Elizabeth M. Ridder

Prevalence of traumatic brain injury among children, adolescents and young adults: Prospective evidence from a birth cohort

Background: Little is known about the incidence and prevalence of traumatic brain injury (TBI), particularly for infants, children and young adults. Primary objective: The purpose of this study was to provide an accurate estimate of the incidence and prevalence of TBIs for individuals between 0–25 years of age. Method and procedures: A birth cohort of 1265 individuals was used, for which information regarding TBI events, both hospitalized and non-hospitalized, had been recorded. Main outcomes and results: The average incidence for this age group ranged from 1.10–2.36 per 100 per year, with an overall prevalence of ∼30%. The most common source of injury was falls for individuals 0–14 years of age and contact sports and motor vehicle accidents for 15–25 year olds. Approximately one third of the individuals who experienced a TBI went on to have one or more additional injuries. Conclusions: The incidence rates reported here are much higher than those previously found. It is clear that TBIs constitute a major health issue and therefore it is important to have accurate information to enable planning for primary healthcare services and to inform prevention programmes.

Sexual orientation and mental health in a birth cohort of young adults

BACKGROUND This paper sought to examine the relationship between sexual orientation and mental health in a New Zealand birth cohort studied to age 25 years. METHOD The analysis is based on a sample of 967 participants (469 males; 498 females) in the Christchurch Health and Development Study. As part of this study information was gathered on: (a) measures of sexual orientation, same-sex behaviour and sexual attraction obtained at ages 21 and 25 years; (b) measures of mental disorders and suicidal behaviours over the interval 21-25 years; (c) measures of childhood and family background. RESULTS Latent class analysis was used to combine indicators of sexual orientation, same sex behaviour and attraction to form an empirically based classification of sexual orientation. The best-fitting model classified the sample into three groups: exclusively heterosexual orientation (87.6%); predominantly heterosexual but with same-sex inclinations or experience (9.6%); predominantly homosexual (2.8%). Proportionately more women than men were classified as predominantly heterosexual (14.2% v. 4.8% respectively) or predominantly homosexual (3.9% v. 1.5% respectively). Cohort members with a predominantly homosexual orientation had rates of mental disorder and suicidal behaviours that were between 1.5 and 12 times higher than for those with an exclusively heterosexual orientation. These associations persisted after adjustment for confounding. The associations between sexual orientation and mental health were more marked for males than females. CONCLUSIONS. The findings suggest a continuum of sexual preferences amongst young adults. Variations in sexual orientation were clearly associated with mental health. These associations tended to be stronger for males.

Suicidal behaviour in adolescence and subsequent mental health outcomes in young adulthood.

BACKGROUND The aim of this study was to examine the linkages between suicidal ideation and attempt in adolescence and subsequent suicidal behaviours and mental health in young adulthood. METHOD Data were gathered during the course of a 25-year longitudinal study of a birth cohort of 1265 New Zealand children. The information collected included: (a) measures of suicidal thoughts and attempts in adolescence (< 18 years); (b) measures of suicidal ideation, suicide attempt, major depression, anxiety disorders, and substance use disorders in young adulthood (18-25 years); and (c) measures of childhood and family background, individual characteristics, and mental disorders in adolescence. RESULTS After statistical adjustment for confounding factors, suicide attempt in adolescence was associated with increased risks of subsequent suicidal ideation (OR 5.7) suicide attempt (OR 17.8) and major depression (OR 1.5). Those reporting suicidal ideation without suicide attempt showed moderate increases in risks of later suicidal ideation (OR 2.5), suicide attempt (OR 2.0) and major depression (OR 1.6). In addition, there was evidence of an interactive relationship in which suicidal behaviour in adolescence was associated with increased risks of later substance use disorders in females but not males. CONCLUSIONS Young people reporting suicidal ideation or making a suicide attempt are an at-risk population for subsequent suicidal behaviour and depression. Further research is needed into the reasons for suicidal adolescent females being at greater risk of later substance use disorder.

Randomized Trial of the Early Start Program of Home Visitation

Objective. To evaluate the extent to which a program of home visitation (Early Start), targeted at families who are facing stress and difficulty, had beneficial consequences for child health, preschool education, service utilization, parenting, child abuse and neglect, and behavioral adjustment. Methods. The study used a randomized, controlled trial design in which 220 families who were participating in the Early Start program were contrasted with a control series of 223 families who were not participating in the program. Families were enrolled in the program after population screening that was conducted by community health nurses. Families were enrolled in the program for up to 36 months. Outcomes were assessed at 6, 12, 24, and 36 months after trial entry. Results. Families in the Early Start series received a mean of 24 months of service. Comparisons between the Early Start and control series over the 36-month follow-up period revealed that families in the Early Start program showed significant benefits in the areas of improved utilization of child health services, reduced rates of hospital attendance for injury/poisoning, increased preschool education, increased positive and nonpunitive parenting, reduced rates of severe parent/child assaults, and reduced rates of early problem behaviors. Effect sizes (Cohens “d”) were found to be in the small to moderate range, with d ranging from .03 to .31 (median: .22). Conclusions. The Early Start program was associated with small to moderate benefits in a wide range of areas relating to child health, preschool education, parenting, child abuse, and early behavioral adjustment. Comparisons with other studies are made, and threats to validity are considered.

Randomized Trial of the Early Start Program of Home Visitation: Parent and Family Outcomes

OBJECTIVE. To examine the extent to which the Early Start program of home visitation had beneficial consequences in the areas of maternal health, family functioning, family economic circumstances, and exposure to stress and adversity. METHODS. The study used a randomized, controlled trial design in which 220 families receiving the Early Start program were contrasted with a control series of 223 families not receiving the program. Families were enrolled in the program after population screening conducted by community health nurses. Families were enrolled in the program for up to 36 months. Outcomes were assessed at 6, 12, 24, and 36 months after trial entry. RESULTS. There was a consistent lack of association between maternal and family outcomes and group membership. There were no significant differences between the Early Start and control series in any comparisons. CONCLUSIONS. This evaluation suggested that the Early Start program failed to lead to parent- and family-related benefits. This absence of benefit for parent/family outcomes is contrasted with the benefits found previously for child-related outcomes, including child health, preschool education, child abuse and neglect, parenting, and behavioral adjustment. This comparison suggests that home visitation programs may provide benefits for child-related outcomes in the absence of parent- or family-related outcomes.