David Batty

Socioeconomic inequalities in common mental disorders and psychotherapy treatment in the UK between 1991 and 2009

BACKGROUND Inequality in health and treatment of disease across socioeconomic status groups is a major public health issue. AIMS To examine differences in socioeconomic status in common mental disorders and use of psychotherapy provided by the public and private sector in the UK between 1991 and 2009. METHOD During these years, 28 054 men and women responded to annual surveys by the nationally representative, population-based British Household Panel Survey (on average 7 measurements per participant; 207 545 person-observations). In each year, common mental disorders were assessed with the self-reported 12-item General Health Questionnaire and socioeconomic status was assessed on the basis of household income, occupational status and education. RESULTS Higher socioeconomic status was associated with lower odds of common mental disorder (highest v. lowest household income quintile odds ratio (OR) 0.88, 95% CI 0.82-0.94) and of being treated by publicly provided psychotherapy (OR = 0.43, 95% CI 0.34-0.55), but higher odds of being a client of private psychotherapy (OR = 3.33, 95% CI 2.36-4.71). The status difference in publicly provided psychotherapy treatment was more pronounced at the end of follow-up (OR = 0.36, 95% CI 0.23-0.56, in 2005-2009) than at the beginning of the follow-up period (OR = 0.96, 95% CI 0.66-1.39, in 1991-1994; time interaction P<0.001). The findings for occupational status and education were similar to those for household income. CONCLUSIONS The use of publicly provided psychotherapy has improved between 1991 and 2009 among those with low socioeconomic status, although social inequalities in common mental disorders remain.

Cardio-metabolic risk factors and cortical thickness in a neurologically healthy male population: Results from the psychological, social and biological determinants of ill health (pSoBid) study

Introduction Cardio-metabolic risk factors have been associated with poor physical and mental health. Epidemiological studies have shown peripheral risk markers to be associated with poor cognitive functioning in normal healthy population and in disease. The aim of the study was to explore the relationship between cardio-metabolic risk factors and cortical thickness in a neurologically healthy middle aged population-based sample. Methods T1-weighted MRI was used to create models of the cortex for calculation of regional cortical thickness in 40 adult males (average age = 50.96 years), selected from the pSoBid study. The relationship between cardio-vascular risk markers and cortical thickness across the whole brain, was examined using the general linear model. The relationship with various covariates of interest was explored. Results Lipid fractions with greater triglyceride content (TAG, VLDL and LDL) were associated with greater cortical thickness pertaining to a number of regions in the brain. Greater C reactive protein (CRP) and intercellular adhesion molecule (ICAM-1) levels were associated with cortical thinning pertaining to perisylvian regions in the left hemisphere. Smoking status and education status were significant covariates in the model. Conclusions This exploratory study adds to a small body of existing literature increasingly showing a relationship between cardio-metabolic risk markers and regional cortical thickness involving a number of regions in the brain in a neurologically normal middle aged sample. A focused investigation of factors determining the inter-individual variations in regional cortical thickness in the adult brain could provide further clarity in our understanding of the relationship between cardio-metabolic factors and cortical structures.

Is the Relationship between Common Mental Disorder and Adiposity Bidirectional? Prospective Analyses of a UK General Population-Based Study

The direction of the association between mental health and adiposity is poorly understood. Our objective was to empirically examine this link in a UK study. This is a prospective cohort study of 3 388 people (men) aged ≥ 18 years at study induction who participated in both the UK Health and Lifestyle Survey at baseline (HALS-1, 1984/1985) and the re-survey (HALS-2, 1991/1992). At both survey examinations, body mass index, waist circumference and self-reported common mental disorder (the 30-item General Health Questionnaire, GHQ) were measured. Logistic regression models were used to compute odds ratios (OR) and accompanying 95% confidence intervals (CI) for the associations between (1) baseline common mental disorder (QHQ score > 4) and subsequent general and abdominal obesity and (2) baseline general and abdominal obesity and re-survey common mental disorders. After controlling for a range of covariates, participants with common mental disorder at baseline experienced greater odds of subsequently becoming overweight (women, OR: 1.30, 1.03 – 1.64; men, 1.05, 0.81 – 1.38) and obese (women, 1.26, 0.82 – 1.94; men, OR: 2.10, 1.23 – 3.55) than those who were free of common mental disorder. Similarly, having baseline common mental health disorder was also related to a greater risk of developing moderate (1.57, 1.21 – 2.04) and severe (1.48, 1.09 – 2.01) abdominal obesity (women only). Baseline general or abdominal obesity was not associated with the risk of future common mental disorder. These findings of the present study suggest that the direction of association between common mental disorders and adiposity is from common mental disorder to increased future risk of adiposity as opposed to the converse.

Intelligence and neuroticism in relation to depression and psychological distress: evidence of interaction using data from Generation Scotland: Scottish Family Health Study and UK Biobank

Background Neuroticism is a risk factor for selected mental and physical illnesses and is inversely associated with intelligence. Intelligence appears to interact with neuroticism and mitigate its detrimental effects on physical health and mortality. However, the inter-ralationships of neuroticism and intelligence for major depressive disorder (MDD) and psychological distress has not been well examined. Methods Associations and interactions between neuroticism and general intelligence (g) on MDD and psychological distress were examined in two population-based cohorts: Generation Scotland: Scottish Family Health Study (GS:SFHS, N=19,200) and UK Biobank (N=90,529). The Eysenck Personality Scale Short Form-Revised measured neuroticism and g was extracted from multiple cognitive ability tests in each cohort. Family structure was adjusted for in GS:SFHS. Results Neuroticism was associated with MDD and psychological distress in both samples. A significant interaction between neuroticism and g in predicting MDD status was found in UK Biobank (OR = 0.96, p < .01), suggesting that higher g ameliorated the adverse effects of neuroticism on the likelihood of having MDD. This interaction was not found in GS:SFHS. In both samples, higher neuroticism and lower intelligence were associated with increased psychological distress. A significant interaction was also found in both cohorts (GS:SFHS: ß = -0.05, p < .01; UK Biobank: ß = -0.02, p < .01), such that intelligence protected against the deleterious effect of neuroticism on psychological distress. Conclusions From two large cohort studies, our findings suggest intelligence acts a protective factor in mitigating the effects of neuroticism on risk for depressive illness and psychological distress.

Weight gain is associated with greater increase in CRP among overweight and obese than among normal weight people

‘It’s frightening to think that you mark your children merely by being yourself. It seems unfair. You can’t assume the responsibility for everything you do – or don’t do.’ Simone de Beauvoir. Empirical data show disparities in childhood obesity incidence on the basis of income, gender and neighbourhood characteristics (Matheson et al., 2008; Harrington et al., 2009). Do these findings identify a section of society that are morally culpable for the increase in childhood obesity, or do they point to structural inequities that serve to exacerbate existing inequalities? The question of responsibility, and particularly parental responsibility, is central to discussions of interventions for childhood obesity. Responsibility may be considered in three distinct ways: causal responsibility, moral responsibility, and blameworthiness (Holm, 2009). Thus whilst parents may be causally responsible, together with others such as the advertising industry, food producers, and government, are they also morally responsible and/or blameworthy? Empirical data, which shows disparities in childhood obesity incidence, may point to a lack of moral responsibility or blameworthiness–at least in some parents. This paper explores the issue of parental responsibility and suggests that the attribution of responsibility is far more complex than may at first appear and that whilst parents are causally responsible, in many cases the moral responsibility and attribution of blame must fall elsewhere. In particular I consider to what extent the state can be seen as morally responsible and the implications that these conclusions have for interventions in childhood obesity. Conflict of interest: None disclosed. Funding: This work was done as part of the IDEFICS Study (www.idefics.eu). We gratefully acknowledge the financial support of the European Community within the Sixth RTD Framework Programme Contract No. 016181 (FOOD). The information in this document reflects the author’s view and is provided as is. No Funding/Research relating to this abstract was funded by.

Validation of the Phenotype of Frailty measurement in the Whitehall II study

Background Frailty is a multi-dimensional geriatric entity shown to be associated with a high risk of disability, hospitalisation, and mortality. In the literature, disability and comorbidity are often used as synonyms of frailty but in fact these are distinct clinical entities. With population ageing, prevention of frailty is increasingly important. To date, there is no standardised measurement of frailty. However, the Phenotype of Frailty definition has been widely used. Objective To examine the concurrent and predictive validity of the Phenotype of Frailty measurement in the ongoing prospective Whitehall II cohort study. Participants A total of 5,196 (26% women) British civil servants aged 55 to 79, who participated in the latest phase (phase 9) of the study between 2007 and 2009. Measurements According to the Phenotype of Frailty, participants were classified as frail if they had at least three out of five of the following: weight loss, slowness, weakness, exhaustion, and low physical activity. They were considered as disabled if they had any difficulties in one or more basic activities of daily living. Comorbidity was defined as two or more self-reported longstanding illnesses. Hospitalisation information until January 2010 was provided by the NHS Information Centre for health and social care. Analysis Concurrent validity of the Phenotype of Frailty definition was studied using logistic regression models to describe multi-adjusted effects of frailty status on disability and comorbidity. Its predictive validity for hospitalisation was performed using multivariate Cox model. Results Of all participants, 3.2% (n=164) participants met frailty criteria, 9.1% were disabled and 35.3% had comorbidity. Multivariable adjusted logistic regression analyses showed that frail participants were more likely to be disabled and to have comorbidity (OR=5.6, 95% CI: 3.7 to 8.5 and OR=1.3, 95% CI: 0.9 to 1.9, respectively) than their non-frail counterparts. With a median follow-up of 17.3 months, the frail group was 43% (RR=1.43, 95% CI: 1.1 to 1.9) more likely to be hospitalised than the non-frail group in a multivariable adjusted Cox model. High risk of hospitalisation among frail participants persisted even after entering in the model disability and comorbidity data. Conclusion Our findings suggest that the Phenotype of Frailty used in the Whitehall II study has a good level of concurrent and predictive validity and is a distinct risk factor for hospitalisation than disability or comorbidity. This measurement appears to be clinically relevant in further research in ageing.

Cognitive and socioeconomic predictors of survival in dementia

pairment and dementia. It is currently unclear whether depression is a true risk factor for cognitive impairment, or an early symptom of cognitive impairment. Our objective was to explore the association of late life depression with mild cognitive impairment (MCI) and dementia in cross-sectional and longitudinal analyses and to explore whether this association is different for Alzheimer’s disease (AD) and vascular dementia (VD). Methods: We analyzed data from a cohort of 2160 elderly community-dwelling participants 65 years and older with an average follow-up of 5.4 years. Depression was assessed using the 10 item CES-D with a cut-off for depression of1⁄4 4 points. Cross-sectional associations were assessed using logistic regression models and longitudinal analyses were assessed using Cox proportional hazards models. Results: Depression was cross-sectionally associated with higher risk of MCI (OR1⁄41.44;95% CI:1.11-1.86) and dementia (OR1⁄42.22;95%CI:1.60-3.06). Depression was longitudinally associated with an increased risk of incident dementia (HR1⁄41.68;95%CI: 1.22-2.32), but not with incident MCI (HR 1⁄4 0.90; 95% CI: 0.66-1.23). Cross-sectional and longitudinal results were similar for AD and VD. Persons with MCI at baseline with co-existing depression had a higher risk of progression to dementia (HR1⁄42.34;95%CI: 1.43-3.84), which was limited to VD (HR1⁄44.30;95%CI: 1.09-17.03; HR for AD1⁄4 1.07; 95% CI: 0.47-2.45). Conclusions: Late life depression was cross-sectionally associated with MCI and dementia and longitudinally with increased dementia risk only. Persons with MCI and co-existing depression have a higher risk of progressing to VD but not AD, suggesting a cerebrovascular mechanism.. The association of depression with prevalent MCI and with progression from MCI to dementia, but not with incident MCI suggests that depression accompanies cognitive impairment but does not precede it.