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Few studies have examined how parenting influences the associations between prenatal maternal stress and children's mental health. The objectives of this study were to examine the sex-specific associations between prenatal maternal stress and child internalizing and externalizing symptoms, and to assess the moderating effects of parenting behaviors on these associations.
This study is based on 15 963 mother–child dyads from the Norwegian Mother, Father, and Child Cohort Study (MoBa). A broad measure of prenatal maternal stress was constructed using 41 self-reported items measured during pregnancy. Three parenting behaviors (positive parenting, inconsistent discipline, and positive involvement) were assessed by maternal report at child age 5 years. Child symptoms of internalizing and externalizing disorders (depression, anxiety, attention-deficit hyperactivity disorder, conduct disorder, and oppositional-defiant disorder) were assessed by maternal report at age 8. Analyses were conducted using structural equation modeling techniques.
Prenatal maternal stress was associated with child internalizing and externalizing symptoms at age 8; associations with externalizing symptoms differed by sex. Associations between prenatal maternal stress and child depression, and conduct disorder and oppositional-defiant disorder in males, became stronger as levels of inconsistent discipline increased. Associations between prenatal maternal stress and symptoms of attention-deficit hyperactivity disorder in females were attenuated as levels of parental involvement increased.
This study confirms associations between prenatal maternal stress and children's mental health outcomes, and demonstrates that these associations may be modified by parenting behaviors. Parenting may represent an important intervention target for improving mental health outcomes in children exposed to prenatal stress.
Adolescence is a high-risk period for the onset of suicidal thoughts and behaviors. Identification of preceding patterns of internalizing and externalizing symptoms that are associated with subsequent suicidal thoughts may offer a better understanding of how to prevent adolescent suicide.
Data from the National Longitudinal Survey of Children and Youth, a prospective population-based Canadian cohort, contained Child Behavior Checklist items which were used to examine profiles and transitions of internalizing and externalizing symptoms in children, aged 6–11 years (n = 8266). The association between these profiles/transitions and suicidal thoughts in adolescents was examined using multivariate logistic regression modeling.
Latent profile analyses identified four measurement invariant profiles of internalizing and externalizing symptoms at ages 6/7 and 10/11: (1) low on all symptoms, (2) moderate on all symptoms, (3) high on all symptoms, and (4) high on hyperactivity/inattention and internalizing. Recurrent (homotypic or heterotypic) and increasing symptoms from 6/7 to 10/11 were associated with suicidal thoughts in adolescence, compared to those with stable low symptoms. Those with decreasing symptoms from 6/7 to 10/11 were not at increased risk of suicidal thought in adolescence.
While patterns of recurrent symptoms were associated with suicidal thoughts, a similar association was observed between profiles at age 10/11 years and suicidal thoughts. This suggests that the recent assessments of mental health symptoms in children may be as sufficient a predictor of adolescent suicidal thought as transition profiles.
Exposure to stressful life events is an established risk factor for the development of adolescent mental disorder. Growing evidence also suggests that neighbourhood social environments, including strong social cohesion, could have a protective effect on mental health. However, little is known about how neighbourhood social cohesion may buffer against the effects of stressful life events on adolescent mental health. Our aim was to assess whether neighbourhood social cohesion modifies the association between stressful life events and adolescent mental health outcomes.
Data were drawn from a nationally-representative prospective sample of Canadian adolescents, including 5183 adolescents aged 12/13 years at T1 and 14/15 years at T2. Caregivers reported neighbourhood social cohesion at T1, and exposure to stressful life events between T1 and T2. Symptoms of mental health and behaviour problems were self-reported by adolescents at T1 and T2. Multivariable logistic regression was used to determine whether the relationship between stressful life events and outcomes was modified by neighbourhood social cohesion.
Associations between stressful life events and adolescent outcomes were statistically significantly lower in neighbourhoods with greater social cohesion for: depression/anxiety (high cohesion OR = 0.98 v. low cohesion OR = 3.11), suicidal ideation (ORhigh = 1.30 v. ORlow = 5.25), aggression/conduct disorder (ORhigh = 1.09 v. ORlow = 4.27), and property offence (ORhigh = 1.21 v. ORlow = 4.21).
Greater neighbourhood social cohesion appeared to buffer the effects of stressful life events on several domains of adolescent mental health. This potentially presents a target for public health intervention to improve adolescent mental health and behavioural outcomes.
Lay opinions and published papers alike suggest mood varies with the seasons, commonly framed as higher rates of depression mood in winter. Memory and confirmation bias may have influenced previous studies. We therefore systematically searched for and reviewed studies on the topic, but excluded study designs where explicit referrals to seasonality were included in questions, interviews or data collection.
Systematic literature search in Cochrane database, DARE, Medline, Embase, PsychINFO and CINAHL, reporting according to the PRISMA framework, and study quality assessment using the Newcastle-Ottawa scale. Two authors independently assessed each study for inclusion and quality assessment. Due to large heterogeneity, we used a descriptive review of the studies.
Among the 41 included studies, there was great heterogeneity in regards to included symptoms and disorder definitions, operationalisation and measurement. We also observed important heterogeneity in how definitions of ‘seasons’ as well as study design, reporting and quality. This heterogeneity precluded meta-analysis and publication bias analysis. Thirteen of the studies suggested more depression in winter. The remaining studies suggested no seasonal pattern, seasonality outside winter, or inconclusive results.
The results of this review suggest that the research field of seasonal variations in mood disorders is fragmented, and important questions remain unanswered. There is some support for seasonal variation in clinical depression, but our results contest a general population shift towards lower mood and more sub-threshold symptoms at regular intervals throughout the year. We suggest future research on this issue should be aware of potential bias by design and take into account other biological and behavioural seasonal changes that may nullify or exacerbate any impact on mood.
Objective: To explore the relationship between migraine and anxiety disorders, mood disorders and perceived mental health in a population-based sample of adolescents. Methods: The Canadian Community Health Survey (CCHS) is a cross-sectional health survey sampling a nationally representative group of Canadians. In this observational study, data on all 61,375 participants aged 12-19 years from six survey cycles were analyzed. The relationships between self-reported migraine, perceived mental health, and mood/anxiety disorders were modeled using univariate and multivariate logistic regression. The migraine–depression association was also explored in a subset of participants using the Composite International Diagnostic Interview–Short Form (CIDI–SF) depression scale. Results: The odds of migraine were higher among those with mood disorders, with the strongest association in 2011-2 (adjusted odds ratio [aOR]=4.59; 95% confidence interval [CI95%]=3.44-6.12), and the weakest in 2009-10 (aOR=3.06, CI95%=2.06-4.55). The migraine–mood disorders association was also significant throughout all cycles, other than 2011-2, when the CIDI–SF depression scale was employed. The odds of migraine were higher among those with anxiety disorders, with the strongest association in 2011-2 (aOR=4.21, CI95%=3.31-5.35) and the weakest in 2010 (aOR=1.87, CI95%=1.10-3.37). The inverse association between high perceived mental health and the odds of migraine was observed in all CCHS cycles, with the strongest association in 2011-2 (aOR=0.58, CI95%=0.48-0.69) and the weakest in 2003-4 (aOR=0.75, CI95%=0.62-0.91). Conclusions: This study provides evidence, derived from a large population-based sample of adolescents, for a link between migraine and mood/anxiety disorders.
To examine the association between diet quality and the diagnosis of an internalizing disorder in children and adolescents.
A prospective study examining the relationship between diet quality and mental health. FFQ responses of 3757 children were used to calculate a composite score for diet quality and its four components: variety, adequacy, moderation and balance. Physicians’ diagnoses on internalizing disorders were obtained by linking the children's dietary information to administrative health data. Negative binomial regression models were used to examine the association between diet quality and diagnosis of an internalizing disorder.
The Canadian province of Nova Scotia.
A provincially representative sample of grade 5 students (age 10–11 years).
Diet quality was not found to be associated with internalizing disorder in a statistically significant manner (incidence rate ratio = 1·09; 95 % CI 0·73, 1·63). However, relative to children with little variety in their diets, children with greater variety in their diet had statistically significant lower rates of internalizing disorder in subsequent years (incidence rate ratio = 0·45; 95 % CI 0·25, 0·82).
These findings suggest the importance of variety in children's diet and opportunities in the prevention of adolescent depression and anxiety.
Antidepressants and anxiolytics have demonstrated short-term efficacy;
however, little is known about the long-term effectiveness of these
To investigate long-term psychiatric outcomes following antidepressant
and/or anxiolytic use during an episode of mental disorder in
Members of the 1946 British birth cohort were assessed for symptoms of
depression and anxiety at age 43. Among 157 with mental disorder, those
using antidepressants and/or anxiolytics were compared with those not
using medications on psychiatric outcomes at age 53.
Use of antidepressants or anxiolytics was associated with a lower
prevalence of mental disorder at age 53 (odds ratio (OR)=0.3, 95% CI
0.1–1.0) after adjustment for eight variables in a
propensity-for-treatment analysis. Only 24% of those being treated with
medications at age 43 were still using them at 53.
Use of antidepressants or anxiolytics during an episode of mental
disorder may have long-term beneficial effects on mental health. This may
be because of a demonstrated willingness to seek help rather than
long-term maintenance therapy.
Psychotropic medication use is common and increasing. Use of such drugs
at the individual level over long periods has not been reported.
To describe antidepressant, anxiolytic and hypnotic drug use, and
associations between such medication use and common mental disorder, over
a 22-year period.
Questions about psychotropic medication use and symptoms of common mental
disorder were asked of more than 3000 members of the 1946 British birth
cohort at multiple time points between ages 31 and 53 years.
Prevalence of any antidepressant, anxiolytic or hypnotic use increased
significantly from 1977 (30.6 per 1000) to 1999 (59.1 per 1000) as the
cohort aged. Less than 30% with mental disorder used antidepressants,
anxiolytics or hypnotics. Previous use of antidepressant, anxiolytic or
hypnotic was a strong predictor of future use during an episode of mental
disorder (odds ratios 3.0–8.4); this association became weaker over
Pharmacotherapy is infrequently used by individuals with common mental
disorder in Britain; this has not changed in the past three decades.
Longitudinal formulations of psychiatric illness have long been familiar. In the 19th century, Thomas Clouston wrote about developmental insanity in young men, presaging modern views of schizophrenia as having some of its origins or first manifestations in early life (Clouston, 1891; O'Connell et al. 1997). At the same time, Sigmund Freud was creating his system of psychoanalysis to understand hysterical conversion and other aspects of adult psychology as sequelae of early psychological events. Now, within an epidemiological and neuroscientific framework, we are beginning to understand that a variety of psychiatric disorders, including those of later life, such as cognitive decline and dementia may be the final common pathway of a long chain of mutable events (Richards et al. 2004). Just as in clinical neurology, where one is taught to place the causal lesion as high as possible so, too, in psychiatry we should look for the seeds of causality earlier rather than later in life.
Self-inflicted injury is commonly seen in emergency departments (EDs). It may be a precursor to death by suicide. The objective of this study was to examine the epidemiology of self-inflicted injury presentations to EDs in the province of Alberta.
Self-inflicted injury records for the 3 fiscal years 1998/99 to 2000/01 were accessed from the Ambulatory Care Classification System, a database that captures all ED encounters in the province of Alberta. Available data for each case included demographic details, location and time of visit, diagnoses and procedures.
There were 22 396 self-inflicted injury presentations to Alberta EDs during the study period. Self-inflicted injury rates were higher in females, younger patients, those on social services and those with Aboriginal treaty status. There were higher rates of return visits in the year following the self-inflicted injury than in other patient groups. Data showed regional variation. Trends could be seen in the timing of self-inflicted injury presentations by hour of day, day of week, and month of year.
Self-inflicted injury is common, with particularly high rates demonstrated among marginalized populations. This study provides comprehensive data on those who present with self-inflicted injuries, and can be used to guide further treatment, research and evaluation for this population.
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