Angela D. Paradis

General and Specific Childhood Risk Factors for Depression and Drug Disorders by Early Adulthood

OBJECTIVE To identify childhood risk factors that predict depression and drug disorders by early adulthood, distinguishing between general risk factors for both disorders and specific risk factors for each individual disorder. METHOD Within a longitudinal community study (N = 360), familial and behavioral-emotional characteristics were assessed in early childhood (ages 5, 6, and 9 years). At age 21, the Diagnostic Interview Schedule, version III-revised, provided lifetime diagnoses of major depression and drug abuse/dependence. RESULTS Sibling substance use disorders predicted depression and drug disorders for both genders. Feelings of anxiety, depression, and peer rejection were general predictors for females. Specific risk factors for depression were parental depression and anxious/depressed behavior in both genders and peer problems for males. Specific risk factors for drug abuse/dependence were larger family size, lower socioeconomic status, hyperactivity, attention problems, and aggression. Parental substance abuse and having younger parents were specific risk factors for drug disorders in males. CONCLUSIONS Familial and behavioral-emotional risk factors for depression and drug disorders were primarily specific, suggesting separate pathways. The unique perspectives of multiple informants facilitate early identification.

Adolescent Protective Factors Promoting Resilience in Young Adults at Risk for Depression

In a longitudinal, community-based study, adolescent protective factors for those at risk for depression were identified that were associated with resilient outcomes in young adulthood. For those with childhood risk factors for major depression, significant protective factors included family cohesion, positive self appraisals, and good interpersonal relations. Findings may help inform the development of prevention and treatment programs for adolescents vulnerable to depression. Implications for future research and clinical practice are discussed.

Major depression in the transition to adulthood: the impact of active and past depression on young adult functioning.

This study examined the association between active and past major depression and deficits in young adult functioning using data from a longitudinal community study (N = 354). Three groups were compared: (1) participants with a 1-year diagnosis of major depression at age 26 (active group); (2) those who experienced major depression during the transition to adulthood, ages 18–25, but did not have active depression at age 26 (past group); and (3) individuals not meeting diagnostic criteria for depression during the transition period. Results highlight serious deficits in psychosocial functioning at age 26 linked to both active and past depression. Although participants with active depression experienced the greatest number of problems, those with past depression evidenced similar deficits across many important domains of functioning. The significant impairments characterizing those with past depression indicate the need for continued monitoring to decrease the risk of recurrence and the establishment of a chronic course of illness.

Major Depression and Drug Disorders in Adolescence: General and Specific Impairments in Early Adulthood

OBJECTIVE To identify adulthood impairments associated with major depression and drug disorders in adolescence, distinguishing between general impairments for both disorders and specific impairments for each disorder. METHOD Within a longitudinal community study (N= 365), the Diagnostic Interview Schedule provided 1-year diagnoses of major depression and drug abuse/dependence at age 18. At age 21, current functioning was assessed. RESULTS Adolescents with either depression or drug disorders had substantial deficits in later functioning, with few impairments shared in common. General areas of impairment included lower global functioning, externalizing behavior problems, and suicidal behaviors. Difficulties specific to depression encompassed multiple internalizing problems: interpersonal difficulties, decreased psychological well-being, career dissatisfaction, and active major depression at age 21. For males only, overall poor health was also a specific depression outcome. Age 21 problems unique to drug disorders included lower likelihood of post-high school education, being fired, and active drug disorders. Males, but not females, were also more likely to report antisocial behaviors in adulthood. CONCLUSIONS Despite several significant commonalities, including suicide attempts, deficits associated with depression and drug disorders were primarily specific, suggesting distinct trajectories. Results highlight the need for specific follow-up services to alleviate continuing problems associated with these disorders.

Long-Term Impact of Family Arguments and Physical Violence on Adult Functioning at Age 30 Years: Findings From the Simmons Longitudinal Study

OBJECTIVE To prospectively examine the extent to which an increase in family arguments by age 15 years and the occurrence of family physical violence by age 18 years are related to deficits in key domains of adult functioning at age 30 years. METHOD The 346 participants were part of a single-age cohort from a predominately white working-class community whose psychosocial development has been traced since age 5 years. Family arguments and violence were assessed through self-reports during adolescence. Developmentally relevant areas of current adult functioning were measured by self-reports, structured diagnostic interviews, and clinical interviewer ratings. RESULTS Both family arguments and physical violence were significantly related to compromised functioning across multiple areas of adult functioning. Although many associations were somewhat attenuated after controlling for sex, other early family adversities, and family history of disorder, most relations retained statistical significance. Both risk factors were linked with later mental health problems and deficits in psychological and occupational/career functioning. Family violence was also linked to poorer physical health at age 30 years. CONCLUSIONS Findings underscore the potential long-term impact of troubled family interactions and highlight the critical importance of early intervention programs for youths experiencing either verbal conflict or physical violence in the home.

Maternal smoking during pregnancy and criminal offending among adult offspring

Background Although a number of previous studies have reported an association between maternal smoking during pregnancy (MSP) and externalising behaviour problems among offspring, it has been suggested that this relationship is spurious due to the failure of these studies to properly account for important confounding factors. Methods The relationship between MSP and adult criminal offending was examined using data from 3766 members of the Providence, Rhode Island, cohort of the Collaborative Perinatal Project. Information on MSP and most potential confounders was collected prospectively throughout pregnancy. In 1999–2000 all offspring had reached 33 years of age and an adult criminal record check was performed. Because previous research has been criticised for not properly accounting for confounding influences, our primary aim was to determine whether the MSP–criminal offending relationship held after efficiently adjusting for a wide range of sociodemographic and family background characteristics using propensity score methods. Results The association between MSP and adult criminal offending remained after controlling for propensity scores. Offspring of mothers who smoked heavily during pregnancy (≥20 cigarettes per day) had the greatest odds of an adult arrest record (OR 1.31, 95% CI 1.06 to 1.62). Findings also suggest that MSP may be an independent risk factor for adult criminal histories marked by multiple arrests. Lastly, our findings show that the impact of MSP operates similarly across both genders. Conclusion Results from this study provide evidence of an association between heavy MSP and long-term criminal offending. Any causal association is likely to be weak to moderate in strength.

Prevalence of schizophrenia disability and associated mortality among Chinese men and women

Schizophrenia is a major cause of psychiatric disability in China. In the present study, we estimated total and age-specific prevalence of both schizophrenia disability and associated mortality among Chinese women and men. We further examined whether sex differences in prevalence were attributable to mortality differences between men and women. Data from the Second China National Sample Survey on Disability (2006) and the 2007-2010 follow-up studies were utilized. Possibly psychiatrically disabled individuals were administered the World Health Organization Disability Assessment Schedule, Version II and the ICD-10 Symptom Checklist for Mental Disorders by trained clinical psychiatrists. In total, 0.37% of men and 0.44% of women were living with schizophrenia disability in China. We did not find statistically significant differences in the 4-year cumulative mortality between men and women. Overall standardized mortality ratios for the age groups of 18-29, 30-39, 40-49, 50-59, 60-69, and 70+ years were 120.89, 29.56, 15.06, 9.16, 10.57, and 4.95, respectively. In conclusion, mortality differences between men and women were unlikely to be a major contributor to sex differences in prevalence. Premature death among younger individuals experiencing schizophrenia disability warrants urgent attention.

Maternal smoking during pregnancy and offspring antisocial behaviour: findings from a longitudinal investigation of discordant siblings

Background Although many observational studies have found a strong association between maternal smoking during pregnancy (MSP) and offspring antisocial behaviour, the likelihood that this relationship is causal remains unclear. To comment on the potential causality of this association, the current investigation used a between–within decomposition approach to examine the association between MSP and multiple indices of adolescent and adult antisocial behaviour. Methods Study participants were offspring of women enrolled in the Providence and Boston sites of the Collaborative Perinatal Project. Information on MSP was collected prospectively. Antisocial behaviour was assessed via self-report and through official records searches. A subset of the adult offspring (average age: 39.6 years) were enrolled in a follow-up study oversampling families with multiple siblings. Participants in this follow-up study self-reported on juvenile and adult antisocial behaviours during a structured interview (n=1684). Official records of juvenile (n=3447) and adult (n=3433) criminal behaviour were obtained for participants in the Providence cohort. Statistical models allowed between-family effects of MSP exposure to differ from within-family effects. In the absence of heterogeneity in between-family versus within-family estimates, a combined estimate was calculated. Results MSP was associated with a range of antisocial behaviours, measured by self-report and official records. For example, MSP was associated with increased odds of elevated levels of antisocial behaviours during adolescence and adulthood, as well as violent and non-violent outcomes during both developmental periods. Conclusions Findings are consistent with a small-to-moderate causal effect of MSP on adolescent and adult antisocial behaviour.

A prospective investigation of neurodevelopmental risk factors for adult antisocial behavior combining official arrest records and self-reports.

Neurodevelopmental deficits are postulated to play an important role in the etiology of persistent antisocial behavior (ASB). Yet it remains uncertain as to which particular deficits are most closely associated with ASB. We seek to advance this understanding using prospectively collected data from a birth cohort in which multiple indices of neurodevelopmental functioning and ASB were assessed. Participants (n = 2776) were members of the Providence, Rhode Island cohort of the Collaborative Perinatal Project. Information on demographic and neurodevelopmental variables was collected from pregnancy through age 7. When all offspring had reached 33 years of age an adult criminal record check was conducted. A subset of subjects also self-reported on their engagement in serious ASB. Bivariate logistic regression was used to examine the relationship between each neurodevelopmental factor and adult ASB and test whether associations varied depending on how ASB was ascertained. After controlling for background and contextual characteristics, maternal smoking during pregnancy, lower childhood verbal and performance IQ, and age 7 aggressive/impulsive behavior all significantly increased the odds of adult ASB. Associations were not modified by sex and did not depend on how ASB was assessed. However, while both males and Black participants were more likely to engage in ASB than their respective female and White counterparts, relationships were significantly stronger for official records than for self-reports. Results point to a particular subset of early neurodevelopmental risks for antisocial outcomes in adulthood. Findings also suggest that prior contradictory results are not due to the use of official records versus self-reported outcomes.

Impact of persistent and adolescent-limited antisocial behaviour on adult health outcomes

Background Persistent engagement in antisocial behaviour across developmental periods is thought to increase the risk for early disease morbidity. However, less is known about potential adverse health outcomes among the much larger subset of individuals with antisocial behaviour limited to adolescence. Methods Using data from the Providence, Rhode Island cohort of the Collaborative Perinatal Project, we examined the association between developmentally based subtypes of antisocial behaviour and health outcomes (n=801). Official arrest records and self-reports of engagement in antisocial behaviour were used to classify participants into antisocial groups (persistent into adulthood, adolescent-limited, no significant problems) that were contrasted across important adult health indicators. Results With few exceptions, those with persistent antisocial behaviour had the highest prevalence of each health problem. Compared to those with no antisocial behaviour, participants with persistent problems had poorer overall health and significantly elevated odds of cardiovascular problems, wheezing, lower back pain, cancer, serious injury and emergency department visits. Those with adolescent-limited behaviour experienced significantly increased odds of health concerns including poorer overall health, hypercholesterolaemia, acute respiratory problems and wheezing, lower back pain and emergency department visits compared to participants with no antisocial behaviour. Both antisocial groups reported barriers to healthcare access. Conclusions Findings highlight the impact of persistent antisocial behaviour on adult health, and suggest that antisocial behaviour limited to adolescence is also an important marker of poor health. Given that antisocial behaviour during adolescence is an important early marker of adverse health outcomes, youth exhibiting serious behavioural problems should be targeted for preventive interventions.