Alessandra Raudino

The quality of parent/child relationships in adolescence is associated with poor adult psychosocial adjustment.

This study used data gathered over the course of a New Zealand longitudinal study (N = 924) to examine the relationships between measures of parental bonding and attachment in adolescence (age 15-16) and later personal adjustment (major depression; anxiety disorder; suicidal behaviour; illicit drug abuse/dependence; crime) assessed up to the age of 30. Key findings included: 1) There were significant (p < 0.05) and pervasive associations between all measures of attachment and bonding and later outcomes. 2) Structural equation modelling showed that all measures of bonding and attachment loaded on a common factor reflecting the quality of parent/child relationships in adolescence. 3) After adjustment for covariates there were modest relationships (β = 0.16-0.17) between the quality of parent/child relationships in adolescence factor and later adjustment. The study findings suggest that the quality of parent/child relationships in adolescence is modestly related to later psychosocial functioning in adulthood.

Common or distinct pathways to psychosis? A systematic review of evidence from prospective studies for developmental risk factors and antecedents of the schizophrenia spectrum disorders and affective psychoses

BackgroundIdentifying the unique and shared premorbid indicators of risk for the schizophrenia spectrum disorders (SSD) and affective psychoses (AP) may refine aetiological hypotheses and inform the delivery of universal versus targeted preventive interventions. This systematic review synthesises the available evidence concerning developmental risk factors and antecedents of SSD and AP to identify those with the most robust support, and to highlight remaining evidence gaps.MethodsA systematic search of prospective birth, population, high-risk, and case-control cohorts was conducted in Medline and supplemented by hand searching, incorporating published studies in English with full text available. Inclusion/exclusion decisions and data extraction were completed in duplicate. Exposures included three categories of risk factors and four categories of antecedents, with case and comparison groups defined by adult psychiatric diagnosis. Effect sizes and prevalence rates were extracted, where available, and the strength of evidence synthesised and evaluated qualitatively across the study designs.ResultsOf 1775 studies identified by the search, 127 provided data to the review. Individuals who develop SSD experience a diversity of subtle premorbid developmental deficits and risk exposures, spanning the prenatal period through early adolescence. Those of greatest magnitude (or observed most consistently) included obstetric complications, maternal illness during pregnancy (especially infections), other maternal physical factors, negative family emotional environment, psychopathology and psychotic symptoms, and cognitive and motor dysfunctions. Relatively less evidence has accumulated to implicate this diversity of exposures in AP, and many yet remain unexamined, with the most consistent or strongest evidence to date being for obstetric complications, psychopathology, cognitive indicators and motor dysfunction. Among the few investigations affording direct comparison between SSD and AP, larger effect sizes and a greater number of significant associations are commonly reported for SSD relative to AP.ConclusionsShared risk factors for SSD and AP may include obstetric complications, childhood psychopathology, cognitive markers and motor dysfunction, but the capacity to distinguish common versus distinct risk factors/antecedents for SSD and AP is limited by the scant availability of prospective data for AP, and inconsistency in replication. Further studies considering both diagnoses concurrently are needed. Nonetheless, the prevalence of the risk factors/antecedents observed in cases and controls helps demarcate potential targets for preventative interventions for these disorders.

Patterns of service utilisation in psychosis: findings of the 2010 Australian national survey of psychosis.

Objective: This paper reports patterns of health service utilisation in the second Australian national survey of psychosis corresponding with changes in available services of this period. Method: Semi-structured interviews were carried out of an age-stratified random sample of adults who screened positive for psychosis. Multivariate logistic regressions were used to identify predictors of service use for a sample of 1825 individuals. Results: Use of psychiatric inpatient services was associated with higher symptom levels, suicidal ideation, poor social functioning and younger age. High users of emergency mental health services similarly reported higher symptom levels, poor functioning and younger age, and also reported being married or in a de facto relationship. Recipients of general practitioner services had greater anxiety symptoms and suicidal thoughts, fewer negative symptoms, single marital status and English as their first language. Rehabilitation service use was associated with greater anxiety symptoms, unemployment, younger age of illness onset, living alone and having no dependent children living at home. Last, outpatient/community services were more frequently used by younger people with good premorbid adjustment, hallucinations and a less severe course of illness. Conclusions: Service utilisation patterns vary with the clinical and socio-demographic features of those who use them – inpatient and emergency service users being similar in such features and differing from users of other services. Comparison with the first national survey of psychosis revealed a significant decline in acute inpatient service use and a substantial increase in the use of outpatient/community and rehabilitation services over the past 10 years.

Childhood Conduct Problems Are Associated with Increased Partnership and Parenting Difficulties in Adulthood.

This paper uses data from a sample of 337 parents studied at age 30 to examine the linkages between childhood conduct problems assessed at ages 7–9 and later partnership and parenting outcomes. The key findings of this study were: 1) increasing levels of childhood conduct problems were associated with increased risk of partnership difficulties, including relationship ambiguity, inter-partner conflict/violence and lower levels of relationship satisfaction; 2) increasing levels of childhood conduct problems were associated with increased risk of parenting difficulties, including over-reactivity, lax and inconsistent discipline, child physical punishment and lower levels of parental warmth and sensitivity. These findings were consistent across both parent reports and interviewer ratings, and in nearly all cases remained after extensive adjustment for confounding and selection bias. Study findings add to the growing body of evidence documenting the adverse consequences of early conduct problems for later adult interpersonal relationships and parenting behaviors.

New South Wales Child Development Study (NSW-CDS): an Australian multiagency, multigenerational, longitudinal record linkage study

Purpose The initial aim of this multiagency, multigenerational record linkage study is to identify childhood profiles of developmental vulnerability and resilience, and to identify the determinants of these profiles. The eventual aim is to identify risk and protective factors for later childhood-onset and adolescent-onset mental health problems, and other adverse social outcomes, using subsequent waves of record linkage. The research will assist in informing the development of public policy and intervention guidelines to help prevent or mitigate adverse long-term health and social outcomes. Participants The study comprises a population cohort of 87 026 children in the Australian State of New South Wales (NSW). The cohort was defined by entry into the first year of full-time schooling in NSW in 2009, at which time class teachers completed the Australian Early Development Census (AEDC) on each child (with 99.7% coverage in NSW). The AEDC data have been linked to the childrens birth, health, school and child protection records for the period from birth to school entry, and to the health and criminal records of their parents, as well as mortality databases. Findings to date Descriptive data summarising sex, geographic and socioeconomic distributions, and linkage rates for the various administrative databases are presented. Child data are summarised, and the mental health and criminal records data of the childrens parents are provided. Future plans In 2015, at age 11 years, a self-report mental health survey was administered to the cohort in collaboration with government, independent and Catholic primary school sectors. A second record linkage, spanning birth to age 11 years, will be undertaken to link this survey data with the aforementioned administrative databases. This will enable a further identification of putative risk and protective factors for adverse mental health and other outcomes in adolescence, which can then be tested in subsequent record linkages.

Comparing algorithms for deriving psychosis diagnoses from longitudinal administrative clinical records.

PurposeRegisters derived from administrative datasets are valuable tools in psychosis research, but diagnostic accuracy can be problematic. We sought to compare the relative performance of four methods for assigning a single diagnosis from longitudinal administrative clinical records when compared with reference diagnoses.MethodsDiagnoses recorded in inpatient and community mental health records were compared to research diagnoses of psychotic disorders obtained from semi-structured clinical interviews for 289 persons. Diagnoses were derived from administrative datasets using four algorithms; ‘At least one’ diagnosis, ‘Last’ or most recent diagnosis, ‘Modal’ or most frequently occurring diagnosis, and ‘Hierarchy’ in which a diagnostic hierarchy was applied. Agreements between algorithm-based and reference diagnoses for overall presence/absence of psychosis and for specific diagnoses of schizophrenia, schizoaffective disorder, and affective psychosis were examined using estimated prevalence rates, overall agreement, ROC analysis, and kappa statistics.ResultsFor the presence/absence of psychosis, the most sensitive and least specific algorithm (‘At least one’ diagnosis) performed best. For schizophrenia, ‘Modal’ and ‘Last’ diagnoses had greatest agreement with reference diagnosis. For affective psychosis, ‘Hierarchy’ diagnosis performed best. Agreement between clinical and reference diagnoses was no better than chance for diagnoses of schizoaffective disorder. Overall agreement between administrative and reference diagnoses was modest, but may have been limited by the use of participants who had been screened for likely psychosis prior to assessment.ConclusionThe choice of algorithm for extracting a psychosis diagnosis from administrative datasets may have a substantial impact on the accuracy of the diagnoses derived. An ‘Any diagnosis’ algorithm provides a sensitive measure for the presence of any psychosis, while ‘Last diagnosis’ is more accurate for specific diagnosis of schizophrenia and a hierarchical diagnosis is more accurate for affective psychosis.

Trajectories of childhood internalizing and externalizing psychopathology and psychotic-like experiences in adolescence: A prospective population-based cohort study

Adolescent internalizing and externalizing psychopathology is strongly associated with adult psychiatric morbidity, including psychotic disorders. This study examined whether internalizing or externalizing trajectories (continuity/discontinuity of symptoms) from middle childhood were associated with adolescent psychotic-like experiences (PLEs). Prospective data were collected from a community sample of 553 children (mean age = 10.4 years; 50% male) and their primary caregivers. Participants completed questionnaire reports of internalizing and externalizing psychopathology and PLEs at baseline, and again approximately 2 years later. Logistic regression was used to examine the association of adolescent PLEs with four trajectories of internalizing and externalizing psychopathology (persistent, incident, remitting, and none), controlling for a range of potential confounders and sampling bias. Significant associations were identified between adolescent PLEs and the incident internalizing (adjusted odds ratio [adj. OR] = 2.96; 95% confidence interval [CI] = 1.60–5.49) and externalizing psychopathology (adj. OR = 2.14; 95% CI = 1.11–4.14) trajectories, as well as the persistent internalizing (adj. OR = 1.90; 95% CI = 1.13–3.18) and externalizing (adj. OR = 1.81, 95% CI = 1.02–3.19) trajectories. Children with remitting psychopathology trajectories were no more likely to present later PLEs than those who never experienced psychopathology. While for many individuals symptoms and illness remit during development without intervention, this study provides important insights regarding potential targets and timing for delivery of early intervention and prevention programs.

Hospital admission for infection during early childhood influences developmental vulnerabilities at age 5 years

Childhood infectious diseases can be associated with later physical and psychological ill health, and the effects of this association may be evident during early childhood development. This study aimed to examine the effects of hospitalisation for early life infection on early childhood development.

4:15 PM CONTINUITY OF EXTERNALISING AND INTERNALISING PSYCHOPATHOLOGY AS PREDICTORS OF PSYCHOTIC-LIKE EXPERIENCES IN A LONGITUDINAL GENERAL POPULATION COHORT OF TEENAGERS

Background Persisting psychotic-like experiences (PLEs) are associated with an increased risk of internalising symptoms in adolescence. Whether this association holds similarly for externalising symptoms, and from mid-childhood, is unclear. This prospective study investigated the extent to which PLE persistence was associated with internalising and externalising psychopathology in a community sample of children aged 9–11 years at study commencement. Methods 8099 children (mean age 10.4 years) completed questionnaires assessing PLEs, externalising and internalising symptoms. A subsample of 547 children completed reassessment, on average, two years later. Results Two-thirds (66%) of children reported PLEs at baseline. Approximately two years later, PLEs persisted in 39% of those children. After adjustment for previous psychopathology and other potential confounds, children with persisting PLEs were at higher risk for internalising (odds ratio [OR] = 1.94; 95% confidence interval [CI] 1.13–3.34) and externalising (OR = 1.97; 95% CI 1.19–3.26) psychopathology than children whose PLEs remitted; and, than children who never presented PLEs. Conclusions Persistent PLEs from mid-childhood are associated with later internalising and externalising psychopathology in the general population, whereas transitory PLEs may be part of a spectrum of normative childhood development. Interventions that target persistent PLEs may contribute to a reduction in common childhood psychopathology.

Intergenerational changes in the context of early motherhood

Abstract Population level shifts in the timing of parenting onset and family composition have been well documented. However, the impacts of these changes on the life course experiences of high risk, teen and younger mothers remain poorly understood To address this issue, this paper examined intergenerational changes in the family formation and parenting experiences of teen and younger mothers who gave birth in the 1970s and the 2000s (G2, N = 108). The study sample consisted of two generations of early parenting women studied as part of the Christchurch Health and Development Study in New Zealand Early motherhood (<25 years) was defined relative to concurrent national childbirth data. Results showed that contemporary young mothers (G2) were subject to greater parental, housing and school instability during their childhood years than early parenting women of their mothers’ generation (G1). These risks persisted following their transition to motherhood, with G2 mothers being at increased risk of non-marital childbearing (65 vs. 11%), single motherhood (38 vs. 21%) and welfare dependence (37 vs. 19%) despite gains in educational achievement (36 vs. 18% tertiary qualified). Further examination of the family circumstances and parenting practices of contemporary G2 mothers showed that about half were working in unskilled or part time employment, with many experiencing a range of financial problems (13–40%). Breastfeeding (89%) and infant immunization (92%) were common, but one in four G2 women were exposing their children to passive cigarette smoke, physical punishment (82%) and abuse (14%). These findings provide support for secular changes in the context of early motherhood, with contemporary young mothers raising their children in family contexts characterized by higher levels of psychosocial adversity than the previous generation of early parenting women. Such findings raise significant concerns for the health and wellbeing of these young mothers and their children.