Bipolar disorder is a multifactorial disorder influenced by multiple genetic and environmental factors.There is limited understanding of how non-genetic factors may impact the age of onset of bipolar disorder

To study the age of onset of bipolar disease in Tunisia (where the average duration of sunshine is 8 hours/day) and compare it to the age of onset in countries with a lower duration of sunshine (Germany 0.17h/day; Norway 1.40h/day).

We conducted a retrospective study of 100 patients with bipolar disorder type I followed at the psychiatric department Aziza Othmana at Razi hospital.The data collection was done using a pre-established paper form exploring sociodemographic and clinical data.The duration of sunshine was estimated according to the average number of hours of sunshine per day in each country collected through meteorological sites.

Our population was predominantly male (60%) with a mean age of 48.7 years.The first episode was manic in 76% of cases. The mean age of onset in our sample was 25.86 years, with extremes ranging from 13 to 49 years.An early onset (threshold age=21 years) was found in 36% of the Tunisian population. The age of onset was earlier in patients with a family history of bipolar disorder: 22.76 years vs 28.23 years. A late onset (threshold age=37 years) was found in 13% of the Tunisian population.

The study confirmed that there is an inverse relationship between the degree of sunlight and the age of onset of the disease, especially in the presence of a family history of mood disorders

No significant relationships.

Bipolar disorder (BD) is a mental illness marked by extreme swings in the mood, energy, and thinking. Although it’s not an official symptom of the disease, some research suggests that it also may affect the empathy.

To investigate empathic responding in patients with BD in euthymic state of illness and to determine associated factors.

A cross-sectional and descriptive study of 78 patients followed for bipolar disorder, during euthymia, at the psychiatric outpatient clinic at CHU Hédi Chaker in Sfax. We used a socio-demographic and clinical data sheet and the Questionnaire of Cognitive And Affective Empathy (QCAE) to assess empathy with its two dimensions : “Affective empathy” and “Cognitive empathy”.

The average age was 36.27 years, the sex ratio was 5.5. Bipolar I disorder was diagnosed in 88.5% of patients. The mean age of onset was 27.73 years, and the mean duration of illness was 8.4 years. 78.2% of patients had a good adherence to treatment. 60.3% of them had residual depressive symptoms during eutymia. QCAE total score was 72.49. (Maximum possible score 124) Cognitive empathy score was 43.21. (Maximum possible score 76) Affective empathy score was 29.36. (Maximum possible score 48) Affective empathy was associated with female gender (p=0), good adherence to treatment (p=0.01) and residual depressive symptoms (p=0.001).

Our study shows that bipolar patients have fairly good levels of empathy. However, in order to better substantiate empathy in BD, comparative studies seem necessary.

No significant relationships.

Numerous studies have documented high rates of functional impairment among bipolar disorder patients, even during phases of euthymia.

To study different domains of functioning impairment in bipolar patients during euthymic phase.

A cross-sectional and descriptive study of 78 patients followed for bipolar disorder, during euthymia, at the psychiatric outpatient clinic at CHU Hédi Chaker in Sfax. We used a socio-demographic and clinical data sheet and the Functioning Assessment Short Test (FAST) to assess functionning : A functional impairment was retained for a total FAST score > 11.

The average age was 36.27 years, the sex ratio was 5.5. Bipolar I disorder was diagnosed in 88.5% of patients. The mean age of onset was 27.73 years, and the mean duration of illness was 8.4 years. *The mean total score at the FAST was 22.23. *Functioning was altered on 69.2% of patients. *The occupational and the cognitive functioning were the two most altered domains in our population (respective mean scores : 8.69 and 5.74). *Autonomy was altered on 17.9% of patients. *Occupationnal functioning was altered on 76.9% of patients. *Cognitive functioning was altered on 70.5% of patients. *Financial issues were observed on 34.6% of patients. *Interpersonal relationships were altered on 41% of patients. *Leisure time difficulties were present with 24.4% of patients.

This work has focused on the very high frequency of functional handicap in euthymic bipolar patients. Thus, several measures must be put in place to prevent or mitigate the negative effects of the impaired functioning on these patients.

No significant relationships.

Electro-convulsive Therapy (ECT) has been considered a useful for the treatment of depression and other affective disorders, however it is considered as a last resort given the risks and possible adverse effects.

The objective of this review is to assess the use of ECT (in terms of efficacy and tolerability) for patients diagnosed with bipolar disorder and how it can be compared with other treatments more commonly used to treat this disorder.

A search was carried out in Medline and in the Virtual Health Library as well as in the Trripdatabase with the search terms “Bipolar disorder”, “Bipolar Depression”, “ECT”, “ECT treatment” and “Mania” in English and narrowing the search to the last 5 years. 8 articles were included for the review after applying inclusion and exclusion criteria.

A favorable and well tolerated response was observed when applied ECT on patients with Bipolar disorder, especially the elderly populations. It was observed that the administration of unilateral and bilateral ECT are both equally effective. A better response was detected to ECT compared to newer treatments like ketamine, as well as lower suicide rate when ECT was used compared to other treatments.

ECT is considered an effective and safe treatment for Bipolar Disorder and should be taken into account not only as a last resort. Even so, given the limitations observed, it is necessary to carry out further investigation on the matter.

No significant relationships.

Arnold Chiari malformation (ACM), a condition in which a portion of the brain pushes through the opening at the base of the skull, can cause headaches, dizziness, difficulty swallowing, muscle weakness and balance problems. The prevalence in the general population has been estimated at slightly less than 1/1000. The majority of these cases are asymptomatic. Chiari malformations are often detected coincidently among patients who have undergone diagnostic imaging for unrelated reasons. Several cases of psychiatric illness comorbid with ACM type 1 (ACM1) are reported in the literature.

Here we reported a patient with bipolar affective disorder, manic episode with a history of depressive episodes for 2 years comorbid with ACM1.

A 39 year-old-woman,with the history of panic disorder and obsessive compulsive disorder comorbid with depression have been using sertraline 50 mg/day for a year, admitted for decreased need of sleep, grandiosity, increased libido,risky behaviours, rapid speech and agitation. The patient met DSM 5 criteria for a manic episode and was hospitalized. She had a positive history of depression in her family. Her lab work up was unremarkable; including negative urine toxicology. MRI scans, for exclusion of organicity, demonstrated ACM1. Her treatment was started with a regimen of haloperidol 20 mg/day, biperiden 10 mg/day. The treatment was switched to olanzapine 20mg/day upon detection of rigidity. Lithium was added as 900mg/day. Neurosurgery, outpatient control was recommended by neurosurgery.

The patient’s symptoms gradually improved within one week with attainment of euthymic mood.

This case might show that ACM1 could cause abnormal functioning of brain circuits promoting psychiatric symptoms.

No significant relationships.

Impairments of empathy have been observed in patients with various psychiatric Disorders. Yet, little research on empathy concerning mood disorders exists.

To compare empathy levels in euthymic bipolar patients (BP) and healthy controls (HC).

A cross-sectional and comparative study of 78 patients followed for bipolar disorder, during euthymia, at the psychiatric outpatient clinic at CHU Hédi Chaker in Sfax, and 78 age-gender matched HC. We used a socio-demographic and clinical data sheet and the Questionnaire of Cognitive And Affective Empathy (QCAE) to assess empathy with its two dimensions : “Affective empathy” and “Cognitive empathy”.

The average age was 36.27 years, the sex ratio was 5.5. Bipolar I disorder was diagnosed in 88.5% of patients. The mean age of onset was 27.73 years, and the mean duration of illness was 8.4 years. Total scores of empathy as well as scores of cognitive and affective empathy were higher in HC than in BP. *Total QCAE BP vs HC : 72.49 vs 80.53 *Cognitive empathy BP vs HC : 43.21 vs 94.24 *Affective empathy BP vs HC : 29.36 vs 30.44 A significant difference in QCAE score and cognitive empathy score between BP and HC was found (p<10-3).

In our study, euthymic BP have been less empathetic than HC. Research on the subject are small and few. Thus, more studies are needed to confirm our results on the effect of mood disorders on empathy.

No significant relationships.

Bipolar disorder is a serious mental disorder. Although bipolar disorder I (BDI) might seem to have a more complex evolution and severe prognosis than bipolar disorder II (BDII) because of cross-sectional symptom severity, BDII has a high episode frequency, high rates of psychiatric comorbidities and recurrent suicidal behaviours that impair functioning and quality of life.

To explore whether there are differences between patients with BDI and BDII concerning sociodemographic and clinical variables of interest.

A sample of 407 euthymic patients with bipolar disorder (307 BDI and 100 BDII) being age 18 or older was recruited from the Bipolar and Depressive Disorders Unit of the Hospital Clinic of Barcelona. Sociodemographic and clinical variables were collected through the administration of semi-structured interview and clinical scales. Differences between groups in these variables were analysed using the Mann-Whitney U and Chi-square tests, as appropriate. The level of significance was set at p <0.05.

We found statistically significant differences between both groups. Patients with BD II were older (p<0.001), presented a longer illness duration (p=0,001) and a greater subsyndromal depressive symptomatology (p=0,010). Patients with BDI had a higher number of previous hospitalizations (p<0,001) and higher rates of psychotic symptoms (p<0,001) even during the first episode (p<0,001).

Our data suggests that clinical differences exist between both bipolar subtypes. The episodes may be more serious, with a greater presence of a history of psychosis, and require more hospitalizations in BDI patients. In the BDII group, persistent subsyndromal symptoms may predominate, especially of the depressive pole.

No significant relationships.

Post traumatic stress disorder (PTSD) is a mental health condition that’s triggered by a psychotraumatic event .

The aim of our study was to investigate the clinical manifestations of PTSD in the pediatric population.

This is a descriptive cross-sectional study carried out on children over the age of 7 and victims of a traumatic event that had occurred at least one month before. They were recruited from August 2020 to April 2021, in child psychiatry department. The clinical manifestations were evaluated using the Clinician Administered PTSD Scale Child and Adolescent version for DSM 5 (CAPS CA5) in Tunisian dialect. The statistical processing of these data was carried out using SPSS 26 software.

We recruited 101 children who had experienced a traumatic event which was in 35.6% physical assault, 47.5% sexual assault and in 16.8 % exposure to death. The mean age was 10.7 years at the onset of traumatic event and 11.74 years at the interview. We noted in our patients a female predominance at 64.4%. Diagnosis of PTSD according to the diagnostic criteria of the DSM5 was retained in 54.5% of cases. Intrusive symptoms were present in 81.2%, with 66.3% of involuntary, intrusive memories. Persistent avoidance of stimuli was noted in 80.2%. 71.3% of cases suffered from negative cognition and mood. We found in 66.3% marked alterations in trauma-related arousal and reactivity. Resulting in clinicialy significant distress in71.3%.

Recognizing PTSD symptoms is essential for diagnosis to initiate specialized care and reduce impairment at this critical age.

No significant relationships.

Functional gastrointestinal disorders (FGID) are common in children and adolescents (CA), cause functional disability and high health care use. Internet based cognitive behavioral therapy (i-CBT) have shown promising effect in Sweden. The treatment is exposure based and target avoidance behavior. Cognitive biases regarding bodily symptoms are suggested to be part of development and maintenance of functional disorders in adults, and could therefore be an important treatment target. Little is known about cognitive biases in CA with FGID, and hence the potential importance, it is crucial to explore more in depth. This study is embedded in The Danish FGID Treatment Study which aims to test Swedish i-CBT treatment in a Danish context.

1) Examine cognitive biases in CA with FGID, compared with healthy controls. 2) Asses these biases before and after treatment for FGID to investigate changes and impact on treatment effect.

We developed a novel experimental approach to examine possible cognitive biases in CA. It consists of a picture task and a FGID-specific version of the Health Norms Sorting Task. We will examine 60 CA with FGID, who are included in The Danish FGID Treatment Study before and after treatment. In addition we will perform the test on 100 healthy controls.

The results are expected to improve our understanding of maintaining cognitive factors in CA with FGID, and how these may affect outcome and change during treatment, and how they differ from the general population.

This study can provide new targets for treatment approaches.

No significant relationships.

Few studies have analyzed the psychometric profile (Homogenous/Heterogenous), established by the Wechsler scale in high intellectual potential children (HIP, IQ>130), regarding the psycho-socio-emotional characteristics.

We aimed to look at the links between the IQ-profile and the psycho-socio-emotional characteristics in HIP.

Anamnestic questionnaire and Wechsler-Intelligence-Scale for children (WISC-V) were conducted and analyzed in 58 healthy children with HIP, aged 7-to-13 years-old (mean 10y; SD 1.8). It was possible to distinguished 27 Homogenousvs 30 Heterogenous IQ-profile.

No significant difference between homogenous/heterogonous groups, FIQ was positively significantly correlated with “Reacting very little emotionally”, “Tendency to isolation”. Visual-Spatial-Index (VSI) with “Ability to adapt to new people” (r=-0.4, p=0.02), “few interests” (r=0.5, p=0.008). Verbal-Comprehension-Index (VCI) with “Reacting strongly to frustration”, “Difficulties to understand limits”, “Separation anxiety”. A significant difference between homogenous/heterogonous groups was shown regarding “few interests” with high rate in the heterogonous group (t= -2.34, p=0.023).

HIP seems to cover specific psycho-socio-emotional characteristics linked to IQ index distribution. Thus, it appears interesting to assess more the emotional and socio-cognitive field to understand these characteristics in HIP children.

No significant relationships.

Autism is a neurodevelopmental disorder characterized by qualitative impairments in social interaction, communication, and restricted and repetitive behaviors [1]. Despite of these symptoms, some patients present different manifestations of irritability. These can be expressed in different kinds of disruptive behaviors. Recent studies shown that, at least 20% of children with autism present irritability symptoms, which cause severe social and familiar disturbances [2].

The aim of this study was to evaluate short-term efficacy of aripiprazole in children in comparison with other antipsychotic. We include behaviors related to irritability as all kinds of aggressions, tantrums and self-injuries.

90 patients were recruited. 45 of the patients received aripiprazole and 45 received other antipsychotic. The initial doses of aripiprazole was 2,5 mg/day. Doses were increase related to symptoms. The range of the doses were from 2,5 to 15 mg/day.

From these 45 patients 12 had a relapse (26,6%) during the next two years. From the second group, 20 (44.4%) of the patients had a relapse during the next two years. Five of the aripiprazole group (11,1%) abandon treatment. From the second group twelve patients (26.6%) also abandon treatment. Prolactin rates with aripiprazole were 28.2 ng/ml for males and 14.1 ng/ml for women.

In general, the result of our research indicated that Aripiprazole was effective and generally safe and well tolerated in the treatment of irritability associated with ASD. One of the limitations was that we do not use scales in order to measure the changes.

No significant relationships.

Methylphenidate and amphetamine are the two most widely used stimulants in managing Attention Deficit Hyperactivity Disorder (ADHD)1. Reynaud’s phenomenon (RP) is a reversible distal vasoconstriction presenting with various dermatological symptoms. RP can secondarily develop after certain medications as well2.

The review was undertaken to synthesize the incidence of RP within ADHD population treated with stimulants, and any causal relation of RP and stimulant-use.

PubMed, Psych-Info and Google Scholar were searched using these keywords: skin change, Raynaud, stimulants and methylphenidate. All relevant study types were included. Results were synthesized narratively.

Initial search yielded 240 articles with 5 articles fulfilling our inclusion criteria. One was retrospective case-controlled study while remaining 4 were case reports. Six cases were identified with an age of 12-19 years, who presented with RP after being treated with methylphenidate-or-dextroamphetamine. In one case, multiple clinical signs of RP were seen with cold distal fingers, transient color changes and even frank ulceration3–6. In two cases, it was seen that RP was dose-dependent with stimulant use and got resolved after decreasing the dosage respectively. In case-control study, 32 cases with RP and 32 controls were enrolled. The results showed a statistically significant association (χ2 =5, p=0.01) between RP and past-or-current stimulant usage.7

The literature review suggests weak evidence of the association between RP and stimulant use but no evidence of any causal link. Further studies are needed to identify characters that can predict this adverse effect in vulnerable ADHD individuals.

No significant relationships.

Psychiatric disorders are common in children, and academic attainment is lower in children with psychiatric disorders. There are few data about the occurrence of mental health problems and the academic attainment among children in Chile.

To determine the occurrence of mental health problems and its association with academic attainment in first-year students of elementary schools in Chile

The study was conducted in 39 urban and rural public elementary schools in Chile in 2019. The academic performance was measured using the Woodcock Muñoz IV Battery and the Corsi Bock-Tapping test. Mental health was assessed using the self-report Dominique Interactive and Strengths in children and Difficulties Questionnaire (SDQ) instruments in their parents and teachers. A triangulation of information was conducted between different informants.

Overall 610 children were included in the analysis (mean age 7.10 years (SD=0.58), 51% women, 36% from rural area). A higher score in mathematics and reading was negatively correlated to a higher score in emotional symptoms, hyperactivity and peer relationship difficulties, separately, based on both teacher- and parent-reported SDQ. The correlation coefficient between reading scores with Dominique Interactive and Strengths externalizing symptoms was -0.22 (p<0,05). A higher maternal education level was associated with higher education attainment in their children (p <0,05). There was no association between rurality and children’s mental health symptoms.

The current results can inform local stakeholders in Chile about the importance of mental health at a very early age.

No significant relationships.

FAS and FASD are completely preventable conditions which can be reduced by methods of prevention aimed at alcohol eliminating by women during pregnancy.

The aim of the study was to assess level of intellectual impairment in children with FAS and FASD.

All children who participated in the study had physical development retardation and various dysmorphological features of FAS or FASD. The sample included 77 children, 8.6±1.03 years of age. FAS was diagnosed in 8 children, FASD in 69 children. Assessments were carried out by pediatrician, psychiatrist and psychologist; level of intelligence was assessed using WISC test.

Among children with FAS average IQ was 65.9 points (extremely low level), which corresponds to «mild mental retardation» diagnosis (F70, ICD-10). Four children with FAS had intelligence corresponding to «very low» level (IQ=70-79), three had «mild mental retardation» (IQ=50-69), and one had «moderate mental retardation» (F71, ICD-10) (IQ=35-49). Among children with FASD average IQ was higher and reached 79.5 points, corresponding to «very low» intelligence level. «Moderate mental retardation» was identified in 7.8% children with FASD; 22.1% children had «mild mental retardation», and 27.3% had «very low». In 37.7% children IQ level was within normal range: «low average» in 19.5% (IQ=80-89) and «average» in 18.2% (IQ=90-109). «Very high intelligence» (IQ=120-129) was detected in 2.6% children, «extremely high intelligence» (IQ=130 points and above) in 2.6%.

All children with FAS had impaired mental development. Children with FASD showed a wide range of total IQ values, from moderate degree of mental retardation to very high intelligence.

No significant relationships.

Mental illness is a growing problem among adolescents. Adolescents are sensitive and at increased risk of developing a first depression. There are knowledge gaps about the long-term effects of prevention programs against depresson for adolescents.

A randomized controlled study among Swedish adolescents in eighth grade, who are at risk of developing depression. The study examines the long-term effects of the “Thoughts and Health” prevention program and whether it is as effective Online as In Real Life (IRL).

In a first step, about 20 junior high schools in the Västra Götaland region will be recruited and randomised into one of three groups.

The adolescents are screened for depression at school

Group 1 - Adolescents at risk of developing depression receive the course program “Thoughts and Health” Online.

Group 2 - Adolescents at risk of developing depression receive the course program “Thoughts and Health” IRL.

Group 3 - Adolescents at risk of developing depression receive the usual school health care (control group).

Psychologists decide inclusion after a diagnostic interview. OUTCOME VARIABLES

Quantitative

- development of depression is measured via self-assessment instruments and follow-up assessment, by a psychologist.

- school attendance and full grades at the end of compulsory school.

- biomarkers

Qualitative

Adolescent’s experiences and perceptions of the course program.

Will create evidence for prevention programs against depression and be used to develop primary prevention for adolescents Online and IRL, which will be of great importance to public health.

Thoughts and Health can be a useful tool to prevent depression among adolescents

No significant relationships.

Cancer is often a diagnosis that generates instability in many Tunisian families. Children of parents with cancer may respond differently to the treatment. Communication about cancer in Tunisian families needs sometimes professional intervention mainly with children.

We aimed to assess psychological impact of cancer parents on their children.

We interviewed 103 parents of children aged 6-18 years between July and December 2020. Children were not interviewed as they were not allowed into the chemotherapy treatment rooms. The questionnaire included items about emotional and behavioral impact on children.

Patients’ characteristics are are shown in Table 1. In our study, 85 patients (82.5%) told their children they were « sick ». Among the children who were not aware of their parent’s condition, there were significantly more preschoolers, p=0.001. The reasons given by the parents in these cases were the young age of their children (60%) and the fear of generating emotional and behavioral trauma and threatening their psychosocial equilibrium (40%). In our participants 88.3% reported communication disorders with their children when referring to the parental illness.

Parental cancer may have unexpected consequences on children’s behavior which should be handled by a specialist , hence efforts should be made for early detection and better understanding of these disorders.

No significant relationships.

Youth integrated care services were developed to overcome common barriers to mental health treatment. Satisfaction is key for services utilization and engagement.

To study users satisfaction with youth integrated care service, “Headspace”, throughout the course of treatment and its correlation with clinical and demographic characteristics and service utilization.

A sample of 112 participants ranging between ages 12-25 who attended the Headspace clinic between March 2016 and June 2018 were assessed in the middle (after 7 sessions) and end of treatment (n=71).

Participants expressed high levels of satisfaction across all service aspects at the middle and end of treatment. The highest rate of satisfaction was with the centre’s staff and the lowest with personal outcomes. A repeated measures ANOVA analysis revealed that only satisfaction with personal outcomes improved significantly over time Length of wait to begin treatment and parental engagement y were negatively correlated with youth satisfaction.

Satisfaction rates of Headspace among youth are high from the start and with their outcomes increase over time. Youth satisfaction with the staff’s attitude and approach and satisfaction with accessibility suggest the service achievement in addressing barriers of help seeking in youth.

No significant relationships.

Autism spectrum disorders (ASD) are associated with high services use, but European data on costs are scarce.

Utilisation and annual costs of 385 individuals with ASD (aged 4-67 years; 18.2% females; 37.4% IQ < 85) from German outpatient clinics were assessed.

Client Service Receipt Inventory

Average annual costs per person were 3287 EUR, with psychiatric inpatient care (19.8%), pharmacotherapy (11.1%), and occupational therapy (11.1%) being the largest cost components. Females incurred higher costs than males (4864 EUR vs. 2936 EUR). In a regression model, female sex (Cost Ratio: 1.65), lower IQ (1.90), and Asperger syndrome (1.54) were associated with higher costs.

In conclusion, ASD-related health costs are comparable to those of schizophrenia, thus underlining its public health relevance. Higher costs in females demand further research.

No significant relationships.

Attention-Deficit/Hyperactivity Disorder (ADHD) runs in families; however, there are mixed results on the interaction effects of parent’s and child’s psychopathology on parenting qualities. Cognitive/schema therapy is a promising treatment approach for adult ADHD; we know little about the effect of cognitive factors on parenting, however.

We aimed to fill this gap by exploring the role of dysfunctional schema modes in the associations between adult ADHD symptoms, child’s externalizing symptoms, and perceived parental competence in a dimensional approach.

A community sample of parents (N=100, mean age=38.25 years, SD=5.73) filled out online questionnaires assessing ADHD symptoms (Adult ADHD Self-Report Scale), dysfunctional schema modes (Schema Mode Inventory), perceived parental competence (Parental Sense of Competence Scale), and child’s psychopathology (Strength and Difficulties Questionnaire).

In a multivariate model, higher levels of parental ADHD symptoms were related to higher levels of dysfunctional schema modes. However, neither the child’s externalizing symptoms nor the interaction term of parent’s symptoms by the child’s symptoms had any effect on dysfunctional schema modes. Furthermore, the child’s externalizing symptoms had a direct negative association with parental self-efficacy beliefs, whereas the relationship between adult ADHD symptoms and parental self-efficacy was mediated by the detached and overcompensating dysfunctional schema modes.

Our results suggest that the activation of dysfunctional schema modes is related to the parent’s but not the child’s psychopathology. The activation of dysfunctional schema modes may play an important role in the self-efficacy beliefs of parents with ADHD. Targeting that cognitive factors may enhance the effect of behavioral parent training programs.

This research was supported by National Research, Development, and Innovation Office (NKFIH) OTKA-PD-134849 grant.

Good quality parenting in early childhood is reliably associated with positive mental and physical health over the lifespan.

The hypothesis that early parenting quality has significant long-term financial benefits has not been previously tested.

Design: Longitudinal study with follow-up from 2012 to 2016; UK multicentre study cohort. Participants: 174 young people drawn from 2 samples, one at moderate risk of poor outcomes and one at high risk, assessed aged 4–6 years then followed up in early adolescence (mean age 12.1 years). Measures: The primary outcome was total costs: health, social care, extra school support, out-of-home placements and family-born expenditure, determined through semistructured economic interviews. Early parenting quality was independently assessed through direct observation of parent–child interaction.

Costs were lower for youths exposed to more sensitive parenting (most sensitive quartile mean £1,619, least sensitive quartile mean £21,763; p < .001). Costs were spread across personal family expenditure and education, health, social and justice services. The cost difference remained significant after controlling for several potential confounders. These included demographic variables (family poverty, parental education); exposure to child abuse; and child/young person variables including level of antisocial behaviour in both childhood and adolescence, IQ and attachment security.

This study is the first showing that more sensitive early parental care predicts lower costs to society many years later, independent of poverty, child and youth antisocial behaviour levels and IQ. The findings provide novel evidence for the public health impact of early caregiving quality and likely financial benefits of improving it.

No significant relationships.