Ian Colman

Outcomes of conduct problems in adolescence: 40 year follow-up of national cohort

Objective To describe long term outcomes associated with externalising behaviour in adolescence, defined in this study as conduct problems reported by a teacher, in a population based sample. Design Longitudinal study from age 13-53. Setting The Medical Research Council National Survey of Health and Development (the British 1946 birth cohort). Participants 3652 survey members assessed by their teachers for symptoms of externalising behaviour at age 13 and 15. Main outcome measures Mental disorder, alcohol abuse, relationship difficulties, highest level of education, social class, unemployment, and financial difficulties at ages 36-53. Results 348 adolescents were identified with severe externalising behaviour, 1051 with mild externalising behaviour, and 2253 with no externalising behaviour. All negative outcomes measured in adulthood were more common in those with severe or mild externalising behaviour in adolescence, as rated by teachers, compared with those with no externalising behaviour. Adolescents with severe externalising behaviour were more likely to leave school without any qualifications (65.2%; adjusted odds ratio 4.0, 95% confidence interval 2.9 to 5.5), as were those with mild externalising behaviour (52.2%; 2.3, 1.9 to 2.8), compared with those with no externalising behaviour (30.8%). On a composite measure of global adversity throughout adulthood that included mental health, family life and relationships, and educational and economic problems, those with severe externalising behaviour scored significantly higher (40.1% in top quarter), as did those with mild externalising behaviour (28.3%), compared with those with no externalising behaviour (17.0%). Conclusions Adolescents who exhibit externalising behaviour experience multiple social and health impairments that adversely affect them, their families, and society throughout adult life.

Parenteral metoclopramide for acute migraine: meta-analysis of randomised controlled trials

Abstract Objective To assess the evidence from controlled trials on the efficacy and tolerability of parenteral metoclopramide for acute migraine in adults. Data sources Cochrane Central Register of Controlled Trials, Medline, Embase, LILACS, CINAHL, conference proceedings, clinical practice guidelines, and other sources. Selection criteria Randomised controlled trials of parenteral metoclopramide for acute migraine in adults. Results We reviewed 596 potentially relevant abstracts and found 13 eligible trials totalling 655 adults. In studies comparing metoclopramide with placebo, metoclopramide was more likely to provide significant reduction in migraine pain (odds ratio 2.84, 95% confidence interval 1.05 to 7.68). Used as the only agent, metoclopramide showed mixed effectiveness when compared with other single agents. Heterogeneity of studies for combination treatment prevented statistical pooling. Treatments that did include metoclopramide were as, or more, effective than comparison treatments for pain, nausea, and relapse outcomes reported in all studies. Conclusions Metoclopramide is an effective treatment for migraine headache and may be effective when combined with other treatments. Given its non-narcotic and antiemetic properties, metoclopramide should be considered a primary agent in the treatment of acute migraines in emergency departments.

A Longitudinal Typology of Symptoms of Depression and Anxiety Over the Life Course

BACKGROUND Little is known about long-term profiles of depressive and anxious symptomatology over the life course and about the developmental determinants of different trajectories. The objective of this study was to identify a novel typology of symptoms of depression and anxiety over the life course and examine its neurodevelopmental antecedents in an epidemiological sample. METHODS A longitudinal latent variable analysis was conducted on measures of anxious and depressive symptoms at ages 13, 15, 36, 43, and 53 years among 4627 members of the Medical Research Council National Survey of Health & Development (the British 1946 birth cohort). Early life predictors of class membership were studied with ordinal logistic regression. RESULTS We identified six distinct profiles up to age 53: absence of symptoms (44.8% of sample); repeated moderate symptoms (33.6%); adult-onset moderate symptoms (11.3%); adolescent symptoms with good adult outcome (5.8%); adult-onset severe symptoms (2.9%); and repeated severe symptoms over the life course (1.7%). Heavier babies had lower likelihood of depressive and anxious symptoms (odds ratio [OR] = .92; 95% confidence interval [CI] .85-.99), whereas delay in first standing (OR = 1.19; 95% CI 1.11-1.28) and walking (OR = 1.22; 95% CI 1.14-1.31) was associated with subsequent higher likelihood of symptoms, controlling for social circumstances and stressful life events during childhood. CONCLUSIONS There was evidence of distinct profiles of depressive and anxious symptomatology over the life course and associations with markers of neurodevelopment. This suggests very early factors are associated with long-term experience of symptoms of depression and anxiety.

Associations between depressive symptoms, sexual behaviour and relationship characteristics: a prospective cohort study of young women and men in the Eastern Cape, South Africa

BackgroundPsychological factors are often neglected in HIV research, although psychological distress is common in low- to middle-income countries, such as South Africa. There is a need to deepen our understanding of the role of mental health factors in the HIV epidemic. We set out to investigate whether baseline depressive symptomatology was associated with risky sexual behaviour and relationship characteristics of men and women at baseline, as well as those found 12 months later.MethodsWe used prospective cohort data from a cluster randomized controlled trial of an HIV prevention intervention in the Eastern Cape Province of South Africa. Our subjects were 1002 female and 976 male volunteers aged 15 to 26. Logistic regression was used to model the cross-sectional and prospective associations between baseline depressive symptomatology, risky sexual behaviors and relationship characteristics. The analysis adjusted for the clustering effect, study design, intervention and several confounding variables.ResultsPrevalence of depressive symptoms was 21.1% among women and 13.6% among men. At baseline, women with depressed symptoms were more likely to report lifetime intimate partner violence (AOR = 2.56, 95% CI 1.89-3.46) and have dated an older partner (AOR = 1.37, 95% CI 1.03-1.83). A year later, baseline depressive symptomatology was associated with transactional sex (AOR = 2.60, 95% CI 1.37, 4.92) and intimate partner violence (AOR = 1.67, 95% CI 1.18-2.36) in the previous 12 months. Men with depressive symptoms were more likely to report ever having had transactional sex (AOR = 1.48, 95% CI 1.01-2.17), intimate partner violence perpetration (AOR = 1.50, 95% CI 0.98-2.28) and perpetration of rape (AOR = 1.81, 95% CI 1.14-2.87). They were less likely to report correct condom use at last sex (AOR = 0.50, 95% CI 0.32-0.78). A year later, baseline depressive symptomatology was associated with failure to use a condom at last sex among men (AOR = 0.60, 95% CI 0.40-0.89).ConclusionsSymptoms of depression should be considered as potential markers of increased HIV risk and this association may be causal. HIV prevention needs to encompass promotion of adolescent mental health.

Parenteral dexamethasone for acute severe migraine headache: meta-analysis of randomised controlled trials for preventing recurrence

Objective To examine the effectiveness of parenteral corticosteroids for the relief of acute severe migraine headache and prevention of recurrent headaches. Design Meta-analysis. Data sources Electronic databases (Cochrane Central Register of Controlled Trials, Medline, Embase, LILACS, and CINAHL), conference proceedings, clinical practice guidelines, contacts with industry, and correspondence with authors. Selection criteria Randomised controlled trials in which corticosteroids (alone or combined with standard abortive therapy) were compared with placebo or any other standard treatment for acute migraine in adults. Review methods Two reviewers independently assessed relevance, inclusion, and study quality. Weighted mean differences and relative risks were calculated and are reported with 95% confidence intervals. Results From 666 potentially relevant abstracts, seven studies met the inclusion criteria. All included trials used standard abortive therapy and subsequently compared single dose parenteral dexamethasone with placebo, examining pain relief and recurrence of headache within 72 hours. Dexamethasone and placebo provided similar acute pain reduction (weighted mean difference 0.37, 95% confidence interval −0.20 to 0.94). Dexamethasone was, however, more effective than placebo in reducing recurrence rates (relative risk 0.74, 95% confidence interval 0.60 to 0.90). Side effect profiles between dexamethasone and placebo groups were similar. Conclusion When added to standard abortive therapy for migraine headache, single dose parenteral dexamethasone is associated with a 26% relative reduction in headache recurrence (number needed to treat=9) within 72 hours.

Foetal origins of depression? A systematic review and meta-analysis of low birth weight and later depression

Background The foetal origins hypothesis suggests an association between low birth weight and later depression, yet evidence supporting this association has been inconsistent. Method We systematically reviewed evidence for an association between low birth weight and adult depression or psychological distress in the general population by meta-analysis. We searched EMBASE, Medline, PsycINFO and ISI Web of Science for studies reporting observational data with low birth weight as the exposure and self- or clinician-rated depression or psychological distress measures as an outcome. Selective studies of exposures such as famine or outcomes such as severe illness only were excluded. Altogether,1454 studies were screened for relevance, 26 were included in the qualitative synthesis, 18 were included in the meta-analysis. A random effects meta-analysis method was used to obtain a pooled estimate of effect size. Results The odds of depression or psychological distress was greater for those of low birth weight (<2500 g) compared to those of normal birth weight (>2500 g) or greater [odds ratio (OR) 1.15, 95% confidence intervals (CI) 1.00–1.32]. However, this association became non-significant after trim-and-fill correction for publication bias (OR 1.08, 95% CI 0.92–1.27). Using meta-regression, no differences in effect size were observed by gender, outcome measure of depression or psychological distress, or whether the effect size was adjusted for possible confounders. Conclusions We found evidence to support a weak association between low birth weight and later depression or psychological distress, which may be due to publication bias. It remains possible that the association may vary according to severity of symptoms or other factors.

The association between fruit and vegetable consumption and mental health disorders: evidence from five waves of a national survey of Canadians.

OBJECTIVE The objective of this study was to examine the association between fruit and vegetable intake (FVI) and mental health disorders. METHOD This study used data from the Canadian Community Health Survey (CCHS), a repeated cross-sectional study of Canadians with five waves between 2000 until 2009 (n=296,121 aged 12 years or older). FVI was assessed based on frequency of consumption. The primary outcome was a major depressive episode over the previous 12 months. Logistic regression models adjusted for age, gender, household income, education, physical activity, chronic illness and smoking. RESULTS In the first wave, greater FVI was significantly associated with lower odds of depression (OR: 0.85 95% CI:0.78-0.92). A combined estimate of all 5 waves demonstrated similar results (OR: 0.72; 95% CI: 0.71-0.75). Relative to those with the lowest FVI, those with the greatest FVI also had significantly lower odds of suffering from distress (OR: 0.87 95% CI: 0.78-0.98). These results were consistent across other waves. Perceived poor mental health status and previous diagnosis of a mood disorder and anxiety disorder also demonstrated statistically significant inverse associations with FVI (all p<0.05). CONCLUSION These findings suggest a potentially important role of a healthy diet in the prevention of depression and anxiety.

Diagnostic transitions from childhood to adolescence to early adulthood

BACKGROUND Quantifying diagnostic transitions across development is needed to estimate the long-term burden of mental illness. This study estimated patterns of diagnostic transitions from childhood to adolescence and from adolescence to early adulthood. METHODS Patterns of diagnostic transitions were estimated using data from three prospective, longitudinal studies involving close to 20,000 observations of 3,722 participants followed across multiple developmental periods covering ages 9-30. Common DSM psychiatric disorders were assessed in childhood (ages 9-12; two samples), adolescence (ages 13-18; three samples), and early adulthood (ages 19 to age 32; three samples) with structured psychiatric interviews and questionnaires. RESULTS Having a disorder at an early period was associated with at least a threefold increase in odds for having a disorder at a later period. Homotypic and heterotypic transitions were observed for every disorder category. The strongest evidence of continuity was seen for behavioral disorders (particularly ADHD) with less evidence for emotional disorders such as depression and anxiety. Limited evidence was found in adjusted models for behavioral disorders predicting later emotional disorders. Adult substance disorders were preceded by behavioral disorders, but not anxiety or depression. CONCLUSIONS Having a disorder in childhood or adolescence is a potent risk factor for a range of psychiatric problems later in development. These findings provide further support for prevention and early life intervention efforts and suggest that treatment at younger ages, while justified in its own right, may also have potential to reduce the risk for disorders later in development.

Very early predictors of conduct problems and crime: results from a national cohort study

BACKGROUND   Longitudinal research has produced a wealth of knowledge about individual, family, and social predictors of crime. However, nearly all studies have started after children are age 5, and little is known about earlier risk factors. METHODS The 1970 British Cohort Study is a prospective population survey of more than 16,000 children born in 1970. Pregnancy, birth, child, parent, and socioeconomic characteristics were measured from medical records, parent interviews, and child assessments at birth and age 5. Conduct problems were reported by parents at age 10, and criminal convictions were self-reported by study members at ages 30-34. RESULTS   Early (up to age 5) psychosocial risk factors were strong predictors of conduct problems and criminal conviction. Among pregnancy and birth measures, only prenatal maternal smoking was strongly predictive. Risk factors were similar for girls and boys. Additive risk scores predicted antisocial behaviour quite strongly. CONCLUSIONS   Risk factors from pregnancy to age 5 are quite strong predictors of conduct problems and crime. New risk assessment tools could be developed to identify young children at high risk for later antisocial behaviour.

Social, Demographic, and Health Outcomes in the 10 Years Following Adolescent Depression

PURPOSE Little attention has been paid to the sociodemographic profiles of depressed youth during the vulnerable transition from adolescence to early adulthood. This study aimed to determine and describe the social, demographic, and health outcomes of adolescent depression during a 10-year period of transition into early adulthood, using a population-based cohort of Canadian teenagers. METHODS Depression status on 1,027 adolescents aged 16-17 years was ascertained from the National Population Health Survey. Social and health outcomes (i.e., employment status, marital status, personal income, education, social support, self-perceived stress, heavy drinking, smoking, migraine headaches, adult depression, antidepressant use, self-rated health, and physical activity) were measured every 2 years until the ages of 26-27 years. Logistic regression was combined with a generalized linear mixed-model approach to determine the odds of health and social outcomes in depressed versus nondepressed adolescents. RESULTS Proximal effects of adolescent depression were observed (at ages 18-19) on all outcomes with the exception of physical activity. Significant effects that persisted after 10 years included depression recurrence, higher severity of symptoms, migraine headaches, poor self-rated health, and low levels of social support. Adolescent depression did not appear to significantly affect employment status, personal income, marital status, or educational attainment. CONCLUSIONS The transition from adolescence to adulthood is a particularly vulnerable period due to educational, employment, and social changes that may be occurring. The results of this study indicate that the onset of depression during adolescence may be indicative of problems of adaptation that persist at least a decade into early adulthood.