Anna Goodman

Strengths and Difficulties Questionnaire as a Dimensional Measure of Child Mental Health

OBJECTIVE To provide the first explicit evaluation of the dimensionality of the total difficulties score of the Strengths and Difficulties Questionnaire (SDQ), a widely used measure of child mental health. We do so by validating the SDQ across its full range against the prevalence of clinical disorder. METHOD We use two large (n = 18,415) nationally-representative surveys of children and adolescents aged 5 to 16 years in the general British population. Strengths and Difficulties Questionnaires were completed separately by parents, teachers, and children aged 11 to 16 years, and children also received a multi-informant clinician-rated clinical diagnosis. Approximately 7,912 children from the baseline survey were also reassessed for clinical diagnosis at 3-year follow-up. RESULTS Across the full range of the parent, teacher, and youth SDQ, children with higher total difficulty scores have greater psychopathology as judged by the prevalence of clinical disorder. This was true cross-sectionally and also in predicting to disorder status 3 years later. There was no evidence of threshold effects for the SDQ at either high or low scores, but rather the odds of disorder increased at a constant rate across the range (odds ratios between 1.14 and 1.28 per 1-point increase in SDQ score). CONCLUSIONS Our findings support the use of the SDQ as a genuinely dimensional measure of child mental health.

Health effects of the London bicycle sharing system: health impact modelling study.

Objective To model the impacts of the bicycle sharing system in London on the health of its users. Design Health impact modelling and evaluation, using a stochastic simulation model. Setting Central and inner London, England. Data sources Total population operational registration and usage data for the London cycle hire scheme (collected April 2011-March 2012), surveys of cycle hire users (collected 2011), and London data on travel, physical activity, road traffic collisions, and particulate air pollution (PM2.5, (collected 2005-12). Participants 578 607 users of the London cycle hire scheme, aged 14 years and over, with an estimated 78% of travel time accounted for by users younger than 45 years. Main outcome measures Change in lifelong disability adjusted life years (DALYs) based on one year impacts on incidence of disease and injury, modelled through medium term changes in physical activity, road traffic injuries, and exposure to air pollution. Results Over the year examined the users made 7.4 million cycle hire trips (estimated 71% of cycling time by men). These trips would mostly otherwise have been made on foot (31%) or by public transport (47%). To date there has been a trend towards fewer fatalities and injuries than expected on cycle hire bicycles. Using these observed injury rates, the population benefits from the cycle hire scheme substantially outweighed harms (net change −72 DALYs (95% credible interval −110 to −43) among men using cycle hire per accounting year; −15 (−42 to −6) among women; note that negative DALYs represent a health benefit). When we modelled cycle hire injury rates as being equal to background rates for all cycling in central London, these benefits were smaller and there was no evidence of a benefit among women (change −49 DALYs (−88 to −17) among men; −1 DALY (−27 to 12) among women). This sex difference largely reflected higher road collision fatality rates for female cyclists. At older ages the modelled benefits of cycling were much larger than the harms. Using background injury rates in the youngest age group (15 to 29 years), the medium term benefits and harms were both comparatively small and potentially negative. Conclusion London’s bicycle sharing system has positive health impacts overall, but these benefits are clearer for men than for women and for older users than for younger users. The potential benefits of cycling may not currently apply to all groups in all settings.

Mental Health and Childhood Adversities: A Longitudinal Study in Kabul, Afghanistan

Objective To identify prospective predictors of mental health in Kabul, Afghanistan. Method Using stratified random-sampling in schools, mental health and life events for 11-to 16-year-old students and their caregivers were assessed. In 2007, 1 year after baseline, the retention rate was 64% (n = 115 boys, 119 girls, 234 adults) with no evidence of selection bias. Self- and caregiver-rated child mental health (Strengths and Difficulties Questionnaire), depressive (Depression Self-Rating Scale), and posttraumatic stress (Child Revised Impact of Events Scale) symptoms and caregiver mental health (Self-Report Questionnaire) were assessed. Lifetime trauma and past-year traumatic, stressful, and protective experiences were assessed. Results With the exception of posttraumatic stress, one-year trajectories for all mental health outcomes showed significant improvement (p < .001). Family violence had a striking impact on the Strengths and Difficulties Questionnaire data, raising caregiver-rated scores by 3.14 points (confidence interval [CI] 2.21–4.08) or half a standard deviation, and self-rated scores by 1.26 points (CI 0.50–2.03); past-year traumatic beatings independently raised self-rated scores by 1.85 points (CI 0.03–3.66). A major family conflict raised depression scores by 2.75 points (CI 0.89–4.61), two thirds of a standard deviation, whereas improved family life had protective effects. Posttraumatic stress symptom scores, however, were solely contingent on lifetime trauma, with more than three events raising scores by 5.38 points (CI 1.76–9.00). Conclusions Family violence predicted changes in mental health problems other than posttraumatic stress symptoms in a cohort that showed resilience to substantial socioeconomic and war-related stressors. The importance of prospectively identifying impacts of specific types of childhood adversities on mental health outcomes is highlighted to strengthen evidence on key modifiable factors for intervention in war-affected populations.

The Nordic Advantage in Child Mental Health: Separating Health Differences from Reporting Style in a Cross-Cultural Comparison of Psychopathology.

BACKGROUND The use of similar standardised measures of psychopathology for population surveys permits cross-cultural comparisons. However, interpretation of findings can be challenging because rating thresholds may differ across cultures. By combining questionnaire and interview data, we explore whether lower questionnaire scores in Norway as compared to Britain reflect genuine differences in child mental health, or simply different reporting thresholds. METHODS Information from the Strengths and Difficulties Questionnaire (SDQ) and the Development and Well-Being Assessment (DAWBA) interview were compared across recent population surveys in Norway and Britain. The Norwegian study (2002-03) had questionnaire data for 6,658 and interview data for 1,024 8-10-year-old children. The British dataset included questionnaire and interview data for 4,898 children of the same age range from two independent surveys (1999 and 2004). RESULTS Norwegian children had lower SDQ scores on all problem scales (emotional, behavioural, hyperactive and peer relationship) according to parents as well as teachers. DAWBA information showed that the Norwegian prevalence of externalising disorders (behavioural and hyperactivity) was about half that found in Britain, whereas rates of emotional disorders were similar. Norwegian and British children with non-emotional disorders had similar questionnaire scores and rates of problem-recognition by parents and teachers. By contrast, questionnaire scores and problem-recognition were all lower in Norwegian children with emotional disorders. CONCLUSIONS Lower Norwegian questionnaire scores for externalising problems appear to reflect real and substantial differences between the two countries. By contrast, lower questionnaire scores for emotional problems seem to reflect under-reporting/under-recognition by Norwegian adults, and not a genuinely lower prevalence of emotional disorders. This illustrates that cross-cultural differences in psychopathology based only on questionnaire data may be misleading. Nevertheless, careful use of questionnaire and interview data can focus mental health research on cross-cultural variations likely to reflect genuine health differences.

New Walking and Cycling Routes and Increased Physical Activity: One- and 2-Year Findings From the UK iConnect Study

OBJECTIVES We evaluated the effects of providing new high-quality, traffic-free routes for walking and cycling on overall levels of walking, cycling, and physical activity. METHODS 1796 adult residents in 3 UK municipalities completed postal questionnaires at baseline (2010) and 1-year follow-up (2011), after the construction of the new infrastructure. 1465 adults completed questionnaires at baseline and 2-year follow-up (2012). Transport network distance from home to infrastructure defined intervention exposure and provided a basis for controlled comparisons. RESULTS Living nearer the infrastructure did not predict changes in activity levels at 1-year follow-up but did predict increases in activity at 2 years relative to those living farther away (15.3 additional minutes/week walking and cycling per km nearer; 12.5 additional minutes/week of total physical activity). The effects were larger among participants with no car. CONCLUSIONS These new local routes may mainly have displaced walking or cycling trips in the short term but generated new trips in the longer term, particularly among those unable to access more distant destinations by car. These findings support the potential for walking and cycling infrastructure to promote physical activity.

The metabolic profile of early Huntington's disease- a combined human and transgenic mouse study

Huntingtons disease (HD) is a debilitating autosomal dominant, neurodegenerative disease with a fatal prognosis. Classical symptoms include motor disturbances, subcortical dementia and psychiatric symptoms but are not restricted to this triad. Patients often experience other problems such as weight loss, although why and when this occurs in the disease course is not known. We studied metabolism using whole body indirect calorimetry in both early stage HD patients and in the R6/2 transgenic mouse model of HD, at times before and after they displayed signs of disease. Using this combined approach we found that patients with early HD tended to be in negative energy balance for reasons not related to their movement disorder, which was paralleled in the transgenic R6/2 mice. These mice had significantly elevated total energy expenditure as they developed overt disease with weight loss due primarily to a loss of muscle bulk. This study has shown for the first time that in HD there is the development of early negative energy balance, which in turn may cause weight loss with loss of muscle bulk in particular. The reason for this is not known but may reflect a catabolic state secondary to hypothalamic pathology, as abnormalities have been reported in the hypothalamus early in the disease course.

Child mental health differences amongst ethnic groups in Britain: a systematic review

BackgroundInter-ethnic differences have been reported for many mental health outcomes in the UK, but no systematic review on child mental health has been published. The aim of this review is to compare the population-based prevalence of child mental disorders between ethnic groups in Britain, and relate these findings to ethnic differences in mental health service use.MethodsA systematic search of bibliographic databases for population-based and clinic-based studies of children aged 0–19, including all ethnic groups and the main child mental disorders. We synthesised findings by comparing each minority group to the White British study sample.Results31 population-based and 18 clinic-based studies met the inclusion criteria. Children in the main minority groups have similar or better mental health than White British children for common disorders, but may have higher rates for some less common conditions. The causes of these differences are unclear. There may be unmet need for services among Pakistani and Bangladeshi children.ConclusionInter-ethnic differences exist but are largely unexplained. Future studies should address the challenges of cross-cultural psychiatry and investigate reasons for inter-ethnic differences.

Health-related quality of life in Huntington's disease: Which factors matter most?†

The aim of this article was to determine which aspects of Huntingtons disease (HD) are most important with regard to the health‐related quality of life (HrQOL) of patients with this neurodegenerative disease. Seventy patients with HD participated in the study. Assessment comprised the Unified Huntingtons Disease Rating Scale (UHDRS) motor, cognitive and functional capacity sections, and the Beck Depression inventory. Mental and physical HrQOL were assessed using summary scores of the SF‐36. Multiple regression analyses showed that functional capacity and depressive mood were significantly associated with HrQOL, in that greater impairments in HrQOL were associated with higher levels of depressive mood and lower functional capacity. Motor symptoms and cognitive function were not found to be as closely linked with HrQOL. Therefore, it can be concluded that, depressive mood and greater functional incapacity are key factors in HrQOL for people with HD, and further longitudinal investigation will be useful to determine their utility as specific targets in intervention studies aimed at improving patient HrQOL, or whether other mediating variables. As these two factors had a similar association with the mental and physical summary scores of the SF‐36, this generic HrQOL measure did not adequately capture and distinguish the true mental and physical health‐related HrQOL in HD.

Low fertility increases descendant socioeconomic position but reduces long-term fitness in a modern post-industrial society

Adaptive accounts of modern low human fertility argue that small family size maximizes the inheritance of socioeconomic resources across generations and may consequently increase long-term fitness. This study explores the long-term impacts of fertility and socioeconomic position (SEP) on multiple dimensions of descendant success in a unique Swedish cohort of 14 000 individuals born during 1915–1929. We show that low fertility and high SEP predict increased descendant socioeconomic success across four generations. Furthermore, these effects are multiplicative, with the greatest benefits of low fertility observed when SEP is high. Low fertility and high SEP do not, however, predict increased descendant reproductive success. Our results are therefore consistent with the idea that modern fertility limitation represents a strategic response to the local costs of rearing socioeconomically competitive offspring, but contradict adaptive models suggesting that it maximizes long-term fitness. This indicates a conflict in modern societies between behaviours promoting socioeconomic versus biological success. This study also makes a methodological contribution, demonstrating that the number of offspring strongly predicts long-term fitness and thereby validating use of fertility data to estimate current selective pressures in modern populations. Finally, our findings highlight that differences in fertility and SEP can have important long-term effects on the persistence of social inequalities across generations.

Migration and autism spectrum disorder: population-based study {

BACKGROUND Migration has been implicated as a risk factor for autism, but evidence is limited and inconsistent. AIMS To investigate the relationship between parental migration status and risk of autism spectrum disorder, taking into consideration the importance of region of origin, timing of migration and possible discrepancies in associations between autism subtypes. METHOD Record-linkage study within the total child population of Stockholm County between 2001 and 2007. Individuals with high- and low-functioning autism were defined as having autism spectrum disorder with and without comorbid intellectual disability, and ascertained via health and habilitation service registers. RESULTS In total, 4952 individuals with autism spectrum disorder were identified, comprising 2855 children with high-functioning autism and 2097 children with low-functioning autism. Children of migrant parents were at increased risk of low-functioning autism (odds ratio (OR) = 1.5, 95% CI 1.3-1.7); this risk was highest when parents migrated from regions with a low human development index, and peaked when migration occurred around pregnancy (OR = 2.3, 95% CI 1.7-3.0). A decreased risk of high-functioning autism was observed in children of migrant parents, regardless of area of origin or timing of migration. Parental age, income or obstetric complications did not fully explain any of these associations. CONCLUSIONS Environmental factors associated with migration may contribute to the development of autism presenting with comorbid intellectual disability, especially when acting in utero. High- and low-functioning autism may have partly different aetiologies, and should be studied separately.