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Tseliou F, Riglin L, Thapar AK, Heron J, Dennison CA, Armitage JM, Thapar A, Rice F, Collishaw S. Childhood correlates and young adult outcomes of trajectories of emotional problems from childhood to adolescence. Psychol Med 2024:1-11. [PMID: 38494928 DOI: 10.1017/s0033291724000631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
BACKGROUND Emotional problems, especially anxiety, have become increasingly common in recent generations. Few population-based studies have examined trajectories of emotional problems from early childhood to late adolescence or investigated differences in psychiatric and functional outcomes. METHODS Using the Avon Longitudinal Study of Parents and Children (ALSPAC, n = 8286, 50.4% male), we modeled latent class growth trajectories of emotional problems, using the parent-reported Strength and Difficulties Questionnaire emotional scale (SDQ-E) on seven occasions (4-17 years). Psychiatric outcomes in young adulthood (21-25 years) were major depressive disorder (MDD), generalized anxiety disorder (GAD), and self-harm. Functional outcomes were exam attainment, educational/occupational status, and social relationship quality. RESULTS We identified four classes of emotional problems: low (67.0%), decreasing (18.4%), increasing (8.9%), and persistent (5.7%) problems. Compared to those in the low class, individuals with decreasing emotional problems were not at elevated risk of any poor adult outcome. Individuals in the increasing and persistent classes had a greater risk of adult MDD (RR: 1.59 95% CI 1.13-2.26 and RR: 2.25 95% CI 1.49-3.41) and self-harm (RR: 2.37 95% CI 1.91-2.94 and RR: 1.87 95% CI 1.41-2.48), and of impairment in functional domains. Childhood sleep difficulties, irritability, conduct and neurodevelopmental problems, and family adversity were associated with a persistent course of emotional problems. CONCLUSIONS Childhood emotional problems were common, but those whose symptoms improved over time were not at increased risk for adverse adult outcomes. In contrast, individuals with persistent or adolescent-increasing emotional problems had a higher risk of mental ill-health and social impairment in young adulthood which was especially pronounced for those with persistent emotional problems.
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Affiliation(s)
- F Tseliou
- Wolfson Centre for Young People's Mental Health, Cardiff University, Wales, UK
- Division of Psychological Medicine and Clinical Neurosciences, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Wales, UK
| | - L Riglin
- Wolfson Centre for Young People's Mental Health, Cardiff University, Wales, UK
- Division of Psychological Medicine and Clinical Neurosciences, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Wales, UK
| | - A K Thapar
- Wolfson Centre for Young People's Mental Health, Cardiff University, Wales, UK
- Division of Psychological Medicine and Clinical Neurosciences, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Wales, UK
| | - J Heron
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK
| | - C A Dennison
- Wolfson Centre for Young People's Mental Health, Cardiff University, Wales, UK
- Division of Psychological Medicine and Clinical Neurosciences, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Wales, UK
| | - J M Armitage
- Wolfson Centre for Young People's Mental Health, Cardiff University, Wales, UK
- Division of Psychological Medicine and Clinical Neurosciences, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Wales, UK
| | - A Thapar
- Wolfson Centre for Young People's Mental Health, Cardiff University, Wales, UK
- Division of Psychological Medicine and Clinical Neurosciences, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Wales, UK
| | - F Rice
- Wolfson Centre for Young People's Mental Health, Cardiff University, Wales, UK
- Division of Psychological Medicine and Clinical Neurosciences, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Wales, UK
| | - S Collishaw
- Wolfson Centre for Young People's Mental Health, Cardiff University, Wales, UK
- Division of Psychological Medicine and Clinical Neurosciences, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Wales, UK
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Rice F, Riglin L, Lomax T, Souter E, Potter R, Smith DJ, Thapar AK, Thapar A. Adolescent and adult differences in major depression symptom profiles. J Affect Disord 2019; 243:175-181. [PMID: 30243197 DOI: 10.1016/j.jad.2018.09.015] [Citation(s) in RCA: 129] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 08/02/2018] [Accepted: 09/09/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Depression is the leading global cause of disability and often begins in adolescence. The genetic architecture and treatment response profiles for adults and adolescents differ even though identical criteria are used to diagnose depression across different age groups. There is no clear consensus on how these groups differ in their symptom profiles. METHODS Using data from a two-generation family study, we compared the presentation of DSM-IV depressive symptoms in adolescents and adults with MDD (Major Depressive Disorder). We also compared DSM-IV depressive symptom counts using latent class analysis. RESULTS Vegetative symptoms (appetite and weight change, loss of energy and insomnia) were more common in adolescent MDD than adult MDD. Anhedonia/loss of interest and concentration problems were more common in adults with MDD. When using latent class analysis to look at depressive symptoms, a vegetative symptom profile was also seen in adolescent depression only. LIMITATIONS Adults and adolescents were recruited in different ways. Adolescent cases were more likely to be first-onset while adult cases were recurrences. It was not possible to examine how recurrence affected adolescent depression symptom profiles. CONCLUSION Differences in how depression presents in adolescents and adults may be consistent with different pathophysiological mechanisms. For adolescents, we found that vegetative/physical disturbances were common (loss of energy, changes in weight, appetite and sleep changes). For adults, anhedonia/loss of interest and concentration difficulties were more common.
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Affiliation(s)
- F Rice
- Division of Psychological Medicine & Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics & Genomics Cardiff University, United Kingdom.
| | - L Riglin
- Division of Psychological Medicine & Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics & Genomics Cardiff University, United Kingdom
| | - T Lomax
- Division of Psychological Medicine & Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics & Genomics Cardiff University, United Kingdom
| | - E Souter
- Division of Psychological Medicine & Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics & Genomics Cardiff University, United Kingdom
| | - R Potter
- Division of Psychological Medicine & Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics & Genomics Cardiff University, United Kingdom
| | - D J Smith
- Institute of Health and Wellbeing, University of Glasgow, Scotland
| | - A K Thapar
- Division of Psychological Medicine & Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics & Genomics Cardiff University, United Kingdom
| | - A Thapar
- Division of Psychological Medicine & Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics & Genomics Cardiff University, United Kingdom
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Riglin L, Eyre O, Cooper M, Collishaw S, Martin J, Langley K, Leibenluft E, Stringaris A, Thapar AK, Maughan B, O'Donovan MC, Thapar A. Investigating the genetic underpinnings of early-life irritability. Transl Psychiatry 2017; 7:e1241. [PMID: 28949337 PMCID: PMC5639253 DOI: 10.1038/tp.2017.212] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 07/30/2017] [Indexed: 02/01/2023] Open
Abstract
Severe irritability is one of the commonest reasons prompting referral to mental health services. It is frequently seen in neurodevelopmental disorders that manifest early in development, especially attention-deficit/hyperactivity disorder (ADHD). However, irritability can also be conceptualized as a mood problem because of its links with anxiety/depressive disorders; notably DSM-5 currently classifies severe, childhood-onset irritability as a mood disorder. Investigations into the genetic nature of irritability are lacking although twin studies suggest it shares genetic risks with both ADHD and depression. We investigated the genetic underpinnings of irritability using a molecular genetic approach, testing the hypothesis that early irritability (in childhood/adolescence) is associated with genetic risk for ADHD, as indexed by polygenic risk scores (PRS). As a secondary aim we investigated associations between irritability and PRS for major depressive disorder (MDD). Three UK samples were utilized: two longitudinal population-based cohorts with irritability data from childhood (7 years) to adolescence (15-16 years), and one ADHD patient sample (6-18 years). Irritability was defined using parent reports. PRS were derived from large genome-wide association meta-analyses. We observed associations between ADHD PRS and early irritability in our clinical ADHD sample and one of the population samples. This suggests that early irritability traits share genetic risk with ADHD in the general population and are a marker of higher genetic loading in individuals with an ADHD diagnosis. Associations with MDD PRS were not observed. This suggests that early-onset irritability could be conceptualized as a neurodevelopmental difficulty, behaving more like disorders such as ADHD than mood disorders.
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Affiliation(s)
- L Riglin
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, Wales, UK
| | - O Eyre
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, Wales, UK
| | - M Cooper
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, Wales, UK
| | - S Collishaw
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, Wales, UK
| | - J Martin
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, Wales, UK
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - K Langley
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, Wales, UK
- School of Psychology, Cardiff University, Cardiff, Wales, UK
| | - E Leibenluft
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - A Stringaris
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - A K Thapar
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, Wales, UK
| | - B Maughan
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - M C O'Donovan
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, Wales, UK
| | - A Thapar
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, Wales, UK
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Abstract
BACKGROUND Most individuals with current epilepsy are solely under the care of the primary care team for follow-up care. Government working party recommendations, expert epilepsy panels and patients have also stressed the central role of the GP in follow-up care. Problems in the provision of care in the community have, however, repeatedly been highlighted. The views of GPs about service provision for people with epilepsy may be an important barrier to providing care, but have not yet been studied in a systematic manner. OBJECTIVES We aimed to ascertain the views of GPs on service provision for people with epilepsy in primary care and on specific initiatives to improve care. METHOD A specially designed postal questionnaire was sent to all 262 GPs on the list of West Glamorgan FHSA. It ascertained what GPs felt their role should be in providing care to people with epilepsy, identified their views on the importance of particular problems in providing this care, as well as obtaining their opinions on possible future initiatives to improve epilepsy care in the community. RESULTS The overall response rate was 70%. Although a majority of responding GPs (55%) agreed that the care of people with epilepsy should be based in general practice, 23% disagreed. A lack of confidence about knowledge of epilepsy (34% responders), unfamiliarity with new drugs (65% responders) and a lack of time (41% responders) were identified as important perceived barriers to providing epilepsy care. Nearly all responding GPs would welcome guidelines for epilepsy care (93% felt they would be very helpful) and an epilepsy liaison nurse in the community was the most popular option in terms of preferred overall strategy for improving care. CONCLUSIONS Despite 40 years of official recommendations regarding the central role of the GP in the follow-up care of people with epilepsy, a number of GPs have difficulty in providing this care. Many feel that they lack knowledge or are too time pressured to improve the situation. Nearly all GPs say that they would find guidelines for epilepsy care very helpful and over half would find epilepsy liaison nurses helpful. There is scope for more innovative ideas for epilepsy care in the community.
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Thapar AK. Care of patients with epilepsy in the community: will new initiatives address old problems? Br J Gen Pract 1996; 46:37-42. [PMID: 8745851 PMCID: PMC1239510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Epilepsy is a serious neurological condition that has important medical, psychological and social consequences. Up to 90% of patients with epilepsy are not under hospital supervision at any one time; the role of the general practitioner is therefore of central importance. There seems little doubt that community care of people with epilepsy must be improved. This article reviews the research findings on the quality of care of people with epilepsy, examines the barriers to effective community care, and looks at local and national initiatives to improve the care of patients with epilepsy in the community. Finally, the review considers how care can best be provided in an efficient, effective and acceptable manner within the resources of present day general practice. A patient-centred model is proposed that would tailor care to the needs of the individual patient.
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Affiliation(s)
- A K Thapar
- University of Wales College of Medicine, Cardiff
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Thapar AK, Thapar A. Psychological sequelae of miscarriage: a controlled study using the general health questionnaire and the hospital anxiety and depression scale. Br J Gen Pract 1992; 42:94-6. [PMID: 1493042 PMCID: PMC1371991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
This study was carried out to assess whether psychiatric morbidity after a miscarriage is higher than that associated with early pregnancy. A total of 60 consecutive women admitted to a Swansea hospital with a miscarriage were compared with 62 consecutive women who attended an antenatal clinic at the same hospital, using the 28-item general health questionnaire and the hospital anxiety and depression scale. These were completed both at initial contact and six weeks later. Women who had had a miscarriage were found to be significantly more anxious and scored higher on the subscale for severe depression than the pregnant women, both at initial assessment and six weeks later. At the six week assessment more somatic symptoms were also experienced by the group who had had a miscarriage. This study highlights the psychological disturbance associated with miscarriage. The primary health care team and hospital staff need to take this into consideration when organizing follow up for women who have had a miscarriage.
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Affiliation(s)
- A K Thapar
- Health Clinic, Aberbargoed, Mid Glamorgan
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