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Wickersham A, Das-Munshi J, Ford T, Jewell A, Stewart R, Downs J. Impact of inconsistent ethnicity recordings on estimates of inequality in child health and education data: a data linkage study of Child and Adolescent Mental Health Services in South London. BMJ Open 2024; 14:e078788. [PMID: 38443076 PMCID: PMC10916132 DOI: 10.1136/bmjopen-2023-078788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 01/12/2024] [Indexed: 03/07/2024] Open
Abstract
OBJECTIVES Ethnicity data are critical for identifying inequalities, but previous studies suggest that ethnicity is not consistently recorded between different administrative datasets. With researchers increasingly leveraging cross-domain data linkages, we investigated the completeness and consistency of ethnicity data in two linked health and education datasets. DESIGN Cohort study. SETTING South London and Maudsley NHS Foundation Trust deidentified electronic health records, accessed via Clinical Record Interactive Search (CRIS) and the National Pupil Database (NPD) (2007-2013). PARTICIPANTS N=30 426 children and adolescents referred to local Child and Adolescent Mental Health Services. PRIMARY AND SECONDARY OUTCOME MEASURES Ethnicity data were compared between CRIS and the NPD. Associations between ethnicity as recorded from each source and key educational and clinical outcomes were explored with risk ratios. RESULTS Ethnicity data were available for 79.3% from the NPD, 87.0% from CRIS, 97.3% from either source and 69.0% from both sources. Among those who had ethnicity data from both, the two data sources agreed on 87.0% of aggregate ethnicity categorisations overall, but with high levels of disagreement in Mixed and Other ethnic groups. Strengths of associations between ethnicity, educational attainment and neurodevelopmental disorder varied according to which data source was used to code ethnicity. For example, as compared with White pupils, a significantly higher proportion of Asian pupils achieved expected educational attainment thresholds only if ethnicity was coded from the NPD (RR=1.46, 95% CI 1.29 to 1.64), not if ethnicity was coded from CRIS (RR=1.11, 0.98 to 1.26). CONCLUSIONS Data linkage has the potential to minimise missing ethnicity data, and overlap in ethnicity categorisations between CRIS and the NPD was generally high. However, choosing which data source to primarily code ethnicity from can have implications for analyses of ethnicity, mental health and educational outcomes. Users of linked data should exercise caution in combining and comparing ethnicity between different data sources.
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Affiliation(s)
- Alice Wickersham
- CAMHS Digital Lab, Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jayati Das-Munshi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Amelia Jewell
- Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Robert Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Johnny Downs
- CAMHS Digital Lab, Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Wan B, Wu Y, Ma N, Zhou Z, Lu W. Four modifiable factors that mediate the effect of educational time on major depressive disorder risk: A network Mendelian randomization study. PLoS One 2023; 18:e0288034. [PMID: 37437071 DOI: 10.1371/journal.pone.0288034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/18/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is a mental illness, which is a notable public health problem that aggravates the global economic burden. This study aimed to investigate the causal relationship between education and MDD risk and the contributions of effects mediated by four modifiable factors. MATERIALS AND METHODS Instrumental variables were screened from several large-scale genome-wide association study (GWAS) data (years of schooling with 766,345 participants, MDD with 59,851 cases and 113,154 controls, neuroticism with 329,821 individuals, smoking behavior with 195,068 cases and 164,638 controls, body mass index [BMI] with 336,107 individuals, and household income with 397,751 individuals). The data were used to evaluate the association of the four modifiable factors (neuroticism, smoking behavior, BMI, and household income) that mediate the effect of education on MDD risk via Mendelian randomization (MR) analysis. RESULTS Each standard deviation increase in years of schooling could reduce the risk for MDD by 30.70%. Higher neuroticism and BMI were associated with a higher risk of MDD. Non-smoking status and increased household income were protective factors for MDD. Notably, the mediator neuroticism, BMI, smoking behavior, and household income explained 52.92%, 15.54%, 31.86%, and 81.30% of the effect of years of schooling on MDD risk, respectively. CONCLUSIONS Longer years of schooling have a protective effect on MDD risk. Reasonable interventions to reduce neuroticism, BMI, smoking, and increasing household income are beneficial for MDD prevention. Our work provides new ideas for the development of prevention strategies for MDD.
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Affiliation(s)
- Bangbei Wan
- Reproductive Medical Center, Hainan Women and Children's Medical Center, Haikou, China
- Department of Urology, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou, China
| | - Yamei Wu
- Reproductive Medical Center, Hainan Women and Children's Medical Center, Haikou, China
| | - Ning Ma
- Reproductive Medical Center, Hainan Women and Children's Medical Center, Haikou, China
| | - Zhi Zhou
- Reproductive Medical Center, Hainan Women and Children's Medical Center, Haikou, China
| | - Weiying Lu
- Reproductive Medical Center, Hainan Women and Children's Medical Center, Haikou, China
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Español-Martín G, Pagerols M, Prat R, Rivas C, Ramos-Quiroga JA, Casas M, Bosch R. The impact of attention-deficit/hyperactivity disorder and specific learning disorders on academic performance in Spanish children from a low-middle- and a high-income population. Front Psychiatry 2023; 14:1136994. [PMID: 37124266 PMCID: PMC10130398 DOI: 10.3389/fpsyt.2023.1136994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/20/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction Past research has demonstrated that attention-deficit/hyperactivity disorder (ADHD), specific learning disorders (SLD), and socioeconomic status (SES) affect a host of educational outcomes. However, there are no studies examining whether SES moderates the association between these neurodevelopmental disorders (ND) and the academic achievement of children and adolescents. The present investigation examined the impact of ADHD and SLD on academic performance in 1,287 Spanish students aged 5-17 from a low-middle (LM)- and a high-income population, when adjusted for comorbidity and demographic factors that may influence educational functioning. Methods Parents completed a questionnaire regarding demographic data along with the Strengths and Difficulties Questionnaire. Additionally, teachers provided information on learning difficulties trough the Protocol for Detection and Management of Dyslexia. Teacher's Version. Academic performance across multiple domains (i.e., first language, foreign language, mathematics) was obtained from school records. ND were determined using standardized diagnostic methods based on the Diagnostic and Statistical Manual of Mental Disorders criteria. To examine the effects of ADHD and SLD on academic achievement and the potential moderating role of SES, a series of ordinal logistic regressions were conducted. Results Emotional/behavioral problems, learning difficulties, and ND were more frequent among individuals from the LM-income population. After controlling for gender, age, parental divorce/separation, grade retention, frequency of screen use, and daily meals, both ADHD and SLD were associated with worse educational outcomes. Lower SES also increased the risk for academic impairment, although the interactions with ADHD or SLD were not significant. Conclusion These findings indicate that ADHD and SLD exert a pervasive impact on academic performance across different socioeconomic backgrounds. Therefore, early detection and effective intervention strategies aimed at students with these ND are crucial to improve their educational functioning and mitigate the negative consequences related to academic problems.
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Affiliation(s)
- Gemma Español-Martín
- Servei de Psiquiatria, Vall d’Hebron Hospital Universitari, Barcelona, Spain
- Grup de Psiquiatria, Salut Mental i Addiccions, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Barcelona, Spain
- Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Mireia Pagerols
- Programa MIND Escoles, Hospital Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Unitat de Farmacologia, Departament de Fonaments Clínics, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
- *Correspondence: Mireia Pagerols,
| | - Raquel Prat
- Programa MIND Escoles, Hospital Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Centre for Health and Social Care Research (CEES), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain
| | - Cristina Rivas
- Programa MIND Escoles, Hospital Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Josep Antoni Ramos-Quiroga
- Servei de Psiquiatria, Vall d’Hebron Hospital Universitari, Barcelona, Spain
- Grup de Psiquiatria, Salut Mental i Addiccions, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Barcelona, Spain
- Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Miquel Casas
- Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Programa MIND Escoles, Hospital Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Rosa Bosch
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Programa MIND Escoles, Hospital Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
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