Childhood family wealth and mental health in a national cohort of young adults

Impact of corrupt admission on the mental health of Chinese adolescents

Through preferential treatment by education officials or through bribery, some adolescents can obtain admission to a junior high school. However, it is unclear whether it affects the mental health of adolescents. This study used Propensity Score Matching to examine the effects of corruption on adolescent mental health. A total of 17,254 junior high school students sample (11-18 years old; 48.7% girls and 53.1% boys) were used from the China Education Panel Survey. 14.1% of adolescents attended a junior high school by corrupt means, corruption had a significantly negative effect on the mental health of these adolescents (ATT = -0.388, p < 0.01), the reasons grounded in the fact that they received more criticisms from teachers and wanted to leave their current school. In general, corruption in the admissions process can have detrimental effects on the mental health of adolescents. This study extends the previous articles on how to improve adolescent mental health and complements the application of cognitive dissonance theory. Findings from this study revealed that anti-corruption in the education sector is necessary, and the institutional design to ensure fair enrolment in basic education will contribute to the mental health of adolescents.

Risk factors, theoretical models, and biological mechanisms of nonsuicidal self-injury: a brief review

Nonsuicidal self-injury (NSSI) refers to the direct, deliberate infliction of harm to one's body tissue without the intention to die. The prevalence of NSSI has increased significantly globally in recent years and has become an important public health problem affecting the health of people, especially adolescents. The occurrence of NSSI in adolescents is the result of the interaction of different factors. Many scholars have proposed various theoretical models to explain the mechanism of NSSI behavior based on previous research on the influencing factors of NSSI. Moreover, advances have been made in genetic and neuroimaging mechanisms related to NSSI. Understanding the genetic and neuroimaging mechanisms of NSSI is important for both describing and treating the disorder. This literature review discusses the progress made on the risk factors, theoretical models, and biological mechanisms of NSSI.

High-risk group and functional subtypes of non-suicidal self-injury in young adults with mental disorders

BACKGROUND

Identifying high-risk groups of non-suicidal self-injury (NSSI) with multiple risk factors and different functional subtypes contribute to implementing person-centered interventions.

METHODS

We investigated NSSI profiles among a sample of 258 psychiatric inpatients aged 18-25 years. All participants completed well-validated measures of internal personal and external environmental characteristics. One-hundred and ninety patients reported a lifetime history of NSSI and completed an additional NSSI assessment. A k-means cluster analysis was conducted to extract characteristics of risk factors and functional subtypes. Independent sample t-test, analysis of variance and χ ² test were used to test the difference of demographic statistical factors, risk factors and functional scores among groups with different frequency of NSSI.

RESULTS

The clustering of risk factors analyses supported 4-clusters. The proportion of repeat NSSI patients was the highest (67.1%) in the group with unfavorable personal and unfavorable environmental characteristics. Functional subtype clustering analyses supported 5-clusters. Among patients with repeated NSSI, those with depression were mainly accompanied by the "Sensation Seeking" subtype (39.7%), bipolar disorder mainly supported the "Anti-suicide" subtype (37.9%), and eating disorders were mostly "Social Influence" subtype (33.3%). There was an interaction between functional subtypes and mental disorders.

LIMITATIONS

All participants were in treatment in a psychiatric service and the results may not be generalizable to a community sample. The data included retrospective self-report which may be inaccurate due to recall bias.

CONCLUSION

It is necessary to identify high-risk groups of NSSI who with unfavorable personal and environmental characteristics and clinical interventions need to consider the heterogeneity of patients' functional subtypes of NSSI.

Low assets predict persistent depression through living difficulties amid large-scale disasters: A cohort study

BACKGROUND

In face of large-scale disasters, persons with fewer assets are at greater risk of persistent poorer mental health than persons with more assets. Everyday daily routine disruptions and financial hardship could mediate this association.

METHODS

This prospective population-representative study in Hong Kong aimed to investigate the relation between assets during the acute phase of COVID-19 (February-August 2020, T1) and persistent probable depression from T1 to March-August 2021 (T2), as well as the mediating effects of daily routine disruptions and financial hardship on the assets-depression association.

RESULTS

Low assets at T1 prospectively related to persistent probable depression from T1 to T2. Primary routine disruptions (i.e., healthy eating and sleep) at T1 and financial hardship at T2 were found to fully mediate the association between T1 assets and persistent probable depression.

LIMITATIONS

Persistent probable depression reported on the PHQ-9 should be further verified with clinical diagnoses/interviews.

CONCLUSIONS

The COVID-19 pandemic was accompanied by a global economic downturn. Persons who have fewer assets could be at greater risk of depression during this period. Our findings suggest a need to provide behavioral and financial assistance to persons with fewer assets in the short run and a need to ensure that everyone has adequate assets to mitigate the mental health consequences of the COVID-19 pandemic in the long run.

Wealth and depression: A scoping review

INTRODUCTION

The inverse relation between income and depression is well established. Less is understood about the relation between wealth and depression. We therefore conducted a scoping review to answer the question: What is known from the existing literature about the relation between wealth and depression?

METHODS

We searched for studies and articles in Medline (via PubMed), Embase, PsycINFO, PsycArticles, EconLit, and SocINDEX from inception through July 19, 2020. Ninety-six articles were included in our review. Key article characteristics were year of publication, sample size, country, study design, definition of depression, definition of wealth, and association between wealth and depression. Thirty-two longitudinal articles were included in a detailed charted review.

RESULTS

Depression was defined in a relatively standard manner across articles. In contrast, definitions and measurements of wealth varied greatly. The majority of studies in the full review (n = 56, 58%) and half of the studies in the longitudinal charted review (n = 16, 50%) reported an inverse relation between wealth and depression. The longitudinal charted review showed that (1) macro-economic events influenced depression, (2) wealth status influenced depression across the lifecourse, (3) wealth protected against depression in the face of stressors such as job loss, (4) subjective or psychosocial factors such as perception of wealth, relative comparison, and social status modified the relation between wealth and depression, and (5) savings interventions were successful in reducing depression and varied by context.

CONCLUSION

These findings suggest that wealth should be included in our consideration of the forces that shape mental health.

Savings, home ownership, and depression in low-income US adults

PURPOSE

While the association between income and depression is well established, less explored is the relation between wealth and depression, particularly among low-income adults. We studied the relation between two types of assets-savings and home ownership-and probable depression to understand how access to different assets may shape depression among low-income US adults.

METHODS

Study sample We conducted a serial cross-sectional, observational study with 12,019 adults with low-income in the United States using National Health and Nutrition Examination Survey (NHANES) data from 2007 to 2016. Measures We measured probable major depressive disorder (MDD) with impairment using the Patient Health Questionnaire-9. Low savings was defined as having $5000 or less in family savings. Statistical analysis We estimated adjusted and unadjusted prevalence, odds ratios, and predicted probability of probable MDD across asset groups.

RESULTS

Of low-income US adults, 5.4% had probable MDD with impairment, 85.9% had low savings, and 54.9% rented their home. Persons with low savings had 2.34 (95% CI 1.44-3.79) times the odds of having probable MDD relative to those with high savings. Home owners had 2.14 (95% CI 1.20-3.86) and home renters had 3.65 (95% CI 1.45-9.20) times the odds of having probable MDD if they had low savings relative to high savings.

CONCLUSION

Family savings and home ownership are associated with lower burden of depression among low-income adults in the US.

Associations between socioprovincial factors and self-reported mental disorders among students from grade 4 to 8 in rural China

Background

The focus on child mental health in developing countries was increasing. However, little was known in China. This study aimed to explore the associations between socioprovincial factors and self-reported mental disorders in rural China.

Methods

Data were from a publicly available survey with 54,498 students from Grade 4 to 8 in rural China. Chi-square test was used for descriptive analysis. Self-reported mental disorders included overall mental disorder, study anxiety, personal anxiety, loneliness, guilt, sensitivity, symptomatic psychosis, phobia, and impulsivity. Multiple logistic regressions and errors-in-variables regression models were employed to explore the associations between socioprovincial factors and mental disorders. Poisson regressions and errors-in-variables regression models were adopted to reveal the associations between socioprovincial factors and number of self-reported mental disorders.

Results

Descriptive statistics showed that mental health was poor in rural adolescents in China. Logistic regression showed that the odds of overall mental disorder and study anxiety were 189% (AOR = 2.89, 95%CI: 2.76, 3.02) and 92% (OR = 1.92, 95%CI: 1.84, 2.00) in Gansu more than those in Anhui, while the odds of personal anxiety, guilt, sensitivity, symptomatic psychosis, and phobia were 92% (AOR = 0.08, 95%CI: 0.08, 0.09), 71% (AOR = 0.29, 95%CI: 0.27, 0.30), 88% (AOR = 0.12, 95%CI: 0.11, 0.13), 69% (AOR = 0.31, 95%CI: 0.29, 0.32), and 78% (AOR = 0.22, 95%CI: 0.21, 0.23) in Gansu less than those in Anhui. Moreover, Gansu (Poisson regression: IRR =1.45, 95%CI: 1.42–1.47; errors-in-variables regression: Coefficient = 0.26, 95%CI: 0.16, 0.36), Ningxia (Poisson regression: IRR =1.63, 95%CI: 1.60–1.67; errors-in-variables regression: Coefficient = 0.43, 95%CI: 0.32, 0.53), Qinghai (Poisson regression: IRR =1.65, 95%CI: 1.60–1.69; errors-in-variables regression: Coefficient = 0.44, 95%CI: 0.34, 0.55), and Shaanxi (Poisson regression: IRR =1.28, 95%CI: 1.25–1.30; errors-in-variables regression: Coefficient = 0.11, 95%CI: 0.00, 0.21) were significantly associated with the number of self-reported mental disorders.

Conclusion

Class and provincial disparities in self-reported mental disorders were reported among the students from Grade 4 to 8 in rural China. Mental health care supported by governments and schools could be an effective way to reduce the disparities in mental disorders among the adolescents.

Socioeconomic Mobility and Psychological and Cognitive Functioning in a Diverse Sample of Adults With and Without HIV

OBJECTIVE

This cross-sectional study examined the effects of socioeconomic status (SES) mobility from childhood to adulthood on psychological and cognitive well-being in African American and non-Hispanic White HIV-positive (HIV+) and HIV-seronegative (HIV-) adults who are part of an ongoing study investigating psychosocial and neurobehavioral effects of HIV.

METHODS

Participants (N = 174, 24.1% female, 59.2% African American, 67.8% HIV+) were categorized into four groups (upward mobility, downward mobility, stable-not-poor, chronic-poverty) based on self-reported childhood and current community SES (which were correlated with objective measures of SES and proxies of childhood SES). SES groups were compared on self-report measures of psychological well-being, subjective executive functioning ratings, and performance across six cognitive domains. Primary analyses were stratified by HIV status.

RESULTS

For the HIV+ group, SES mobility was associated with psychological well-being (chronic burden of stress: F(7,101) = 3.17, mean squared error [MSE] = 49.42, p = .030, η2 = 0.14; depressive symptoms: F(7,101) = 4.46, MSE = 70.49, p = .006,η2 = 0.14), subjective ratings of executive dysfunction (F(7,101) = 6.11, MSE = 114.29, p = .001,η2 = 0.18), and objective performance in executive functioning (F(9,99) = 3.22, MSE = 249.52, p = .030, η2 = 0.15) and learning (F(9,99) = 3.01, MSE = 220.52, p = .034, η2 = 0.13). In the control group, SES mobility was associated with chronic stress burden (F(5,49) = 4.677, p = .025, η2 = 0.15); however, no other relationships between SES mobility and outcomes of interest were observed (all p values > .20). In general, downward mobility and chronic poverty were associated with worse ratings across psychological well-being measures and cognitive performance.

CONCLUSIONS

Findings within the HIV+ group are consistent with previous studies that report downward mobility to be associated with poor psychological outcomes. People living with HIV may be particularly vulnerable to the adverse effects of socioeconomic instability.

Low assets and financial stressors associated with higher depression during COVID-19 in a nationally representative sample of US adults

BACKGROUND

COVID-19 and related containment policies have caused or heightened financial stressors for many in the USA. We assessed the relation between assets, financial stressors and probable depression during the COVID-19 pandemic.

METHODS

Between 31 March 2020 and 13 April 2020, we surveyed a probability-based, nationally representative sample of US adults ages 18 and older using the COVID-19 and Life stressors Impact on Mental Health and Well-being survey (n=1441). We calculated the prevalence of probable depression using the Patient Health Questionnaire-9 (cut-off ≥10) and exposure to financial stressors by financial, physical and social assets categories (household income, household savings, home ownership, educational attainment and marital status). We estimated adjusted ORs and predicted probabilities of probable depression across assets categories and COVID-19 financial stressor exposure groups.

RESULTS

We found that (1) 40% of US adults experienced COVID-19-related financial stressors during this time period; (2) low assets (OR: 3.0, 95% CI 2.1 to 4.2) and COVID-19 financial stressor exposure (OR: 2.8, 95% CI 2.1 to 3.9) were each associated with higher odds of probable depression; and (3) among persons with low assets and high COVID-19 financial stressors, 42.7% had probable depression; and among persons with high assets and low COVID-19 financial stressors, 11.1% had probable depression. Persons with high assets and high COVID-19 financial stressors had a similar prevalence of probable depression (33.5%) as persons with low assets and low COVID-19 financial stressors (33.5%). The more assets a person had, the lower the level of probable depression.

CONCLUSION

Populations with low assets are bearing a greater burden of mental illness during the COVID-19 pandemic.

The Direct and Indirect Influences of Adverse Childhood Experiences on Physical Health: A Cross-Sectional Study

A growing and significant body of research has documented the close relationship between adverse childhood experiences (ACEs) and health outcomes in adults. Less is known about the complex pathways through which ACEs exert their influence. This article examines the direct relationship between the quality of perceived physical health and childhood adversities. The association between the adversities and the physical health with other psychological and social variables is also analyzed. Data were collected from a sample of 170 subjects, using tools to assess adverse childhood experiences, physical health-related quality of life, socioeconomic vulnerability, emotion regulation, coping strategies, attachment, and social support. Results showed a high frequency of ACEs among the adult population, and the correlation with poor physical health was highly significant. Regression equations to predict physical health also revealed the following as significant variables: wishful thinking, social withdrawal, and cognitive restructuring as coping styles; reappraisal to achieve emotion regulation; fear of rejection or abandonment, and desire for closeness in relation to attachment figures; hardship; and poor financial support. The relationship between the different forms of ACE and social vulnerability identifies the important indirect contribution of childhood adversity to health and socioeconomic conditions in adulthood.

Do assets explain the relation between race/ethnicity and probable depression in U.S. adults?

Depression is a leading cause of disability in the U.S. across all race/ethnicity groups. While non-Hispanic Black and Hispanic persons have worse physical health on most indicators than non-Hispanic White persons, the literature on the association between race/ethnicity and rates of depression is mixed. Given unequal distribution of assets across racial/ethnic groups, it is possible that social and economic differences may explain differential rates of depression across race/ethnicity groups. Using National Health and Nutrition Examination Survey (NHANES) data from 2007–2016, we constructed a nationally representative sample of 26,382 adults over 18 years old (11,072 non-Hispanic White, 5,610 non-Hispanic Black, 6,981 Hispanic, and 2,719 Other race). We measured symptoms of depression using the Patient Health Questionnaire-9 (PHQ-9), with a score of 10 or more indicating probable depression. We identified three kinds of assets: financial assets (income), physical assets (home ownership), and social assets (marital status and education). We estimated the weighted prevalence of probable depression across race/ethnicity groups, odds ratios controlling for assets, and predicted probabilities of probable depression across race/ethnicity and asset groups. Three results contribute to our understanding of the differences in probable depression rates between race/ethnicity groups: 1) Non-Hispanic Black and Hispanic persons had a higher weighted prevalence of probable depression in the U.S. than non-Hispanic White persons. In models unadjusted for assets, non-Hispanic Black and Hispanic persons had 1.3 greater odds of probable depression than non-Hispanic White persons (p<0.01). 2) We found an inverse relation between assets and probable depression across all race-ethnicity groups. Also, non-Hispanic Black and Hispanic persons had fewer assets than non-Hispanic Whites. 3) When we controlled for assets, non-Hispanic Black and Hispanic persons had 0.8 times lower odds of probable depression than non-Hispanic White persons (p<0.05). Thus, when holding assets constant, minorities had better mental health than non-Hispanic White persons in the U.S. These three findings help to reconcile findings in the literature on race/ethnicity and depression. Given vastly unequal distribution of wealth in the U.S., it is not surprising that racial minorities, who hold fewer assets, would have an overall larger prevalence of mental illness, as seen in unadjusted estimates. Once assets are taken into account, Black and Hispanic persons appear to have better mental health than non-Hispanic White persons. Assets may explain much of the relation between race/ethnicity group and depression in the U.S. Future research should consider the role of assets in protecting against mental illness.

Socioeconomic Factors Associated With Burnout Among Oncology Trainees

PURPOSE:

Burnout in the medical workforce leads to early retirement, absenteeism, career changes, financial losses for medical institutions, and adverse outcomes for patients. Recent literature has explored burnout in different specialties of medicine. This article examines burnout among medical oncology trainees and identifies factors associated with burnout and professional dissatisfaction, including socioeconomic factors.

METHODS:

US medical oncology programs were sent a survey that included the Maslach Burnout Index–Human Services Survey as well as demographic, socioeconomic, and program-specific questions tailored to medical oncology fellowship. Primary binary end points included burnout, satisfaction with being a physician, and satisfaction with being a medical oncologist. Binomial logistic models determined associations between various characteristics and end points.

RESULTS:

Overall, 261 US fellows completed the survey. Seventy percent of international medical graduates reported no educational debt, whereas only 36% of US graduates reported no educational debt. Eighty-two percent of survey respondents reported their mother had at least a bachelor’s degree, and 87% of respondents reported their father had at least a bachelor’s degree. At least 27% of respondents had symptoms of burnout. Factors inversely associated with burnout on multivariable analysis included having a mother who graduated college (odds ratio [OR], 0.27), reporting an adequate perceived balance between work and personal life (OR, 0.22), feeling that faculty care about educational success (OR, 0.16), and being in the final year of training (OR, 0.45). Having debt ≥ $150,000 (OR, 2.14) was directly associated with burnout.

CONCLUSION:

Symptoms of burnout are common among medical oncology fellows and are associated with educational debt and socioeconomic factors.

Is wealth associated with depressive symptoms in the United States?

PURPOSE

The aim of the study was to assess the relation between family wealth and depression in U.S. adults.

METHODS

Participants were 5134 members of the 2015-2016 National Health and Nutrition Examination Survey who were aged 18 years or older and completed the depression screener. Using the Patient Health Questionnaire and household demographics interview data, we calculate the adjusted odds of depressive symptoms for persons with low relative to high family savings, using multivariable logistic regression. We estimate predicted probabilities of having depressive symptoms for low and high family savings groups at low, middle, and high family income categories.

RESULTS

Overall, 57.4% of the total weighted population had low family savings (below $20,000), and 23.7% of the weighted population had depressive symptoms. Persons with low family savings had 1.49 times higher odds (95% confidence interval, 1.01-2.21) of having depressive symptoms than persons with high family savings, controlling for gender, age, race, education, marital status, family size, and family income. Predicted probabilities of depressive symptoms were higher for low family savings groups than high family savings groups at every income level.

CONCLUSIONS

Family wealth is associated with lower prevalence of current depressive symptoms in U.S. adults. Wealth may be an important determinant of population mental health, separate and independent from income.

Nonsuicidal Self-Injury and Suicide: The Role of Life Events in Clinical and Non-Clinical Populations of Adolescents

BACKGROUND

Nonsuicidal self-injury (NSSI) is highly prevalent in clinical and non-clinical populations of adolescents. Several studies have supported both the distinction and the strong association between NSSI and suicidal behavior. Although there is a great deal of data on the role of life events in both suicidal behavior and NSSI, few studies have assessed the role of life events in the NSSI-suicidal behavior relationship. Our aims were to explore the relationship between NSSI and suicidal behavior, and the possible moderating role of stressful life events in a clinical and non-clinical adolescent population.

METHOD

A clinical (n = 202) and a nonclinical (n = 161) population of adolescents, aged 13-18 years were assessed. The Mini International Neuropsychiatric Interview Kid, Deliberate Self-Harm Inventory and the Life Events List were used. Group differences related to suicidal behavior, NSSI, and life events were tested with Wilcoxon tests. Two- and three-way interactions were tested with negative binomial regression models including zero-inflation parameter.

RESULTS

The prevalence of suicidal behavior (W = 7,306, p < .001), NSSI (W = 9,652, p < .001) and life events (W = 10,410 p < .001) were significantly higher in the clinical than in the non-clinical group. Between number of life events and NSSI, a moderate effect size (.38, 95%CI [.28,.46]) was found. The main effect of NSSI (χ² (1) = 109.65, p < .001) and group membership (χ² (1) = 39.13, p < .001) predicted suicidal behavior; the main effect of quantity of life events did not explain suicidal behavior. The interaction between NSSI and number of life events (χ² (1) = 10.49, p < .01) was associated with suicidal behavior. Among interpersonal, non-interpersonal events and adverse childhood circumstances, only interpersonal events were associated with both suicidal behavior (χ² (1) = 6.08, p < .05) and had a moderating effect (χ² (1) = 8.59, p < .01) on the NSSI-suicidal behavior relationship. Patterns of the effects of life events on the NSSI-suicidal behavior relationship did not differ in the two groups.

CONCLUSION

Our results confirm the importance of prevention and intervention of NSSI, considering its high prevalence and frequent co-occurrence with suicidal behavior in both clinical and non-clinical adolescent populations. Moreover, to support NSSI and suicide prevention, we would like to highlight the importance of stressful life events, especially those associated with interpersonal conflicts, require special attention.

Childhood Socioeconomic Status and Late-Adulthood Mental Health: Results From the Survey on Health, Ageing and Retirement in Europe

Objectives

A growing literature acknowledges the association between childhood socioeconomic status (SES) and health in late adulthood (i.e., 50+). Less, however, is known about the association with mental health outcomes, such as depression. We use the Survey on Health, Ageing, and Retirement in Europe (SHARE) to analyze overall and gender-specific associations between childhood SES and late-adulthood depression.

Methods

Using life history and contemporaneous data from 21,989 SHARE respondents in combination with principal component analysis we construct indices of childhood SES. We measure late-adulthood depression using the EURO-D scale. Contemporaneous SES is operationalized as the logarithm of household equivalized income. We estimate associations using linear regression models.

Results

We document a positive association between childhood SES and the late-adulthood EURO-D score. The association persists even when allowing for contemporaneous SES. Zooming in on gender-specific associations reveals that the association for mental health is particularly pronounced for women.

Discussion

Our findings reveal the long-term association between childhood socioeconomic conditions and depression later in life, which persists even after taking into account current socioeconomic conditions and are stronger for women than for men. These results imply that boosting childhood socioeconomic conditions can potentially have effects lasting well beyond the childhood phase.

Early childhood development in Iran and its provinces: Inequality versus average

BACKGROUND

Early childhood development is influenced by family socioeconomic status in such a way that socioeconomic deprivation might be accompanied with adverse outcomes in early development of a child. This study aimed to assess early childhood development based on average and also based on the distribution of socioeconomic inequality in Iran and its provinces.

METHODS

Using data from provincially representative Multiple Indicator Demographic and Health Survey (2010), we developed a suitable latent class approach to construct a proxy of socioeconomic status. A composite index of early childhood development was used. We assessed inequality in early childhood development using the concentration index method.

RESULTS

At province level (n = 30), the highest and lowest averages of early childhood development were 13.60 (SD = 2.99) and 5.81 (SD = 3.29), respectively. Concentration indices indicated pro-rich inequality in early childhood development at national and provincial level. The concentration index of early childhood development was 0.087 (95% CI = 0.085-0.0098) in Iran. Moreover, the consistent positive values of the concentration indices revealed that early childhood development inequality favored best-off children in all provinces. However, early childhood development was disproportionally distributed among provinces and rated 0.016 to 0.149.

CONCLUSIONS

Iranian children in more prosperous households reported higher early childhood development compared with those in poor households at national and provincial level. It is vital to consider inequality in addition to average level of childhood development across Iranian provinces to reach a more comprehensive understanding of childhood development for public policy action in the country.

Direct Self-Injurious Behavior (D-SIB) and Life Events among Vocational School and High School Students

Although several studies have recently assessed direct self-injurious behavior (D-SIB) among adolescents, it is still understudied in adolescents attending vocational schools: an educational setting generally associated with lower socioeconomic status. After extending the "Saving and Empowering Young Lives in Europe" (SEYLE) project to a vocational school population, we examined their D-SIB and life event characteristics compared to the high school population. SEYLE's Hungarian randomly selected high school sample (N = 995) was completed with a randomly selected vocational school sample (N = 140) in Budapest, Hungary. Participants aged 14⁻17 years completed the SEYLE project's self-administered questionnaires. D-SIB lifetime prevalence was significantly higher (29.4%) in the vocational school group compared to the high school group (17.2%) (Χ²(1) = 12.231, p< 0.001). D-SIB was associated with suicidal ideation in the vocational school group. Different life events were more frequent in the high school than in the vocational school group, and associations between D-SIB and life events differed in the vocational school group compared to the high school group. In conclusion, vocational school students are a vulnerable population with a higher prevalence of D-SIB compared to high school students. Life events and their association with D-SIB also differ in vocational school students compared to high school students. Taking all these into account might contribute to prevention/intervention designed for this population.

Confounding and Statistical Significance of Indirect Effects: Childhood Adversity, Education, Smoking, and Anxious and Depressive Symptomatology

The life course perspective, the risky families model, and stress-and-coping models provide the rationale for assessing the role of smoking as a mediator in the association between childhood adversity and anxious and depressive symptomatology (ADS) in adulthood. However, no previous study has assessed the independent mediating role of smoking in the association between childhood adversity and ADS in adulthood. Moreover, the importance of mediator-response confounding variables has rarely been demonstrated empirically in social and psychiatric epidemiology. The aim of this paper was to (i) assess the mediating role of smoking in adulthood in the association between childhood adversity and ADS in adulthood, and (ii) assess the change in estimates due to different mediator-response confounding factors (education, alcohol intake, and social support). The present analysis used data collected from 1994 to 2008 within the framework of the Tromsø Study (N = 4,530), a representative prospective cohort study of men and women. Seven childhood adversities (low mother's education, low father's education, low financial conditions, exposure to passive smoke, psychological abuse, physical abuse, and substance abuse distress) were used to create a childhood adversity score. Smoking status was measured at a mean age of 54.7 years (Tromsø IV), and ADS in adulthood was measured at a mean age of 61.7 years (Tromsø V). Mediation analysis was used to assess the indirect effect and the proportion of mediated effect (%) of childhood adversity on ADS in adulthood via smoking in adulthood. The test-retest reliability of smoking was good (Kappa: 0.67, 95% CI: 0.63; 0.71) in this sample. Childhood adversity was associated with a 10% increased risk of smoking in adulthood (Relative risk: 1.10, 95% CI: 1.03; 1.18), and both childhood adversity and smoking in adulthood were associated with greater levels of ADS in adulthood (p < 0.001). Smoking in adulthood did not significantly mediate the association between childhood adversity and ADS in adulthood. However, when education was excluded as a mediator-response confounding variable, the indirect effect of childhood adversity on ADS in adulthood was statistically significant (p < 0.05). This study shows that a careful inclusion of potential confounding variables is important when assessing mediation.