Validity of the Malaise Inventory in general population samples

Early life stress in relation with risk of overweight, depression, and their comorbidity across adulthood: findings from a British birth cohort

BACKGROUND

Multimorbidity, known as the co-occurrence of at least two chronic conditions, has become of increasing concern in the current context of ageing populations, though it affects all ages. Early life risk factors of multimorbidity include adverse childhood experiences (ACEs), particularly associated with psychological conditions and weight problems. Few studies have considered related mechanisms and focus on old age participants. We are interested in estimating, from young adulthood, the risk of overweight-depression comorbidity related to ACEs while adjusting for early life confounders and intermediate variables.

METHODS

We used data from the 1958 National Child Development Study, a prospective birth cohort study (N = 18 558). A four-category outcome (no condition, overweight only, depression only and, overweight-depression comorbidity) was constructed at 23, 33, and 42 years. Multinomial logistic regression models adjusting for intermediate variables co-occurring with this outcome were created. ACEs and sex interaction on comorbidity risk was tested.

RESULTS

In our study sample (N = 7762), we found that ACEs were associated with overweight-depression comorbidity risk throughout adulthood (RRR [95% CI] at 23y = 3.80 [2.10-6.88]) though less overtime. Comorbidity risk was larger than risk of separate conditions. Intermediate variables explained part of the association. After full-adjustment, an association remained (RRR [95% CI] at 23y = 2.00 [1.08-3.72]). Comorbidity risk related to ACEs differed by sex at 42.

CONCLUSION

Our study provides evidence on the link and potential mechanisms between ACEs and the co-occurrence of mental and physical diseases throughout the life-course. We suggest addressing ACEs in intervention strategies and public policies to go beyond single disease prevention.

Vegetarianism and mental health: Evidence from the 1970 British Cohort Study

BACKGROUND

Reducing animal product consumption has benefits for population health and the environment. The relationship between vegetarianism and mental health, however, remains poorly understood. This study explores this relationship in a nationally representative cohort in Great Britain.

METHODS

We use data from the 1970 British Cohort Study, which collected information on vegetarianism at age 30 in 2000 (n = 11,204) and psychological distress (PD) at ages 26, 30, 34, 42, and 46-48 in 2016/18. We first developed a statistical adjustment strategy by regressing PD at age 30 on vegetarianism and 14 confounders measured at ages 10 and 26. We then ran multilevel growth curve models, testing whether within-person changes in PD between ages 30 and 46-48 differed by vegetarianism, before and after statistical adjustment.

RESULTS

At age 30, 4.5 % of participants reported being vegetarian. In the cross-sectional models at age 30, vegetarians reported more distress compared with non-vegetarians in bivariate analysis (b = 0.30, 95%CI 0.09, 0.52), but this difference disappeared in the fully-adjusted model (b = 0.02, 95%CI -0.17, 0.21). In the longitudinal models between ages 30 and 46/48, there were no differences in within-person changes in psychological distress between vegetarians and non-vegetarians (p = .723). Sensitivity analyses using red meat consumption yielded similar findings.

CONCLUSION

In this British cohort, vegetarianism at age 30 was not associated with changes in psychological distress during mid-adulthood. Since psychological distress in early adulthood predicted vegetarianism at age 30, more studies are needed to disentangle the progression of this relationship over the life-course.

In the Words of Early Adolescents: A Novel Assessment of Positive Psychological Well-Being Predicts Young Adult Depressive Symptoms

PURPOSE

Given the burden of depression in young adulthood, identifying protective early life factors is important. Protective factors like positive psychological well-being may be challenging to assess via conventional methods if early adolescents lack personal insight or informants disagree. We investigated whether essays written by 11-year-olds could indicate the presence of positive psychological well-being and predict depressive symptom levels in young adulthood, beyond informant reports of problematic behaviors.

METHODS

Data were from 4,599 individuals in the 1958 National Child Development Study who wrote an essay at age 11 about how they imagined their life at age 25. Coders rated essays for seven facets of positive psychological well-being, which were averaged together (α = 0.92). Participants self-reported depressive symptoms (yes/no) at age 23 on the 24-item Malaise Inventory. Depressive symptoms were modeled as a sum, both continuously (range = 0-24) and dichotomously (depressed: total scores ≥8). Linear and logistic regressions adjusted for relevant age 11 covariates including teacher-reported internalizing and externalizing behaviors.

RESULTS

Unadjusted logistic regression showed a 1-SD higher positive psychological well-being score in early adolescence was associated with reduced odds of being depressed 12 years later (odds ratio = 0.83, 95% confidence interval [0.75, 0.93], p = .001). Associations remained when adjusting for all covariates (odds ratio = 0.87, 95% confidence interval [0.78, 0.98], p = .02); patterns were similar with continuous depressive symptoms.

DISCUSSION

A well-being measure derived from the words of 11-year-olds was associated with young adult depressive symptoms independent of teacher-reported internalizing and externalizing behaviors. Incorporating early adolescents' perspectives on positive functioning provides valuable information about current and future health beyond problem behaviors.

The long-term effects of childhood adiposity on depression and anxiety in adulthood: A systematic review

OBJECTIVE

This review aimed to evaluate the association between childhood adiposity and depression and anxiety risk in adulthood.

METHODS

MEDLINE, PsychInfo, Embase, CINAHL, and Scopus were searched on June 6, 2022, to identify studies that investigated the association between childhood weight status (age ≤18 years) and outcomes of depression and/or anxiety in adulthood (age ≥19 years). Study quality was assessed using the Newcastle-Ottawa Scale and results were narratively synthesized.

RESULTS

Sixteen studies were eligible for inclusion, with heterogeneity in methods and follow-up durations complicating comparisons. Six out of eight studies found a statistically significant association between childhood adiposity and increased likelihood of depression in adulthood, particularly in females. However, overall evidence was of moderate quality and study limitations prevented causal conclusions. In contrast, limited evidence and mixed findings were reported for the associations between childhood adiposity and depressive symptom severity or anxiety outcomes in adulthood.

CONCLUSIONS

Evidence suggests that childhood adiposity is associated with greater vulnerability to depression in adulthood, particularly in females. However, further research is warranted to address the limitations discussed. Future research should also explore how changes in weight status from childhood to adulthood might differentially influence the likelihood of depression.

Depression Earlier on in Life Predicts Frailty at 50 Years: Evidence from the 1958 British Birth Cohort Study

Frailty and depression in older ages have a bidirectional relationship, sharing some symptoms and characteristics. Most evidence for this has come from cross-sectional studies, or longitudinal studies with limited follow-up periods. We used data from the National Child Development Study (1958 Birth Cohort) to investigate the relationship between depression and early-onset frailty using a life course perspective. The primary outcome was frailty based on a 30-item inventory of physical health conditions, activities of daily living and cognitive function at 50 years. The main exposure was depression (based on a nine-item Malaise score ≥ 4) measured at 23, 33 and 42 years. We investigated this relationship using multiple logistic regression models adjusted for socio-demographic factors, early life circumstances and health behaviours. In fully adjusted models, when modelled separately, depression at each timepoint was associated with around twice the odds of frailty. An accumulated depression score showed increases in the odds of frailty with each unit increase (once: OR 1.92, 95%CI 1.65, 2.23; twice OR 2.33, 95%CI 1.85, 2.94; thrice: OR 2.95, 95%CI 2.11, 4.11). The public health significance of this finding is that it shows the potential to reduce the physical burden of disease later in life by paying attention to mental health at younger ages.

Does Anyone Suffer From Teenage Motherhood? Mental Health Effects of Teen Motherhood in Great Britain Are Small and Homogeneous

Teen mothers experience disadvantage across a wide range of outcomes. However, previous research is equivocal with respect to possible long-term mental health consequences of teen motherhood and has not adequately considered the possibility that effects on mental health may be heterogeneous. Drawing on data from the 1970 British Birth Cohort Study, this article applies a novel statistical machine-learning approach-Bayesian Additive Regression Trees-to estimate the effects of teen motherhood on mental health outcomes at ages 30, 34, and 42. We extend previous work by estimating not only sample-average effects but also individual-specific estimates. Our results show that sample-average mental health effects of teen motherhood are substantively small at all time points, apart from age 30 comparisons to women who first became mothers at age 25‒30. Moreover, we find that these effects are largely homogeneous for all women in the sample-indicating that there are no subgroups in the data who experience important detrimental mental health consequences. We conclude that there are likely no mental health benefits to policy and interventions that aim to prevent teen motherhood.

Does moderate to vigorous physical activity mediate the association between depression and physical function in midlife: Evidence from two British birth cohort studies

BACKGROUND

Mental health and physical health are intrinsically linked, yet the mechanisms are not well understood. We investigated whether moderate-vigorous physical activity (MVPA) mediated the association between depression and physical function (PF) in midlife.

METHODS

Individuals from two UK birth cohorts born within one week in 1958 (n = 7278) and 1970 (n = 6097) with data on depression (ages 33/34; Malaise Inventory), MVPA (age 42; self-reported) and PF (ages 50/56; Short Form-36 subscale). Covariates included sex, childhood and adulthood social class, maternal mental health, childhood mood, alcohol consumption, smoking habits, sleep, marital status, BMI and long-standing illness/disability. Linear or multinomial logistic regression models examined associations between depression, MVPA and PF. We used a parametric g-computation mediation analysis approach to estimate percent differences in PF.

RESULTS

Depression was associated with less frequent MVPA and poorer PF. Lower MVPA was associated with worse PF. The direct effect - randomised analogue not operating via MVPA - of depression on PF was -18.8 % (95%CI:--25.8,-11.8) and -15.8 % (20.6,-11.0) in the 1958 and 1970 cohorts, respectively. The indirect effect - operating via MVPA - was -0.5 % (-1.0,-0.03) and -0.2 % (-0.6, 0.3), resulting in a total proportion mediated of 3.1 % (0.1, 6.0) and 0.9 % (-1.6, 3.4).

LIMITATIONS

MVPA was self-reported. Intermediate confounders and mediators were measured at the same age, however associations did not change in sensitivity analysis considering age 46 MVPA (1958 cohort).

CONCLUSIONS

Although higher MVPA was protective against poor PF, there was only minor evidence that it mediated the association between depression and PF. Further investigation into other potential mediators of pathways from mental to physical health is needed.

Long-term psychological distress trajectories and the COVID-19 pandemic in three British birth cohorts: A multi-cohort study

BACKGROUND

Growing evidence suggests that population mental health outcomes have worsened since the pandemic started. The extent that these changes have altered common age-related trends in psychological distress, where distress typically rises until midlife and then falls after midlife in both sexes, is unknown. We aimed to analyse whether long-term pre-pandemic psychological distress trajectories were disrupted during the pandemic, and whether these changes have been different across cohorts and by sex.

METHODS AND FINDINGS

We used data from three nationally representative birth cohorts comprising all people born in Great Britain in a single week of 1946 (National Survey of Health and Development, NSHD), 1958 (National Child Development Study, NCDS), or 1970 (British Cohort Study, BCS70). The follow-up data used spanned 39 years in NSHD (1982 to 2021), 40 years in NCDS (1981 to 2001), and 25 years in BCS70 (1996 to 2021). We used psychological distress factor scores, as measured by validated self-reported questionnaires (NSHD: Present State Examination, Psychiatric Symptoms Frequency, and 28- and 12-item versions of General Health Questionnaire; NCDS and BCS70: Malaise Inventory; all: 2-item versions of Generalized Anxiety Disorder scale and Patient Health Questionnaire). We used a multilevel growth curve modelling approach to model the trajectories of distress across cohorts and sexes and obtained estimates of the differences between the distress levels observed during the pandemic and those observed at the most recent pre-pandemic assessment and at the peak in the cohort-specific pre-pandemic distress trajectory, located at midlife. We further analysed whether pre-existing cohort and sex inequalities had changed with the pandemic onset using a difference-in-differences (DiD) approach. The analytic sample included 16,389 participants. By September/October 2020, distress levels had reached or exceeded the levels of the peak in the pre-pandemic life-course trajectories, with larger increases in younger cohorts (standardised mean differences [SMD] and 95% confidence intervals of SMDNSHD,pre-peak = -0.02 [-0.07, 0.04], SMDNCDS,pre-peak = 0.05 [0.02, 0.07], and SMDBCS70,pre-peak = 0.09 [0.07, 0.12] for the 1946, 1958, and 1970 birth cohorts, respectively). Increases in distress were larger among women than men, widening pre-existing sex inequalities (DiD and 95% confidence intervals of DiDNSHD,sex,pre-peak = 0.17 [0.06, 0.28], DiDNCDS,sex,pre-peak = 0.11 [0.07, 0.16], and DiDBCS70,sex,pre-peak = 0.11 [0.05, 0.16] when comparing sex inequalities in the pre-pandemic peak in midlife to those observed by September/October 2020). As expected in cohort designs, our study suffered from high proportions of attrition with respect to the original samples. Although we used non-response weights to restore sample representativeness to the target populations (those born in the United Kingdom in 1946, 1958, and 1970, alive and residing in the UK), results may not be generalisable to other sections within the UK population (e.g., migrants and ethnic minority groups) and countries different than the UK.

CONCLUSIONS

Pre-existing long-term psychological distress trajectories of adults born between 1946 and 1970 were disrupted during the COVID-19 pandemic, particularly among women, who reached the highest levels ever recorded in up to 40 years of follow-up data. This may impact future trends of morbidity, disability, and mortality due to common mental health problems.

Association between psychological distress trajectories from adolescence to midlife and mental health during the pandemic: evidence from two British birth cohorts

BACKGROUND

This paper examined whether distinct life-course trajectories of psychological distress from adolescence to midlife were associated with poorer mental health outcomes during the pandemic.

METHODS

We present a secondary analysis of two nationally representative British birth cohorts, the 1958 National Child Development Study (NCDS) and 1970 British Cohort Study (BCS70). We used latent variable mixture models to identify pre-pandemic longitudinal trajectories of psychological distress and a modified Poisson model with robust standard errors to estimate associations with psychological distress, life satisfaction and loneliness at different points during the pandemic.

RESULTS

Our analysis identified five distinct pre-pandemic trajectories of psychological distress in both cohorts. All trajectories with prior symptoms of psychological distress irrespective of age of onset, severity and chronicity were associated with a greater relative risk of poorer mental health outcomes during the pandemic and the probability of poorer mental health associated with psychological distress trajectories remained fairly constant. The relationship was not fully attenuated when most recent pre-pandemic psychological distress and other midlife factors were controlled for.

CONCLUSIONS

Whilst life-course trajectories with any prior symptoms of psychological distress put individuals at greater risk of poor mental health outcomes during the pandemic, those with chronic and more recent occurrences were at highest risk. In addition, prior poor mental health during the adult life-course may mean individuals are less resilient to shocks, such as pandemics. Our findings show the importance of considering heterogeneous mental health trajectories across the life-course in the general population in addition to population average trends.

Parent- and teacher-reported associations from adolescent bifactor models of psychopathology: an outcome-wide association study of 26 outcomes in mid-life

BACKGROUND

Adolescent mental health problems have lasting impacts on health and social functioning later in life. Evidence to date mostly comes from studies of specific diagnostic categories/dimensions, but hierarchical models can elucidate associations with general as well as specific dimensions of psychopathology. We provide evidence on long-term outcomes of general and specific dimensions of adolescent psychopathology using both parent and teacher reports.

METHODS

Parents and teachers from the Isle of Wight study completed Rutter behaviour scales when participants were 14-15 years old (n = 2,275), assessing conduct, emotional and hyperactivity problems. Metric-invariant bifactor models for parents and teachers were used to test domain-specific and domain-general associations with 26 self-reported psychosocial outcomes at mid-life (age 44-45 years, n = 1,423). Analyses examined the individual and joint contributions of parent and teacher reports of adolescent psychopathology. All analyses were adjusted for covariates (gender, IQ and family social class) and weighted to adjust for the probability of nonresponse.

RESULTS

Parent- and teacher-reported general factors of psychopathology (GFP) were associated with 15 and 12 outcomes, respectively, across the socioeconomic, relationship, health and personality domains, along with an index of social exclusion. Nine outcomes were associated with both parent- and teacher-reported GFP, with no differences in the strength of the associations across reporters. Teacher-reported specific factors (conduct, emotional and hyperactivity) were associated with 21 outcomes, and parent-reported specific factors were associated with seven. Five outcomes were associated with the same specific factors from both reporters; only one showed reporter differences in the strength of the associations.

CONCLUSIONS

These findings confirm the relevance of the GFP and the utility of teacher as well as parent reports of adolescent mental health in predicting psychosocial outcomes later in the life course.

Exploring the associations of daily movement behaviours and mid-life cognition: a compositional analysis of the 1970 British Cohort Study

BACKGROUND

Movement behaviours (eg, sedentary behaviour (SB), moderate and vigorous physical activity (MVPA), light intensity physical activity (LIPA) and sleep) are linked to cognition, yet the relative importance of each component is unclear, and not yet explored with compositional methodologies.

OBJECTIVE

To (i) assess the associations of different components of daily movement and participant's overall cognition, memory and executive function, and (ii) understand the relative importance of each individual component for cognition.

METHODS

The 1970 British Cohort Study (BCS70) is a prospective birth cohort study of UK-born adults. At age 46, participants consented to wear an accelerometer device and complete tests of verbal memory and executive function. Compositional linear regression was used to examine cross-sectional associations between 24-hour movement behaviours and standardised cognition scores. Isotemporal substitution was performed to model the effect of reallocating time between components of daily movement on cognition.

RESULTS

The sample comprised 4481 participants (52% female). Time in MVPA relative to SB, LIPA and sleep was positively associated with cognition after adjustments for education and occupational physical activity, but additional adjustment for health status attenuated associations. SB relative to all other movements was robustly positively associated with cognition. Modelling time reallocation between components revealed an increase in cognition centile after MVPA theoretically replaced 9 min of SB (OR=1.31; 95% CI 0.09 to 2.50), 7 min of LIPA (1.27; 0.07 to 2.46) or 7 min of sleep (1.20; 0.01 to 2.39).

CONCLUSIONS

Relative to time spent in other behaviours, greater MVPA and SB was associated with higher cognitive scores. Loss of MVPA time, given its smaller relative amount, appears most deleterious. Efforts should be made to preserve MVPA time, or reinforce it in place of other behaviours.

Changes in the adult consequences of adolescent mental ill-health: findings from the 1958 and 1970 British birth cohorts

BACKGROUND

Adolescent mental health difficulties are increasing over time. However, it is not known whether their adulthood health and socio-economic sequelae are changing over time.

METHODS

Participants (N = 31 349) are from two prospective national birth cohort studies: 1958 National Child Development Study (n = 16 091) and the 1970 British Cohort Study (n = 15 258). Adolescent mental health was operationalised both as traditional internalising and externalising factors and a hierarchical bi-factor. Associations between adolescent psychopathology and age 42 health and wellbeing (mental health, general health, life satisfaction), social (cohabitation, voting behaviour) and economic (education and employment) outcomes are estimated using linear and logistic multivariable regressions across cohorts, controlling for a wide range of early life potential confounding factors.

RESULTS

The prevalence of adolescent mental health difficulties increased and their associations with midlife health, wellbeing, social and economic outcomes became more severe or remained similar between those born in 1958 and 1970. For instance, a stronger association with adolescent mental health difficulties was found for those born in 1970 for midlife psychological distress [odds ratio (OR) 1970 = 1.82 (1.65-1.99), OR 1958 = 1.60 (1.43-1.79)], cohabitation [OR 1970 = 0.64 (0.59-0.70), OR 1958 = 0.79 (0.72-0.87)], and professional occupations [OR 1970 = 0.75 (0.67-0.84), OR 1958 = 1.05 (0.88-1.24)]. The associations of externalising symptoms with later outcomes were mainly explained by their shared variance with internalising symptoms.

CONCLUSION

The widening of mental health-based inequalities in midlife outcomes further supports the need to recognise that secular increases in adolescent mental health symptoms is a public health challenge with measurable negative consequences through the life-course. Increased public health efforts to minimise adverse outcomes are needed.

Adult life-course trajectories of psychological distress and economic outcomes in midlife during the COVID-19 pandemic: evidence from the 1958 and 1970 British birth cohorts

PURPOSE

Financial adversity in times of economic recession have been shown to have an unequal effect on individuals with prior mental health problems. This study investigated the relationship between mental health groupings across the adult life-course and change in financial situation and employment status during the COVID-19 pandemic, as well as the use of financial measures to mitigate the economic shock.

METHODS

Using two nationally representative British birth cohorts, the National Child Development Study (1958) n = 17,415 and 1970 British Cohort Study n = 17,198, we identified 5 different life-course trajectories of psychological distress from adolescence to midlife which were similar but not identical across the two cohorts. We explored their relation to changes in financial and employment circumstances at different stages during the pandemic from May 2020 to March 2021, applying multinomial logistic regression and controlling for numerous early life covariates, including family socio-economic status (SES). In addition, we ran modified Poisson models with robust standard errors to identify whether different mental health trajectories were supported by government and used other methods to mitigate their financial situation.

RESULTS

We found that the financial circumstances of pre-pandemic trajectories of psychological distress with differential onset, severity, and chronicity across the life-course were exacerbated by the COVID-19 economic shock. The 'stable-high' (persistent severe symptoms) and 'adult-onset' (symptoms developing in 30s, but later decreasing) groups were vulnerable to job loss. Compared to pre-pandemic trajectory groupings with no, minor, or psychological distress symptoms in early adulthood, the 'stable-high', 'midlife-onset' (symptoms developing in midlife), and 'adult-onset' trajectory groups were more likely to seek support from the UK governments economic response package. However, trajectories with pre-pandemic psychological distress were also at greater risk of reducing consumption, dis-saving, relying on increased financial help from family and friends, and also taking payment holidays (agreements with lenders to pause mortgage, credit card or loan payments for a set period) and borrowing.

CONCLUSION

This work highlights different trajectories of pre-pandemic psychological distress, compared to groups with no symptoms were more vulnerable to pandemic-related economic shock and job loss. By adopting unsustainable mitigating measures (borrowing and payment holidays) to support their financial circumstances during COVID-19, these mental health trajectories are at even more risk of lasting adverse impacts and future economic difficulties.

Early-onset burdensome multimorbidity: an exploratory analysis of sentinel conditions, condition accrual sequence and duration of three long-term conditions using the 1970 British Cohort Study

OBJECTIVES

The prevalence of multiple long-term condition (LTC) multimorbidity is increasing with younger onset among socioeconomically deprived populations. Research on life course trajectories towards multimorbidity is limited and early-onset multimorbidity poorly characterised. Understanding sentinel conditions (the first LTC occurring in the life course), the sequence of LTC accrual and the permanency of the reporting of LTCs may help identify time points for prevention efforts. We used a longitudinal birth cohort to estimate the prevalence of a common three-condition early-onset multimorbidity (multiple long-term condition multimorbidity (MLTC-M)) group at midlife, describe the frequency of sentinel conditions, the sequence of LTC accrual and explore the permanency of one of these conditions: psychological distress.

SETTING

1970 British Cohort Study (BCS70).

PARTICIPANTS

17 196 cohort members born in 1970.

OUTCOME MEASURES

Prevalence of the most common three-condition multimorbidity group at age 46. The nature and timing of sentinel conditions, the sequencing patterns of subsequent LTC accrual and the permanency of the reporting of psychological distress.

RESULTS

At age 46 high blood pressure, psychological distress and back pain were the most common three-condition MLTC-M group, (4.3%, n=370). A subgroup of 164 (44.3%) people provided complete information on LTC across all time points. Psychological distress measured by the Malaise Index was the most common sentinel condition, occurring in 25.0% (n=41), followed by back pain (22%, n=36). At age 26, 45.1% (75/164) reported their sentinel condition. The most common sequence of LTC accrual was the co-reporting of psychological distress and back pain followed by high blood pressure. Almost one-third (30.5%, n=50) reported a variation of psychological distress across the adult life course.

CONCLUSION

In these exploratory analyses, psychological distress and back pain were the most common sentinel conditions, and along with high blood pressure these three conditions represented the most common three-condition MLTC-M group. These analyses suggest that birth cohorts, like the BCS70, may usefully inform life course-multimorbidity research.

Risk Factors for Problematic Drinking in One's Thirties and Forties: A Longitudinal Analysis of the 1970 British Cohort Study

Alcohol drinking and risk factors for problematic drinking may vary across a lifespan. The objective of this study was to identify risk factors for problematic drinking in men and women in their thirties and forties. Alcohol drinking and potential risk factors for problematic drinking were assessed at ages 30, 34, 42, and 46 in the 1970 British Cohort Study. Multilevel models included 10,079 observations in 3880 men and 9241 observations in 3716 women. In men, formerly smoking, currently smoking, having a degree, having malaise, and having a mother who drank while pregnant were independently associated with increased risk of problematic drinking. In women, formerly smoking, currently smoking, being physically active in one's leisure time, having a degree, having a managerial or professional occupation, having malaise, and having a mother who drank while pregnant were independently associated with increased risk of problematic drinking. In men and women, cohabiting as a couple was associated with decreased risk of problematic drinking. This study suggests that several risk factors may be associated with problematic drinking in men and women in their thirties and forties. Policy makers should consider the role of modifiable risk factors in the prevention of problematic drinking.

Salivary cortisol in longitudinal associations between affective symptoms and midlife cognitive function: A British birth cohort study

Affective disorders are associated with accelerated cognitive ageing. However, current understanding of biological mechanisms which underlie these observed associations is limited. The aim of this study was to test: 1) Whether cortisol acts as a pathway in the association between depressive or anxiety symptoms across adulthood and midlife cognitive function; 2) Whether cortisol is associated with later depressive or anxiety symptoms, and cognitive function. Data were used from the National Child Development Study (NCDS), a sample of infants born in mainland UK during one week of 1958. A measure of the accumulation of affective symptoms was derived from data collected from age 23 to 42 using the Malaise Inventory Scale. Salivary cortisol measures were available at age 44-45. Cognitive function (memory, fluency, information processing) and affective symptoms were assessed at the age of 50. Path models were run to test whether salivary cortisol explained the longitudinal association between depressive or anxiety disorder symptoms and cognitive function. Direct effects of affective symptoms are shown across early to middle adulthood on cognitive function in midlife (memory and information processing errors). However, there were no effects of affective symptoms on cognitive function through cortisol measures. Additionally, cortisol measures were not significantly associated with subsequent affective symptoms or cognitive function at the age of 50. These results do not provide clear evidence to suggest that cortisol plays a role in the association between affective symptoms and cognitive function over this period of time. These findings contribute to our understanding of how the association between affective symptoms and cognitive function operates over time.

Associations between illicit drug use in early adulthood and mortality: Findings from a National Birth Cohort

Illicit drug use is known to be associated with premature mortality. Whether exposure to socioeconomic disadvantage and mental health problems in childhood help to explain this association, is unclear. We analysed data from 11,250 participants in the 1970 British Birth Cohort study. At 10-years of age, socioeconomic disadvantage (parental socioeconomic position, material disadvantage, family disruption) and mental health problems with antisocial behaviour, attention, and anxiety were reported by mothers and teachers. At 30-years of age, study members provided information on their illicit drug use, exposure to socioeconomic disadvantage and mental health problems. At 30-years, 19.2% of participants had used an illicit drug in the past year. Mortality was elevated for eight of the twelve drugs assessed. Family disruption, maternal, and teacher assessments of antisocial behaviour at 10-years were associated with illicit drug use at 30-years. There was, however, very little change in these associations when exposure to childhood socioeconomic disadvantage (% change in hazard ratios [HR] 0-10%) or mental health problems (0.4-11.9%) were added to the sex-adjusted model. Adding exposure to socioeconomic disadvantage (0.8-38.9%) and mental health problems (31.7-74.1%) in adulthood to the sex-adjusted model resulted in marked attenuation in HRs for all drugs. These findings imply that interventions which provide opportunities for education, employment and access to effective mental health treatments in early adulthood may help to reduce mortality among drug users.

Psychological distress from early adulthood to early old age: evidence from the 1946, 1958 and 1970 British birth cohorts

BACKGROUND

Existing evidence on profiles of psychological distress across adulthood uses cross-sectional or longitudinal studies with short observation periods. The objective of this research was to study the profile of psychological distress within the same individuals from early adulthood to early old age across three British birth cohorts.

METHODS

We used data from three British birth cohorts: born in 1946 (n = 3093), 1958 (n = 13 250) and 1970 (n = 12 019). The profile of psychological distress - expressed both as probability of being a clinical case or a count of symptoms based on comparable items within and across cohorts - was modelled using the multilevel regression framework.

RESULTS

In both 1958 and 1970 cohorts, there was an initial drop in the probability of being a case between ages 23-26 and 33-34. Subsequently, the predicted probability of being a case increased from 12.5% at age 36 to 19.5% at age 53 in the 1946 cohort; from 8.0% at age 33 to 13.7% at age 42 in the 1958 cohort and from 15.7% at age 34 to 19.7% at age 42 in the 1970 cohort. In the 1946 cohort, there was a drop in the probability of caseness between ages 60-64 and 69 (19.5% v. 15.2%). Consistent results were obtained with the continuous version of the outcome.

CONCLUSIONS

Across three post-war British birth cohorts midlife appears to be a particularly vulnerable phase for experiencing psychological distress. Understanding the reasons for this will be important for the prevention and management of mental health problems.

Obesity in early adulthood and physical functioning in mid-life: Investigating the mediating role of c-reactive protein

INTRODUCTION

Obesity in adulthood is associated with reduced physical functioning (PF) at older ages. However, mechanisms underpinning this association are not well understood. We investigated whether and the extent to which C-reactive protein (CRP) mediates the association between early-adult obesity and mid-life PF.

METHODS

We used data from 8495 participants in the 1958 British birth cohort study. Body mass index (BMI), CRP and PF were measured at 33, 45 and 50y, respectively. Poor PF was defined as the lowest (sex-specific) 10% on the Short-form 36 Physical Functioning subscale. We accounted for prospectively measured confounders in early-life (e.g., social class at birth) and in mid-adulthood (e.g., 42y comorbidities). We decomposed the total effect of early-adult obesity on mid-life PF into direct and indirect (via CRP) effects, by employing a mediation analysis based on parametric g-computation.

RESULTS

The estimated total effect of obesity at 33y on poor PF at 50y, expressed as an odds ratio (OR), was 2.41 (95% CI: 1.89, 3.08). The direct effect of obesity on poor PF (i.e., not operating via CRP), was 1.97 (95% CI: 1.51, 2.56), with an indirect effect of 1.23 (95% CI: 1.10, 1.37). As such, the proportion of the total effect which was mediated by the effect of obesity on CRP at 45y, was 23.27% (95% CI: 8.64%, 37.90%).

CONCLUSION

Obesity in early-adulthood was associated with over twice the odds of poor PF in mid-life, with approximately 23% of the obesity effect operating via a downstream effect on CRP. As current younger generations are likely to spend greater proportions of their life course in older age and with obesity, both of which are associated with poor PF, there is an urgent need to identify mechanisms, and thus potential modifiable intermediaries, linking obesity to poor PF.

Psychological Distress Before and During the COVID-19 Pandemic Among Adults in the United Kingdom Based on Coordinated Analyses of 11 Longitudinal Studies

Importance

How population mental health has evolved across the COVID-19 pandemic under varied lockdown measures is poorly understood, and the consequences for health inequalities are unclear.

Objective

To investigate changes in mental health and sociodemographic inequalities from before and across the first year of the COVID-19 pandemic in 11 longitudinal studies.

Design, Setting, and Participants

This cohort study included adult participants from 11 UK longitudinal population-based studies with prepandemic measures of psychological distress. Analyses were coordinated across these studies, and estimates were pooled. Data were collected from 2006 to 2021.

Exposures

Trends in the prevalence of poor mental health were assessed in the prepandemic period (time period 0 [TP 0]) and at 3 pandemic TPs: 1, initial lockdown (March to June 2020); 2, easing of restrictions (July to October 2020); and 3, a subsequent lockdown (November 2020 to March 2021). Analyses were stratified by sex, race and ethnicity, education, age, and UK country.

Main Outcomes and Measures

Multilevel regression was used to examine changes in psychological distress from the prepandemic period across the first year of the COVID-19 pandemic. Psychological distress was assessed using the 12-item General Health Questionnaire, the Kessler 6, the 9-item Malaise Inventory, the Short Mood and Feelings Questionnaire, the 8-item or 9-item Patient Health Questionnaire, the Hospital Anxiety and Depression Scale, and the Centre for Epidemiological Studies-Depression across different studies.

Results

In total, 49 993 adult participants (12 323 [24.6%] aged 55-64 years; 32 741 [61.2%] women; 4960 [8.7%] racial and ethnic minority) were analyzed. Across the 11 studies, mental health deteriorated from prepandemic scores across all 3 pandemic periods, but there was considerable heterogeneity across the study-specific estimated effect sizes (pooled estimate for TP 1: standardized mean difference [SMD], 0.15; 95% CI, 0.06-0.25; TP 2: SMD, 0.18; 95% CI, 0.09-0.27; TP 3: SMD, 0.21; 95% CI, 0.10-0.32). Changes in psychological distress across the pandemic were higher in women (TP 3: SMD, 0.23; 95% CI, 0.11, 0.35) than men (TP 3: SMD, 0.16; 95% CI, 0.06-0.26) and lower in individuals with below-degree level education at TP 3 (SMD, 0.18; 95% CI, 0.06-0.30) compared with those who held degrees (SMD, 0.26; 95% CI, 0.14-0.38). Increased psychological distress was most prominent among adults aged 25 to 34 years (SMD, 0.49; 95% CI, 0.14-0.84) and 35 to 44 years (SMD, 0.35; 95% CI, 0.10-0.60) compared with other age groups. No evidence of changes in distress differing by race and ethnicity or UK country were observed.

Conclusions and Relevance

In this study, the substantial deterioration in mental health seen in the UK during the first lockdown did not reverse when lockdown lifted, and a sustained worsening was observed across the pandemic period. Mental health declines have been unequal across the population, with women, those with higher degrees, and those aged 25 to 44 years more affected than other groups.

Physical Inactivity From Childhood to Adolescence and Incident Depression

INTRODUCTION

The long-term impact of physical activity during early life on the risk of depression in later stages of adulthood remains unclear. This study examines the association between physical activity during childhood and adolescence and the incidence of depressive symptoms in early, middle, and late adulthood.

METHODS

Data from a birth cohort (the 1958 National Child Development Survey), including births (N=17,415) in England, Wales, and Scotland, were used. After birth, 11 more follow-ups were carried out between ages 7 and 62 years (2020). Leisure-time physical activity was assessed through a self-reported questionnaire. Psychological measures were assessed with the teacher-rated Bristol Social Adjustment Guide, the teacher-rated Rutter scale, and the self-rated Malaise Inventory. Leisure-time physical activity and psychological symptoms were examined in all the 11 follow-up assessments included in this study. Best-fit model was used to obtain hazard ratios and 95% CIs of depression symptoms by physical activity status in different ages, including demographic, behavioral, and health-related variables as potential confounders.

RESULTS

After multivariate analysis, being physically active at age 16 years reduced the risk of incident elevated depressive symptoms (hazard ratio=0.73, 95% CI=0.62, 0.85) throughout adulthood. The long-term impacts of physical activity practiced at age 16 years persisted throughout adulthood up to age 62 years.

CONCLUSIONS

Adolescence is a critical early-life period to promote physical activity for reducing the incidence of elevated depressive symptoms throughout adulthood. Public health policies should promote healthy lifestyles during the lifespan to reduce both the burden of physical inactivity and depressive symptoms at the population level.

Prospective Associations of Leisure-Time Physical Activity With Psychological Distress and Well-Being: A 12-Year Cohort Study

OBJECTIVE

This study aimed to investigate the associations of leisure-time physical activity with psychological distress and well-being, and potential mediators.

METHODS

We used data from the 1970 British Cohort Study (n = 5197; 2688 men), including waves 34y (2004), 42y (2012), and 46y (2016). Participants reported leisure-time physical activity frequency and intensity (exposure) at age 34 years (baseline); cognition (vocabulary test), body mass index, disability, mobility and pain perception (potential mediators) at age 42 years; and psychological distress (Malaise Inventory) and well-being (Warwick-Edinburgh scale) at age 46 years. Baseline confounders included sex, country, education, employment status, alcohol use, tobacco smoking, and psychological distress. Main analyses included logistic regression and mediation models.

RESULTS

Higher leisure-time physical activity intensity at baseline was associated with lower psychological distress at 46y (β = -0.038 [95% confidence interval {CI} =-0.069 to -0.007]), but not leisure-time physical activity frequency. Baseline leisure-time physical activity frequency and intensity were associated with higher psychological well-being at 46y (frequency: β = 0.089 [95% CI = 0.002 to 0.176]; intensity: β = 0.262 [95% CI = 0.123 to 0.401]); and total: β = 0.041 [95% CI = 0.013 to 0.069]). Only body mass index at 42y partially mediated the association between leisure-time physical activity frequency (15.7%) and total leisure-time physical activity (6.2%) at 34y, with psychological well-being at 46y.

CONCLUSIONS

Our findings highlight the role of leisure-time physical activity in psychological distress and well-being, with greater effect sizes associated with higher frequency and intensity of leisure-time physical activity. Future interventions should consider examining potential mediators of the association of leisure-time physical activity with psychological well-being, such as body mass index.

Mortality among rough sleepers, squatters, residents of homeless shelters or hotels and sofa-surfers: a pooled analysis of UK birth cohorts

Background

Homelessness encompasses a wide spectrum of experience. Rough sleepers and people attending homeless shelters have been found to be at an increased risk of mortality. It is unclear whether risks are also elevated in those squatting, living temporarily in low-cost hotels or ‘sofa-surfing’ with friends or family members. This study examines mortality in a representative nationwide sample of people who have slept rough, squatted, lived in shelters or low-cost hotels and sofa-surfed.

Methods

Using unpublished data from two national birth cohorts, namely the National Child Development Study and the 1970 British Birth Cohort study, Cox proportional-hazards models and random-effects meta-analyses were used to analyse associations between homelessness and different types of homeless experience (rough sleeping, squatting, staying in a homeless shelter or low-cost hotel, and sofa-surfing) and mortality.

Results

Out of the 23 678 participants, 1444 (6.1%) reported having been homeless and 805 (3.4%) deaths occurred. Homelessness was associated with an increased risk of mortality [hazard ratio (HR) 1.68, 95% confidence interval (CI) 1.24–2.26]. Mortality risk was raised across the spectrum of homeless experience, from sleeping rough (HR 4.71, 95% CI 2.38–9.30), to squatting (HR 6.35, 95% CI 2.73–14.75), staying in a homeless shelter (HR 4.89, 95% CI 2.36–10.11), staying in a low-cost hotel (HR 3.38, 95% CI 1.30–8.79 through to sofa-surfing (HR 2.86, 95% CI 1.84–4.42). Associations remained after separate control for socio-economic status, mental health, substance use, accidents and assaults, and criminality.

Conclusions

Mortality rates were raised across all types of homeless experience. This included squatting and sofa-surfing that have not previously been reported. Studies that have omitted the less severe, but more prevalent, use of low-cost hotels and sofa-surfing may have underestimated the impacts of homelessness on mortality.

Childhood neglect and trajectories of affective symptoms throughout adulthood: A British birth cohort study

BACKGROUND

Childhood maltreatment, including neglect, can affect an individual's mental health. However, there is a gap in current literature investigating the long-term, dynamic effects of childhood neglect on adult affective symptoms (AS).

METHOD

Data were used from the National Child Development Study (a British 1958 birth cohort). Childhood neglect was prospectively measured at ages 7 and 11. Five distinct trajectories of AS have been derived previously, using data from the Malaise Inventory Scale (at ages 23, 33, 42 and 50): 'no symptoms', 'persistent mild/moderate symptoms', 'low and increasing symptoms', 'high and increasing symptoms' and 'high and decreasing symptoms' (John et al., 2019). Multinomial logistic regressions were used to explore whether childhood neglect was associated with AS trajectory membership, while adjusting for a number of covariates.

RESULTS

Results revealed that childhood neglect was significantly associated with 'high and decreasing', 'high and increasing' and 'persistent mild/moderate' AS trajectories from young adulthood through midlife. There was no association with the 'low and increasing' AS trajectory. When testing for at age specific effects, neglect experienced at age 7 only, or at age 11 only, was predictive of 'high and decreasing symptoms' trajectory, whereas neglect experienced at both ages was predictive of 'persistent mild/moderate symptoms' trajectory.

CONCLUSIONS

Childhood neglect has negative long-lasting effects on trajectories of adult mental health. This finding has important implications for early intervention for individuals who have experienced childhood neglect.

Dynamics between psychological distress and body mass index throughout adult life; evidence from 3 large cohort studies

BACKGROUND

Associations between body mass index (BMI) and psychological distress (PD) have been reported; however, few longitudinal studies have accounted for likely life-course differences in BMI and PD stability, consistency, and their interplay across time.

METHODS

Via random intercepts cross-lagged panel models, we assessed the predictive effects (from BMI to PD or vice-versa) across the last two centuries in the Coronary Artery Risk Development in Young Adults [CARDIA, beginning in 1985-6] study using the Center for Epidemiological Studies-Depression Scale [CES-D], and in the National Child Development Study [NCDS, beginning in 1958] and British Cohort Study [BCS, beginning in 1970] using the Malaise Inventory [MI]), assessed at least 4 times in adult life.

FINDINGS

In CARDIA (n = 4724), NCDS58 (n = 7149) and BCS70 (n = 5967), autoregressive effects were stronger for BMI than for PD, meaning that carry-over effects from one occasion to the next were larger for BMI than for PD. Small interindividual correlations between traits of higher BMI and higher PD were identified among females (r_female<|0·2|) but not males (r_male<|0·03|) in CARDIA and NCDS. Cross-lagged effects were very weak or close to zero (standardized effects η<|0·1|).

INTERPRETATION

In the United States, depressive symptoms and BMI were positively correlated at the trait level among females. In the United Kingdom, relationships between PD and BMI were inconsistent between generations, with effect sizes of unlikely clinical importance, indicating negligible dominance of an intraindividual effect of BMI on PD or vice versa.

Depressive symptoms during early adulthood and the development of physical multimorbidity in the UK: an observational cohort study

BACKGROUND

An understanding of whether early-life depression is associated with physical multimorbidity could be instrumental for the development of preventive measures and the integrated management of depression. We therefore aimed to map out the cumulative incidence of physical multimorbidity over adulthood, and to determine the association between the presence of depressive symptoms during early adulthood and the development of physical multimorbidity in middle age.

METHODS

In this observational cohort study, we used pooled data from the 1958 National Child Development Study (NCDS) and the 1970 British Cohort Study (BCS). Cohort waves were pooled in each decade of adult life available (when cohort members were aged 26 years in the BCS and 23 years in the NCDS [baseline]; 34 years in the BCS and 33 years in the NCDS [age 34 BCS/33 NCDS]; 42 years in the BCS and NCDS [age 42 BCS/NCDS]; and 46 years in the BCS and 50 years in the NCDS [age 46 BCS/50 NCDS]). We included participants who had completed the nine-item Malaise Inventory at baseline, and did not have a history of physical multimorbidity, any physical multimorbidity at baseline, or the presence of depressive symptoms before the development of physical multimorbidity. The presence of depressive symptoms was determined using the nine-item Malaise Inventory (cutoff score ≥4). Physical multimorbidity was defined as having at least two measures of any of the following ten self-reported groups of long-term conditions: asthma or bronchitis; backache; bladder or kidney conditions; cancer; cardiovascular conditions; convulsions or epilepsy; diabetes; hearing conditions; migraine; and stomach, bowel, or gall conditions. Cumulative incidence (with 95% CI) of physical multimorbidity was calculated for each decade considered after baseline, with physical multimorbidity being assessed as both a dichotomous and categorical variable. The association between depressive symptoms and the development of physical multimorbidity was assessed using adjusted relative risk ratios (with 95% CIs).

FINDINGS

Analyses included 15 845 participants, of whom 4001 (25·25%; 95% CI 24·57-25·93) had depressive symptoms at baseline and 11 844 (74·75%; 74·07-75·42) did not. The cumulative incidence of physical multimorbidity (dichotomous) ranged over the study period from 2263 (18·44%; 95% CI 17·75-18·14) of 12 273 participants at age 34 BCS/33 NCDS, to 4496 (42·90%; 41·95-43·85) of 10 481 participants at age 46 BCS/50 NCDS, and was consistently higher in participants with depressive symptoms at baseline. The adjusted relative risk of physical multimorbidity was higher in participants with depressive symptoms than in those without and remained stable over the study period (adjusted relative rate ratio 1·67, 95% CI 1·50-1·87, at age 34 BCS/33 NCDS; 1·63, 1·48-1·79, at age 42 BCS/NCDS; and 1·58, 1·43-1·73, at age 46 BCS/50 NCDS).

INTERPRETATION

The presence of depressive symptoms during early adulthood is associated with an increased risk of the development of physical multimorbidity in middle age. Although further research about the drivers of this relationship is needed, these results could help to enhance the integrated management of individuals with depressive symptoms and the development of preventive strategies to reduce the effect and burden of physical multimorbidity.

FUNDING

UK Medical Research Council and Guy's Charity.

Emotional and behavioural pathways to adolescent substance use and antisocial behaviour: results from the UK Millennium Cohort Study

This study examines the emotional and behavioural pathways to adolescent substance use and antisocial behaviour. Using a sample of 17,223 participants from the UK Millennium Cohort Study, we applied parallel-process growth mixture modelling on emotional and behavioural symptoms in those aged 3-14 and employed latent class analysis to identify patterns of substance use and antisocial behaviours at age 14. We then performed a multinomial regression analysis to explore the association between emotional and behavioural trajectories and patterns of adolescent substance use and antisocial behaviours, including sociodemographic, family, and maternal factors. We found five trajectories of emotional and behavioural symptoms and four classes of adolescence substance use and antisocial behaviour. Children and adolescents in the 'high externalising and internalising' and 'moderate externalising' trajectories were more likely to belong to any problematic behaviour class, especially the 'poly-substance use and antisocial behaviours' class. Inclusion in the 'moderate externalising and internalising (childhood limited)' class was associated with higher odds of belonging to the 'alcohol and tobacco' class. These associations remained significant after adjusting for important sociodemographic and contextual factors, such as maternal substance use, poverty, and parental status. Interventions on adolescent health promotion and risk behaviour prevention need to address the clustering of substance use and antisocial behaviour as well as the significant influence of early and chronic internalising and externalising symptoms on the aetiology of these behaviours.

Impact of lockdown on key workers: findings from the COVID-19 survey in four UK national longitudinal studies

BACKGROUND

Key workers played a pivotal role during the national lockdown in the UK's response to the COVID-19 pandemic. Although protective measures have been taken, the impact of the pandemic on key workers is yet to be fully elucidated.

METHODS

Participants were from four longitudinal age-homogeneous British cohorts (born in 2001, 1990, 1970 and 1958). A web-based survey provided outcome data during the first UK national lockdown (May 2020) on COVID-19 infection status, changes in financial situation, trust in government, conflict with people around, household composition, psychological distress, alcohol consumption, smoking and sleep duration. Generalised linear models with logit link assessed the association between being a key worker and the above outcomes. Adjustment was made for cohort design, non-response, sex, ethnicity, adult socioeconomic position (SEP), childhood SEP, the presence of a chronic illness and receipt of a shielding letter. Meta-analyses were performed across the cohorts.

FINDINGS

13 736 participants were included. During lockdown, being a key worker was associated with increased chances of being infected with COVID-19 (OR 1.43, 95% CI 1.22 to 1.68) and experiencing conflict with people around (OR 1.19, 95% CI 1.03 to 1.37). However, key workers were less likely to be worse off financially (OR 0.32, 95% CI 0.24 to 0.65), to consume more alcohol (OR 0.88, 95% CI 0.79 to 0.98) or to smoke more (OR 0.60, 95% CI 0.44 to 0.80) during lockdown. Interestingly, being a key worker was not associated with psychological distress (OR 0.95, 95% CI 0.85 to 1.05).

INTERPRETATION

Being a key worker during the first UK COVID-19 lockdown was a double-edged sword, with both benefits and downsides. The UK government had the basic duty to protect its key workers from SARS-CoV-2 infection, but it may have failed to do so, and there is an urgent need to rectify this in light of the ongoing third wave.

The impact of the COVID-19 pandemic on the health of adults with intellectual impairment: evidence from two longitudinal UK surveys

BACKGROUND

People with an intellectual impairment experience high levels of social and health inequalities. We investigated the impact of COVID-19 on the physical and mental health of people with intellectual impairment, controlling for demographic risk, socio-economic circumstances and pre-pandemic health levels.

METHOD

Data were drawn from two UK birth cohorts that surveyed their participants on the impact of COVID-19 in May 2020: the Millennium Cohort Study (20-year-old participants) and the British Cohort Survey (50-year-old participants). Health outcomes (COVID-19 infection, COVID-19 symptoms, self-reported physical health, mental health, health service use and impact on health behaviours) were compared between people with and without intellectual impairment, adjusting for gender and ethnicity. Differences were further adjusted for self-reported health pre-pandemic and the impact of COVID-19 on socio-economic circumstances.

RESULTS

Controlling for gender and ethnicity, poor health was reported less often by younger adults [relative risks (RR): 0.44 95% confidence interval (CI) 0.23, 0.86] and more often by older adults (RR: 1.99 95% CI 1.45, 2.73) with intellectual impairment compared with peers. Older adults were also more likely to experience fever and loss of taste/smell. Adjusting for pre-pandemic health and socio-economic circumstances eliminated some differences in the older cohort, but not in the younger one.

CONCLUSION

In young adulthood, the impact of COVID-19 on health outcomes was not negative. The pattern was reversed in later adulthood, although differences were mostly eliminated after adjustment suggesting a socio-economic and age gradient of COVID-19 impacts on intellectual impairment.

Patterns of Atopic Eczema Disease Activity From Birth Through Midlife in 2 British Birth Cohorts

Importance

Atopic eczema is characterized by a heterogenous waxing and waning course, with variable age of onset and persistence of symptoms. Distinct patterns of disease activity such as early-onset/resolving and persistent disease have been identified throughout childhood; little is known about patterns into adulthood.

Objective

This study aimed to identify subtypes of atopic eczema based on patterns of disease activity through mid-adulthood, to examine whether early life risk factors and participant characteristics are associated with these subtypes, and to determine whether subtypes are associated with other atopic diseases and general health in mid-adulthood.

Design, Setting, and Participants

This study evaluated members of 2 population-based birth cohorts, the 1958 National Childhood Development Study (NCDS) and the 1970 British Cohort Study (BCS70). Participant data were collected over the period between 1958 and 2016. Data were analyzed over the period between 2018 and 2020.

Main Outcomes and Measures

Subtypes of atopic eczema were identified based on self-reported atopic eczema period prevalence at multiple occasions. These subtypes were the outcome in models of early life characteristics and an exposure variable in models of midlife health.

Results

Latent class analysis identified 4 subtypes of atopic eczema with distinct patterns of disease activity among 15 939 individuals from the NCDS (51.4% male, 75.4% White) and 14 966 individuals from the BCS70 (51.6% male, 78.8% White): rare/no (88% to 91%), decreasing (4%), increasing (2% to 6%), and persistently high (2% to 3%) probability of reporting prevalent atopic eczema with age. Sex at birth and early life factors, including social class, region of residence, tobacco smoke exposure, and breastfeeding, predicted differences between the 3 atopic eczema subtypes and the infrequent/no atopic eczema group, but only female sex differentiated the high and decreasing probability subtypes (odds ratio [OR], 1.99; 95% CI, 1.66-2.38). Individuals in the high subtype were most likely to experience asthma and rhinitis, and those in the increasing subtype were at higher risk of poor self-reported general (OR, 1.29; 95% CI, 1.09-1.53) and mental (OR 1.45; 95% CI, 1.23-1.72) health in midlife.

Conclusions and Relevance

The findings of this cohort study suggest that extending the window of observation beyond childhood may reveal clear subtypes of atopic eczema based on patterns of disease activity. A newly identified subtype with increasing probability of activity in adulthood warrants additional attention given observed associations with poor self-reported health in midlife.

Homelessness in early adulthood and biomedical risk factors by middle-age: the 1970 British Cohort Study

Background

Homelessness has been linked to premature mortality but the relationship with biomedical risk factors is uncertain.

Methods

We analysed data from 8581 participants in the 1970 British Birth Cohort Study. Homelessness and type of experience were self-reported at 30 years of age. Nine biomarkers outcomes were collected at 46 years of age: body mass index (BMI), blood pressure, total and high-density cholesterol, triglycerides, glycated haemoglobin, C-reactive protein (CRP), insulin-like growth factor 1 and we computed the 10-year risk for coronary heart disease.

Results

By 30 years of age, 5.8% of participants had been homeless with sofa surfing the most common experience (4.3%). Homelessness was associated with socioeconomic disadvantage, mental health problems and substance use in early adulthood, but these differences were not expressed in biomarkers. After accounting for early adulthood characteristics, residing in a bed and breakfast was associated with a higher BMI (0.59, 95% CI 0.13 to 1.05) and CRP (0.16, 95% CI 0.04 to 0.29), squatting with a lower BMI (−1.69, 95% CI –3.08 to −0.21) and rough sleeping with a higher 10-year risk of coronary heart disease (0.03, 95% CI 0.01 to 0.05).

Conclusions

Exposure to homelessness in early adulthood was essentially unrelated to biomarkers in middle age. Inconsistent links were found for specific types of experience.

Prospective associations of different contexts of physical activity with psychological distress and well-being among middle-aged adults: An analysis of the 1970 British Cohort Study

BACKGROUND

Our aim was to investigate whether different types and social contexts of physical activity (PA) participation are prospectively associated with psychological distress and well-being among middle-aged adults.

METHODS

Data from the 1970 British Cohort Study was used (N = 5144-2733 women). At age 42y, participants reported their type of leisure-time PA, which was classified as individual PA or group PA (exposure). At age 46y, participants reported co-primary outcomes: psychological distress (Malaise Inventory) and well-being (Warwick-Edinburgh scale). Highest academic achievement, employment status, country of interview, baseline values of psychological distress and well-being, smoking, alcohol use, TV-viewing and total physical activity at 42y were used as covariates. Main analyses included linear regression stratifying by sex.

RESULTS

Jogging, cross-country, road-running (both sexes) as well as team sports (men) were associated with higher well-being. Health, fitness, gym or conditioning activities and jogging, cross-country (women), road-running (women) and team sports (men) were associated with lower psychological distress. Participation in both individual and group PA were associated with lower psychological distress and higher well-being for both sexes in crude models. However, adjusted models revealed that only group PA was associated with lower psychological distress (B: -0.106; 95%CI: -0.188 to -0.025) and higher well-being (0.835; 0.050 to 1.619) among men but not women. In the sensitivity analysis, group PA was associated with higher well-being (0.855; 0.094 to 1.616) when compared with individual PA among men. Group PA was not associated with psychological distress among both sexes and well-being among women when compared with individual PA.

CONCLUSION

Group PA was prospectively associated with lower psychological distress and higher well-being among men but not females. Future PA interventions could focus on group activities for males. Further research to understand the relationship between individual/group PA and mental health is required in females.

Prevalence and early-life determinants of mid-life multimorbidity: evidence from the 1970 British birth cohort

BACKGROUND

We sought to: [1] estimate the prevalence of multimorbidity at age 46-48 in the 1970 British Cohort Study-a nationally representative sample in mid-life; and [2] examine the association between early-life characteristics and mid-life multimorbidity.

METHOD

A prospective longitudinal birth cohort of a community-based sample from the 1970 British Cohort Study (BCS70). Participants included all surviving children born in mainland Britain in a single week in April 1970; the analytical sample included those with valid data at age 46-48 (n = 7951; 2016-2018). The main outcome was multimorbidity, which was operationalised as a binary indicator of two or more long-term health conditions where at least one of these conditions was of physical health. It also included symptom complexes (e.g., chronic pain), sensory impairments, and alcohol problems.

RESULTS

Prevalence of mid-life multimorbidity was 33.8% at age 46-48. Those with fathers from unskilled social occupational class (vs professional) at birth had 43% higher risk of mid-life multimorbidity (risk ratio = 1.43, 95% confidence interval 1.15 to 1.77). After accounting for potential child and family confounding, an additional kilogram of birthweight was associated with 10% reduced risk of multimorbidity (risk ratio = 0.90, 95% confidence interval 0.84 to 0.96); a decrease of one body mass index point at age 10 was associated with 3% lower risk (risk ratio = 1.03, 95% confidence interval 1.01 to 1.05); one standard deviation higher cognitive ability score at age 10 corresponded to 4% lower risk (risk ratio = 0.96, 95% confidence interval 0.91 to 1.00); an increase of one internalising problem at age 16 was equated with 4% higher risk (risk ratio = 1.04, 95% confidence interval 1.00 to 1.08) and of one externalising problem at age 16 with 6% higher risk (risk ratio = 1.06, 1.03 to 1.09).

CONCLUSION

Prevalence of multimorbidity was high in mid-life (33.8% at age 46-48) in Britain. Potentially modifiable early-life exposures, including early-life social circumstances, cognitive, physical and emotional development, were associated with elevated risk of mid-life multimorbidity.

Changes in emotional problems, hyperactivity and conduct problems in moderate to late preterm children and adolescents born between 1958 and 2002 in the United Kingdom

Background

Preterm birth is a risk factor for the development of emotional and behavioural problems in childhood and adolescence. Given the substantial improvements in neonatal care across decades, it has been expected that the difference in emotional problems, hyperactivity, and conduct problems between moderate to late preterm (MLPT) and full term (FT) children and adolescents have declined in recent years.

Methods

Data from four UK population-based studies were used: The National Child Development Study (NCDS; 1958), the British Cohort Study (BCS70; 1970), the Avon Longitudinal Study of Parents and Children (ALSPAC, 1991-1992) and the Millennium Cohort Study (MCS; 2000-2002). Emotional problems, hyperactivity and conduct problems were assessed with mother-reports in early childhood (5-7 years), late childhood (10-11 years) and adolescence (14-16 years). Furthermore, emotional problems were self-reported in adolescence in BCS70, ALSPAC and MCS.

Results

In the most recent cohort, the MLPT group had higher mother-reported emotional problems than those born FT in late childhood and adolescence, whereas there were no differences in self-reported emotional problems in adolescence. Regarding mother-reported hyperactivity symptoms, the MLPT group had higher scores than the FT group in the two most recent cohorts in late childhood and in the most recent cohort in adolescence. Regarding mother-reported conduct problems, MLPT children had significantly higher scores than the FT children in the oldest and in the most recent cohort in late childhood. On the other hand, in adolescence, MLPT children had significantly lower scores in conduct problems in comparison to FT children in the cohort born in 1991-1992.

Conclusions

Mother-reported emotional problems and hyperactivity symptoms of those born MLPT have increased from the birth years 1958 to 2000-2002 during late childhood and adolescence, whereas self-reported emotional problems were similar in MLPT and FT groups during adolescence from 1970 to 2000-2002. Findings are less consistent regarding conduct problems. The current findings highlight the importance of raising the awareness of teachers about the association between MLPT birth and behavioural and emotional problems in late childhood and adolescence to prevent the long-term negative outcomes associated with the sequalae of MLPT birth.

Life-course Psychological Distress and Total Mortality by Middle Age: The 1970 Birth Cohort Study

BACKGROUND

The onset of psychological distress most commonly occurs in adolescence and, in keeping with other exposures, is time-varying across the life course. Most studies of its association with mortality risk are, however, conducted in middle- and older-aged populations with a single baseline assessment. This may lead to an underestimation of the magnitude of distress-mortality relationship.

METHODS

We used data from the 1970 British Cohort Study, a prospective cohort study. Psychological distress and covariates were collected at ages 5, 10, and 26. Vital status was ascertained between ages 26 and 44 years.

RESULTS

Eighteen years of mortality surveillance of 5,901 individuals (3,221 women) gave rise to 74 deaths. After adjustment for a series of confounding factors which included early life socioeconomic status, birth characteristics, and cognition, relative to the unaffected group, distress in childhood only was associated with around a 50% elevation in mortality risk (hazard ratio = 1.45; 95% confidence interval = 0.84, 2.51), whereas distress in adulthood only was related to a doubling of risk (1.95; 0.90, 4.21). In study members with persistent distress symptoms (childhood and adulthood), there was a tripling of the death rate (3.10; 1.42, 6.74) (P value for trend across these categories: 0.002).

CONCLUSION

The suggestion of a strong association between life-course distress and death warrants replication in a study with a greater number of events.

Maternal and Paternal Distress in Early Childhood and Child Adiposity Trajectories: Evidence from the Millennium Cohort Study

OBJECTIVE

The current study investigated associations between mothers' and fathers' distress reported in early childhood (at ages 9 months and 3 years) and childhood adiposity trajectories from ages 5 to 14 years.

METHODS

Linear mixed-effects models were undertaken in the Millennium Cohort Study. Self-reported maternal and paternal distress was measured at ages 9 months and 3 years. BMI and fat mass index (FMI) were modeled from ages 5 to 14 years, adjusting for socioeconomic and child characteristics and stratifying by child sex.

RESULTS

Maternal distress reported at 9 months was associated with steeper increases in BMI and FMI trajectories for girls (BMI: β = 0.06; 95% CI: 0.01 to 0.11; FMI: β = 0.04; 95% CI: 0.00 to 0.08). Paternal distress reported at 9 months was associated with steeper increases in BMI and FMI for both girls (BMI: β = 0.06; 95% CI: 0.00 to 0.12, FMI: β = 0.05; 95% CI: -0.02 to 0.10) and boys (BMI: β = 0.09; 95% CI:  0.03 to 0.15, FMI: β = 0.06; 95% CI: 0.01 to 0.10). Maternal "moderate" distress at 3 years was associated with steeper BMI and FMI trajectories for girls only (BMI: β = 0.08; 95% CI: 0.03 to 0.12, FMI; β = 0.06; 95% CI: 0.02 to 0.10).

CONCLUSIONS

Maternal and paternal distress experienced in early childhood, particularly during infancy, was associated with steeper adiposity trajectories for children from ages 5 to 14 years.

Childhood socio-economic position and affective symptoms in adulthood: The role of neglect

BACKGROUND

Childhood neglect is more common within low-income families and can have long-term effects on mental health. Despite this, the extent to which it can mediate the well documented longitudinal inverse relationship between childhood socio-economic position (SEP) and adult affective symptoms is yet to be investigated.

METHOD

Data (9595 males and 8959 females) from participants of the National Child Development Study (NCDS) were used to investigate the extent to which prospectively measured neglect mediates the relationship between SEP (age 11) and affective symptoms (ages 23 and 50).

RESULTS

Neglect partially mediated the relationship between childhood SEP and affective symptoms at ages 23 (b = -0.02, [-0.02, -0.02]) and 50 (b = -0.02, [-0.02, -0.01]), after controlling for other family-related adversities. In addition, gender moderated the direct effect of SEP on affective symptoms at both ages 23 (b = -0.06, t = -4.87, [-0.08, -0.03]) and 50 (b = -0.05, t = -3.86, [-0.07, -0.02]), with the relationship being stronger for females; but did not moderate the indirect effect of neglect at either age 23 (b = 0.01, t = 1.09 [-0.01, 0.02]) or 50 (b = 0.00, t = -0.60 [-0.02, 0.01]).

CONCLUSIONS

Neglect in childhood should be viewed as having serious implications for the mental health of both men and women. Greater investments into social support interventions that reduce incidences of neglect are also warranted.

Role of cardiometabolic risk in the association between accumulation of affective symptoms across adulthood and mid-life cognitive function: national cohort study

BACKGROUND

Affective symptoms are associated with cognition in mid-life and later life. However, the role of cardiometabolic risk in this association has not been previously examined.

AIMS

To investigate how cardiometabolic risk contributes to associations between affective symptoms and mid-life cognition.

METHOD

Data were used from the National Child Development Study (NCDS), a sample of people born in Britain during one week in 1958. Measures of immediate and delayed memory, verbal fluency and information processing speed and accuracy were available at age 50. Affective symptoms were assessed at ages 23, 33 and 42 years and a measure of accumulation was derived. A cardiometabolic risk score was calculated from nine cardiometabolic biomarkers at age 44. Path models were run to test these associations, adjusting for sex, education, socioeconomic position and affective symptoms at age 50.

RESULTS

After accounting for missing data using multiple imputation, path models indicated significant indirect associations between affective symptoms and mid-life immediate memory (β = -0.002, s.e. = 0.001, P = 0.009), delayed memory (β = -0.002, s.e. = 0.001, P = 0.02) and verbal fluency (β = -0.002, s.e. = 0.001, P = 0.045) through cardiometabolic risk.

CONCLUSIONS

These findings suggest that cardiometabolic risk may play an important role in the association between affective symptoms and cognitive function (memory and verbal fluency). Results contribute to understanding of biological mechanisms underlying associations between affective symptoms and cognitive ageing, which can have implications for early detection of, and intervention for, those at risk of poorer cognitive outcomes.

Associations between mentally-passive and mentally-active sedentary behaviours during adolescence and psychological distress during adulthood

It is unclear if different types of sedentary behaviour during the adolescence are differentially associated with psychological distress during adolescence and adulthood. It is also unknown what may mediate this potential proposed association. The current study aimed to analyse the association of mentally-active and mentally-passive sedentary behaviours during adolescence (16y) with subsequent psychological distress during adulthood (42y), and to examine the role of potential mediators (42y). Data from the 1970 British Cohort Study was used (N = 1787). At age 16y participants reported time and frequency in mentally-passive (TV-viewing and watching movies) and mentally-active (reading books, doing homework and playing computer games) sedentary behaviours, psychological distress and organized sports participation. At 42y, participants reported cognition (vocabulary test), TV-viewing, psychological distress, self-rated health, body mass index and employment status. Education was collected throughout the follow-up years. Logistic regression and mediation models assessed associations. Multiple imputation using chained equations was used to assess the impact of missing data. Mentally-passive sedentary behaviour in adolescence was a risk factor for psychological distress during adulthood in complete-cases analysis [OR:1.44(95%CI:1.09-1.90)], which was confirmed by the model with multiple imputation. Mentally-active sedentary behaviour at 16y was not associated with psychological distress at 42y. Adult TV-viewing during weekends (24.7%), and self-rated health (19.0%) mediated the association between mentally-passive sedentary behaviour during adolescence and psychological distress during adulthood. However, the mediation was not clear in the models with multiple imputation. Mentally-passive sedentary behaviour during adolescence was associated with elevated psychological distress during adulthood and this association was mediated TV-viewing and self-rated health in adulthood.

Disentangling trait, occasion-specific, and accumulated situational effects of psychological distress in adulthood: evidence from the 1958 and 1970 British birth cohorts

BACKGROUND

The trajectories of psychological distress differ between individuals, but these differences can be difficult to understand because the measures contain both consistent and situational features; however, in longitudinal studies these sources of information can be disentangled. In addition to occasion-specific features, interindividual differences can be decomposed into two sources of information: trait and carry-over effects between neighboring occasions that are not related to the trait (i.e. accumulated situational effects).

METHODS

To disentangle these three sources of variance throughout adulthood, the consistency (trait and accumulated situational effects) and occasion specificity of nine indicators of psychological distress from the Malaise Inventory were examined in two birth cohorts, the 1958 National Child Development Study (NCDS58), and the 1970 British Cohort Study (BCS70).

RESULTS

The scale was administered at ages 23, 33, 42, and 50 in NCDS58 (n = 7147), and at ages 26, 30, 34, and 42 in BCS70 (n = 6859). For each psychological symptom, more variance was consistent than occasion-specific. The majority of the consistency was due to trait variance as opposed to accumulated situational effects, indicating that an individual predisposed to be distressed at the beginning of the study remained more likely to be distressed over the whole period. Symptoms of rage were notably more consistent among males than females in both cohorts (78.1% and 81.3% variance explained by trait in NCDS58 and BCS70, respectively), and among females in the NCDS58 (69%).

CONCLUSIONS

Symptoms of psychological distress exhibited high stability throughout adulthood, especially among men, due mostly to interindividual trait differences.

Association of public care in childhood with social, criminal, cognitive, and health outcomes in middle-age: five decades of follow-up of members of the 1958 birth cohort study

BACKGROUND

Children who have been exposed to public (out-of-home) care experience a range of negative outcomes by late adolescence and early adulthood. The longer-term impact of childhood care is, however, uncertain.

AIM

To examine if there is a prospective association between childhood public care and adverse life outcomes in middle-age.

METHODS

We used data from the UK 1958 birth cohort study of 18 558 individuals. Parents reported offspring care status at age 7, 11 and 16. An array of social, criminal, cognitive, and health outcomes was self-reported by cohort members at age 42 (71% response proportion in eligible sample) and a cognitive test battery was administered at age 50 (62% response).

RESULTS

A total of 420 (3.8%) of 11 160 people in the analytical sample experienced childhood public care by age 16. Net of confounding factors, experience of public care (vs none) was linked to 11 of the 28 non-mutually exclusive endpoints captured in middle-age, with the most consistent effects apparent for psychosocial characteristics: 4/7 sociodemographic (eg, odds ratio; 95% confidence interval for homelessness: 2.1; 1.4 to 3.1); 2/2 antisocial (eg, use of illicit drug: 2.0; 1.2 to 3.5); 2/3 psychological (eg, mental distress: 1.6; 1.2 to 2.1); 1/3 health behaviours (eg, current cigarette smoker: 1.7; 1.3 to 2.2); 2/8 somatic health (physical disability: 2.7; 1.9 to 3.8); and 0/5 cognitive function (eg, beta coefficient; 95% confidence interval for immediate word recall: -0.1; -0.3 to 0.1) endpoints.

CONCLUSIONS

The present study suggests that selected associations apparent between childhood care and outcomes in adolescence and early adulthood are also evident in middle-age.

Childhood Obesity and Device-Measured Sedentary Behavior: An Instrumental Variable Analysis of 3,864 Mother-Offspring Pairs

OBJECTIVE

Intergenerational data on mother-offspring pairs were utilized in an instrumental variable analysis to examine the longitudinal association between BMI and sedentary behavior.

METHODS

The sample included 3,864 mother-offspring pairs from the 1970 British Cohort Study. Height and weight were recorded in mothers (age 31 [5.4] years) and offspring (age 10 years) and repeated in offspring during adulthood. Offspring provided objective data on sedentary behavior (7-day thigh-worn activPAL) in adulthood at age 46 to 47 years.

RESULTS

Maternal BMI, the instrumental variable, was associated with offspring BMI at age 10 (change per kg/m² , β = 0.11; 95% CI: 0.09 to 0.12), satisfying a key assumption of instrumental variable analyses. Offspring (change per kg/m² , β = 0.010; 95% CI: -0.02 to 0.03 h/d) and maternal BMI (β = 0.017; 95% CI: 0.001 to 0.03 h/d) was related to offspring sedentary time, suggestive of a causal impact of BMI on sedentary behavior (two-stage least squares analysis, β = 0.18 [SE 0.08], P = 0.015). For moderate-vigorous physical activity, there were associations with offspring BMI (β = -0.010; 95% CI: -0.017 to -0.004) and maternal BMI (β = -0.007; 95% CI: -0.010 to -0.003), with evidence for causality (two-stage least squares analysis, β = -0.060 [SE 0.02], P = 0.001).

CONCLUSIONS

There is strong evidence for a causal pathway linking childhood obesity to greater sedentary behavior.

No man is an island: social resources, stress and mental health at mid-life

BACKGROUND

Positive social relationships are known to mitigate the negative effects of stress on mental health. However, the direction of association between social resources and mental health remains unclear, and it is not known whether higher than average levels of social resources confer additional benefits, in the short and longer term.

AIMS

To investigate the concurrent and longitudinal contribution of higher levels of social resources in reducing the risk of mental health symptoms after exposure to stress at age 45, and to identify life-course precursors of mid-life social resources.

METHOD

The National Child Development Study (NCDS) is a prospective birth cohort of over 17 000 births in 1958. We tested concurrent and longitudinal associations between different levels of social resources at age 45 and mental health symptoms among individuals exposed to stress and verified whether prior mental health symptoms (age 42) explained these associations. We also tested a range of child, family and adult precursors of mid-life social resources.

RESULTS

Higher than average levels of social resources were required to confer benefits to mental health among individuals exposed to high stress levels, both concurrently at age 45 and in the longer term at age 50. In general, these associations were not attributable to prior mental health symptoms. Key predictors of mid-life social resources included evidence of early sociability.

CONCLUSIONS

Having a broad network of social ties and better personal support helps individuals withstand exposure to higher levels of stress. Given that sociable children had better mid-life social resources, early intervention may benefit individuals' social resources later in life.

Adverse childhood experiences and adult mood problems: evidence from a five-decade prospective birth cohort

BACKGROUND

Retrospectively recalled adverse childhood experiences (ACEs) are associated with adult mood problems, but evidence from prospective population cohorts is limited. The aims of this study were to test links between prospectively ascertained ACEs and adult mood problems up to age 50, to examine the role of child mental health in accounting for observed associations, and to test gender differences in associations.

METHODS

The National Child Development Study is a UK population cohort of children born in 1958. ACEs were defined using parent or teacher reports of family adversity (parental separation, child taken into care, parental neglect, family mental health service use, alcoholism and criminality) at ages 7-16. Children with no known (n = 9168), single (n = 2488) and multiple (n = 897) ACEs were identified in childhood. Adult mood problems were assessed using the Malaise inventory at ages 23, 33, 42 and 50 years. Associations were examined separately for males and females.

RESULTS

Experiencing single or multiple ACEs was associated with increased rates of adult mood problems after adjustment for childhood psychopathology and confounders at birth [2+ v. 0 ACEs - men: age 23: odds ratio (OR) 2.36 (95% confidence interval (CI) 1.7-3.3); age 33: OR 2.40 (1.7-3.4); age 42: OR 1.85 (1.4-2.4); age 50: OR 2.63 (2.0-3.5); women: age 23: OR 2.00 (95% CI 1.5-2.6); age 33: OR 1.81 (1.3-2.5); age 42: OR 1.59 (1.2-2.1); age 50: OR 1.32 (1.0-1.7)].

CONCLUSIONS

Children exposed to ACEs are at elevated risk for adult mood problems and a priority for early prevention irrespective of the presence of psychopathology in childhood.

Infant domestic adoption: outcomes at mid-life

BACKGROUND

Adoption studies can cast light on environmental influences on development, but heterogeneity in preplacement experiences often complicates interpretation of findings.

METHODS

We studied infant-adopted samples drawn from the 1958 and 1970 British birth cohorts and examined mental health, well-being, physical health and externalizing outcomes at mid-life. Outcomes for adopted cohort members were compared with those of (a) individuals raised in two biological parent families ('general population' comparisons) and (b) birth comparison groups of other nonadopted children from similar circumstances at birth.

RESULTS

In both cohorts, to-be-adopted children shared early characteristics in common with birth comparison children, but were placed in more socially advantaged adoptive homes. Followed to mid-life, there were few group differences on indicators of physical health or psychological well-being. Levels of psychological distress were comparable in the adopted and general population samples in both cohorts, and more favourable than in the birth comparison groups among women in the 1958 cohort; more beneficial childhood family circumstances contributed to these differences. Rates of adult externalizing outcomes were comparable in the adopted and birth comparison groups in both cohorts, and higher than in the general population samples; indicators of maternal and prenatal exposures contributed to these differences.

CONCLUSIONS

Rearing in adoptive homes may provide protective effects in relation to internalizing problems but may not be as protective in relation to externalizing outcomes.

Association of illicit drug use in adolescence with socioeconomic and criminal justice outcomes in adulthood: prospective findings from a UK national birth cohort

BACKGROUND

Illicit drug use in adolescence has been linked to drug use and poor mental health in adult life, but few studies have examined the relation between adult economic and criminal justice outcomes.

METHODS

We analysed data from 14 082 participants (6999 women) in the 1970 British Birth Cohort Study. Illicit drug use over study members' lifetime and in the past year were self-reported at 16 years of age. Thirteen outcomes were self-reported at 30 years of age, including illicit drug use, smoking, problems with alcohol, mental and physical health, experience of socioeconomic disadvantage and experiences with the criminal justice system.

RESULTS

At 16 years of age, 20.3% of the participants had ever tried an illicit drug and 7.2% had used in the past year. After adjustment for childhood socioeconomic status and mental health problems, and following correction for multiple testing, there was a dose-response association between illicit drug use at 16 years with illicit drug use in adult life in the past year (OR; 95% CI - 1.83, 1.51 to 3.12), experiencing homelessness (1.74, 1.16 to 2.62), being arrested (1.57, 1.29 to 1.92) and cautioned (1.97, 1.50 to 2.57) by the police, and being found guilty at court (1.73, 1.34 to 2.23).

CONCLUSIONS

Adolescent drug use was associated with an array of social and criminal outcomes in later life.

Gendered Pathways of Internalizing Problems from Early Childhood to Adolescence and Associated Adolescent Outcomes

Despite trends indicating worsening internalizing problems, characterized by anxiety and depression, there is dearth of research examining gender differences in developmental trajectories of internalizing problems from early childhood to adolescence. Drawing on the UK Millennium Cohort Study (n = 17,206, 49% female), this study examines trajectories of parent-reported, clinically-meaningful (reflecting the top 10%) internalizing problems from ages 3 to 14 years and their early predictors and adolescent outcomes. Group-based modelling revealed three trajectories when examining boys and girls together, but there were significant gender differences. When examining boys and girls separately, four trajectories were identified including two relatively stable trajectories showing either high or low probabilities of internalizing problems. An increasing trajectory was also found for both boys and girls, showing an increasing probability of internalizing problems which continued to rise for girls, but levelled off for boys from age 11. A decreasing trajectory was revealed for boys, while a moderate but stable trajectory was identified for girls. Boys and girls in the increasing and high probability groups were more likely to report a number of problematic outcomes including high BMI, self-harm, low mental wellbeing, depressive symptoms, and low educational motivation than the low group. Girls on the increasing trajectory also reported more cigarette and cannabis use and early sexual activity at age 14 compared to girls on the low trajectory. Findings suggest that intervention strategies take a systemic view, targeting not only internal feelings, but also behaviours potentially associated with later negative outcomes.

Adult mood problems in children with neurodevelopmental problems: evidence from a prospective birth cohort followed to age 50

PURPOSE

Specific child neurodevelopmental (ND) disorders such as ADHD and learning problems are associated with concurrent and future (up to early adulthood) mood problems. However, it is unclear whether findings generalise to population traits as well as diagnoses, to general as well as specific neurodevelopmental domains, and whether risk associations extend to later adulthood or diminish with age.

METHODS

We used data from a UK cohort of children born in 1958, the National Child Development Study (NCDS). ND problems were assessed at ages 7 and 11 years with parent- and teacher ratings of restlessness, hyperactivity and motor co-ordination difficulties, and by individual tests of reading, arithmetic and general cognitive ability. Mood (depression/anxiety) problems were assessed using the Malaise symptom screen at 23, 33, 42, and 50 years. Factor analyses were conducted to assess whether the specific neurodevelopmental domains could be aggregated into a general "ND" latent factor as well as specific factors. Associations with mood outcomes were then tested.

RESULTS

A bi-factor model with a general "ND" latent factor and specific "motor" and "cognition" factors fits the data well. The specific cognition and motor factor scores were associated with mood problems in early adulthood only. The "ND" factor demonstrated associations with mood problems at each adult follow-up (men - age 23 years: β = 0.17; age 33: β = 0.16; age 42: β = 0.14; age 50: β = 0.16; women - 23 years: β = 0.25; 33 years: β = 0.26; 42 years: β = 0.14; 50 years: β = 0.16; all ps < 0.01). Interactions by sex indicated that the association between this general factor and mood problems was more pronounced for women than men at ages 23 years (β = 0.09, p = 0.005) and 33 years (β = 0.10, p = 0.003), but not at 42 or 50 years (ps > 0.8).

CONCLUSIONS

Our results suggest that, in a population-based cohort, a general, childhood neurodevelopmental difficulty factor is stably associated with mood problems in adult life.