Marie-Claude Geoffroy

Closing the gap in academic readiness and achievement: the role of early childcare

BACKGROUND Socially disadvantaged children with academic difficulties at school entry are at increased risk for poor health and psychosocial outcomes. Our objective is to test the possibility that participation in childcare--at the population level--could attenuate the gap in academic readiness and achievement between children with and without a social disadvantage (indexed by low levels of maternal education). METHODS A cohort of infants born in the Canadian province of Quebec in 1997/1998 was selected through birth registries and followed annually until 7 years of age (n = 1,863). Children receiving formal childcare (i.e., center-based or non-relative out-of-home) were distinguished from those receiving informal childcare (i.e., relative or nanny). Measures from 4 standardized tests that assessed cognitive school readiness (Lollipop Test for School Readiness), receptive vocabulary (Peabody Picture Vocabulary Test Revised), mathematics (Number Knowledge Test), and reading performance (Kaufman Assessment Battery for children) were administered at 6 and 7 years. RESULTS Children of mothers with low levels of education showed a consistent pattern of lower scores on academic readiness and achievement tests at 6 and 7 years than those of highly educated mothers, unless they received formal childcare. Specifically, among children of mothers with low levels of education, those who received formal childcare obtained higher school readiness (d = 0.87), receptive vocabulary (d = 0.36), reading(d = 0.48) and math achievement scores (d = 0.38; although not significant at 5%) in comparison with those who were cared for by their parents. Childcare participation was not associated with cognitive outcomes among children of mothers with higher levels of education. CONCLUSIONS Public investments in early childcare are increasing in many countries with the intention of reducing cognitive inequalities between disadvantaged and advantaged children. Our findings provide further evidence suggesting that formal childcare could represent a preventative means of attenuating effects of disadvantage on childrens early academic trajectory.

Depressive Symptoms and Physical Activity During 3 Decades in Adult Life: Bidirectional Associations in a Prospective Cohort Study

IMPORTANCE Associations have been documented between physical activity and depressive symptoms, but the direction of this association is unclear. OBJECTIVE To examine whether depressive symptoms are concurrent with physical activity and to examine the direction of the relationship from 23 to 50 years of age. DESIGN, SETTING, AND PARTICIPANTS Participants included members of the 1958 British Birth Cohort, a general population sample of all persons born in England, Scotland, and Wales in a single week in March 1958 who were followed up to 50 years of age (2008). We included approximately 11,000 cohort members with information on depressive symptoms or frequency of physical activity at 23, 33, 42, or 50 years of age. EXPOSURES Depressive symptoms were measured using the Psychological subscale of the Malaise Inventory; frequency of physical activity, by questionnaire. MAIN OUTCOMES AND MEASURES Number of depressive symptoms (on a scale of 0 to 15 items), depression (defined as being in the top 10% for symptoms at 23, 33, 42, or 50 years of age), and frequency of physical activity (times per week). RESULTS At most ages, we found a trend of fewer depressive symptoms with more frequent activity; for example, per higher frequency of activity per week at 50 years of age, the mean number of symptoms was lower by 0.06 (95% CI, -0.09 to -0.04). In longitudinal analyses, activity was associated with fewer symptoms from 23 to 50 years of age (per higher frequency of activity per week, symptoms were lower by 0.06 [95% CI, -0.07 to -0.05]), and the magnitude of association did not vary with age (P=.21 for interaction). Those who were inactive at 23 years of age and remained inactive 5 years later showed no change in symptom level (mean difference, -0.01 [95% CI, -0.04 to 0.02]); those increasing activity to 3 times/wk had a lower mean number of symptoms (mean difference, -0.18 [95% CI, -0.22 to -0.15]). Such differences equate to estimated reductions in odds of depression by 19%. A longitudinal relationship observed between symptoms and activity weakened with age (P<.001 for interaction). Mean activity among those with no symptoms at 23 years of age and 5 years later was higher by 0.60 (95% CI, 0.57-0.64) times/wk; in those with 1 additional depressive symptom, 0.53 (95% CI, 0.49-0.56) times/wk. Activity frequency did not differ among those with no symptoms at 43 years of age who subsequently had 0 or 1 symptom at 48 years of age. Associations for depression were generally similar to those for the full symptom spectrum. CONCLUSIONS AND RELEVANCE The relationship between activity and depressive symptoms was bidirectional, albeit more persistent during adult life in the direction from activity to depressive symptoms. Findings suggest that activity may alleviate depressive symptoms in the general population and, in turn, depressive symptoms in early adulthood may be a barrier to activity.

Prospective Association of Morning Salivary Cortisol with Depressive Symptoms in Mid-Life: A Life-Course Study

Objective Associations of cortisol and depression vary at different life-stages, yet population-based, prospective studies are scarce. We aimed to assess associations of morning cortisol with depressive symptoms in mid-life taking account of lifetime psychological health. Methods Participants were 5,403 men and women from the 1958 British Birth Cohort whose salivary cortisol was assessed at 45y (45min after waking (T1) and 3h later (T2)) and who completed the 5-item Mental-Health Index (MHI-5) about depressive symptoms at age 50y. Lifetime psychological health was identified from child and adult measures. Results For women, higher T2 cortisol at 45y predicted depression (MHI-5 scores ≤52) at 50y (odds ratio [OR]=1.17; 95% confidence intervals [CI] 1.05,1.30 per standard deviation increase in T2 cortisol), attenuating when adjusted for current (45y) and previous (7-42y) psychological health (OR=1.11; 95% CI 0.98, 1.24). Similarly, an association in women of flatter cortisol delta (T2-T1) with depressive symptoms at 50y weakened after adjustment for current (45y) and previous (7-42y) psychological health. For men, lower T2 cortisol at 45y predicted greater depressive symptoms at 50y and the association strengthened when adjusted for lifetime psychological health. Likewise, lower cortisol AUC predicted higher risk of depression for men after adjusting for prior psychological health (OR=0.85; CI 0.72, 1.00). Associations were largely unaltered by control for covariates. Conclusions In women, higher cortisol in late morning at 45y is prospectively associated with depressive symptoms at 50y through a link with lifetime psychological health. In men, lower cortisol predicts subsequent symptoms, independent of depressive history.

Investigation of bidirectional associations between depressive symptoms and physical activity from age 11 to 50 years in the 1958 British Birth Cohort

Abstract Background Understanding the relation between physical activity and depressive symptoms is important because if activity could alleviate or prevent depressive symptoms, it would represent a low-risk, low-cost intervention at the population level with auxiliary health benefits. Alternatively, if depressive symptoms are related to an absence of activity, that would inform understanding of barriers to activity. Yet, the direction of the relation and whether it changes with age is unclear. In the 1958 British Birth Cohort, we investigated whether depressive symptoms are concurrent with activity and assessed the direction of association from age 11 to 50 years. Methods The 1958 Cohort is a large nationwide study, with follow-up of all births during 1 week in March, 1958. Activity frequency and depressive symptoms were assessed by questionnaires at 11, 16, 23, 33, 42, and 50 years (N varied from 14 072 at 11 years to 9633 at 50 years). These measures—ie, activity frequency and depressive symptoms at different life stages—were the primary outcomes. Relations were examined for the full depressive symptom spectrum and for those with elevated symptom levels (top 10% at each age, sex specific), referred to as depressed. Cross-sectional associations between activity and depressive symptoms were examined with linear and logistic regression. For longitudinal analyses, we used mixed effects models (to account for repeated measures in the same individuals), providing yearly estimates for activity associations with the depressive symptoms trajectory (in non-lagged and lagged models) and vice versa. We tested whether relations varied with age, using an interaction (age) term. Mixed effects models allow for missing outcome data; however, to minimise data loss, missing covariates were imputed with multiple imputation chained equations. Findings Cross-sectionally, at all ages except 33 years, there was evidence (p interaction 0·05). In general, associations were similar for the depression trajectory. Results were replicated, though weaker, in lagged models. Interpretation The relation between activity and depressive symptoms was bidirectional, albeit more persistent over decades of life for activity to depressive symptoms. Repeated, prospective data for activity and depressive symptoms spanning adolescence to mid-adulthood are rare; however, measures are self-reported. Findings emphasise the importance of activity to alleviate depressive symptoms and, in turn, depressive symptoms before mid-life could be a potential barrier to uptake and increase in activity. Funding This work was supported by the Department of Health Policy Research Programme through the Public Health Research Consortium. The GOSH/UCL Institute of Child Health was supported in part by the Department of Healths NIHR Biomedical Research Centre.

Timing and Chronicity of Maternal Depression Symptoms and Children's Verbal Abilities

Objective To test the associations between the timing and chronicity of maternal depression symptoms (MDS) and childrens long‐term verbal abilities. Study design Participants were 1073 mother‐child pairs from a population‐based birth cohort in Canada. MDS were assessed at ages 5 months, 1.5, 3.5, and 5 years using the Center for Epidemiologic Studies Depression Scale. Verbal abilities were measured at 5, 6, and 10 years using the Peabody Picture Vocabulary Test‐Revised (PPVT‐R). Multiple linear regression models were used to estimate the association between timing (early: 5 months and/or 1.5 years vs late 3.5 and/or 5 years) and chronicity (5 months, 1.5, 3.5, and 5 years) of exposure to elevated MDS and childrens mean PPVT‐R scores. Results Children exposed to chronic MDS had lower PPVT‐R scores than children never exposed (mean difference = 9.04 [95% CI = 2.28‐15.80]), exposed early (10.08 [3.33‐16.86]) and exposed late (8.69 [1.85‐15.53]). There were no significant differences between scores of children in the early compared with the late exposure group. We adjusted for mother‐child interactions, family functioning, socioeconomic status, PPVT‐R administration language, childs birth order, and maternal IQ, psychopathology, education, native language, age at birth of child, and parenting practices. Maternal IQ, (&eegr;2 = 0.028), native language (&eegr;2 = 0.009), and MDS (&eegr;2 = 0.007) were the main predictors of childrens verbal abilities. Conclusions Exposure to chronic MDS in early childhood is associated with lower levels of verbal abilities in middle childhood. Further research is needed in larger community samples to test the association between MDS and childrens long‐term language skills.

Association between irritability and suicide-related outcomes across the life-course. Systematic review of both community and clinical studies

BACKGROUND Irritability is gaining considerable attention as a risk factor for suicide-related outcomes (suicide mortality, attempt, and ideation). However, the evidence of this association is scant. We conducted a systematic review of the evidence regarding the associations between irritability and suicide-related outcomes across the life-course. METHODS We conducted a systematic search on Medline and PsycINFO (up to January 2018) for original articles published in English investigating the association between irritability and suicide-related outcomes. Two researchers independently screened the articles, assessed the quality of the evidence (New-Castle-Ottawa Scale) and extracted study characteristics. RESULTS Thirty-nine studies were retrieved, most were of low/medium quality. Twelve assessed irritability in childhood/adolescence (6 in community samples, 6 in clinical samples) and 27 in adulthood (7 in community samples, 20 in clinical samples). In both childhood/adolescence and adult samples, most community-based studies reported a positive association between irritability and suicidal ideation and/or attempt, while clinical studies reported mixed findings. More specifically, in clinical studies, the association of irritability with suicide-related outcomes (i) was not supported among adult depressed patients, (ii) findings were inconsistent in adult bipolar patients, (iii) for inpatients/outpatients with various psychiatric disorders/conditions, association was observed in adulthood but not in childhood/adolescence. LIMITATIONS Differences in methodology and definition/measurement of irritability limited the comparability of included studies. CONCLUSIONS Although irritability has been proposed as a promising transdiagnostic factor associated with suicide-related outcomes, the absence of consensus in the definition of irritability (vs anger or reactive/impulsive aggression), the poor methodological quality, and the lack of developmental considerations mitigate the conclusions.

Diurnal cortisol and mental well-being in middle and older age: evidence from four cohort studies

Objectives We conducted an individual participant meta-analysis to test the hypothesis that cortisol patterns indicative of dysregulated hypothalamic–pituitary–adrenal axis functioning would be prospectively associated with poorer well-being at follow-up. Setting Four large UK-based cohort studies. Participants Those providing valid salivary or serum cortisol samples (n=7515 for morning cortisol; n=1612 for cortisol awakening response) at baseline (age 44–82) and well-being data on the Warwick Edinburgh Mental Wellbeing Scale at follow-up (0–8 years) were included. Results Well-being was not associated with morning cortisol, diurnal slope or awakening response though a borderline association with evening cortisol was found. Adjusting for sex and follow-up time, each 1 SD increase in evening cortisol was associated with a −0.47 (95% CI −1.00 to 0.05) point lower well-being. This was attenuated by adjustment for body mass index, smoking and socioeconomic position. Between-study heterogeneity was low. Conclusions This study does not support the hypothesis that diurnal cortisol is prospectively associated with well-being up to 8 years later. However, replication in prospective studies with cortisol samples over multiple days is required.