Association of birth order with adolescent mental health and suicide attempts: a population-based longitudinal study

Self-reported knowledge, attitude and mental health status of in-school adolescents in Nigeria

BACKGROUND

 The global rise in adolescent mental health conditions highlights the need for preventive interventions particularly in schools for timely access to young people, building on inherent strengths and competencies.

AIM

 The study aims to determine the knowledge, attitude, mental health status and the predictors of mental health status of in-school adolescents.

SETTING

 The study was conducted in government-owned secondary schools in Lagos State, Nigeria. Simple random sampling was used to select one of three senatorial districts; one junior and one senior secondary school with a nurse-led school clinic were purposively selected from the sampled district.

METHODS

 Within a cross-sectional survey design, a self-administered questionnaire was used to obtain data from a sample of in-school adolescents aged 10-19 years (n = 148), enrolled in junior and senior classes.

RESULTS

 Most in-school adolescents reported poor knowledge (62.2%; n = 92) and poor attitude (54.7%; n = 81) towards mental health; 37.2% (n = 55) reported being substantially at risk of conduct problems. A high proportion (79.7%) indicated normal prosocial behaviours. Level of knowledge (odds ratio [OR] = 3.25; p  0.05; 95% confidence interval [CI] = 1.34-7.86) as well as third or higher birth order (OR = 3.46; p  0.05; 95% CI = 1.34-8.94) were significant predictors of mental health status.

CONCLUSION

 Most in-school adolescents lack knowledge, have a poor attitude towards mental health and are more likely to display conduct problems impacting their mental health status.Contribution: The study provides baseline evidence for designing in-school programmes with a mental wellness focus to promote the mental health of adolescents, leveraging professional and parental networks.

Adverse childhood experiences in firstborns and mental health risk and health-care use in siblings: a population-based birth cohort study of half a million children in England

BACKGROUND

Adverse childhood experiences (ACEs) often affect multiple children within families, yet studies tend to focus on the health outcomes of individual children, underestimating the needs of affected families. We aimed to examine the association between firstborns exposed to ACEs between 1 year before and 2 years after birth (the first 1000 days) and the risks of mental health problems, mental health-related health-care contacts, and all-cause hospital admissions in multiple children from the same mother, compared to firstborns without ACEs.

METHODS

We derived a population-based birth cohort in England using linked electronic health records for first-time mothers (aged 14-55 years) with their children (born 2002-18). We followed up the cohort from 1 year before birth up to 18 years after birth across the Clinical Practice Research Datalink GOLD and Aurum databases (primary care), Hospital Episode Statistics (secondary care), and the Office of National Statistics (death registrations) between April 1, 2001, and March 31, 2020. We included six different ACE domains, including child maltreatment, intimate partner violence, maternal substance misuse, maternal mental health problems, adverse family environments, and high-risk presentations of child maltreatment, in the records of the mother or the firstborn in the first 1000 days. The primary outcome was the number of children (aged 5-18 years) with recorded mental health problems per mother. We used adjusted and weighted negative binomial regression models to estimate incidence rate ratios.

FINDINGS

Of 333 048 firstborns and their mothers, 123 573 (37·1%) had any ACEs between 1 year before and 2 years after birth, and 65 941 (19·8%) of all mothers had at least one child with a mental health problem between ages 5 years and 18 years (median follow-up 11·4 years [IQR 9·2-14·1]). Mothers with firstborns with ACEs had 1·71 (95% CI 1·68-1·73) times as many children in total with mental health problems (mean 29·8 children per 100 mothers, 29·4-30·1) compared with mothers without firstborns with ACEs (mean 17·4 children per 100 mothers, 17·3-17·6), translating into a mean difference of 12·3 (95% CI 11·9-12·7) additional children with mental health problems per 100 mothers. These mothers also had increased incidence rates of children with all-cause emergency admissions and mental health-related contacts. There was no significant difference in the risk of mental health problems between firstborn and later-born children.

INTERPRETATION

ACEs in firstborns during the first 1000 days were associated with increased mental health problems and health-care needs in multiple children in the same family. The findings highlight the importance of early identification of vulnerable first-time parents and firstborns and increased policy focus on sustained support beyond the first 1000 days to promote healthier long-term family outcomes. Future evaluations of interventions should include the health outcomes of multiple children within families.

FUNDING

NIHR Policy Research Programme.

Suicide attempts and non-suicidal self-injury in Chinese adolescents: Predictive models using a neural network model

INTRODUCTION

Suicide attempts (SA) are a significant contributor to suicide deaths, and non-suicidal self-injury (NSSI) can increase the risk of SA. Many adolescents experience both NSSI and SA, which are affected by various factors. This study aimed to identify the risk factors and essential warning signs of SA, establish a predictive model for SA using multiple dimensions and large samples, and provide a multidimensional perspective for clinical diagnosis and intervention.

METHODS

A total of 9140 participants aged 12-18 years participated in an online survey; 6959 participants were included in the statistical analysis. A multilayer perceptron algorithm was used to establish a prediction model for adolescent SA (with or without); adolescents with NSSI behavior were extracted as a subgroup to establish a prediction model.

RESULTS

Both the prediction model performance of the SA group and the NSSI-SA subgroup were strong, with high accuracy, and AUC values of 0.93 and 0.88, indicating good discrimination. Decision curve analysis (DCA) demonstrated that the clinical intervention value of the prediction results was high and that the clinical intervention benefits of the NSSI-SA subgroup were greater than those of the SA group.

CONCLUSIONS

Our study demonstrated that the predictive model has a high degree of accuracy and discrimination, thereby identifying significant factors associated with adolescent SA. As long as adolescents exhibit NSSI behavior, relative suicide interventions should be implemented to prevent future hazards. This study can provide guidance and more nuanced insights for clinical diagnosis as well as a foundation for clinical treatment.

Effectiveness of Psycho-Religious Sexuality Education upon Anger and Depression of Iranian Female Adolescents: The Relationship of Quality Family Relationships and Birth Order

Sexually active adolescents tend to have a wider range of psychosocial problems, including depression, anger, poor academic achievement, low self-esteem, and substance use. Developing a high-quality and curriculum-based comprehensive sexuality education (CSE) program is of great importance for adolescents following Iranian culture. Due to the lack of such an educational program, the purpose of this study was to investigate the effectiveness of psycho-religious CSE upon anger and depression of Iranian female adolescents, as well as the relationship of quality family relationships and birth order. The research design is quasi-experimental with pre-test and post-test with experimental and control groups. The statistical population of this study comprised all Iranian female adolescents aged 15 to 18 years in Mashhad who participated in this workshop voluntarily. For data collection, the Child and Adolescent Depression Inventory and Spielberger's State-Trait Anger Expression Inventory (STAXI) were used. SPSS 21 software and analysis of variance (ANOVA) and covariance (ANCOVA) were used for data analysis. The results showed that there was a significant difference in the mean difference between depression and anger in the control and experimental groups (p-Value < 0.05). The results also showed a significant relationship between birth order and the quality of family relationships on depression and anger. Psycho-religious-based SE can reduce depression and anger in female students. These findings can be used in planning educational interventions with a psycho-religious-based approach to reducing anger, depressive symptoms and dangerous sexual behaviors among adolescents.

Longitudinal pathways from adolescent depressive symptoms to cardiovascular disease risk in adulthood

RATIONALE

Despite existing literature on the impact of adolescent depressive symptoms on a variety of youth outcomes, little is known about whether and how adolescent depressive symptoms are associated with physical health in adulthood.

OBJECTIVE

This study aimed to investigate the longitudinal association between adolescent depressive symptoms and cardiovascular disease (CVD) risk in adulthood. An extensive list of potential mechanisms underlying this association, including health behaviors, substance use, academic effort and achievement, and school-based relationships, was also examined.

METHODS

Using the sibling sample from the National Longitudinal Study of Adolescent to Adult Health (N = 3011), this study employed sibling fixed-effects models to address unobservable family-level confounders, such as genetic factors, parental and familial characteristics, and school and neighborhood environments.

RESULTS

Adolescent depressive symptoms were associated with an increased risk of CVD in about 13 years later (b = 0.698). Sibling fixed-effects estimates revealed that, despite some attenuation (approximately 31%), this association is robust to adjustment for unobserved family-level heterogeneity. Substance use and academic effort/achievement explained about 35% and 16% of the association between adolescent depressive symptoms and adult CVD risk, respectively. In contrast, health behaviors and school-based relationships played little or no role in mediating the association.

CONCLUSION

The findings of this study suggest that policymakers and practitioners may wish to develop interventions to reduce adolescent depressive symptoms and to help adolescents with depressive symptoms avoid substance use and promote effort in school. Early interventions targeting adolescents with depressive symptoms may be a cost-effective strategy for preventing adult physical health problems.

Birth order and sickness absence: Register-based evidence from Finland

BACKGROUND

In working ages, sickness absence is strongly related to persons' health condition. We studied how birth order was associated with receipt of sickness allowance, distinguishing between mental disorders, musculoskeletal disorders and injuries.

METHODS

A follow-up study based on the entire Finnish population was conducted for sibling groups born 1969-1982, in which each sibling was observed from age 35 years in the period 2004-2018. Focus was on within-family variation in first-time sickness allowance receipt.

RESULTS

Results of stratified Cox regressions revealed that each increase in birth order was associated with a slightly higher risk of sickness absence from any cause. For mental disorders, associations were stronger; the hazard ratio as compared to first borns was 1.03 (95% CI: 0.98-1.08) of second borns, 1.10 (0.99-1.22) of third borns, and 1.52 (1.25-1.85) of fourth or higher borns. Corresponding numbers for musculoskeletal disorders were 1.12 (1.07-1.17), 1.19 (1.09-1.30) and 1.15 (0.96-1.38), and for injuries 1.06 (1.01-1.12), 1.09 (1.21-1.14) and 0.96 (0.77-1.20), respectively.

CONCLUSIONS

Birth order effects were generally stronger for women than men, and to some extent influenced by educational level, occupation, income, and family composition. Possible latent mechanisms behind the associations may relate to within-family dynamics at childhood.

Birth order and health events attributable to alcohol and narcotics in midlife: A 25-year follow-up of a national Swedish birth cohort and their siblings

Higher birth order is associated with increased risks of adverse health outcomes attributable to alcohol or narcotics in adolescence, but it remains unclear whether these observed birth order effects are also present in midlife. Drawing on a national Swedish cohort born in 1953 and their siblings, we estimate associations between birth order and alcohol- or narcotics-attributable hospitalization or death with a 25-year follow-up to assess whether birth order differences are observed during this life course period. Health events attributable to alcohol or narcotics use were identified using the Swedish National Patient and Cause of Death registers, respectively. We apply Cox proportional hazards models to estimate average birth order differences in hazards for alcohol- or narcotics-attributable hospitalization or death between ages 30 and 55. We estimate birth order differences between families, and use two fixed-effects approaches to estimate birth order differences within families and within families of the same type. Bivariate results indicate increased hazards for both outcomes with higher birth order; however, these results are no longer observed after adjustment for familial background characteristics in all models. Our results thereby show limited evidence for birth order differences in midlife. This study highlights that shared factors within the family of origin may be stronger predictors of adverse health outcomes attributable to substance use among siblings during this life course period. Future research should disentangle the contributions of the social environment within the family of origin for adverse health outcomes attributable to alcohol or narcotics among siblings.

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We estimate birth order differences for alcohol or narcotics use outcomes between ages 30-55.

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Birth order differences are not observed for alcohol- or narcotics-attributable events in midlife.

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Family background characteristics may be stronger predictors of these outcomes.

Exploring the effects of birth order on human lifespan in Polish historical populations, 1738–1968

While the relationships between birth order and later outcomes in life, including health and wealth, have been the subject of investigation for several decades, little or no data exist regarding the relationship between birth order and life expectancy in the Polish population. The aim of this study was to explore the link between birth order and lifespan in Polish historical populations. We obtained 8523 records from a historical dataset that was established for parishioners from the borough of Bejsce, including 4463 males and 4060 females. These data pertain to the populations that lived over a long period in a group of localities for which parish registers were well preserved. The Mann-Whitney U test, the Kruskal-Wallis ANOVA and ANCOVA were run. The results strongly suggest that birth order affects male longevity. However, no such association was found for females. On balance, the hypothesis that first-born boys live longer because they are born to relatively younger parents has received some empirical support and deserves further study. We hypothesise that the effects of birth order on human health and lifespan might be overshadowed by other factors, including educational attainment, socioeconomic status and lifestyle.

Depression Among Adolescents in a Rural Area of Haryana, India: A Community-Based Study Using Patient Health Questionnaire-9

Introduction: The estimates of prevalence of depression among adolescents in the Indian community are limited; most studies are institution-based. Early identification and management of depression can provide significant health dividends to the affected adolescents, and better health consequences in their adulthood.

Objectives: To determine the prevalence of depression among 10- to 19-year-old residents in a rural area of Haryana, India, and to assess factors associated with adolescent depression.

Methods: A sample of 630 adolescents (between 10 to 19 years of age) residing in the selected area of Ballabgarh (Haryana) were selected using simple random sampling technique. Home visits were made, in which participants were administered the Patient Health Questionnaire (PHQ)-9 to screen for depression. The prevalence and 95%CI were estimated. In addition, a semi-structured interview schedule was administered to identify sociodemographic variables and other factors associated with adolescent depression. Unadjusted and adjusted OR were reported with p-value, using multivariable logistic regression analysis.

Results: The age-adjusted prevalence of depression among adolescents was 20.6% (95% CI: 16.9-24.2). The prevalence in late and early adolescence was 11.7% and 8.9%, respectively. It was higher in girls (22.3%) as compared with boys (19.2%). Mild depression was the most common type identified. On multivariable logistic regression, depression was associated with birth order of four or more (Adjusted OR (AOR)=3.0 (95%CI: 1.4-6.3), p<0.01), presence of long-standing illness in the past three months (AOR=3.0 (95%CI: 1.4-6.1), p<0.01), impaired self-perceived body image (AOR=2.9 (95%CI: 1.8-4.6), p<0.01), and perceived stressful event(s) in the past six months (AOR=4.9 (95%CI: 2.8-8.6), p<0.01).

Conclusion: One in five adolescents was screened positive for depression, necessitating focus on screening and early identification of depressive symptoms, especially at the primary care level.

Association of Birth Order With Mental Health Problems, Self-Esteem, Resilience, and Happiness Among Children: Results From A-CHILD Study

Objective: This study aimed to investigate the association of birth order with mental health problems, self-esteem, resilience, and happiness among children aged 9-10 years. Methods: This was a cross-sectional study using data from the Adachi Child Health Impact of Living Difficulty (A-CHILD) study, which was a population-based study of children in fourth grade in public schools in Adachi City, Tokyo, Japan in 2018 (N = 3,744). Parent-rated Strengths and Difficulties Questionnaire (SDQ) and self-rated resilience, happiness, and self-esteem score were used to assess child mental health. Multiple regression analysis for continuous outcomes and logistic regression for dichotomous outcomes were used to examine the association of birth order with mental health problems, resilience, happiness, and self-esteem. The analysis was controlled for child sex, mother's age, mother's education, caregiver's depressive symptoms, household income, and living with grandparents. Results: Last-borns showed the lowest total difficulties score in the SDQ, while only children showed the highest (p < 0.001). The highest prosocial behaviors score was found among last-borns (p < 0.001). Resilience score was also highest among last-borns, followed by first-borns, middle-borns, and only children. The lowest happiness score was found among middle-borns. Self-esteem score did not differ by sibling types. These associations were similar in the adjusted model and dichotomized outcomes model. Conclusions: Differential impacts of birth order on child mental health, for both positive and negative sides, were found. Further research is warranted to elucidate the mechanism of the association between birth order and the development of behavior problems and the positive aspects such as resilience, happiness, and self-esteem among children.

Psycho-social factors associated with high depressive symptomatology in female adolescents and gender difference in adolescent depression: an epidemiological survey in China's Hubei Province

BACKGROUND

Exploring etiological clues to adolescent depression, especially in female adolescents, might be helpful to improve the social environment of female adolescents. The aim at this study is to explore psycho-social factors of female adolescents with high depressive symptomatology and gender differences in depressive symptoms among Chinese adolescents.

METHOD

We examined 4100 adolescents from Wuhan city and Jianli county via a cross-sectional study. Depressive symptomatology was screened through the Chinese version of Center for Epidemiology Studies Depression Scale. Multivariate logistic regression was performed to explore the factors related to high depressive symptomatology in female and male adolescents, respectively.

RESULTS

The prevalence of high depressive symptomatology in female and male were 38.9 and 30.2% respectively. The psycho-social factors of high depressive symptomatology in female adolescents were age (Adjusted odds ratio [aOR] = 1.201, 95% confidence interval [CI], 1.076 ~ 1.341), single parent family (aOR = 2.004, 95%CI, 1.448 ~ 2.772) and fathers' education level (compared to primary school and below, [Junior middle school, aOR = 0.641, 95%CI, 0.439 ~ 0.934; Senior middle school, aOR = 0.603, 95%CI, 0.410 ~ 0.888; College degree and above, aOR = 0.639, 95%CI, 0.437 ~ 0.936]).

CONCLUSION

Fathers' education level was associated with high depressive symptomatology in female adolescents. Female adolescents whose father with primary school education or below deserves more attention. Further epidemiologic researches need to be conducted to explore the different risk factors between female and male adolescents in China.

Mood Symptoms, Suicide, and Associated Factors Among Jimma Community. A Cross-Sectional Study

Background: The global burden of mental health problems is high and is predicted to rise. At present, mood symptoms are the foremost common psychological problems worldwide, yet little is known regarding their magnitude and associated factors in developing countries. Therefore, this study aimed to assess the magnitude and associated factors of anxiety, depressive, manic symptoms, and suicidal behavior among the rural Jimma community, Ethiopia. Methods: A community-based quantitative cross-sectional survey was employed on 423 households selected through systematic random sampling. An adapted version of the Mini International Neuropsychiatric Interview tool was used for the structured face-to-face interview. The collected data were checked for completeness, coded, and inserted into Epi Data version 3.1 and exported to SPSS version 23 for analysis. Variables with P < g0.05 and odds ratio (OR) [95% confidence interval (CI)] on multivariate logistic regression analysis were considered as factors associated with the outcome variable. Results: Overall, 185 (44.0%), 55 (13.1%), 44 (10.5%), and 23 (5.5%) of the respondents had anxiety, depressive, manic symptom, and suicide behavior, respectively. The odds of having anxiety symptoms were nearly 5 times higher among those who had perceived discrimination and racism experience compared to their counterpart [adjusted OR (AOR), 5.02; 95% CI, 1.90-13.26]. Likewise, recently bereaved participants had 4-fold higher odds of reporting depressive symptoms (AOR, 3.9; 95% CI, 1.4-10.4) than the non-bereaved ones. Furthermore, respondents who had depressive symptoms were almost four and a half times more likely to have manic symptoms compared to those who did not (AOR, 4.3; 95% CI, 1.71-11.02). Conclusion: Anxiety, depressive, manic symptoms, and suicidal behavior were prevalent in the community and positively associated with multiple psychosocial factors. Implementing accessible and affordable community-based mental health services is recommended to mitigate the problems.

AVPR1A main effect and OXTR-by-environment interplay in individual differences in depression level

Background

Multiple studies of depression indicated a significant role of gene-by-environment interactions; however, they are mainly limited to the examination of modulating effect of recent stressful life events. Other environmental factors occurring at different stages of ante- and postnatal development may affect the association between multiple genes and depression. The study aimed to analyze the main and haplotype-based effect of serotonergic system and HPA-axis gene polymorphisms on depression and to detect gene-by-environment interaction models explaining individual variance in depression in mentally healthy young adults from Russia.

Methods

Depression score was assessed using Beck Depression Inventory (BDI) in 623 healthy individuals (81% women; 17-25 years) of Caucasian origin (Russians, Tatars, Udmurts) from Russia. The main- and gene-based effects of 12 SNPs in SLC6A4 (5-HTTLPR, rs1042173), HTR2A (rs7322347), OXTR (rs7632287, rs2254298, rs13316193, rs53576, rs2228485, rs237911), AVPR1A (rs3803107, rs1042615), and AVPR1B (rs33911258) genes, and gene-by-environment interactions were tested with linear regression models (PLINK v.1.9) adjusted for multiple comparisons.

Results

We observed ethnicity-specific main effect of the AVPR1A rs3803107 (P = 0.003; P_FDR = 0.047) and gene-based effect of the OXTR gene (Р = 0.005; P_perm = 0.034) on BDI-measured depression, and modifying effect of paternal care on OXTR rs53576 (P = 0.004; P_FDR = 0.012) and birth order on OXTR rs237911 (P = 0.006; P_FDR = 0.018) association with depression level.

Limitations

A hypothesis driven candidate gene approach, which examined a limited number of genetic variants in a moderately large sample, was used.

Conclusions

Our preliminary findings indicate that familial environment may play a permissive role modulating the manifestation of OXTR-based depression variance in mentally healthy subjects.

In-utero and perinatal influences on suicide risk: a systematic review and meta-analysis

BACKGROUND

Adverse in-utero and perinatal conditions might contribute to an increased suicide risk throughout the lifespan; however, existing evidence is sparse and contradictory. We aimed to investigate in-utero and perinatal exposures associated with suicide, suicide attempt, and suicidal ideation.

METHODS

We did a systematic review and meta-analysis and searched MEDLINE, Embase, and PsycINFO from inception to Jan 24, 2019, for population-based prospective studies that investigated the association between in-utero and perinatal factors and suicide, suicide attempt, and suicidal ideation. Only papers published in English in peer-reviewed journals were considered. Two researchers independently extracted formal information (eg, country, year, duration of follow-up) and number of cases and non-cases exposed and non-exposed to each risk factor. We calculated pooled odds ratios (ORs) with 95% CIs using random-effects models and used meta-regression to investigate heterogeneity. This study was registered with PROSPERO, number CRD42018091205.

FINDINGS

We identified 42 eligible studies; they had a low risk of bias (median quality score 9/9 [IQR 8-9]). Family or parental characteristics, such as high birth order (eg, for fourth-born or later-born vs first-born, pooled OR 1·51 [95% CIs 1·21-1·88]), teenage mothers (1·80 [1·52-2·14]), single mothers (1·57 [1·31-1·89]); indices of socioeconomic position, such as low maternal (1·36 [1·28-1·46]) and paternal (1·38 [1·27-1·51]) education; and fetal growth (eg, low birthweight 1·30 [1·09-1·55] and small for gestational age 1·18 [1·00-1·40]) were associated with higher suicide risk. Father's age, low gestational age, obstetric characteristics (eg, caesarean section), and condition or exposure during pregnancy (eg, maternal smoking or hypertensive disease) were not associated with higher suicide risk. Similar patterns of associations were observed for suicide attempt and suicidal ideation; however, these results were based on a lower number of studies. In meta-regression, differences in length of follow-up explained most between-study heterogeneity (inital I² ranged from 0 to 79·5).

INTERPRETATION

These findings suggest that prenatal and perinatal characteristics are associated with increased suicide risk during the life course, supporting the developmental origin of health and diseases hypothesis for suicide. The low number of studies for some risk factors, especially for suicide attempt and ideation, leaves gaps in knowledge that need to be addressed. The mechanisms underlying the reported associations and their causal nature still remain unclear.

FUNDING

Horizon 2020 (EU).