Lianne J. Woodward

Risk factors and life processes associated with the onset of suicidal behaviour during adolescence and early adulthood

BACKGROUND This study examined associations between childhood circumstances, adolescent mental health and life events, and the development of suicidal behaviour in young people aged between 15 and 21 years. METHOD Data were gathered over the course of a 21-year longitudinal study of a birth cohort of 1265 children born in New Zealand. The measures collected included: (1) patterns of suicidal behaviour (ideation, attempt) (15-21 years); (2) social background, family functioning, parental and individual adjustment during childhood (0-16 years); and (3) time dynamics of mental health and stressful life events during adolescence and early adulthood (15-21 years). RESULTS By the age of 21 years, 28.8% of the sample reported having thought about killing themselves and 7.5% reported having made a suicide attempt. The childhood profile of those at greatest risk of suicidal behaviour was that of a young person reared in a family environment characterized by socio-economic adversity, marital disruption, poor parent-child attachment and exposure to sexual abuse, and who as a young adolescent showed high rates of neuroticism and novelty seeking. With the exception of the socio-economic and personality measures, the effects of childhood factors were largely mediated by mental health problems and exposure to stressful life events during adolescence and early adulthood. Mental health problems including depression, anxiety disorders, substance use disorder, and to some extent conduct disorder, in addition to exposure to adverse life events, were significantly associated with the onset of suicidal behaviours. CONCLUSIONS Findings support a life course model of the aetiology of suicidal behaviour in which risk of developing suicidal behaviour depends on accumulative exposure to a series of social, family, personality and mental health factors.

Life course outcomes of young people with anxiety disorders in adolescence

OBJECTIVE This study examined associations between the extent of anxiety disorder in adolescence (14-16 years) and young peoples later risks of a range of mental health, educational, and social role outcomes (16-21 years). METHOD Data were gathered over the course of a 21-year longitudinal study of a birth cohort of 1,265 New Zealand children. Measures collected included (1) an assessment of DSM-III-R anxiety disorders between the ages of 14 and 16 years; (2) assessments of mental health, educational achievement, and social functioning between the ages of 16 and 21 years; and (3) measures of potentially confounding social, family, and individual factors. RESULTS Significant linear associations were found between the number of anxiety disorders reported in adolescence and later risks of anxiety disorder; major depression; nicotine, alcohol, and illicit drug dependence; suicidal behavior; educational underachievement; and early parenthood. Associations between the extent of adolescent anxiety disorder and later risks of anxiety disorder, depression, illicit drug dependence, and failure to attend university were shown to persist after statistical control for the confounding effects of sociofamilial and individual factors. CONCLUSIONS Findings suggest that adolescents with anxiety disorders are at an increased risk of subsequent anxiety, depression, illicit drug dependence, and educational underachievement as young adults. Clinical and research implications are considered.

The stability of child abuse reports: a longitudinal study of the reporting behaviour of young adults

BACKGROUND The aims of this study were to use longitudinal report data on physical and sexual abuse to examine the stability and consistency of abuse reports. METHODS The study was based on the birth cohort of young people studied in the Christchurch Health and Development Study. At ages 18 and 21 years, these young people were questioned about their childhood exposure to physical punishment and sexual abuse. Concurrent with these assessments, sample members were also assessed on measures of psychiatric disorder and suicidal behaviour. RESULTS Reports of childhood sexual abuse and physical punishment were relatively unstable and the values of kappa for test-retests of abuse reporting were in the region of 0.45. Inconsistencies in reporting were unrelated to the subjects psychiatric state. Latent class analyses suggested that: (a) those not abused did not falsely report being abused; and (b) those who were abused provided unreliable reports in which the probability of a false negative response was in the region of 50%. Different approaches to classifying subjects as abused led to wide variations in the estimated prevalence of abuse but estimates of the relative risk of psychiatric adjustment problems conditional on abuse exposure remained relatively stable. CONCLUSIONS There was substantial unreliability in the reporting of child abuse. This unreliability arose because those who were subject to abuse often provided false negative reports. The consequences of errors in reports appear to be: (a) that estimates of abuse prevalence based on a single report are likely to seriously underestimate the true prevalence of abuse; while (b) estimates of the relative risk of psychiatric adjustment problems conditional on abuse appear to be robust to the effects of reporting errors.

Does father absence place daughters at special risk for early sexual activity and teenage pregnancy

The impact of father absence on early sexual activity and teenage pregnancy was investigated in longitudinal studies in the United States (N = 242) and New Zealand (N = 520), in which community samples of girls were followed prospectively from early in life (5 years) to approximately age 18. Greater exposure to father absence was strongly associated with elevated risk for early sexual activity and adolescent pregnancy. This elevated risk was either not explained (in the US. study) or only partly explained (in the New Zealand study) by familial, ecological, and personal disadvantages associated with father absence. After controlling for covariates, there was stronger and more consistent evidence of effects of father absence on early sexual activity and teenage pregnancy than on other behavioral or mental health problems or academic achievement. Effects of father absence are discussed in terms of life-course adversity, evolutionary psychology, social learning, and behavior genetic models.

Preschool executive functioning abilities predict early mathematics achievement.

Impairments in executive function have been documented in school-age children with mathematical learning difficulties. However, the utility and specificity of preschool executive function abilities in predicting later mathematical achievement are poorly understood. This study examined linkages between childrens developing executive function abilities at age 4 and childrens subsequent achievement in mathematics at age 6, 1 year after school entry. The study sample consisted of a regionally representative cohort of 104 children followed prospectively from ages 2 to 6 years. At age 4, children completed a battery of executive function tasks that assessed planning, set shifting, and inhibitory control. Teachers completed the preschool version of the Behavior Rating Inventory of Executive Function. Clinical and classroom measures of childrens mathematical achievement were collected at age 6. Results showed that childrens performance on set shifting, inhibitory control, and general executive behavior measures during the preschool period accounted for substantial variability in childrens early mathematical achievement at school. These associations persisted even after individual differences in general cognitive ability and reading achievement were taken into account. Findings suggest that early measures of executive function may be useful in identifying children who may experience difficulties learning mathematical skills and concepts. They also suggest that the scaffolding of these executive skills could potentially be a useful additional component in early mathematics education.

Maternal Age and Educational and Psychosocial Outcomes in Early Adulthood

The relationships between maternal age (at birth) and educational and psychosocial outcomes at age 18 were examined in a birth cohort of 1025 New Zealand children. This analysis indicated the presence of consistent tendencies for increasing maternal age to be associated with declining risks of educational underachievement, juvenile crime, substance misuse, and mental health problems. Children with teenage mothers had risks of later adverse outcomes that were 1.5 to 8.9 times higher than the risks for offspring of mothers aged over 30. Subsequent analyses revealed that the associations between maternal age and later educational and psychosocial outcomes were largely, but not wholly, explained by associations between maternal age and the child-rearing practices and home environments experienced by children. In general, increasing maternal age tended to be associated with more nurturant, supportive, and stable home environments. In turn, these linkages between maternal and childhood environment explained most of the association between maternal age and later outcomes. The theoretical and applied implications of these results are considered.

Very preterm children show impairments across multiple neurodevelopmental domains by age 4 years.

Objectives: Neurodevelopmental outcomes associated with preterm birth are of major health and educational concern. This study examined the neuromotor, cognitive, language and emotional/behavioural outcomes of a regional cohort of 4-year-old children born extremely preterm (EPT: 23–27 weeks’ gestation), very preterm (VPT: 28–33 weeks) and full term (FT: 38–41 weeks). Of particular interest were children’s risks of impairment across multiple neurodevelopmental domains. Methods: Data were gathered as part of a prospective longitudinal study of 105 very preterm (⩽33 weeks gestation) and 107 FT children born during 1998–2000. At 4 years corrected age, children underwent a comprehensive multidisciplinary assessment that included a paediatric neurological examination, cognitive and language testing, and an assessment of child emotional and behavioural adjustment. Results: At age 4 years, compared to FT children, EPT and VPT children had increased risks of cerebral palsy (EPT 18%, VPT 15%, FT 1%), cognitive delay (EPT 33%, VPT 36%, FT 13%), language delay (EPT 29%, VPT 29%, FT 10%) and emotional/behavioural adjustment problems (EPT 37%, VPT 13%, FT 11%). EPT and VPT children were three times more likely to have multiple domain impairments than FT children (EPT 30%, VPT 29%, FT 10%). Conclusions: A substantial proportion of preschool children born very preterm show clinically significant problems in at least one neurodevelopmental domain, with impairment in multiple domains being common. There is a need to monitor preschool development across a range of functional domains and to consider the likely cascading effects of multiple impairments on later development.

Development of emotional and behavioral regulation in children born extremely preterm and very preterm: biological and social influences.

This study describes the development of emotional and behavioral regulation in a regional cohort of children born extremely preterm (<28 weeks gestational age, n = 39), very preterm (<34 weeks gestational age, n = 56), and full term (n = 103). At 2 and 4 years, children born at younger gestational ages demonstrated poorer self-regulation across multiple contexts spanning observed interactions, formal cognitive testing, and parental report of child behavior at home. Among children born preterm, the 2 strongest predictors of impairments in self-regulation were the presence of moderate-to-severe cerebral white matter abnormalities on neonatal magnetic resonance and a less sensitive parenting style when children were aged 2 years. Findings support the importance of early neurological development and parenting for developing regulation in children born very preterm.

Unemployment and psychosocial adjustment in young adults: causation or selection?

This study investigates the relationships between unemployment following school leaving and psychosocial adjustment problems (mental health, substance use, crime, suicidal behaviours and teenage pregnancy) in a birth cohort of over 1000 New Zealand born young people. The data were gathered during the course of the Christchurch Health and Development Study (CHDS). The CHDS is a longitudinal study of a birth cohort of 1265 children born in the Christchurch (NZ) urban region who have been studied from birth to age 21. Data were gathered by personal interview on: (a) exposure to unemployment and (b) personal adjustment over the period from age 16 to age 21. Measures of personal adjustment included mental health (depression, anxiety), substance use, crime, suicidal behaviours and (for females) teenage pregnancy. Data were analysed using a fixed effects regression model that took into account both observed and non-observed sources of confounding and the possibility of reverse causal associations between personal adjustment and unemployment. Before adjustment for confounding and reverse causality there were significant (p < 0.001) associations between exposure to unemployment and measures of mental health, substance use, crime, suicidal behaviours and teenage pregnancy. Adjustment for confounding factors and reverse causality reduced these associations quite substantially and after control for sources of confounding a number of associations became nonsignificant. Nonetheless, after such control, exposure to unemployment remained significantly (p < 0.05) associated with suicidal ideation, substance abuse and criminal behaviours. It is concluded that, in part, the associations between unemployment and personal adjustment are spurious and reflect the presence of confounding factors that are related to both unemployment and adjustment. Nonetheless, the findings suggest that exposure to unemployment may be associated with increased risks of suicidal thoughts, crime and substance use.

Parenting Behavior Is Associated With the Early Neurobehavioral Development of Very Preterm Children

OBJECTIVE. There is an increasing focus on social and environmental factors that promote and support the early development of highly vulnerable children such as those born very preterm. The aim of this study was to assess the relationship between parenting behavior, parent-child synchrony, and neurobehavioral development in very preterm children at 24 months of age. METHODS. Participants were 152 very preterm children (<30 weeks’ gestation or <1250 g birth weight) and their parents/guardians. At 2 years’ corrected age, parents/guardians and children completed a semistructured parent-child interaction task assessing dyad synchrony and parenting behavior (positive affect, negative affect, sensitivity, facilitation, and intrusiveness). Cognitive and motor development was assessed by using the Bayley Scales of Infant Development II, and the Infant Toddler Social and Emotional Assessment was used to assess socioemotional development (social-emotional competence and internalizing and externalizing behavior). RESULTS. After controlling for social risk, most parenting domains were associated with cognitive development, with parent-child synchrony emerging as the most predictive. Greater parent-child synchrony was also associated with greater social-emotional competence, as was parenting that was positive, warm, and sensitive. Parents who displayed higher levels of negative affect were more likely to rate their children as withdrawn, anxious, and inhibited, but, unexpectedly, higher negative affect was also associated with more optimal psychomotor development. Parenting was not associated with externalizing behaviors at this age. CONCLUSIONS. Specific parenting behaviors, particularly parent-child synchrony, were associated with neurobehavioral development. These findings have implications for the development of targeted parent-based interventions to promote positive outcomes across different developmental domains during the first 2 years of life for very preterm children.