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Bailey S, Newton N, Perry Y, Grummitt L, Goldbach J, Barrett E. It's time for change: inequities and determinants of health-related quality of life among gender and sexually diverse young people in Australia. Qual Life Res 2024:10.1007/s11136-024-03633-z. [PMID: 38605187 DOI: 10.1007/s11136-024-03633-z] [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] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE This study was guided by three research aims: firstly, to examine the longitudinal trends of health-related quality of life (HR-QoL) among gender and sexuality diverse (LGBTQA2S+) young people through adolescence (ages 14-19); secondly, to assess longitudinal associations between poor mental health and HR-QoL among LGBTQA2S+ young people through adolescence; and thirdly, to examine differences in HR-QoL among LGBTQA2S+ young people during early adolescence (ages 14 and 15) depending on select school-, peer-, and parent-level factors. METHODS This study used three of nine available waves of data from a large population-level, probability sample-based, longitudinal cohort study, namely the K' cohort: children aged 4-5 years old at time of study enrolment followed-up biennially (~ 61% retention rate). HR-QoL weighted means and standard deviations were calculated using Child Health Utility 9D (CHU-9D) scores for LGBTQA2S+ participants at ages 14 and 15 (Wave 6), ages 16 and 17 (Wave 7), and ages 18 and 19 (Wave 8). To strategically identify policy-relevant modifiable behavioural factors suitable for prevention and early intervention, non-parametric Wilcoxon signed-rank tests tested differences in mean CHU-9D ranks at ages 14 and 15 (Wave 6) between groups (gender identity: trans vs. cis; identity-level sexuality: gay, lesbian, bisexual, or other diverse sexuality vs. heterosexual; group-level sexuality: sexually diverse vs. not sexually diverse) and selected school factors (school acceptance, belonging, freedom of expression), peer factors (peer relationship quality, trust, respect), and family factors (parental acceptance, understanding, trust), with Hedge's g correction statistics computed for effect sizes. Longitudinal associations between gender, sexuality, and poor mental health (depressive symptoms, anxiety, symptoms, self-harm thoughts/behaviour, and suicidal thoughts/behaviour) and HR-QoL were tested using mixed-effects models with random intercepts and random slopes for nested clustering (participants within postcodes). RESULTS HR-QoL disparities disproportionately affecting LGBTQA2S+ groups relative to their cisgender, heterosexual peers, were well-established by age 14 to 15 relatively steeper reductions in HR-QoL were observed throughout adolescence among all LGBTQA2S+ groups, with HR-QoL widening the most for trans participants. Poor mental health was significantly associated with HR-QoL declines. LGBTQA2S+ participants with positive school- and parent factors related to feelings of acceptance, belonging, and freedom of self-expression, reported significantly higher HR-QoL during early adolescence. CONCLUSION Evidence-based public health policy responses are required to address the dire HR-QoL inequities among LGBTQA2S+ young people, particularly trans young people. Prioritising the promotion of school- and family-based interventions which foster LGBTQA2S+ inclusivity, acceptance, and a sense of belonging from early adolescence through young adulthood, represents a feasible, evidence-based, and cost-effective response to address these HR-QoL disparities.
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Affiliation(s)
- Sasha Bailey
- The Matilda Centre for Research in Mental Health and Substance Use, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Nicola Newton
- The Matilda Centre for Research in Mental Health and Substance Use, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Yael Perry
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Lucinda Grummitt
- The Matilda Centre for Research in Mental Health and Substance Use, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jeremy Goldbach
- The Brown School, Washington University in St. Louis, St. Louis, USA
| | - Emma Barrett
- The Matilda Centre for Research in Mental Health and Substance Use, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Bailey S, Newton NC, Perry Y, Lin A, Grummitt L, Barrett EL. Mental ill-health and substance use among sexuality diverse adolescents: The critical role of school climate and teacher self-efficacy. Aust N Z J Psychiatry 2024; 58:162-174. [PMID: 37772601 PMCID: PMC10838476 DOI: 10.1177/00048674231202427] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
INTRODUCTION Mental ill-health, substance use and their co-occurrence among sexuality diverse young people during earlier adolescence is relatively understudied. The preventive utility of positive school climate for sexuality diverse adolescents' mental health is also unclear, as well as the role of teachers in conferring this benefit. METHOD Using Wave 8 'B Cohort' data from the Longitudinal Study of Australian children (N = 3127, Mage = 14.3), prevalence ratios and odds ratios were used to assess prevalence and disparities in mental ill-health and substance use, and multinomial logistic regression for co-occurring outcomes, among sexuality diverse adolescents relative to heterosexual peers. Logistic regression was used to assess associations between school climate and teacher self-efficacy with sexuality diverse adolescents' mental health. RESULTS Mental ill-health prevalence ranged from 22% (suicidal thoughts/behaviour) to 46% (probable depressive disorders) and substance use between 66% (cigarette use) and 97% (alcohol use). Sexuality diverse participants were significantly more likely to report self-harm and high levels of emotional symptoms in co-occurrence with cigarette, alcohol and/or cannabis use. For each 1-point increase in school climate scores as measured by the Psychological Sense of School Membership scale, there was 10% reduction in sexuality diverse adolescents reporting high levels of emotional symptoms, probable depressive disorder, self-harm thoughts/behaviour and suicidal thoughts/behaviour. For each 1-point increase in lower perceived (worse) teacher self-efficacy scores as measured by four bespoke teacher self-efficacy items, odds of sexuality diverse adolescent-reported suicidal thoughts/behaviour increased by 80%. DISCUSSION Mental ill-health, substance use and especially their co-occurrence, are highly prevalent and pose significant and inequitable health and well-being risks. Schools represent a potential site for focusing future prevention efforts and educating and training teachers on sexuality diversity is a promising pathway towards optimising these.
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Affiliation(s)
- Sasha Bailey
- The Matilda Centre for Research in Mental Health and Substance Use, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Nicola C Newton
- The Matilda Centre for Research in Mental Health and Substance Use, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Yael Perry
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Ashleigh Lin
- The University of Western Australia, Perth, WA, Australia
| | - Lucinda Grummitt
- The Matilda Centre for Research in Mental Health and Substance Use, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Emma L Barrett
- The Matilda Centre for Research in Mental Health and Substance Use, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Bailey S, Newton N, Perry Y, Davies C, Lin A, Marino JL, Skinner RS, Grummitt L, Barrett E. Minority stressors, traumatic events, and associations with mental health and school climate among gender and sexuality diverse young people in Australia: Findings from a nationally representative cohort study. J Adolesc 2024; 96:275-290. [PMID: 38018791 DOI: 10.1002/jad.12274] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 09/19/2023] [Accepted: 11/07/2023] [Indexed: 11/30/2023]
Abstract
INTRODUCTION Population-level, nationally representative data on the prevalence of minority stressors and traumatic events, mental ill-health effects, and the preventative utility of school climate, among gender and sexuality diverse young people in Australia, is significantly lacking. In this study, we estimated the prevalence and distribution of minority stressors and traumatic events among young people by sexuality identity (gay/lesbian, bisexual, other sexuality, heterosexual), sexuality diversity (sexuality diverse, not sexuality diverse), and gender identity (transgender, cisgender) and assessed associations with mental ill-health and the moderating role of school climate factors. METHODS Using Wave 8 (2018) follow-up data from a population-level, nationally representative longitudinal cohort study, the sample comprised 3037 young people aged 17-19 years in Australia. Prevalence ratios for minority stressors and traumatic events were calculated for gender and sexuality diverse categories using logistic regression models. Linear regression models were used to test associations between traumatic events and minority stressors, and mental ill-health. Multivariate linear regression tested school climate factors as effect modifier between minority stressors and mental ill-health among sexuality diverse young people. RESULTS Rates of traumatic events and minority stressors were highest among bisexual and gay/lesbian young people and were significantly associated with mental ill-health among all gender and sexuality diverse young people. Highest mental ill-health effects were observed among trans young people. Among sexuality diverse young people, positive and negative feelings toward school climate were associated with decreased and increased mental ill-health, respectively. After accounting for sexuality diversity, positive overall school climate appeared protective of mental ill-health effects of sexuality-based discrimination. DISCUSSION Minority stressors, traumatic events, and associated mental ill-health are prevalent among gender and sexuality diverse young people in Australia, especially trans, bisexual, and gay/lesbian young people. Promotion of affirmative, safe, and inclusive school climate demonstrates significant promise for the prevention and early intervention of mental ill-health among gender and sexuality diverse young people.
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Affiliation(s)
- Sasha Bailey
- The Matilda Centre for Research in Mental Health and Substance Use, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Nicola Newton
- The Matilda Centre for Research in Mental Health and Substance Use, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Yael Perry
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Cristyn Davies
- School of Medicine, Specialty of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Ashleigh Lin
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, The University of Melbourne, Parkville, Australia
- School of Population Health, University of Western Australia, Perth, Australia
| | - Jennifer L Marino
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
- Melbourne School of Population and Global Health, Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Australia
- The Royal Children's Hospital, Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Australia
| | - Rachel S Skinner
- School of Medicine, Specialty of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Lucinda Grummitt
- The Matilda Centre for Research in Mental Health and Substance Use, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Emma Barrett
- The Matilda Centre for Research in Mental Health and Substance Use, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Grummitt L, Kelly EV, Newton NC, Stapinski L, Lawler S, Prior K, Barrett EL. Self-compassion and avoidant coping as mediators of the relationship between childhood maltreatment and mental health and alcohol use in young adulthood. Child Abuse Negl 2023:106534. [PMID: 37945423 DOI: 10.1016/j.chiabu.2023.106534] [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] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 10/15/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Exposure to childhood maltreatment increases the risk of mental health and substance use problems. Understanding the mechanisms linking maltreatment to these problems is critical for prevention. OBJECTIVE To examine whether self-compassion and avoidant coping mediate the relationship between childhood maltreatment and mental ill-health and alcohol use. PARTICIPANTS AND SETTING Australians aged 18-20 years at baseline were recruited through social media and professional networks. METHODS Participants (n = 568) completed an online survey, and were followed up annually for two subsequent surveys. Mediation models were conducted with the SPSS PROCESS macro. Maltreatment was the predictor; Wave 2 self-compassion and avoidant coping as mediators; Wave 3 mental health and alcohol use as outcomes. RESULTS Childhood maltreatment predicted greater mental health symptoms (b = 0.253, 95 % CI = 0.128-0.378), and alcohol use (b = 0.057, 95 % CI = 0.008-0.107). Both self-compassion (b = 0.056, 95 % CI = 0.019-0.093) and avoidant coping (b = 0.103, 95 % CI = 0.024-0.181) mediated the relationship between maltreatment and mental health. Additionally, avoidant coping, but not self-compassion, mediated the relationship (b = 0.040, 95 % CI 0.020-0.061) with alcohol use. However, when controlling for pre-existing mental health and substance use, neither self-compassion nor avoidant coping mediated the relationship with mental health. Only avoidant coping mediated the link with alcohol use (b = 0.010, 95 % CI = 0.001-0.020). CONCLUSIONS Findings suggests that by adulthood, self-compassion and avoidant coping may not explain future change in mental health symptoms; however, avoidant coping accounts for change in alcohol use across early adulthood. Reducing avoidant coping may prevent hazardous alcohol use across young adulthood among people exposed to childhood maltreatment.
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Affiliation(s)
- Lucinda Grummitt
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Camperdown 2006, NSW, Australia.
| | - Erin V Kelly
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Camperdown 2006, NSW, Australia.
| | - Nicola C Newton
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Camperdown 2006, NSW, Australia.
| | - Lexine Stapinski
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Camperdown 2006, NSW, Australia.
| | - Siobhan Lawler
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Camperdown 2006, NSW, Australia.
| | - Katrina Prior
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Camperdown 2006, NSW, Australia.
| | - Emma L Barrett
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Camperdown 2006, NSW, Australia.
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Bailey S, Newton N, Perry Y, Grummitt L, Baams L, Barrett E. Trauma-informed prevention programmes for depression, anxiety, and substance use among young people: protocol for a mixed-methods systematic review. Syst Rev 2023; 12:203. [PMID: 37907971 PMCID: PMC10617188 DOI: 10.1186/s13643-023-02365-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/07/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Mental ill-health and substance use bear a substantial burden and harm on young people and often arise from co-occurring and compounding risk factors, such as traumatic stress. Trauma-informed prevention of mental ill-health and substance use demonstrates significant promise in reducing this burden. A systematic literature review is required to identify and summarise the effectiveness, feasibility, acceptability, and design principles underpinning existing trauma-informed mental ill-health and/or substance use prevention programmes for young people aged 12-24 years. METHODS MEDLINE, Embase, CINAHL, PsychINFO, and Cochrane Library will be searched from 2012 through September 2022. Reference lists of included articles will be citation-chained. Title and abstracts will be screened and two reviewers will review articles full-text. One reviewer will extract data from eligible articles using a piloted data extraction form, and 20% of the data will be verified by a second reviewer. Risk of bias will be assessed using the Cochrane risk-of-bias tool for randomised trials (RoB 2), Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I), and The Joanna Briggs Institute Critical Appraisal Checklist for Quasi-Experimental Studies and The Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research (CASP), depending on the study type. Characteristics of existing trauma-informed mental ill-health and/or substance use prevention programmes for young people will be summarised narratively. Effectiveness, feasibility, and acceptability will be qualitatively described and summarised, with proportions and effect sizes quantitatively synthesised, where possible. DISCUSSION Trauma-informed approaches to prevention demonstrate significant promise, yet to date, no study has systematically summarised and synthesised the available literature. To fill this gap, the present review will systematically identify and summarise the effectiveness, feasibility, acceptability, and design principles underpinning existing trauma-informed mental health and/or substance use prevention programmes for young people aged 12-24. This review will inform the development, adaptation, evaluation, and implementation of future trauma-informed mental ill-health and substance use prevention programmes for young people. Findings will inform critical efforts to interrupt and prevent already elevated trajectories of mental ill-health, substance use, and related harms among those young people exposed to adversity. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022353883.
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Affiliation(s)
- S Bailey
- The Matilda Centre for Research in Mental Health and Substance Use, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - N Newton
- The Matilda Centre for Research in Mental Health and Substance Use, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Y Perry
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - L Grummitt
- The Matilda Centre for Research in Mental Health and Substance Use, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - L Baams
- University of Groningen, Groningen, Netherlands
| | - E Barrett
- The Matilda Centre for Research in Mental Health and Substance Use, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Teh JZ, Grummitt L, Haroutonian C, Cross NE, Skinner B, Bartlett DJ, Yee B, Grunstein RR, Naismith SL, D’Rozario AL. Overnight declarative memory consolidation and non-rapid eye movement sleep electroencephalographic oscillations in older adults with obstructive sleep apnea. Sleep 2023; 46:zsad087. [PMID: 37052122 PMCID: PMC10666962 DOI: 10.1093/sleep/zsad087] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 03/01/2023] [Indexed: 04/14/2023] Open
Abstract
STUDY OBJECTIVES To compare overnight declarative memory consolidation and non-rapid eye movement (NREM) sleep electroencephalogram (EEG) oscillations in older adults with obstructive sleep apnea (OSA) to a control group and assess slow-wave activity (SWA) and sleep spindles as correlates of memory consolidation. METHODS Forty-six older adults (24 without OSA and 22 with OSA) completed a word-pair associate's declarative memory task before and after polysomnography. Recall and recognition were expressed as a percentage of the morning relative to evening scores. Power spectral analysis was performed on EEG recorded at frontal (F3-M2, F4-M1) and central (C3-M2, C4-M1) sites. We calculated NREM absolute slow oscillation (0.25-1 Hz) and delta (0.5-4.5 Hz) EEG power, and slow (11-13 Hz) spindle density (number of events per minute of N2 sleep) and fast (13-16 Hz) spindle density. RESULTS There were no significant differences in overnight recall and recognition between OSA (mean age 58.7 ± 7.1 years, apnea-hypopnea index (AHI) 41.9 ± 29.7 events/hour) and non-OSA (age 61.1 ± 10.3 years, AHI 6.6 ± 4.2 events/hour) groups. The OSA group had lower fast spindle density in the frontal region (p = 0.007). No between-group differences in SWA were observed. In the Control group, overnight recognition positively correlated with slow spindle density in frontal (rho = 0.555, p = 0.020) and central regions (rho = 0.490, p = 0.046). Overnight recall was not related to SWA or spindle measures in either group. CONCLUSIONS Older adults with OSA had deficits in fast sleep spindles but showed preserved overnight declarative memory consolidation. It is possible that compensatory mechanisms are being recruited by OSA patients to preserve declarative memory consolidation despite the presence of sleep spindle deficits.
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Affiliation(s)
- Jun Z Teh
- School of Psychology, Faculty of Science, Brain and Mind Centre and Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
- NHMRC Centre of Research Excellence to Optimise Sleep in Brain Ageing and Neurodegeneration (CogSleep CRE), Sydney, NSW, Australia
| | - Lucinda Grummitt
- School of Psychology, Faculty of Science, Brain and Mind Centre and Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - Carla Haroutonian
- School of Psychology, Faculty of Science, Brain and Mind Centre and Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
| | - Nathan E Cross
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
| | - Bradley Skinner
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
| | - Delwyn J Bartlett
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
- NHMRC Centre of Research Excellence to Optimise Sleep in Brain Ageing and Neurodegeneration (CogSleep CRE), Sydney, NSW, Australia
| | - Brendon Yee
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW, Australia
| | - Ronald R Grunstein
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
- NHMRC Centre of Research Excellence to Optimise Sleep in Brain Ageing and Neurodegeneration (CogSleep CRE), Sydney, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW, Australia
| | - Sharon L Naismith
- School of Psychology, Faculty of Science, Brain and Mind Centre and Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
- NHMRC Centre of Research Excellence to Optimise Sleep in Brain Ageing and Neurodegeneration (CogSleep CRE), Sydney, NSW, Australia
| | - Angela L D’Rozario
- School of Psychology, Faculty of Science, Brain and Mind Centre and Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
- CIRUS Centre for Sleep and Chronobiology, Woolcock Institute of Medical Research, Macquarie University, Sydney, NSW, Australia
- NHMRC Centre of Research Excellence to Optimise Sleep in Brain Ageing and Neurodegeneration (CogSleep CRE), Sydney, NSW, Australia
- School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
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Grummitt L, Barrett E, Kelly E, Newton N. An Umbrella Review of the Links Between Adverse Childhood Experiences and Substance Misuse: What, Why, and Where Do We Go from Here? Subst Abuse Rehabil 2022; 13:83-100. [PMID: 36411791 PMCID: PMC9675346 DOI: 10.2147/sar.s341818] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 11/09/2022] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND AND OBJECTIVES A wealth of research has identified adverse childhood experiences (ACEs; abuse, neglect, violence or disorder in the home) as a strong risk factor for substance misuse. Synthesis of the existing evidence is critical to shape policy and inform directions for future research. Existing reviews have focused on specific substances or substance use outcomes (eg, disorder), and do not include discussion of the mechanisms that operate between ACEs and substance misuse. The current umbrella review aims to synthesize reviews on the relationship between ACEs and substance misuse, review the evidence on the mechanisms linking these, identify existing gaps in our knowledge, and discuss critical directions for future research, practice, and public policy. METHODS Two electronic databases (PsycINFO and Medline) were searched for reviews published between 1998 and 2022 on the link between ACEs and substance misuse. Twenty articles met eligibility criteria and were qualitatively synthesized. RESULTS Results overwhelmingly demonstrated an elevated risk of substance misuse or disorder, among adolescents and adults exposed to ACEs. Research on the mechanisms that explain this link highlights a multitude of potential intervention targets, with childhood stress propelling a cascade of effects across neurobiological, endocrine, immune, metabolic, and nervous systems, impacting psychosocial and cognitive functioning. Nonetheless, the literature is subject to limitations surrounding potential unmeasured cofounders and causality, as well as decontextualizing childhood adversity from broader structural issues that influence the link between ACEs and substance misuse. Research, policy, and practice that seek to holistically understand and address the relationship between ACEs and substance misuse within the broader social determinants of health is crucial.
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Affiliation(s)
- Lucinda Grummitt
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Camperdown, NSW, Australia
| | - Emma Barrett
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Camperdown, NSW, Australia
| | - Erin Kelly
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Camperdown, NSW, Australia
| | - Nicola Newton
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Camperdown, NSW, Australia
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Newton NC, Debenham J, Slade T, Smout A, Grummitt L, Sunderland M, Barrett EL, Champion KE, Chapman C, Kelly E, Lawler S, Castellanos-Ryan N, Teesson M, Conrod PJ, Stapinski L. Effect of Selective Personality-Targeted Alcohol Use Prevention on 7-Year Alcohol-Related Outcomes Among High-risk Adolescents: A Secondary Analysis of a Cluster Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2242544. [PMID: 36394873 PMCID: PMC9672969 DOI: 10.1001/jamanetworkopen.2022.42544] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
IMPORTANCE Alcohol consumption is one of the leading preventable causes of burden of disease worldwide. Selective prevention of alcohol use can be effective in delaying the uptake and reducing harmful use of alcohol during the school years; however, little is known about the durability of these effects across the significant transition from early adolescence into late adolescence and early adulthood. OBJECTIVE To examine the sustained effects of a selective personality-targeted alcohol use prevention program on alcohol outcomes among adolescents who report high levels of 1 of 4 personality traits associated with substance use. DESIGN, SETTING, AND PARTICIPANTS A cluster randomized clinical trial was conducted to assess the effectiveness of the selective personality-targeted PreVenture program on reducing the growth of risky alcohol use and related harms from early to late adolescence and early adulthood. Participants included grade 8 students attending 14 secondary schools across New South Wales and Victoria, Australia, in 2012 who screened as having high levels of anxiety sensitivity, negative thinking, impulsivity, and/or sensation seeking. Schools were block randomized to either the PreVenture group (7 schools) or the control group (7 schools). The primary end point of the original trial was 2 years post baseline; the present study extends the follow-up period from July 1, 2017, to December 1, 2019, 7 years post baseline. Data were analyzed from July 22, 2021, to August 2, 2022. INTERVENTIONS The PreVenture program is a 2-session, personality-targeted intervention designed to upskill adolescents to better cope with their emotions and behaviors. MAIN OUTCOMES AND MEASURES Self-reported monthly binge drinking, alcohol-related harms, and hazardous alcohol use measured by the Alcohol Use Disorders Identification Test-Concise consumption screener. RESULTS Of 438 participants (249 male [56.8%]; mean [SD] age, 13.4 [0.5] years) from 14 schools, 377 (86.2%) provided follow-up data on at least 2 occasions, and among those eligible, 216 (54.0%) participated in the long-term follow-up. Compared with the control condition, the PreVenture intervention was associated with reduced odds of any alcohol-related harm (odds ratio [OR], 0.81 [95% CI, 0.70-0.94]) and a greater mean reduction in the frequency of alcohol-related harms (β = -0.22 [95% CI, -0.44 to -0.003]) at the 7.0-year follow-up. There were no differences in the odds of monthly binge drinking (OR, 0.80 [95% CI, 0.56-1.13]) or hazardous alcohol use (OR, 0.87 [95% CI, 0.59-1.27]) at the 7.0-year follow-up. Exploratory analyses at the 5.5-year follow-up showed that compared with the control condition, the PreVenture intervention was also associated with reduced odds of monthly binge drinking (OR, 0.87, [95% CI, 0.77-0.99]) and hazardous alcohol use (OR, 0.91 [95% CI, 0.84-0.99]), but this was not sustained. CONCLUSIONS AND RELEVANCE This study demonstrated that a brief selective personality-targeted alcohol use prevention intervention delivered in the middle school years can have sustained effects into early adulthood. TRIAL REGISTRATION anzctr.org.au Identifier: ACTRN12612000026820.
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Affiliation(s)
- Nicola C. Newton
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Jennifer Debenham
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Tim Slade
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Anna Smout
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Lucinda Grummitt
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Matthew Sunderland
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Emma L. Barrett
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Katrina E. Champion
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Cath Chapman
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Erin Kelly
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Siobhan Lawler
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Natalie Castellanos-Ryan
- Department of Psychiatry, University of Montreal, Montreal, Quebec, Canada
- Sainte Justine Hospital Research Centre, Montreal, Quebec, Canada
| | - Maree Teesson
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Patricia J. Conrod
- Department of Psychiatry, University of Montreal, Montreal, Quebec, Canada
- Sainte Justine Hospital Research Centre, Montreal, Quebec, Canada
| | - Lexine Stapinski
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
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Grummitt L, Kelly E, Barrett E, Keyes K, Newton N. Targets for intervention to prevent substance use in young people exposed to childhood adversity: A systematic review. PLoS One 2021; 16:e0252815. [PMID: 34097711 PMCID: PMC8183991 DOI: 10.1371/journal.pone.0252815] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/21/2021] [Indexed: 12/14/2022] Open
Abstract
Background and aims Childhood adversity is a strong, and concerningly prevalent, risk factor for the later development of substance misuse. Yet despite substantial accumulating evidence for causal mechanisms, there has been little attempt to synthesize the strength of the evidence. Importantly, these mechanisms may be amenable to intervention, providing targets for substance use prevention among those exposed to childhood adversity. The present review aimed to systematically identify mediating and moderating mechanisms operating between childhood adversity and substance use. Methods A systematic review was conducted. Electronic databases (PubMed, MEDLINE, PsycINFO, Web of Science and CINAHL) were searched from 1998 to 2020 for modifiable mediators and moderators of the relationship between childhood adversity and substance use in people aged 10–24. Data was qualitatively synthesised, using a socio-ecological perspective to group mediators/moderators into individual, interpersonal, community, and public policy/cultural levels of behaviour. Results After screening against eligibility criteria, 50 studies were included in the current review. The mediators at the individual level of behaviour showing the largest and most consistent effect sizes included externalising behaviour, anger, coping motives for substance use, and post-traumatic stress symptoms. Among individual-level moderators, religiosity, future orientation and depressive symptoms all attenuated the relationship between childhood adversity and substance use. At the interpersonal level, peer relationships and mother-child relationships mediated the effect of adversity on substance use. Moderators included family cohesion and relationship quality. Community factors were less commonly studied, though school mobility and educational achievement mediated 14% and 28% of the total effect of childhood adversity on substance use respectively. No mediators or moderators were identified for public policy/culture. Conclusions A substantial proportion of the relationship between childhood adversity and substance use in youth is mediated through individual, interpersonal and community factors. Coupled with the knowledge that existing, evidence-based programs effectively address many of the identified mediators and moderators, this review advances knowledge on optimal targets to prevent substance misuse among those exposed to childhood adversity.
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Affiliation(s)
- Lucinda Grummitt
- NHMRC Centre of Research Excellence PREMISE, The Matilda Centre for Research in Mental Health and Substance Use, Sydney Medical School, The University of Sydney, Sydney, Australia
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
- * E-mail:
| | - Erin Kelly
- NHMRC Centre of Research Excellence PREMISE, The Matilda Centre for Research in Mental Health and Substance Use, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Emma Barrett
- NHMRC Centre of Research Excellence PREMISE, The Matilda Centre for Research in Mental Health and Substance Use, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Katherine Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America
| | - Nicola Newton
- NHMRC Centre of Research Excellence PREMISE, The Matilda Centre for Research in Mental Health and Substance Use, Sydney Medical School, The University of Sydney, Sydney, Australia
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10
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Gardner LA, Champion KE, Parmenter B, Grummitt L, Chapman C, Sunderland M, Thornton L, McBride N, Newton NC. Clustering of Six Key Risk Behaviors for Chronic Disease among Adolescent Females. Int J Environ Res Public Health 2020; 17:E7211. [PMID: 33023089 PMCID: PMC7579129 DOI: 10.3390/ijerph17197211] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 09/29/2020] [Accepted: 09/29/2020] [Indexed: 12/28/2022]
Abstract
Chronic diseases are the leading cause of disability and mortality globally. In Australia, females are at heightened risk. This research explored the prevalence, patterns, and correlates of six key risk behaviors (physical inactivity, poor diet, recreational screen time, inadequate sleep, alcohol use, and smoking) among adolescent females and whether knowledge of health guidelines was associated with adherence. Adolescent females completed an anonymous online questionnaire (N = 687; Mage = 13.82). Logistic regression assessed the association between knowledge and adherence. A Latent Class Analysis (LCA) and three-step procedure identified risk behavior clusters and their correlates. Despite positive health self-ratings (77% good/very good), most participants reported insufficient moderate-to-vigorous physical activity (MVPA; 89%), vegetable intake (89%), and excessive screen time (63%). Knowledge of guidelines was associated with adherence for MVPA, vegetable intake, sleep, and alcohol abstinence. Three classes emerged: "moderate risk" (76%), "relatively active, healthy eaters" (19%), and "excessive screen users" (5%). These risk-behavior clusters were associated with perceived value of academic achievement and physical wellbeing. Adolescent females commonly perceive they are in good health, despite engaging in unhealthy behaviors. Public health interventions should utilize effective behavior change strategies, adopt a multiple health behavior change approach (MHBC), and be tailored to specific risk profiles and values among females.
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Affiliation(s)
- Lauren A. Gardner
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney 2006, Australia; (K.E.C.); (L.G.); (C.C.); (M.S.); (L.T.); (N.C.N.)
| | - Katrina E. Champion
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney 2006, Australia; (K.E.C.); (L.G.); (C.C.); (M.S.); (L.T.); (N.C.N.)
| | - Belinda Parmenter
- Department of Exercise Physiology, School of Medical Sciences, UNSW Sydney, Sydney 2052, Australia;
| | - Lucinda Grummitt
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney 2006, Australia; (K.E.C.); (L.G.); (C.C.); (M.S.); (L.T.); (N.C.N.)
| | - Cath Chapman
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney 2006, Australia; (K.E.C.); (L.G.); (C.C.); (M.S.); (L.T.); (N.C.N.)
| | - Matthew Sunderland
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney 2006, Australia; (K.E.C.); (L.G.); (C.C.); (M.S.); (L.T.); (N.C.N.)
| | - Louise Thornton
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney 2006, Australia; (K.E.C.); (L.G.); (C.C.); (M.S.); (L.T.); (N.C.N.)
| | - Nyanda McBride
- National Drug Research Institute, Curtin University, Perth 6102, Australia;
| | | | - Nicola C. Newton
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney 2006, Australia; (K.E.C.); (L.G.); (C.C.); (M.S.); (L.T.); (N.C.N.)
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11
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Nepal S, Stapinski L, Newton N, Grummitt L, Lawler S, Guckel T, Lynch S, Chapman C, Teesson M. Positive Choices: Addressing the evidence-practice gap in alcohol and other drug prevention. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Issue
Alcohol and other drug (AOD) use during adolescence puts young people at risk of juvenile offending, poor educational outcomes, school dropout, and mental health issues. Since parents and school teachers are the primary source of contact for adolescents, it is important that they are equipped with accurate and up-to-date response strategies. There are a number of effective drug prevention strategies, however, they are not widely implemented.
Description of the practice
To address this evidence-practice gap, the Positive Choices initiative was launched in 2015. Positive Choices supports implementation of evidence-based and prevention strategies through provision of training and a centralised information and resources portal for young people, their parents and teachers. The portal contains information factsheets and webinars and was developed in consultation with AOD experts and target users. Drug education resources and curriculum programs meeting pre-specified criteria for relevance, quality and evidence-base are listed in the resources database.
Results
Positive Choices has been accessed by one-million Australian and international users. The most popular resources are videos, factsheets, webinars. In 2019, 71% parents and 65% teachers said that they would continue using the website. Half (54%) of school staff were not currently implementing evidence-based prevention strategies, of these 89% intended to shift to evidence-based practice after using Positive Choices. The majority of the users have said they would recommend the website to their colleagues and friends.
Lessons
Positive Choices is effective in changing users' intentions to implement evidence-based strategies. Drug education programs need to engage parents and teachers if they are to be effective.
Key messages
Positive Choices has increased users’ awareness of evidence-based prevention strategies. Positive Choices has increased users’ intentions to implement evidence-based prevention strategies.
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Affiliation(s)
- S Nepal
- Matilda Centre for Research in Mental Health & Substance Use, University of Sydney, Darlington, Australia
| | - L Stapinski
- Matilda Centre for Research in Mental Health & Substance Use, University of Sydney, Darlington, Australia
| | - N Newton
- Matilda Centre for Research in Mental Health & Substance Use, University of Sydney, Darlington, Australia
| | - L Grummitt
- Matilda Centre for Research in Mental Health & Substance Use, University of Sydney, Darlington, Australia
| | - S Lawler
- Matilda Centre for Research in Mental Health & Substance Use, University of Sydney, Darlington, Australia
| | - T Guckel
- Matilda Centre for Research in Mental Health & Substance Use, University of Sydney, Darlington, Australia
| | - S Lynch
- Matilda Centre for Research in Mental Health & Substance Use, University of Sydney, Darlington, Australia
| | - C Chapman
- Matilda Centre for Research in Mental Health & Substance Use, University of Sydney, Darlington, Australia
| | - M Teesson
- Matilda Centre for Research in Mental Health & Substance Use, University of Sydney, Darlington, Australia
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12
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Haroutonian C, Grummitt L, Grunstein R, D'Rozario A, Naismith S. Novel word learning and lexical integration in mild cognitive impairment: role of spindles and slow wave activity in overnight consolidation. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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13
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Kelly EV, Grummitt L, Teesson M, Newton NC. Associations between personality and uptake of tobacco smoking: Do they differ across adolescence? Drug Alcohol Rev 2019; 38:818-822. [PMID: 31418960 DOI: 10.1111/dar.12975] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 07/30/2019] [Accepted: 08/01/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND AIMS Tobacco use is one of the leading causes of death globally, yet it is entirely preventable. Tobacco smoking typically begins in adolescence, and thus efforts to intervene early are vital. Personality has been identified as a risk factor for smoking in adolescence. The current study aimed to examine whether associations between personality traits (impulsivity, sensation-seeking, anxiety sensitivity and hopelessness) and new onset tobacco smoking differ across adolescence. DESIGN AND METHODS At baseline, 527 secondary-school students (mean age 13 years) completed a validated personality questionnaire and were surveyed on recent tobacco smoking. Participants were followed-up at 12-, 24- and 36-months. Logistic regression was conducted to examine prospective associations between the four personality types and tobacco smoking at each follow-up. RESULTS Results revealed age-related differences in the associations between personality and smoking in adolescence. Baseline sensation-seeking was significantly associated with new onset tobacco smoking at age 14; baseline impulsivity was significantly associated with new onset tobacco smoking at age 15; and baseline hopelessness was significantly associated with new onset tobacco smoking at age 16. DISCUSSION AND CONCLUSIONS This study extends knowledge by demonstrating age-specific effects on the association between personality and smoking. This has important implications for prevention and could inform the development of tailored smoking interventions to be delivered at different ages. Future research will examine personality-targeted intervention in reducing tobacco smoking in Australian adolescents across different ages.
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Affiliation(s)
- Erin V Kelly
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, Australia
| | - Lucinda Grummitt
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, Australia
| | - Maree Teesson
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, Australia
| | - Nicola C Newton
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, Australia
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14
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D’Rozario AL, Grummitt L, Cross NE, Bartlett DJ, Grunstein RR, Naismith S. 0848 CLINICAL, POLYSOMNOGRAPHIC AND NEUROPHYSIOLOGICAL CORRELATES OF
SLEEP-DEPENDENT MEMORY WITH AGING. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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