Poor self-rated oral health in older age is influenced by socioeconomic disadvantage across the life-course. Addressing socioeconomic factors in middle and older ages are likely to be important for better oral health in later life.

Birth size is not associated with depressive symptoms from adolescence to middle-age: results from the Northern Swedish Cohort study

Low birth weight has been shown to be related to increased risk of depression later in life - but the evidence is not conclusive. We examined the association of size at birth with repeatedly measured depressive symptoms in 947 individuals from the Northern Swedish Cohort, a community-based age-homogeneous cohort born in 1965, and followed with questionnaires between ages 16 and 43 (participation rate above 90% in all the surveys). Information on birth size was retrieved from archived birth records. Length of gestation was known for a subsample of 512 individuals (54%). We studied the association of birth weight and ponderal index with self-reported depressive symptoms at ages 16, 21, 30 and 43; with the life-course average of depressive symptoms score and with longitudinal trajectories of depressive symptoms retrieved by latent class growth analysis. Socioeconomic background, mental illness or alcohol problems of a parent, exposure to social adversities in adolescence and prematurity were accounted for in the analyses. We did not find any relationship between weight or ponderal index at birth and our measure of depressive symptoms between ages 16 and 43 in a series of different analyses. Adjustment for length of gestation did not alter the results. We conclude that size at birth is not associated with later-life depressive symptoms score in this cohort born in the mid-1960s in Sweden. The time and context need to be taken into consideration in future studies.

Paid and unpaid working hours among Swedish men and women in relation to depressive symptom trajectories: results from four waves of the Swedish Longitudinal Occupational Survey of Health

BACKGROUND

Long working hours and unpaid work are possible risk factors for depressive symptoms. However, little is known about how working hours influence the course of depressive symptoms. This study examined the influence of paid, unpaid working hours and total working hours on depressive symptoms trajectories.

METHODS

The study was based on data from four waves of the Swedish Longitudinal Occupational Survey of Health (SLOSH 2008-2014). We applied group-based trajectory modelling in order to identify trajectories of depressive symptoms and studied paid and unpaid working hours and total working hours as risk factors.

RESULTS

Six trajectory groups were identified with symptoms: 'very low stable', 'low stable', 'doubtful increasing', 'high decreasing', 'mild decreasing' and 'high stable'. More time spent on unpaid work was associated with the 'low stable' (OR 1.16, 95% CI 1.04 to 1.30) and the 'high stable (OR 1.40, 95% CI 1.18 to 1.65) symptom trajectories compared with being in the 'very low stable' symptom group. In addition, more total working hours was associated with a higher probability of having 'high decreasing' (OR 1.30, 95% CI 1.14 to 1.48) and 'high stable' (OR 1.22, 95% CI 1.01 to 1.47) symptoms, when adjusting for sex, age, civil status and socioeconomic status. The results, however, differed somewhat for men and women. More unpaid working hours was more clearly associated with higher symptom trajectories among women. More total working hours was associated with 'high stable' symptoms among women only.

CONCLUSIONS

This study supported heterogeneous individual patterns of depressive symptoms over time among the Swedish working population. The results also indicate that a higher burden of unpaid work and longer total working hours, which indicate a double burden from paid and unpaid work, may be associated with higher depressive symptom trajectories, especially among women.

Intimate Partner Violence Associated with Postpartum Depression, Regardless of Socioeconomic Status

Objective This study examined whether socioeconomic status moderated the association between intimate partner violence (IPV) and postpartum depression among a community-based sample of women. Defining the role of poverty in the risk of postpartum depression for IPV victims enables prioritization of health promotion efforts to maximize the effectiveness of existing maternal-infant resources. Methods This cross-sectional telephone-survey study interviewed 301 postpartum women 2 months after delivery, screening them for IPV and depression [using Edinburgh Postnatal Depression Scale (EPDS)]. Socioeconomic status was defined by insurance (Medicaid-paid-delivery or not). This analysis controlled for the following covariates, collected through interview and medical-record review: demographics, obstetric history, prenatal health and additional psychosocial risk factors. After adjusting for significant covariates, multiple linear regression was conducted to test whether socioeconomic status confounded or moderated IPV's relationship with EPDS-score. Results Ten percent of participants screened positive for postpartum depression, 21.3 % screened positive for current or previous adult emotional or physical abuse by a partner, and 32.2 % met poverty criteria. IPV and poverty were positively associated with each other (χ(2) (1) = 11.76, p < .001) and with EPDS score (IPV: beta 3.2 (CI 2.0, 4.5) p < .001, poverty: beta 1.3 (CI 0.2, 2.4) p = .017). In the multiple linear regression, IPV remained significantly associated, but poverty did not (IPV: adjusted beta 3.1 (CI 1.8, 4.3) p < .001, poverty: adjusted beta 0.8 (CI -0.3, 1.9) p = .141), and no statistically significant interaction between IPV and poverty was found. Conclusions Study findings illustrated that IPV was strongly associated with postpartum depression, outweighing the influence of socioeconomic status upon depression for postpartum women.

Pathways from problems in adolescent family relationships to midlife mental health via early adulthood disadvantages - a 26-year longitudinal study

Poor childhood family conditions have a long-term effect on adult mental health, but the mechanisms behind this association are unclear. Our aim was to study the pathways from problematic family relationships in adolescence to midlife psychological distress via disadvantages in early adulthood. Participants of a Finnish cohort study at the age of 16 years old in 1983 were followed up at ages 22, 32 and 42 years old (N = 1334). Problems in family relationships were measured with poor relationship with mother and father, lack of parental support in adolescent’s individuation process and poor home atmosphere, and mental health was assessed using Kessler’s Psychological Distress Scale (K10). We analyzed the indirect effects of adolescent family relations on mental health at age 42 years old via various disadvantages (somatic and psychological symptoms, relationship/marital status, low education/unemployment and heavy drinking) at ages 22 and 32 years old. Problematic adolescent family relationships were associated with midlife psychological distress in women (0.19; 95% CI 0.11, 0.26) and men (0.13; 95% CI 0.04, 0.21). However, after adjustment for adolescent psychological symptoms, the association was only significant for women (0.12; 95% CI 0.04, 0.20). Poor family relationships were associated with various disadvantages in early adulthood. The association from poor family relationships (16 years old) to psychological distress (42 years old) was in part mediated via psychological symptoms in women (0.03; 95% CI 0.01, 0.04) and men (0.02; 95% CI 0.00, 0.04) and in women also via heavy drinking in early adulthood (0.02; 95% CI 0.00, 0.03). Adolescent family relationships have a role in determining adult mental health. Targeted support addressing psychological well-being and hazardous drinking for adolescents with problematic family relationships might prevent disadvantages in early adulthood, and further prevent poor midlife mental health.

Cognitive ability in young adulthood and risk of dementia in a cohort of Danish men, brothers, and twins

INTRODUCTION

We examined the association between cognitive ability in young adulthood and dementia in Danish men, brothers, and male twins.

METHODS

In total, 666,986 men born between 1939 and 1959 were identified for dementia diagnosis in national registries from 1969 to 2016. The association between cognitive ability from draft board examination and dementia was examined using Cox regression.

RESULTS

During a 44-year follow-up, 6416 (0.96%) men developed dementia, 1760 (0.26%) and 970 (0.15%) of which were classified as Alzheimer's and vascular dementia, respectively. Low cognitive ability was associated with increased risk of dementia (hazard ratio [HR]_{per SD decrease} 1.33 [95% confidence interval {CI} = 1.30-1.35]) with the strongest associations for vascular dementia (HR_{per SD decrease} 1.47 [95% CI = 1.31-1.56]) and a weaker for Alzheimer's disease (HR_{per SD decrease} 1.07 [95% CI = 1.03-1.13]). The intrabrother and twin analyses (taking shared family factors into account) showed attenuated risk estimates but with wide CIs.

DISCUSSION

Low early-life cognitive ability increases the risk of dementia before the age of 78 years. The association is partly explained by shared family factors.

Sociological inquiry into mental health: the legacy of Leonard I. Pearlin

As a tribute to the body of work created by our late colleague Leonard I. Pearlin, this essay assesses how the evolution of the Stress Process Model, the centerpiece of his work, repeatedly reinvented sociological research on stress and mental health and explains why this model, therefore, possesses the potential to renew itself well into the future. This essay revisits some of Pearlin's seminal contributions: the original specification of the stress process and three extensions of it--the concept of stress proliferation, the formulation of the role of social structure and functioning in the stress process, and the articulation of linkages between the stress process and the life course perspective. The resultant body of work has had formative influences on the ways sociologists now think about the impact of society on the inner emotional lives of its members.

Economic stress in childhood and adulthood, and poor psychological health: three life course hypotheses

Investigations of mental health in a life course perspective are scarce. The aim is to investigate associations between economic stress in childhood and adulthood, and poor psychological health in adulthood with reference to the accumulation, critical period and social mobility hypotheses in life course epidemiology. The 2008 public health survey in Skåne is a cross-sectional postal questionnaire study. A random sample was invited which yielded 28,198 respondents aged 18-80 (55% participation). Psychological health was assessed with the GHQ12 instrument. Logistic regression models were used to investigate the associations adjusting for age, country of birth, socioeconomic status, emotional support, instrumental support and trust, and stratifying by sex. The accumulation hypothesis was confirmed because combined childhood and adulthood exposures to economic stress were associated with poor psychological health in a graded manner. The social mobility hypothesis was also confirmed. The critical period hypothesis was not confirmed because both childhood and adulthood economic stress remained significantly associated with poor psychological health in adulthood. Economic stress in childhood is associated with mental health in adulthood.