Richie Poulton

Work stress precipitates depression and anxiety in young, working women and men

BACKGROUNDnRates of depression have been rising, as have rates of work stress. We tested the influence of work stress on diagnosed depression and anxiety in young working adults.nnnMETHODnParticipants were enrolled in the Dunedin study, a 1972-1973 longitudinal birth cohort assessed most recently in 2004-2005, at age 32 (n=972, 96% of 1015 cohort members still alive). Work stress (psychological job demands, work decision latitude, low work social support, physical work demands) was ascertained by interview. Major depressive disorder (MDD) and generalized anxiety disorder (GAD) were ascertained using the Diagnostic Interview Schedule (DIS) and diagnosed according to DSM-IV criteria.nnnRESULTSnParticipants exposed to high psychological job demands (excessive workload, extreme time pressures) had a twofold risk of MDD or GAD compared to those with low job demands. Relative risks (RRs) adjusting for all work characteristics were: 1.90 [95% confidence interval (CI) 1.22-2.98] in women, and 2.00 (95% CI 1.13-3.56) in men. Analyses ruled out the possibility that the association between work stress and disorder resulted from study members socio-economic position, a personality tendency to report negatively, or a history of psychiatric disorder prior to labour-market entry. Prospective longitudinal analyses showed that high-demand jobs were associated with the onset of new depression and anxiety disorder in individuals without any pre-job history of diagnosis or treatment for either disorder.nnnCONCLUSIONSnWork stress appears to precipitate diagnosable depression and anxiety in previously healthy young workers. Helping workers cope with work stress or reducing work stress levels could prevent the occurrence of clinically significant depression and anxiety.

Early childhood factors associated with the development of post-traumatic stress disorder: results from a longitudinal birth cohort

BACKGROUNDnChildhood factors have been associated with increased risk of developing post-traumatic stress disorder (PTSD). Previous studies assessed only a limited number of childhood factors retrospectively. We examined the association between childhood neurodevelopmental, temperamental, behavioral and family environmental characteristics assessed before age 11 years and the development of PTSD up to age 32 years in a birth cohort.nnnMETHODnMembers of a 1972-73 New Zealand birth cohort (n=1037) who were assessed at ages 26 and 32 years for PTSD as defined by DSM-IV.nnnRESULTSnWe identified two sets of childhood risk factors. The first set of risk factors was associated both with increased risk of trauma exposure and with PTSD assessed at age 26. These included childhood externalizing characteristics and family environmental stressors, specifically maternal distress and loss of a parent. The second set of risk factors affected risk for PTSD only and included low IQ and chronic environmental adversity. The effect of cumulative childhood factors on risk of PTSD at age 26 was substantial; over 58% of cohort members in the highest risk quartile for three developmental factors had PTSD as compared to only 25% of those not at high risk on any factors. Low IQ at age 5, antisocial behavior, and poverty before age 11 continued to predict PTSD related to traumatic events that occurred between the ages of 26 and 32.nnnCONCLUSIONSnDevelopmental capacities and conditions of early childhood may increase both risk of trauma exposure and the risk that individuals will respond adversely to traumatic exposures. Rather than being solely a response to trauma, PTSD may have developmental origins.

Generalized anxiety disorder and depression : childhood risk factors in a birth cohort followed to age 32

BACKGROUNDnThe close association between generalized anxiety disorder (GAD) and major depressive disorder (MDD) prompts questions about how to characterize them in future diagnostic systems. We tested whether risk factors for MDD and GAD are similar or different.nnnMETHODnThe representative 1972-73 Dunedin birth cohort of 1037 males and females was followed to age 32 with 96% retention. Adult GAD and MDD were diagnosed at ages 18, 21, 26, and 32 years, and juvenile anxiety/depression were also taken into account. Thirteen prospective risk measures indexed domains of family history, adverse family environment, childhood behavior, and adolescent self-esteem and personality traits.nnnRESULTSnCo-morbid MDD+GAD was antedated by highly elevated risk factors broadly across all domains. MDD+GAD was further characterized by the earliest onset, most recurrence, and greatest use of mental health services and medication. Pure GAD had levels of risk factors similar to the elevated levels for co-morbid MDD+GAD; generally, pure MDD did not. Pure GAD had risks during childhood not shared by pure MDD, in domains of adverse family environment (low SES, somewhat more maltreatment) and childhood behavior (internalizing problems, conduct problems, somewhat more inhibited temperament). Pure MDD had risks not shared by pure GAD, in domains of family history (of depression) and personality (low positive emotionality).nnnCONCLUSIONSnSpecific antecedent risk factors for pure adult MDD versus GAD may suggest partly different etiological pathways. That GAD and co-morbid MDD+GAD share many risk markers suggests that the presence of GAD may signal a pathway toward relatively more severe internalizing disorder.

Does Childhood Television Viewing Lead to Attention Problems in Adolescence? Results From a Prospective Longitudinal Study

CONTEXT. There is controversy over whether childhood television viewing causes attention problems. The findings from cross-sectional and longitudinal studies have been mixed. To our knowledge, no longitudinal studies have assessed the impact of childrens television viewing on attention problems in adolescence. The objective of this study was to assess this association. DESIGN, PARTICIPANTS, AND SETTING. Study members were a general population birth cohort of 1037 participants (502 female) born in Dunedin, New Zealand, between April 1972 and March 1973. Parental estimates of childrens television-viewing time were obtained at ages 5, 7, 9, and 11 years. Self-, parent-, and teacher-reported attention problems in adolescence were obtained at ages 13 and 15 years. RESULTS. The mean of hours of television viewing during childhood was associated with symptoms of attention problems in adolescence. These associations remained significant after controlling for gender, attention problems in early childhood, cognitive ability at 5 years of age, and childhood socioeconomic status. This association was also independent of adolescent television viewing. CONCLUSIONS. Childhood television viewing was associated with attention problems in adolescence, independent of early attention problems and other confounders. These results support the hypothesis that childhood television viewing may contribute to the development of attention problems and suggest that the effects may be long-lasting.

The impact of xerostomia on oral-health-related quality of life among younger adults

BackgroundRecent research has suggested that chronic dry mouth affects the day-to-day lives of older people living in institutions. The condition has usually been considered to be a feature of old age, but recent work by our team produced the somewhat surprising finding that 10% of people in their early thirties are affected. This raises the issue of whether dry mouth is a trivial condition or a more substantial threat to quality of life among younger people. The objective of this study was to examine the association between xerostomia and oral-health-related quality of life among young adults while controlling for clinical oral health status and other potential confounding factors.MethodsCross-sectional analysis of data from a longstanding prospective observational study of a Dunedin (New Zealand) birth cohort: clinical dental examinations and questionnaires were used at age 32. The main measures were xerostomia (the subjective feeling of dry mouth, measured with a single question) and oral-health-related quality of life (OHRQoL) measured using the short-form Oral Health Impact Profile (OHIP-14).ResultsOf the 923 participants (48.9% female), one in ten were categorised as xerostomic, with no apparent gender difference. There was a strong association between xerostomia and OHRQoL (across all OHIP-14 domains) which persisted after multivariate analysis to control for clinical characteristics, gender, smoking status and personality characteristics (negative emotionality and positive emotionality).ConclusionXerostomia is not a trivial condition; it appears to have marked and consistent effects on sufferers day-to-day lives.

Systemic inflammation and lung function in young adults

Background: Impaired lung function is associated with systemic inflammation and is a risk factor for cardiovascular disease in older adults. It is unknown when these associations emerge and to what extent they are mediated by smoking, chronic airways disease, and/or established atherosclerosis. We explored the association between the forced expiratory volume in one second (FEV1) and the systemic inflammatory marker C-reactive protein (CRP) in young adults. Methods: Associations between spirometric lung function and blood CRP were assessed in a population based birth cohort of approximately 1000 New Zealanders at ages 26 and 32 years. Analyses adjusted for height and sex to account for differences in predicted lung function and excluded pregnant women. Results: There were significant inverse associations between FEV1 and CRP at both ages. Similar results were found for the forced vital capacity. These associations were similar in men and women and were independent of smoking, asthma, and body mass index. Conclusions: Reduced lung function is associated with systemic inflammation in young adults. This association is not related to smoking, asthma, or obesity. The reasons for the association are unexplained, but the findings indicate that the association between lower lung function and increased inflammation predates the development of either chronic lung disease or clinically significant atherosclerosis. The association between poor lung function and cardiovascular disease may be mediated by an inflammatory mechanism.

Progression of Dental Caries and Tooth Loss between the Third and Fourth Decades of Life: A Birth Cohort Study

The majority of what is known of the experience of dental caries among adults is from cross-sectional studies, and there are surprisingly few population-level longitudinal studies of dental caries among adults. Dental examinations were conducted at age 26 and again at age 32 among participants in a longstanding prospective study of a birth cohort born in Dunedin (New Zealand) in 1972/1973. Some 901 individuals (88.8%) were dentally examined at both ages. The mean number of remaining teeth and tooth surfaces fell between 26 and 32, reflecting ongoing tooth loss. The overall prevalence of caries rose from 94.9 to 96.8%, while there were greater increases in the proportion with caries-associated tooth loss (from 10.8 to 22.8%). Caries experience was greatest in the molar teeth and upper premolars, and was lowest in the lower anterior teeth. The mean crude caries increment (CCI) was 5.0 surfaces (SD 6.6); 681 (75.5%) experienced 1+ CCI, and the mean CCI among those individuals was 6.6 surfaces (SD 6.9). Substantial dental caries and tooth loss experience occur as people move from the third into the fourth decade of life.

Associations between respiratory symptoms, lung function and gastro-oesophageal reflux symptoms in a population-based birth cohort

BackgroundSeveral studies have reported an association between asthma and gastro-oesophageal reflux, but it is unclear which condition develops first. The role of obesity in mediating this association is also unclear. We explored the associations between respiratory symptoms, lung function, and gastro-oesophageal reflux symptoms in a birth cohort of approximately 1000 individuals.MethodsInformation on respiratory symptoms, asthma, atopy, lung function and airway responsiveness was obtained at multiple assessments from childhood to adulthood in an unselected birth cohort of 1037 individuals followed to age 26. Symptoms of gastro-oesophageal reflux and irritable bowel syndrome were recorded at age 26.ResultsHeartburn and acid regurgitation symptoms that were at least moderately bothersome at age 26 were significantly associated with asthma (odds ratio = 3.2; 95% confidence interval = 1.6–6.4), wheeze (OR = 3.5; 95% CI = 1.7–7.2), and nocturnal cough (OR = 4.3; 95% CI = 2.1–8.7) independently of body mass index. In women reflux symptoms were also associated with airflow obstruction and a bronchodilator response to salbutamol. Persistent wheezing since childhood, persistence of asthma since teenage years, and airway hyperresponsiveness since age 11 were associated with a significantly increased risk of heartburn and acid regurgitation at age 26. There was no association between irritable bowel syndrome and respiratory symptoms.ConclusionReflux symptoms are associated with respiratory symptoms in young adults independently of body mass index. The mechanism of these associations remains unclear.

Association between exhaled nitric oxide and systemic inflammatory markers

BACKGROUNDnAsthma is an inflammatory condition of the airways, and there is some evidence to suggest that it is associated with a systemic inflammatory response, as measured by C-reactive protein (CRP) and fibrinogen. Exhaled nitric oxide is a noninvasive measure of asthmatic airway inflammation.nnnOBJECTIVEnTo determine if there is an association between exhaled nitric oxide and these systemic inflammatory markers.nnnMETHODSnThe Dunedin Multidisciplinary Health and Development Study is a birth cohort of approximately 1,000 individuals born between April 1, 1972, and March 31, 1973. At the age of 32 years, study members were assessed for diagnosis of asthma, atopy by skin prick testing, smoking, body mass index, exhaled nitric oxide, high-sensitivity serum CRP, and plasma fibrinogen level.nnnRESULTSnThere was no significant association between exhaled nitric oxide and CRP (P = .99). There was a trend to an inverse association between exhaled nitric oxide and fibrinogen (P = .049), but this was not significant after adjusting for smoking and use of corticosteroids or after further adjustment for body mass index and atopy (P = .71).nnnCONCLUSIONnIn this population-based sample of young adults, there was no association between airway inflammation, as measured by exhaled nitric oxide, and systemic inflammation, as measured by either CRP or fibrinogen.

Psychosocial correlates of 6-n-propylthiouracil (PROP) ratings in a birth cohort

This study investigated the relation between ratings of 6-n-propylthiouracil (PROP) and two psychosocial constructs, socioeconomic status and IQ, which are related to health outcomes. A 3.2mM solution of PROP was rated by 922 32-year-old members of a birth cohort (450 women) relative to the strongest imaginable sensation of any kind using the generalised Labelled Magnitude Scale. Women had higher PROP ratings than men. Following normalisation of PROP ratings, multiple linear regression showed that higher ratings were independently associated with lower childhood socioeconomic status, lower childhood IQ scores and ratings of an imagined stimulus made on the same scale (r(2)=0.12). Results suggest that psychosocial variables, sex and scale use, in addition to established genetic determinants, may help explain variability in ratings of supra-threshold concentrations of PROP.