Cohort Profile: The Mater-University of Queensland Study of Pregnancy (MUSP)

A two-generation study of attachment in mothers and their young adult offspring: Latent classes of attachment and associations with anxiety and depression

BACKGROUND

Evidence supports the conceptualization of adult attachment as existing along a continuum of attachment security and insecurity; however, ongoing debates persist regarding the use of categorical versus continuous approaches to studying attachment. Attachment data collected from a large community sample of mothers and their offspring in young adulthood were used to examine i) latent classes of adult attachment, ii) associations between mother and offspring attachment, iii) the relationship between adult attachment and mental health symptoms.

METHODS

Mothers and offspring were each administered the Attachment Style Questionnaire when offspring were aged 21-years. Latent class analyses (LCA) were performed to examine response patterns across ASQ items. Associations between mothers' and offspring attachment, and correlations between attachment domains and depression/anxiety subscales were examined.

RESULTS

LCA identified four latent classes across a continuum of secure and insecure attachment rather than four distinct adult attachment styles. Anxious attachment subscales correlated strongly with depression/anxiety symptoms in both cohorts. Mothers' attachment was significantly but weakly correlated with their young adult offspring attachment.

LIMITATIONS

Attachment was measured at one time point and as such, a causal maternal-offspring attachment relationship could not be established.

CONCLUSIONS

Findings support a dimensional view of attachment security and insecurity over a four-category model of adult attachment. Attachment correlated with anxiety and depressive symptoms and highlights the importance of considering adult attachment when addressing mental health. There was limited evidence of a relationship between middle aged mothers and their offspring in young adulthood, suggesting other factors influence attachment in adulthood.

Associations of gestational weight gain with the long-term postpartum weight gain, body mass index, waist circumference and abdominal obesity: A 27-year prospective cohort study

BACKGROUND

This prospective cohort study aimed to investigate the associations between gestational weight gain (GWG) and long-term postpartum maternal weight gain, body mass index (BMI), waist circumference (WC), and the risk of general and abdominal obesity, beyond motherhood (some 27 y after childbirth).

METHODS

Participants were 1953 women enrolled in the Mater-University of Queensland Study of Pregnancy cohort study that started in the early 1980 s, with the most recent follow-up at 27 y postpartum. We examined the prospective associations of GWG in pregnancy with weight, BMI, and WC and the risk of adiposity 27 y after the index pregnancy. We used linear and multinomial logistic regressions to examine the independent effect of GWG on each outcome, adjusting for potential confounders and mediators.

RESULTS

The average GWG during pregnancy was 14.88 kg (SD 5.24). One in four women (25.50%) gained below the Institute of Medicine (IOM) recommendations and one in three (34.00%) gained excess weight during pregnancy. Every 100 g/week increment of GWG was associated with 2.0 (95% CI: 1.5, 2.6) kg, 0.7 (0.5, 0.9) kg/m2, 1.3 (0.8, 1.8) cm greater body weight, BMI, and WC, respectively 27 y postpartum. Women who gained inadequate weight in pregnancy had significantly lower odds of general obesity (OR; 0.70, 95% CI:0.53,0.94) or abdominal obesity (0.73; 0.56,0.96), whereas those who gained excess gestational weight had much higher odds of general obesity (4.49; 3.36,6.00) and abdominal obesity (3.09; 2.29,4.16). These associations were independent of potential confounders.

CONCLUSION

Maternal GWG in pregnancy independently and strongly predicted beyond motherhood weight gain trajectory. GWG within IOM recommendation may prevent long-term development of both general and central obesity.

Self-Reported and Agency-Notified Child Abuse as Contributors to Suicidal Behaviour in a Population-Based Birth Cohort Study at 30-Year-Follow-Up

This was a record-linkage analysis of a birth cohort to examine the association between self-reported self-harm in adulthood and childhood maltreatment (CM) as prospectively notified to authorities and self-reported on the Child Trauma Questionnaire. There were 2507 participants at 30-year follow-up with data on both CM and self-reported self-harm including an intent to die. Of the participants, 304 (12.1%) had self-harmed at some time in their lives while 150 (4.2%) had wanted to die. The prevalence of self- and agency-reported maltreatment was 513 (20.5%) and 143 (5.7%) respectively. On adjusted analyses, CM irrespective of reporting source showed significant associations with both suicidal outcomes. Physical and emotional abuse showed the strongest associations while findings for neglect were mixed. The only association for sexual abuse was for self-reported maltreatment and intent to die but numbers may have been under-powered.

Self-reported child maltreatment and cardiometabolic risk in 30-year-old adults

BACKGROUND

Childhood maltreatment (CM) is associated with both dietary fat intake and obesity in later life. There is less information on associations with metabolic risk factors and specific types of CM such as physical, sexual and emotional abuse, as well as neglect.

AIMS

To assess the association between five types of self-reported CM and a range of obesity and metabolic indicators in a subsample of a birth cohort.

METHODS

This was a study of 1689 adults born in a major metropolitan maternity hospital in Australia and followed up 30 years later. Body mass index, bioimpedance and fasting lipid levels/insulin resistance were measured. Details on self-reported CM were collected using the Child Trauma Questionnaire. We adjusted for birth weight, parental income and relationship at participants' birth, as well as maternal age and alcohol or tobacco use. We also adjusted for participants' smoking, depression, educational level, marital and employment status at follow up.

RESULTS

One-fifth reported maltreatment (n = 362), most commonly emotional neglect (n = 175), followed by emotional abuse (n = 128), physical neglect (n = 123), sexual (n = 121) and physical abuse (n = 116). On adjusted analyses, there were significant associations for CM, particularly neglect or emotional abuse, and one or more of the following outcomes: obesity, the total cholesterol/high-density lipoprotein cholesterol (TC/HDL-C) ratio and HDL levels. Results for other outcomes were more equivocal.

CONCLUSIONS

Of child maltreatment types, emotional abuse and neglect show the strongest associations with obesity and several cardiometabolic risk factors, therefore highlighting the public health importance of early intervention to reduce childhood adversity.

A 40-year study of child maltreatment over the early life course predicting psychiatric morbidity, using linked birth cohort and administrative health data: protocol for the Childhood Adversity and Lifetime Morbidity (CALM) study

BACKGROUND

Child maltreatment is a major public health issue worldwide. Retrospective studies show a strong association between self-reported child maltreatment and poor mental and physical health problems. Prospective studies that use reports to statutory agencies are less common, and comparisons of self- and agency-reported abuse in the same cohort even rarer.

AIMS

This project will link state-wide administrative health data with prospective birth cohort data (N = 7223) from Brisbane in Queensland, Australia (including notifications to child protection agencies), to compare psychiatric outcomes in adulthood of agency- and self-reported child maltreatment while minimising attrition bias.

METHOD

We will compare people with all forms of self- and agency-reported child maltreatment to the rest of the cohort, adjusting for confounding in logistic, Cox or multiple regression models based on whether outcomes are categorical or continuous. Outcomes will be hospital admissions, emergency department presentations or community/out-patient contacts for ICD-10 psychiatric diagnoses, suicidal ideation and self-harm as recorded in the relevant administrative databases.

CONCLUSIONS

This study will track the life course outcomes of adults after having experienced child maltreatment, and so provide an evidence-based understanding of the long-term health and behavioural consequences of child maltreatment. It will also consider health outcomes that are particularly relevant for adolescents and young adults, especially in relation to prospective notifications to statutory agencies. Additionally, it will identify the overlap and differences in outcome for two different sources of child maltreatment identification in the same cohort.

Does Childhood Maltreatment Lead to Low Life Success? Comparing Agency and Self-Reports

BACKGROUND

The long-term mental and physical health consequences of childhood maltreatment have been well documented. Less known are the longer-term consequences of childhood maltreatment, specifically the extent to which childhood maltreatment predicts adult life success.

OBJECTIVES

To prospectively assess the extent to which childhood experiences of physical, sexual, emotional abuse and childhood neglect predict life success at 30 years of age.

PARTICIPANTS AND SETTING

Data are from the Mater-University of Queensland Study of Pregnancy (MUSP), a pre-birth cohort study which follows children from conception to 30 years of age.

METHODS

Details of childhood maltreatment are from two sources; child safety agency notifications (and substantiations) linked to the survey data with self-reports of childhood experiences of maltreatment obtained at the 30-year follow-up using the Child Trauma Questionnaire (CTQ). Life success is a 9-item composite measure (alpha = 0.76) obtained at the 30-year follow-up. We use logistic regression models (with control for covariates) to examine the association between overall as well as specific forms of childhood maltreatment on adult life success. We further test these models using different cut-offs and propensity analyses to adjust for loss to follow-up.

RESULTS

Childhood maltreatment whether measured by agency report or self-report predicts overall low life success; agency substantiation OR = 1.88(1.14,3.08) & self-report OR = 2.60 (2.10,3.25). Self-report physical abuse, OR = 2.37(1.72,3.28); sexual abuse, OR = 2.85(2.05,3.96); emotional abuse, OR = 2.53(1.85,3.45) and neglect, OR = 2.36(1.83,3.03) all predict higher levels of low life success.

CONCLUSIONS

Our findings suggest that the long-term consequences of childhood maltreatment extend to a wide range of day-to-day circumstances and extend into mid- to later life.

The Association between Body Weight Misclassification in Adolescence and Body Fat and Waist Circumference in Adulthood: A Longitudinal Study

This study examined the longitudinal association between adolescent body weight misclassifications and body fat and waist circumference during adulthood. A sample was derived from a large Australian birth cohort study. The data analyses were restricted to 1002 participants for whom data on both measured and perceived weight at a 14-year follow-up and the actual measure of adult body fat and waist circumference at a 30-year follow-up were available. To determine misclassifications, we compared the perceived weight with the measured weight. The results were presented as means and mean differences (with a 95% confidence interval) of the body fat percentages and waist circumference levels across the weight misclassification groups, adjusting for potential covariates. For both male and female adolescents, weight underestimation was significantly associated with an increase in body fat percentages and waist circumference in adulthood as compared to those who correctly estimated their weight. In the mean difference analyses, adolescent males and females who underestimated their weight were found to have significantly higher body fat, and waist circumference means than those who correctly estimated their weight in the unadjusted and adjusted comparisons. The adolescent males who overestimated their weight had higher body fat, and waist circumference means when they reached adulthood. Increased awareness of weight misclassification and actual weight among adolescents might contribute to better control of weight gain in adulthood.

Do adversities experienced over the early life course predict mental illness and substance use behaviour in adulthood: A birth cohort study

A range of adult health outcomes have been linked to early childhood adversities. These early adversities include parental marital breakdown and family economic disadvantage. Childhood experiences of maltreatment have also been linked to a variety of adult health outcomes. As both childhood adversities and child maltreatment often co-occur, we examine whether childhood adversities at 3 stages of the child's early life course predict any of nine adult mental health outcomes controlling for past experiences of child trauma (maltreatment). Data are from a long running birth cohort study, the Mater-University of Queensland Study of Pregnancy (MUSP). We use bivariate and multinomial logistic regression with adjustment for confounding, to predict adult outcomes. Experiences of recent life events in pregnancy appear to be unrelated to adult mental health. Recent life events experienced at the 5-year follow-up independently predicts lifetime ever depression and cannabis use disorder. Experiences of recent life events at 14-years of age predict lifetime ever depression, cannabis and amphetamine use in adulthood. Our findings support early childhood interventions which should be supplemented with a focus on later childhood and the adolescent period of development. Interventions should also focus on the broader social and demographic context within which children are born. Efforts to reduce the occurrence and consequences of childhood maltreatment should be given primary attention in order to reduce the childhood factors contributing to adult mental illness.

A study of the association between psychiatric symptoms and oral health outcomes in a population-based birth cohort at 30-year-old follow-up

OBJECTIVE

Most studies of the association between psychiatric disorders and poor oral health have been conducted in clinical settings. Where available, data from community surveys have generally been cross-sectional or considered anxiety and depression as a consequence of poor oral health, not the other way round. This study therefore used a birth cohort to assess the association of mental health, measured both cross-sectionally and longitudinally, and oral health at 30-year follow-up.

METHODS

There were 2456 adults with data on dental outcomes and oral health care at 30-year follow-up. Psychiatric morbidity was measured at both 21- and 30-year follow-up using standardised instruments including the Centre for Epidemiological Studies-Depression (CES-D) scale and Composite International Diagnostic Interview (CIDI).

RESULTS

At follow-up, 850 participants (34.6%) had undergone a dental extraction for infection or decay, and 810 had experienced significant dental pain over their lifetime. One third had not visited a dental clinic in the previous two years and 40% failed to brush their teeth at least twice daily. On adjusted analyses, dental extraction and pain were significantly associated with psychiatric morbidity cross-sectionally at 30-year follow-up and also longitudinally when psychiatric symptoms were present at both 21 and 30 years old. Several cross-sectional measures of psychiatric morbidity were also associated with frequency of tooth brushing. There were no associations with dental clinic visits.

CONCLUSIONS

The study demonstrates there are associations between oral and mental health, which are not limited to clinical settings, but were observed at a population level.

Parental imprisonment as a risk factor for cardiovascular and metabolic disease in adolescent and adult offspring: A prospective Australian birth cohort study

Objectives

Parental imprisonment is linked with child health in later life. The present study provides the first prospective cohort analysis and non-U.S. based study examining parental imprisonment and cardiometabolic risk factors in adolescence and adulthood.

Methods

The study followed 7,223 children born from live, singleton births from 1981 to 1984 in Brisbane, Australia. Data on parental imprisonment was collected at mother interview when the children were ages 5 and 14. Our sample analyzes offspring with biometric data collected by health professionals, including 3,794 at age 14, 2,136 at age 21, and 1,712 at age 30. Analyses used multivariate linear and logistic regression, and time-varying growth curve models.

Results

Among female respondents, parental imprisonment at ages ≤5 was associated with higher body-mass index (BMI) at ages 14, 21, and 30; higher systolic blood pressure (SBP) and diastolic blood pressure (DBP) at age 30; and increased sedentary hours, larger waist circumference, and odds of a high-risk waist circumference at age 30. Parental imprisonment when the child was aged ≤14 was associated with increased BMI and SBP at age 30 for females. In growth-curve models, parental imprisonment when the child was aged ≤5 and ≤ 14 among females was linked with increased BMI; parental imprisonment when the child was aged ≤5 was associated with increased SBP and DBP. No significant associations were observed for males.

Conclusions

Using prospective cohort data, our results support research showing that parental imprisonment, particularly in early childhood, is associated with increased BMI, blood pressure, sedentary hours, and waist circumference in females in early adulthood. These findings implicate parental imprisonment as a risk factor for cardiometabolic health issues in later life among females.

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First prospective study examining parental imprisonment and cardiovascular risk using non-U.S. data.

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Study analyzes outcomes for children at ages 14, 21, and 30.

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Outcomes include BMI, waist circumference, systemic and diabolic blood pressure, and sedentary behaviors.

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Cardiometabolic risk factors strongest for females experiencing parental imprisonment at or below age 5.

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Findings hold in both cross-sectional and time-varying models.

Paternal Borderline Symptoms and Offspring Outcomes in Young Adulthood

Borderline personality disorder symptoms (BPDsx) in mothers have been linked to psychopathology in their offspring. However, it is still unclear whether BPDsx in fathers influences offspring psychopathology and, if so, how this risk transmission may occur. A total of 448 father-mother-offspring triads completed a longitudinal study following children from birth until age 20 and included self-report questionnaires and clinical interviews when children were 15 and 20 years old. Results revealed that paternal BPDsx were predictive of youth BPDsx and internalizing symptoms, even after controlling for maternal BPDsx. Chronic family stress was a significant mediator of the relationship between paternal BPDsx and offspring BPDsx, internalizing symptoms, and externalizing symptoms. Fathers' expressed emotion and child temperament were not significant mediators. Although offspring sex predicted youth outcomes, it was not a significant moderator of the association between paternal BPDsx and offspring symptoms. Finally, controlling for comorbid paternal disorders weakened the association between paternal BPDsx and youth psychopathology.

A Comparison of Oral Health Outcomes of Self-Reported and Agency-Notified Child Maltreatment in a Population-Based Birth Cohort at 30-Year-Old Follow-Up

OBJECTIVE

Information on the oral health outcomes of childhood maltreatment in adulthood is limited and reliant on retrospective questionnaires that are subject to recall bias. There are no data from prospective studies using maltreatment reports to statutory agencies. We therefore assessed the effect on dental outcomes and oral health care at 30-year follow-up using both prospective agency notifications and retrospective self-reports of child maltreatment in the same birth cohort.

METHODS

There were 2456 adults with data on dental outcomes and oral health care at follow-up. Information on self-reported abuse was collected using the Child Trauma Questionnaire and linked to child maltreatment notifications to statutory agencies.

RESULTS

The prevalence of self- and agency-reported maltreatment was 599 (24.4%) and 142 (5.8%), respectively. At follow-up, 850 participants (34.6%) had undergone a dental extraction for infection or decay, and 810 had experienced significant dental pain over their lifetime. One-third had not visited a dental clinic in the previous 2 years, and 40% failed to brush their teeth at least twice daily. On adjusted analyses, both self- and agency-reported maltreatment showed significant associations with dental extraction (odds ratio = 1.47 [95% confidence interval = 1.21-1.80] and odds ratio = 1.44 [95% confidence interval = 1.01-2.06], respectively). There were similar results for brushing frequency, whereas self-reported maltreatment was associated with dental pain. However, associations were weaker for dental clinic visits and some child maltreatment subtypes.

CONCLUSIONS

Child maltreatment is associated with adverse oral health consequences in adulthood and is thus a dental and wider public health issue.

A comparison of psychosis-like symptoms following self-reported and agency-notified child abuse in a population-based birth cohort at 30-year-follow-up

There is a strong association between self-reported child abuse and subsequent psychosis in retrospective data. Prospective studies of reports to statutory agencies are less common with limited information on people in their 30s. There have also been no comparisons of the influence of self- and agency-reported abuse on psychosis in adulthood. We therefore compared the prevalence of delusions and hallucinations in 30-year-olds who had experienced either self- or agency-reported childhood maltreatment with that in the remainder of a birth cohort. There were 2427 participants with data on psychosis and child abuse at 30-year follow-up. Information on self-reported abuse came from the Child Trauma Questionnaire (CTQ) and was linked to notifications of child maltreatment reported to statutory agencies. We measured psychotic-like experiences using the Peter's Delusions Inventory (PDI) and screening questions from the Composite International Diagnostic Interview. The prevalence of self- and agency-reported maltreatment was 599 (24.7%) and 141 (5.8%) respectively. At 30-year follow-up, 556 participants had PDI scores in the top two deciles, while 232 had experienced visual hallucinations and 134 auditory phenomena. On adjusted analyses, self-reported maltreatment, apart from sexual abuse, showed a strong association with all three outcomes. Associations were less strong for agency-notified child maltreatment and largely restricted to physical and emotional abuse. These findings suggest that people presenting with psychosis should be screened for child maltreatment, particularly physical and emotional abuse, as well as the possibility of psychosis considered in survivors of child maltreatment.

Does the millennial generation of women experience more mental illness than their mothers?

BACKGROUND

There is concern that rates of mental disorders may be increasing although findings disagree. Using an innovative design with a daughter-mother data set we assess whether there has been a generational increase in lifetime ever rates of major depressive disorder, generalised anxiety disorder, panic disorder, and post-traumatic stress disorder (PTSD) experienced prior to 30 years of age.

METHODS

Pregnant women were recruited during 1981-1983 and administered the Composite International Diagnostic Interview (CIDI) at the 27-year follow-up (2008-11). Offspring were administered the CIDI at the 30-year follow-up (2010-2014). Comparisons for onset of diagnosis are restricted to daughter and mother dyads up to 30 years of age. To address recall bias, disorders were stratified into more (≥12 months duration) and less persistent episodes (< 12 months duration) for the purposes of comparison. Sensitivity analyses with inflation were used to account for possible maternal failure to differentially recall past episodes.

RESULTS

When comparing life time ever diagnoses before 30 years, daughters had higher rates of persistent generalised anxiety disorder, and less persistent major depressive disorder, generalised anxiety disorder and PTSD.

CONCLUSIONS

In the context of conflicting findings concerning generational changes in mental disorders we find an increase in generational rates of persistent generalised anxiety disorders and a range of less persistent disorders. It is not clear whether this finding reflects actual changes in symptom levels over a generation or whether there has been a generational change in recognition of and willingness to report symptoms of mental illness.

Queensland Family Cohort: a study protocol

INTRODUCTION

The perinatal-postnatal family environment is associated with childhood outcomes including impacts on physical and mental health and educational attainment. Family longitudinal cohort studies collect in-depth data that can capture the influence of an era on family lifestyle, mental health, chronic disease, education and financial stability to enable identification of gaps in society and provide the evidence for changes in government in policy and practice.

METHODS AND ANALYSIS

The Queensland Family Cohort (QFC) is a prospective, observational, longitudinal study that will recruit 12 500 pregnant families across the state of Queensland (QLD), Australia and intends to follow-up families and children for three decades. To identify the immediate and future health requirements of the QLD population; pregnant participants and their partners will be enrolled by 24 weeks of gestation and followed up at 24, 28 and 36 weeks of gestation, during delivery, on-ward, 6 weeks postpartum and then every 12 months where questionnaires, biological samples and physical measures will be collected from parents and children. To examine the impact of environmental exposures on families, data related to environmental pollution, household pollution and employment exposures will be linked to pregnancy and health outcomes. Where feasible, data linkage of state and federal government databases will be used to follow the participants long term. Biological samples will be stored long term for future discoveries of biomarkers of health and disease.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from the Mater Research Ethics (HREC/16/MHS/113). Findings will be reported to (1) QFC participating families; (2) funding bodies, institutes and hospitals supporting the QFC; (3) federal, state and local governments to inform policy; (4) presented at local, national and international conferences and (5) disseminated by peer-review publications.

A comparison of the psychological outcomes of self-reported and agency-notified child abuse in a population-based birth cohort at 30-year-follow-up

BACKGROUND

Retrospective studies show a strong association between child abuse and subsequent psychiatric morbidity. Prospective studies are less common with conflicting data in young adults. We assessed the effect on psychological outcomes at 30-year follow-up of prospective agency notifications compared to retrospective self-reports of childhood maltreatment in the same birth cohort.

METHODS

We used data on self-reported child abuse from 2425 young adults who completed the Child Trauma Questionnaire (CTQ) at the 30-year follow-up of a prospective birth cohort study commenced in 1981. These were linked to notifications of maltreatment to child protection agencies. The outcomes were DSM-IV diagnoses from the Composite International Diagnostic Interview-Auto version (CIDI).

RESULTS

A quarter of the sample (n=600) self-reported maltreatment of any type, 326 (13.4%) rating this as severe. The most common maltreatment type was neglect (n=382), followed by emotional (n=225), sexual (n=198) and physical abuse (n=197). On adjusted analyses, there were differences between agency- and self-reported maltreatment in the psychological effects on 30-year-olds. In the case of depression, and especially post-traumatic disorder, there were significant associations irrespective of reporting sources. In the case of anxiety, there was a strong association with all forms of self-reported maltreatment. However, agency-reported cases were only significantly associated with emotional abuse in the previous 30-days.

LIMITATIONS

The attrition rate from baseline to follow-up and the possibility of insufficient power to detect statistical significance in agency-reported cases CONCLUSIONS: The association between child maltreatment and psychiatric symptoms may vary by diagnosis and reporting source. Each source possibly captures different populations.

Gender Differences in Intimate Partner Violence in Current and Prior Relationships

Although much available research indicates that intimate partner violence (IPV) is male perpetrated, growing recent evidence suggests a gender symmetry model of family violence. This article examines gender differences in IPV in current and prior relationships reported by young adults. Data comprised 2,060 young adults (62.1% females) who participated in the 30-year follow-up of the Mater Hospital and University of Queensland Study of Pregnancy (MUSP) in Brisbane, Australia. The Composite Abuse Scale was used to measure IPV during the last 12 months in the respondents' most recent relationship. Similar proportions of males and females reported leaving their prior relationships. Both males and females who were not currently in a relationship reported experiencing much higher rates of IPV than those who were in a relationship. There were no differences in the past experience of IPV between males and females who were not currently in a relationship, but males in a current relationship reported they experienced most forms of IPV more often than did females. IPV typically involves both male and female perpetrators and victims. It does appear that the majority of relationships involving higher rates of IPV were dissolved. IPV was more likely to have occurred in relationships that ended than in relationships that persisted. Males more often remain in an abusive relationship and report experiencing higher rates of IPV in their current relationships compared with females.

A Comparison of the Smoking Outcomes of Self-reported and Agency-Notified Child Abuse in a Population-Based Birth Cohort at 30-Year-Old Follow-up

INTRODUCTION

Retrospective studies show a strong association between self-reported child abuse and subsequent tobacco use. Prospective studies using reports to statutory agencies are less common with limited information on people in their 30s. In addition, there have been no comparisons of the effect of self- and agency-reported abuse on smoking. We therefore assessed the effect on the prevalence and persistence of smoking at the 30-year-old follow-up of prospective agency notifications of child abuse compared to retrospective self-reports of maltreatment in the same birth cohort.

METHODS

There were 2443 young adults with data on smoking and child abuse at 30-year-old follow-up. Information on self-reported abuse was collected using the Child Trauma Questionnaire (CTQ) and linked to notifications of child maltreatment to statutory agencies.

RESULTS

The prevalence of self- and agency-reported maltreatment was 600 (24.7%) and 142 (5.8%), respectively. At follow-up, 565 participants smoked (23.1%) but only 91 (3.8%) smoked 20 or more cigarettes a day. Of the 206 participants who smoked at 14 years, 101 were still smoking at follow-up. On adjusted analyses, both self- and agency-reported maltreatment showed a significant association with the prevalence and persistence of smoking from 14 years old. However, associations were weaker for some of the agency-notified child maltreatment subtypes possibly because of lower numbers.

CONCLUSIONS

Child maltreatment is associated with both an increased prevalence and persistence of smoking at 30-year-old follow-up irrespective of reporting source. This is despite self- and agency-reported maltreatment possibly representing different populations. Smoking cessation programs should therefore target both groups.

IMPLICATIONS

Retrospective studies show an association between self-reported child abuse and subsequent tobacco use. Prospective studies of reports to statutory agencies are less common with limited information on people in their 30s. In addition, there have been no comparisons of self- and agency-reported abuse on smoking outcomes even though they may represent different populations. We therefore compared the effect of both on smoking outcomes at 30-year-old follow-up of 2443 adults from the same birth cohort. On adjusted analyses, both self- and agency-reported maltreatment showed significant associations with the prevalence and persistence of smoking. Smoking prevention and cessation programs should therefore target both groups.

Income, Gender, and Forms of Intimate Partner Violence

Poverty and socioeconomic disadvantage place demands on intimate relationships and provide fertile ground for disagreements and conflicts. It is not known whether poverty also leads to intimate partner violence (IPV). This study investigates the association between income and forms of IPV victimization for both males and females. We also examine whether income inequalities are related to IPV and whether the gender balance of household income contributes to IPV victimization. Data are from a cohort of 2,401 young offspring (60.3% females) who participated at the 30-year follow-up of the Mater-University of Queensland Study of Pregnancy in Brisbane, Australia. Participants completed questionnaires including their income details and the Composite Abuse Scale. Within low-income families, both partners experience higher levels of IPV. Females' income is not independently related to experiencing IPV either for females or males. Females and males experience a higher rate of IPV when the husband earns a low income. When considering partners' relative income, families in which both partners earned a low income experienced higher levels of almost all forms of IPV. Income (im)balance in which females earn more or partners both have higher income was less often associated with the experience OF IPV IPV appears to be mutually experienced in the setting of the poverty. Objective economic hardship and scarcity create a context which facilitates IPV for both partners in a relationship.

Agency notification and retrospective self-reports of childhood maltreatment in a 30-Year cohort: Estimating population prevalence from different data sources

BACKGROUND

There is little known about how two sources of child maltreatment reports correspond, specifically for emotional, physical, sexual abuse and emotional or physical neglect.

OBJECTIVE

To compare agency and self-reports of child maltreatment and determine whether they are predicted by similar early life course adverse experiences. Participants Data are taken from a long running birth cohort study (Mater-University of Queensland Study of Pregnancy - MUSP). Mothers (N=7223) were recruited in 1981-83 and their children were followed-up 30 years later (2010-14). In 2000 data from the relevant child protection agency were accessed and linked to the survey data. Setting Consecutive women giving birth to a live singleton baby at a major obstetrical service in Brisbane, Australia were recruited and both mother and child were repeatedly follow-up over a 30 year period. Methods Birth cohort study with data linkage of child protection agency records and self-report survey data (using the Childhood Trauma Questionnaire - CTQ) of childhood maltreatment experiences. We compare reports of emotional, physical and sexual abuse and neglect using agency and self-reports (Cramer's V and kappa).

RESULTS

Most children who are notified cases of maltreatment subsequently self-report they experienced little or no maltreatment in childhood. Most children who report experiencing severe maltreatment have not previously been notified to the protection agency. Teenage mothers have children who are notified 2.89 (1.52, 5.52) times, self-report 2.01 (1.31, 3.09) times and both notified and self-report 3.61 (2.26, 6.10) times more than their older comparison mothers.

CONCLUSIONS

Different methods of assessing maltreatment identify different subsets of those children who have experienced maltreatment.

Child maltreatment and mental health problems in 30-year-old adults: A birth cohort study

Retrospective studies have shown a high association between child abuse and subsequent psychiatric morbidity. Prospective studies are rarer with limited data at 30-year follow-up. This was a prospective record-linkage analysis to examine whether notified and/or substantiated child maltreatment was associated with adverse psychological outcomes in early adulthood when participants were 30 years old. We used data from 2861 young adults who completed the 30-year follow-up phase of the Mater-University of Queensland Study of Pregnancy and its Outcomes, a prospective study commenced in 1981. Exposure to suspected child maltreatment was measured by linkage with state child protection data. The primary outcomes were DSM-IV diagnoses derived from the Composite International Diagnostic Interview-Auto version (CIDI). There were child abuse notifications on 171 participants, of which 103 were substantiated. The most common notifications were for physical abuse (n=96) followed by emotional abuse and neglect (n=80 each). There were 63 notifications of sexual abuse. Of those completing the CIDI at follow-up, 257 participants (9%) reported a depressive disorder, 703 (25%) an anxiety disorder and 138 (5%) PTSD. After adjustment for potential confounders, there were variations in the long-term effects of different types of abuse with physical abuse having a stronger association with depression, and sexual abuse with PTSD. Both emotional abuse and neglect were associated to varying degrees with depression, anxiety and PTSD. Substantiated abuse or multiple forms of abuse had generally the worst outcomes.

Early life predictors of development of blood pressure from childhood to adulthood: Evidence from a 30-year longitudinal birth cohort study

BACKGROUND AND AIMS

The early life predictors of changes in the blood pressures of offspring between childhood and young adulthood have not been well defined. Thus, this study aimed to determine the life course association of offspring's blood pressure with prenatal and early infancy lifestyle, and other factors taking advantage of a large community-based, longitudinal study of a birth cohort in Australia - the MUSP study.

METHODS

The systolic and diastolic blood pressure (SBP, DBP) was measured for 3793, 3782, 2628 and 1780 offspring of the Australian longitudinal cohort study at 5, 14, 21 and 30 years of their age, respectively. Individual PP and mean arterial pressure (MAP) was equated, and Generalized Estimating Equations with time (age) and predictor interaction modelling were performed.

RESULTS

Blood pressures of the offspring increased significantly between 5 and 30 years. Early life factors such as pre-pregnancy overweight/obesity, and hypertensive disorder in pregnancy were significantly positively associated, and duration of gestation and pre-pregnancy thinness of the mothers negatively associated with this life course increase in the offspring's blood pressure. Rapid increase in body weight from birth to 5 years had a strong association with increasing blood pressures components throughout their life course.

CONCLUSIONS

Several maternal pre-pregnancy and pregnancy factors along with the early life growth characteristics of offspring are important predictors of increase in blood pressure of the offspring from their childhood to adulthood.

Gender differences in social harms from drinking among young Australians: findings from the Mater University Study of Pregnancy and its Outcomes

Background: Despite the growing interest in investigating social harms from drinking, little is known about drinkers' reports of these harms and their gender differences among Australian young adults at age 30. We aimed to examine gender differences of social harms from drinking as reported by drinkers.Methods: 2,200 young adults at age 30 with complete data on social harms from drinking were drawn from the 30-year follow-up of the Mater-University of Queensland Study of Pregnancy. Measures included percentages of 11 past-year drinkers' self-reported social harms stratified by gender. Logistic regression was used to examine associations between gender and each social harm, accounting for relevant confounding.Results: More than one in five young adults (22%) reported at least one social harm in the past year. Among binge drinkers, 44% reported at least one social harm. After adjustments for social roles and binge drinking, we found no gender differences on several self-reported social harms: friendship problems, people criticizing drinking, non-marital family problems, employment problems, and alcohol-fuelled fights. However, men were more likely to report spousal threats to leave, drink-driving legal problems and financial problems.Conclusions: Our findings demonstrate that young adults are still vulnerable to risky drinking at age 30 and the social harm resulting from drinking. Thus, alcohol prevention campaigns should target this age group and include women in their focus. Strategies aiming to reduce alcohol-related harms, such as screening in clinical settings for risky drinking and alcohol-related harms, followed by motivational behavior interventions, could be beneficial among these vulnerable groups.

Adolescent cannabis use, cognition, brain health and educational outcomes: A review of the evidence

We review the findings of systematic reviews and meta-analyses of case-control studies that examine brain functioning and cognitive correlates of adolescent cannabis use using structural and functional neuroimaging tools and standardised neuropsychological tests. We also examine prospective epidemiological studies on the possible effects of adolescent and young adult cannabis use on cognitive performance in adult life and the completion of secondary education. We summarize the findings of studies in each of these areas that have been published since the most recent systematic review. Systematic reviews find that adolescent cannabis use is inconsistently associated with alterations in the structure of prefrontal and temporal brain regions. Meta-analyses reveal functional alterations in the parietal cortex and putamen. Differences in the orbitofrontal cortex predate cannabis use; it is unclear if they are affected by continued cannabis use and prolonged abstinence. Longitudinal and twin studies report larger declines in IQ among cannabis users than their non-using peers but it is unclear whether these findings can be attributed to cannabis use or to genetic, mental health and environmental factors. Several longitudinal studies and a meta-analysis of cross-sectional studies suggest that there is some cognitive recovery after abstinence from cannabis. Longitudinal studies and some twin studies have found that cannabis users are less likely to complete secondary school than their non-using controls. This association might reflect an effect of cannabis use and/or the social environment of cannabis users and their cannabis using peers. Cognitive performance is altered in some domains (e.g. IQ, verbal learning) in young people while they are regularly using cannabis. There are two important messages to adolescents and young adults: First, cannabis has potentially detrimental effects on cognition, brain and educational outcomes that persist beyond acute intoxication. Second, impaired cognitive function in cannabis users appears to improve with sustained abstinence.

Predictors of Persistent Body Weight Misclassification from Adolescence Period to Adulthood: A Longitudinal Study

This study examined whether body weight misclassification continues from adolescence to adulthood and the associated predictors behind that misclassification. Data are from a sample of a longitudinal Australian birth-cohort study. Data analyses were restricted to 2938 participants whose measured and perceived body weights were recorded during their adolescence and adulthood follow-ups. To identify misclassification, we objectively compared their measured and perceived body weights at each follow-up. Potential predictors during early life or adolescence periods were included in data analyses. At each follow-up, underestimation was recorded more often among overweight and obese participants, whereas overestimation was mostly recorded among underweight ones. Over 40% males and females were able to correctly estimate their body weight at one follow-up, whereas almost 30% males and 40% females were able to do so in more than one follow-ups. One-third females and 45% males underestimated their body weight at one follow-up, whereas 13% females and a quarter of males were able to do so in more than one follow-ups. Being female, dieting, being overweight, having an overweight mother, and having poor mental health were the most significant predictors for more than one follow-up misclassifications. Further studies are needed to evaluate the impact of persistent misclassification on population health benefits.

Intimate partner violence and subsequent depression and anxiety disorders

PURPOSE

The current longitudinal study examines the temporal association between different types of intimate partner violence (IPV) at early adulthood (21 years) and subsequent depression and anxiety disorders in young adulthood (30 years).

METHODS

Participants were from the Mater-University of Queensland Study of Pregnancy. A cohort of 1529 was available for analysis. IPV was measured using the Composite Abuse Scale at 21 years. At the 21 and 30-year follow-ups, major depression disorder and anxiety disorders were measured using the Composite International Diagnostic Interview.

RESULTS

We found a temporal relationship between almost all forms of IPV at 21 years and females' new cases of major depression disorder at 30 years. This association was not found for females who had previously been diagnosed with depression disorder. IPV did not predict the onset of new anxiety disorders, but it had a robust association with anxiety disorders in females with a previous anxiety diagnosis. We observed no significant link between IPV and males' subsequent major depression disorder. Interestingly, the experience of emotional abuse was a robust predictor of new cases of anxiety disorders but only for males.

CONCLUSION

Our results suggest the need for sex-specific and integrated interventions addressing both IPV and mental health problems simultaneously. IPV interventions should be informed by the extend to which pre-existing anxiety and depression may lead to different psychological responses to the IPV experience. Increased risk of anxiety disorders predicted by emotional abuse experienced by males challenges beliefs about invulnerability of men in the abusive relationships and demands further attention.

Generational changes in young adults' sleep duration: a prospective analysis of mother-offspring dyads

OBJECTIVE

To quantify the changes in sleep duration over two generations of young adults.

METHODS

We used data from the Mater-University of Queensland Study of Pregnancy cohort to compare sleep duration in mother and offspring. The analyses were restricted to 1,731 mothers who were young adults (mean age 21.96 years; SD±1.90) at the baseline measurement, and their offspring who were about the same age (mean age 20.6 years; SD±0.86) when assessed 21 years later. Maternal sleep was explored by asking the mother, during the first trimester, about her typical sleep duration prior to pregnancy, while offspring participants were asked about the sleep duration in the last month at the time assessed. Multinomial logistic regression for correlated responses was used to assess generational changes.

RESULTS

We found that offspring had 3.2 (2.7, 3.9) times the odds of sleeping for short duration (≤6 hours/night) and 1.7 (1.5, 1.9) times the odds of sleeping for a longer duration (≥9 hours/night) compared with their mothers. Gender-based analysis found that daughters had 3.0 (2.3, 5.0) times the odds of sleeping for a short duration, while sons had 3.4 (2.6, 6.4) times the odds of sleeping for a short duration compared with their mothers.

CONCLUSIONS

There is a significant decline in sleep duration below recommendations as well as a substantial increase in long-duration above the recommendations over two generations of young adults. Therefore, the focus of sleep health should not be limited to short sleep, but on the need for achieving optimal sleep recommended for the age.

Exercise and Schizophrenia

Schizophrenia is a psychiatric disorder characterized by distortions of thinking and perception, with no strictly pathognomonic symptoms that can be divided into positive, negative, and cognitive symptom domains. People with schizophrenia have, between others, a reduced life expectancy and cardiorespiratory and muscular fitness and increased risk of cardiovascular disease, metabolic syndrome, obesity, hypertension, and hyperlipidemia compared to the general population. Furthermore, the economic burden of mental disorders including schizophrenia is evident and it is expected to increase to more than double by 2030. Therefore, reducing the growing burden of mental disorders such as schizophrenia should be a health priority. Improved prevention and treatment are two key factors that may reduce the burden of schizophrenia. Pharmacological- and psychotherapy-based interventions have been traditionally considered for treating schizophrenia disorders; however, there is an increasing amount of scientific evidence confirming that physical activity and physical exercise should be highly considered in prevention and treatment of schizophrenia disorders. In this chapter, we aim to summarize and discuss the research progress of physical activity and exercise in prevention and treatment of schizophrenia disorder. Specifically, we summarized and discussed the research progress of the prognostic use of physical activity for incident schizophrenia; the importance of other outcomes typically improved by physical activity/exercise such as obesity and fitness (cardiorespiratory and muscular fitness) for future schizophrenia; the research progress of the evidence of the benefits of exercise in people with schizophrenia disorders differentiating between effects of exercise on varied health outcomes, cognitive functioning, and cardiorespiratory fitness; and finally the clinical practice recommendations.

Does child maltreatment predict alcohol use disorders in young adulthood? A cohort study of linked notifications and survey data

BACKGROUND AND AIMS

Most studies of the association between child maltreatment and subsequent problem alcohol use are retrospective. We studied the association of prospectively substantiated child maltreatment with problem alcohol use in adulthood.

DESIGN

We used a prospective cohort record linkage correlational design using data from a statutory child protection agency of prospectively substantiated child maltreatment linked to a birth cohort from a major metropolitan maternity hospital.

SETTING

The Mater-University of Queensland Study of Pregnancy in Brisbane, Australia.

PARTICIPANTS

Of the 3762 young people at the 21-year follow-up, 169 (4.5%) had a history of substantiated maltreatment by 16 years. This was most commonly emotional abuse (n = 90).

MEASUREMENTS

The main outcome was heavy alcohol use at the 21-year follow-up, defined as four or more standard drinks per day. Secondary outcomes were life-time and 12-month diagnoses of alcohol use disorders in  2531 participants who completed the Composite International Diagnostic Interview-auto (CIDI-auto) version. Predictor variables were physical, sexual and emotional abuse, as well as neglect.

FINDINGS

At follow-up, 407 of the 3762 participants reported heavy alcohol use (10.8%). On adjusted analyses, participants who had experienced emotional abuse were significantly more likely to report heavy alcohol use at the time of interview (adjusted odds ratio = 1.856; 95% confidence interval = 1.038-3.319; P = 0.037). Neglect was associated with a life-time CIDI diagnosis of an alcohol use disorder. Other types of child maltreatment were not significantly associated with any of the outcomes.

CONCLUSIONS

Prospectively identified experience of childhood emotional abuse and neglect appears to be positively associated with problem alcohol use at age 21.

Does adolescent heavier alcohol use predict young adult aggression and delinquency? Parallel analyses from four Australasian cohort studies

While the association between heavy alcohol consumption and aggression has been well documented, the causal direction of this association, particularly at a population level, is disputed. A number of causal sequences have been proposed. First, that aggression leads to heavy alcohol use. Second, that heavy alcohol use leads to aggression. Third, that the association between alcohol use and aggression is due to confounding by (a) sociodemographic variables or (b) delinquency. We report here data from four Australasian prospective longitudinal studies of adolescents, to assess the temporal sequence of heavy drinking and aggression over the period from adolescence to young adulthood. The four cohort studies provide a total sample of 6,706 persons (Australian Temperament Project, n = 1701; Christchurch Health and Development Study, n = 931; Mater-University of Queensland Study of Pregnancy, n = 2437; Victorian Adolescent Health Cohort Study, n = 1637). We use multinomial logistic regression to determine whether early adolescent aggression predicts subsequent age of onset of heavy episodic drinking (HED), after adjustment for concurrent sociodemographic factors and delinquency. We then consider whether HED predicts subsequent aggression, after adjusting for past aggression, concurrent delinquency, and a range of confounders. There are broadly consistent findings across the four cohort studies. Early aggression strongly predicts subsequent HED. HED predicts later aggression after adjustment for prior aggression and other confounders. Policies that alter population levels of alcohol consumption are likely to impact on levels of aggression in societies where HED linked to aggression is more common.

Intimate partner violence in emerging adulthood and subsequent substance use disorders: findings from a longitudinal study

AIMS

To examine the temporal association between the experience of different types of intimate partner violence (IPV) in early adulthood (21 years) and substance use disorders in young adulthood (30 years).

DESIGN

Prospective birth cohort study using data from the Mater-University of Queensland Study of Pregnancy (MUSP).

SETTING

Brisbane, Australia.

PARTICIPANTS

A total of 1353 people (822 females and 531 males).

MEASUREMENTS

IPV was measured using the Composite Abuse Scale (CAS) and alcohol, substance and nicotine use disorders were assessed using the Composite International Diagnostic Interview (CIDI).

FINDINGS

In females, the experience of different forms of IPV at 21 years remained a robust risk factor for subsequent alcohol use disorder [adjusted odds ratios (aORs) ranged from 1.6 to 2.6 (all P < 0.05)], substance use disorder [aORs ranged from 2.1 to 4.0 (all P < 0.001)] and nicotine use disorder [aORs ranged from 2.0 to 2.4 (all P < 0.05)] at 30 years, even after controlling for antecedent substance disorders. However, in males only physical and emotional abuse (but not harassment) were significant in predicting alcohol use disorder [aORs ranged from 1.4 to 1.8 (all P < 0.05)] and drug use disorder [aORs ranged from 1.6 to 2.0 (all P < 0.05)] in the fully adjusted model.

CONCLUSION

Intimate partner violence (IPV) in early adulthood is robustly associated with alcohol, substance and nicotine use disorders in women, whereas in men the association is clear for only some forms of IPV and types of disorder.

Effect of maternal smoking in pregnancy and childhood on child and adolescent sleep outcomes to 21 years: a birth cohort study

BACKGROUND

The effects of prenatal maternal smoking have been studied extensively, however little research has examined the effects of prenatal exposure to maternal smoking on offspring sleep, particularly over several developmental periods. We examined the effects of prenatal maternal smoking and postnatal smoking from birth to 14 years, on offspring sleep at 6 months, 5, 14 and 21 years.

METHODS

This was a prospective, community-based birth cohort study involving 7223 women who delivered a singleton child in Brisbane, Australia between 1981 and 1983. Women were recruited at the first antenatal visit. Offspring sleep problems were reported by mothers at 6 months, 5 and 14 years, and by youth at 14 and 21 years. 3738 mothers prospectively reported their smoking status from pregnancy to 14 years postpartum. Youth snoring was reported by mothers at 14 years and by youth at 21 years. Multinomial logistic regression analyses were performed.

RESULTS AND DISCUSSION

Prenatal maternal smoking was independently associated with an increased risk of offspring adolescent parasomnias including walking and talking in sleep and nightmares, and an increased likelihood of being in the highest quintile for maternal and youth reported sleep problems at 14 years. Maternal postnatal smoking was associated with increased likelihood of offspring snoring at 14 years.

CONCLUSIONS

Exposure to maternal prenatal smoking has different effects on offspring sleep compared to exposure to postnatal smoking. Prenatal smoking exposure may be associated with changes in neurodevelopment whereas postnatal smoking is more likely to affect the respiratory system. These findings highlight the long lasting and potentially serious clinical effects of exposure to pre and postnatal maternal smoking on offspring, the mechanisms by which warrant further investigation.

Does attrition affect estimates of association: A longitudinal study

Survey research frequently involves missing cases attributable to refusals to participate, lack of success in accessing all potential respondents or loss to follow-up in longitudinal studies. There is concern that those not recruited or those lost are a select group whose absence from a study may bias the findings of the study. This study provides a test of the extent to which selective loss to follow-up in a longitudinal study may lead to biased findings. The Mater-University Study of Pregnancy collected baseline information for 7718 pregnant women. Follow-ups occurred five years, 14 years, 21 years and 27 years after the birth, for 6753 eligible women. Participants at baseline were partitioned according to follow-up status for each follow-up. We compare baseline (at recruitment) measures of association, with these same measures of association for those retained in the study (Group A) and those lost to follow-up (Group B) at each phase of data. Using univariate logistic regression we compared the strength of association between maternal mental health and various baseline socio-demographic factors for different rates of loss to follow-up. Estimates of association at baseline, and at each follow-up are similar irrespective of the rate of loss to follow-up and whether the comparison is with those retained in the study or those lost to follow-up. There were no statistically significant differences in 90.8% of baseline comparisons with Group A, and 96.9% of comparisons with Group B measures of association. We conclude that differential loss to follow-up rarely affects estimates of association. We suggest that loss to follow-up may produce misleading findings only in circumstances where loss to follow-up is combined with a number of other sources of bias.

The association between the longitudinal course of common mental disorders and subsequent physical activity status in young adults: A 30-year birth cohort study

Low physical activity is a major public health concern. There has been extensive research examining the role of physical activity as a potentially modifiable risk factor for the onset of mental illness. However, fewer studies have reported how mental disorders affect future physical activity. Using data from a large birth cohort, the current study explored the association between the longitudinal course of common mental disorders (affective disorders, anxiety disorders, and substance use disorders, as well as any common mental disorder) and subsequent physical activity status among young adults living in Australia. Prospective data from the Mater-University of Queensland Study of Pregnancy, consisting of 1611 young adults, were analyzed. The longitudinal course of mental disorder diagnoses between ages 21 and 30 was derived from the Composite International Diagnostic Interview. Physical activity status at age 30 was estimated using International Physical Activity Questionnaire long form. Logistic regression was used to examine the association between the longitudinal course of common mental disorders between 21 and 30 years and subsequent physical activity status at age 30. After adjusting for confounding factors, there was no association between the longitudinal course of affective disorders, anxiety disorders, substance use disorders, or any common mental disorder at ages 21 and 30 and physical activity status at age 30. Our findings suggest that there is no longitudinal association between the common mental disorder diagnoses and physical activity status among young adults living in Australia.

Child maltreatment and mental health problems in adulthood: birth cohort study

BACKGROUND

Retrospective studies have shown a high association between child abuse and subsequent psychiatric morbidity. Prospective studies are rarer.AimsTo examine, using a prospective record-linkage analysis, whether substantiated child maltreatment is associated with adverse psychological outcomes in early adulthood.

METHOD

The participants were 3778 mother and child pairs enrolled in a population-based birth cohort study in Brisbane, Australia. Exposure to suspected child maltreatment was measured by linkage with state child protection agency data. The primary outcomes were the internalising and externalising scales of the Youth Self-Report and the Centre for Epidemiological Studies-Depression scales (CES-D) at approximately 21 years of age. A subset completed the Composite International Diagnostic Interview-Auto version (CIDI-Auto).

RESULTS

In total, 171 (4.5%) participants had a history of substantiated child maltreatment, most commonly emotional abuse (n = 91), followed by physical abuse (n = 78), neglect (n = 73) and sexual abuse (n = 54). After adjustment for potential confounders, depressive symptoms on the CES-D, as well as internalising and externalising behaviours were strongly associated with substantiated abuse in all forms, except sexual abuse. The results for the subset of the sample who completed the CIDI-Auto were less clear. Anxiety, especially post-traumatic stress disorder, showed the strongest association whereas the findings for depressive disorder were equivocal. However, across all diagnostic categories, emotional abuse and neglect, as well as multiple forms of abuse, showed a consistent association.

CONCLUSIONS

Child maltreatment, particularly neglect and emotional abuse, has serious adverse effects on early adult mental health. These two warrant the attention given to other forms of child maltreatment. Children experiencing more than one type of maltreatment are at particular risk.Declaration of interestNone.

Prenatal and early life origins of adolescence sleep problems: evidence from a birth cohort

PURPOSE

This study aims to identify the prenatal and early life predictors of adolescence sleep problems.

METHODS

Sleep data (n = 5081) from the 14-year (13.92 ± 0.34 years) follow-up of a birth cohort were analyzed to explore the predictors of adolescence trouble sleeping, nightmares, snoring and sleep talking/walking. Data from the antenatal period till adolescence were explored for identifying predictors of adolescence sleep problems. Modified Poisson regression with a robust error variance was used to identify significant predictors.

RESULTS

Our results suggest that about a quarter of adolescents in our study sample had sleep maintenance problems (nightmares: 27.88%, snoring: 23.20%, sleepwalking/talking 27.72%). The prevalence rate of sleep initiation problems was even higher (trouble sleeping: 40.61%). Our results suggest that antenatal and early-life factors, e.g. maternal smoking, anxiety, sleep problems in childhood, attention deficit hyperactivity disorder (ADHD) symptoms, and poor health are significant predictors of adolescence sleep problems.

CONCLUSIONS

This study demonstrates the predictive role of prenatal and early life risk factors in adolescence sleep problems. It seems that exposure to prenatal and early life risk factors increase the vulnerability for sleep problems later in life, which is further supported by poor health and lifestyle choices in adolescence. Therefore, close observation and mitigation of factors associated with early life risk factors could be a potential strategy for preventing sleep problems later in life.

Young adult pregnancy status and the risk of developing overweight and obesity among women and men

Pregnancies can end in miscarriage, birth or termination. Although it is well known that pregnancy results in weight gain across the life course, it is unknown whether pregnancies which end in termination and miscarriage contribute to this. The study used a sub-sample of 3630 adult offspring from the original cohort of the Mater University of Queensland Study of Pregnancy (MUSP) and its outcomes, in Brisbane, Australia. Anthropometric data were measured at 5, 14 and 21 years of age and experience of pregnancy including termination, miscarriage and births were self-reported at 21 years. Multivariable analyses were conducted to determine whether pregnancy status of young people independently associated with overweight or obesity status. The women who had at least one birth were more likely to have overweight (odds ratio [OR] 1.52; 95% confidence interval [CI]: 1.01, 2.27) or obese (OR 2.38; 95% CI: 1.58, 3.59) compared to women who did not experience any pregnancy. Women whose pregnancies were terminated or miscarried were at the same risk of overweight or obesity as women who did not experience any pregnancy. For men, there is no association between the pregnancies in their partners and the mean difference in their body mass index. Young women whose pregnancies result in a birth, but not terminations or miscarriages, are at greater risk of having overweight or obesity following the birth.

Validation of the importance of continua in representing delusional ideation in the general population

BACKGROUND

Previous studies have examined the distribution of psychotic like experiences (PLE) with the aim of informing the debate concerning the categorical versus continuous nature of psychosis. We extend this research by subjecting a number of competing models of delusional ideation to validation analysis to further examine previous findings.

METHODS

We constructed latent variable models representing the factor structure of delusional ideation reported previously, using self-reported delusional ideation (Peter's Delusional Inventory; PDI) at age 21 in a general population prospective birth cohort study. After firstly eliminating models which exhibited poor fit we performed a longitudinal validation analyses among the competing models to investigate whether increasing levels of ideation were associated with developmental antecedents, correlates and distal indicators of psychotic disorder.

RESULTS

Four latent variable models were found to adequately represent the delusional ideation data, two comprised exclusively of continua (a multidimensional 5 factor model and a bifactor model with 1 general and 4 specific factors), and two which included both categories and continua (two factor mixture models, each with 3 classes and 1 factor per class, but with varying levels of parameter restrictions). Exclusively categorical latent models obtained poor fit and the categorical components of hybrid models failed to discriminate on psychotic illness, while among the models incorporating continuous latent factors validation analyses did not clearly identify any model as better than the others.

CONCLUSION

We provide novel evidence of the importance of continua in adequately and validly representing delusional ideation in the general population. Beyond this, our data suggests it is not possible to further refine the structure of delusional ideation in the general population.

Maternal intimate partner violence victimization and child maltreatment

There is some limited evidence of an association between maternal intimate partner victimization (IPV) and children's experience of maltreatment. Using data from a longitudinal study, we examine whether this relationship is independent of range of potential confounders including socio-economic, familial and psychological factors. Data were taken from the 14 and 30-year follow-ups of the Mater-University of Queensland Study of Pregnancy (MUSP) in Australia. A subsample of 2064 mothers and children (59.0% female) whose data on maternal IPV and child maltreatment was available, were analysed. In families with maternal IPV, two in five children reported being maltreated, compared to one in five children maltreated in families without maternal IPV. Except for sexual maltreatment which was consistently higher in female offspring, there was no gender differences in experiencing different types of maltreatment in families manifesting maternal IPV. Although both males and females were at increased risk of child maltreatment in families where mothers were victimized by their male partners, male children were more likely to be emotionally maltreated. The main associations were substantially independent of measured confounders, except for father's history of mental health problems which attenuated the association of maternal IPV victimization and male offspring's physical abuse. Our findings confirm that there is a robust association between maternal IPV and child maltreatment. Both maternal IPV victimization and child maltreatment co-occur in a household characterized by conflict and violence. Consequences of IPV go beyond the incident and influence all family members. Efforts to reduce child maltreatment may need to address the greater level of IPV associated with the cycle of family violence.

Gender Difference in Offspring's Alcohol Use Disorder by 21 Years: A Longitudinal Study of Maternal Influences

AIMS

There is little known about the extent to which maternal alcohol consumption influences offspring's alcohol use disorder. This study aims to examine whether different maternal alcohol consumption trajectories predict gender difference in adolescent alcohol use disorder at child age 21 years.

METHODS

Data are from a prospective cohort, the Mater-University of Queensland Study of Pregnancy (MUSP) and its outcomes. The study involves 2531 mother-child pairs for whom data are available at the 21-year follow-up survey. Maternal alcohol consumption trajectories were determined by group-based trajectory modelling. Offspring's lifetime ever alcohol use disorder was assessed using DSM-IV diagnostic criteria.

RESULTS

Over 14 years of follow-up after the birth of a child, three distinct alcohol consumption trajectories were identified (abstainer, low-stable. and moderate-escalating drinker). A maternal trajectory of moderate-escalating alcohol consumption independently predicted offspring's lifetime ever alcohol use disorder at 21 years after adjustment for a range of potential confounders. "Cross-gender influence" is observed in the study.

CONCLUSIONS

A maternal life course pattern of alcohol consumption may have an independent effect on offspring alcohol consumption, with male offspring being more vulnerable to the effects of maternal alcohol use than are female offspring. Programs intended to address alcohol consumption by adolescents and young adults need to focus on the behaviors of both parents but acknowledging that maternal patterns of alcohol consumption may be particularly important for male offspring.

Does leaving an abusive partner lead to a decline in victimization?

Background

This paper investigates gender differences in persistence of intimate partner violence (IPV), for those remaining or leaving an abusive relationship. We followed a sample of males and females to examine whether leaving an abusive partner may alter the continuity of victimization.

Methods

Data were taken from the 21 and 30-year follow-ups of the Mater Hospital and University of Queensland Study of Pregnancy (MUSP) in Australia. A cohort of 1265 respondents, including 874 females and 391 males, completed a 21-item version of the Composite Abuse Scale.

Results

We found proportionally similar rates of IPV victimization for males and females at both the 21 and 30 year follow-ups. Females who reported they had an abusive partner at the 21 year follow-up were more likely to subsequently change their partner than did males. Harassment and then emotional abuse appeared to have a stronger association for females leaving a partner. For males, a reported history of IPV was not significantly associated with leaving the partner. There was no significant association between leaving (or not) a previous abusive relationship and later victimization, either for male or female respondents.

Conclusion

Changing a partner does not interrupt the continuity of victimization either for male or female respondents, and previous IPV victimization remained a determining factor of re-abuse, despite re-partnering.

The association between adolescent psychopathology and subsequent physical activity in young adulthood: a 21-year birth cohort study

BACKGROUND

The beneficial effects of physical activity (PA) for both physical and mental wellbeing are well established. Given that adolescence presents a critical developmental period during which life-long patterns of PA become established, the exploration of the longitudinal impact of adolescent psychopathology on adult PA status is of interest.

METHODS

We analysed prospective data from 3663 young adults who participated in the Mater-University of Queensland Study of Pregnancy. Psychopathology was measured using the Youth Self-Report (YSR) at age 14. Participants' engagement in three types of PA (vigorous exercise, moderate exercise and walking) at age 21 were dichotomised into either 'none' or 'any'. For our main analysis, we examined the association between the YSR score and subsequent PA engagement using logistic regression. We also conducted sensitivity analyses of longitudinal associations between the YSR internalising and externalising symptoms score at age 14 and PA engagement at age 21.

RESULTS

We found no longitudinal association between the total YSR score at age 14 and PA engagement at age 21. In addition, there was no longitudinal association between the YSR internalising or externalising symptoms and PA engagement.

CONCLUSION

Our findings suggest that there is no longitudinal association between adolescent psychopathology and PA in young adulthood.

Longitudinal association between physical activity engagement during adolescence and mental health outcomes in young adults: A 21-year birth cohort study

OBJECTIVE

Previous studies provide mixed evidence that physical activity engagement (PAE) in adolescence is associated with later mental health outcomes. This study aimed to examine the association between PAE at age 14 and mental health outcomes at age 21 using a large birth cohort study.

MATERIAL AND METHODS

Prospective data from the Mater-University of Queensland Study of Pregnancy, consisting of 3493 young adults, were analyzed. PAE at age 14 was estimated using self-report, and participants were categorized into; (1) frequent, (2) infrequent, or (3) no PAE group. Mental health outcomes at age 21 consisted of; (1) common mental disorders, (2) psychosis-related outcomes, and, (3) emotional and behavioral problems. The association between PAE in adolescence and later mental health outcomes in young adulthood was examined using logistic regression, adjusted for age, sex, body mass index, and adolescent psychopathology.

RESULTS

No PAE at age 14 was associated with the increased likelihood of lifetime diagnosis of any affective disorder, elevated delusional ideation, and endorsement of visual perceptual disturbance at age 21. Conversely, infrequent PAE at age 14 was associated with the decreased likelihood of subsequent lifetime diagnosis of any substance use disorder.

CONCLUSION

Our findings suggest that lack of PAE in adolescence influences some, but not all, later mental health outcomes. Interventions to increase PAE in adolescence may represent an opportunity to prevent future mental health problems.

Childhood Maltreatment and Young Adulthood Hallucinations, Delusional Experiences, and Psychosis: A Longitudinal Study

Child maltreatment is a widespread public health problem associated with a range of mental health disorders later in life. In order to effectively address these disorders, there is a need to understand more about the mental health consequences of different types of child maltreatment. This study examines the associations between prospectively substantiated child maltreatment (ages 0-14 y) and reports of hallucinations and delusional experiences at 21 years after birth. As well, we examined 12-month and lifetime psychotic disorders using data from a longitudinal birth cohort. The study comprised 3752 participants from the Mater-University of Queensland Study of Pregnancy, a prospective Australian prebirth cohort study. Psychotic experiences and 12-month and lifetime psychosis were measured using the Achenbach Young Adults Self-Report, the Peter's Delusions Inventory, and Composite International Diagnostic Interview at the 21-year follow-up. In adjusted analyses, those children who had experienced any maltreatment and who were emotionally abused and neglected were more likely to report (1) hallucinations and lifetime delusional experiences and (2) more likely to experience lifetime psychosis than their nonabused counterparts. In expanded models, those exposed to multiple forms of maltreatment, in particular with emotional abuse and neglect, had an increased likelihood of hallucinations and delusional experiences. There is an association between child maltreatment, especially emotional abuse and neglect, and later hallucinations, delusional experiences, and psychosis. It is, however, relevant to note that the vast majority of children experiencing childhood maltreatment do not appear to develop psychotic experiences or psychotic disorder. Further research to determine the reasons for highly variable outcomes of child maltreatment is warranted.

Change in receptive vocabulary from childhood to adulthood: associated mental health, education and employment outcomes

BACKGROUND

Population-based studies have found that early language delays are associated with poorer long-term outcomes in adolescence and adulthood. Few studies have explored the influence of change in language ability over time on adult outcomes.

AIM

To examine the educational, vocational and mental health outcomes for adults accounting for different vocabulary developmental profiles over a 16-year period.

METHODS & PROCEDURES

A total of 1914 participants of the Mater-University of Queensland Study of Pregnancy (MUSP) were categorized into four groups based on their vocabulary skills at 5 and 21 years: (1) persistently good (n = 1679), (2) persistently poor (n = 33), (3) improved (n = 160), and (4) deteriorated (n = 42). The associations between vocabulary group and educational, vocational, and mental health outcomes at 21 years were investigated.

OUTCOMES & RESULTS

Adults with deteriorated and persistently poor vocabulary skills were less likely to have completed secondary school; with the improved, deteriorated and persistently poor groups being less likely to be engaged in education, employment or training at the 21-year follow-up, compared with the persistently good group. Adults with deteriorated performance were at an increased risk of affective disorders, as well as substance and alcohol abuse/misuse.

CONCLUSIONS & IMPLICATIONS

These findings provide evidence that impaired vocabulary skills in adulthood, regardless of whether the deficit was acquired early or later, are associated with adverse outcomes. Clinicians and educators need to be aware of these adversities and ensure they are supporting children and adolescents in whom language difficulties exist or emerge so as to prevent poor long-term outcomes from occurring.