Rosemary Abbott

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.

Urban–rural mental health differences in Great Britain: findings from the National Morbidity Survey

Studies of urban-rural differences in prevalence of non-psychotic mental disorder have not given consistent findings. Such differences have received relatively little study in Great Britain. Data from 9777 subjects in the Household Survey of the National Morbidity Survey of Great Britain were analysed for differences between urban, semi-rural, and rural areas. Psychiatric morbidity was assessed by scores on the Revised Clinical Interview Schedule (CIS-R), together with alcohol dependence, drug dependence, and receipt of treatment from general practitioners. Associations with other characteristics were examined by logistic regression. Urban subjects had higher rates than rural of CIS-R morbidity, alcohol dependence, and drug dependence, with semi-rural subjects intermediate. Urban subjects also tended to be members of more deprived social groups, with more adverse living circumstances and greater life stress--factors themselves associated with disorder. Urban-rural differences in alcohol and drug dependence were no longer significant after adjustment for these factors by logistic regression, and differences on CIS-R morbidity were considerably reduced. There were no differences in treatment. There are considerable British urban-rural differences in mental health, which may largely be attributable to more adverse urban social environments.

Remission and recurrence of depression in the maintenance era: Long-term outcome in a Cambridge cohort.

BACKGROUND Long-term studies of severe depression have described high rates of non-recovery, recurrence, chronic incapacity and mortality. A more recent cohort was followed-up to ascertain whether the course had improved given developments in pharmacological and psychological treatments in the last 15 years. METHOD Subjects from a cohort of 70 mainly severe recurrent depressives originally recruited to a shorter follow-up study from 1990-1992 were followed-up after 8-11 years. Data included longitudinal information on course of depression and other psychiatric disorders, pharmacological and psychological treatment and social functioning during follow-up. RESULTS Sixty-nine (99%) subjects were successfully followed-up, with 61 of 66 living subjects interviewed and detailed follow-up data obtained in total on 65. Sixty (92%) of 65 subjects recovered during follow-up, with two-thirds subsequently suffering a recurrence. Eleven (17%) suffered from an episode of chronic depression of at least 2 years duration during follow-up. Social function at follow-up was good and there were high levels of pharmacological and psychological treatment. Greater severity of illness was the most consistent predictor of poor outcome. Times to recovery and recurrence and recovery and recurrence rates were very similar to older studies. CONCLUSIONS The long-term outcome of depression still shows high recurrence rates and does not appear to have changed in the last 20 years.

Psychometric evaluation and predictive validity of Ryff's psychological well-being items in a UK birth cohort sample of women.

BackgroundInvestigations of the structure of psychological well-being items are useful for advancing knowledge of what dimensions define psychological well-being in practice. Ryff has proposed a multidimensional model of psychological well-being and her questionnaire items are widely used but their latent structure and factorial validity remains contentious.MethodsWe applied latent variable models for factor analysis of ordinal/categorical data to a 42-item version of Ryffs psychological well-being scales administered to women aged 52 in a UK birth cohort study (n = 1,179). Construct (predictive) validity was examined against a measure of mental health recorded one year later.ResultsInter-factor correlations among four of the first-order psychological well-being constructs were sufficiently high (> 0.80) to warrant a parsimonious representation as a second-order general well-being dimension. Method factors for questions reflecting positive and negative item content, orthogonal to the construct factors and assumed independent of each other, improved model fit by removing nuisance variance. Predictive validity correlations between psychological well-being and a multidimensional measure of psychological distress were dominated by the contribution of environmental mastery, in keeping with earlier findings from cross-sectional studies that have correlated well-being and severity of depression.ConclusionOur preferred model included a single second-order factor, loaded by four of the six first-order factors, two method factors, and two more distinct first-order factors. Psychological well-being is negatively associated with dimensions of mental health. Further investigation of precision of measurement across the health continuum is required.

Duration of relapse prevention after cognitive therapy in residual depression: follow-up of controlled trial.

BACKGROUND Although there is good evidence that cognitive therapy (CBT) lessens relapse and recurrence in unipolar depression, the duration of this effect is not known. METHOD One hundred and fifty-eight subjects, from a randomized controlled trial of CBT plus medication and clinical management versus medication and clinical management alone, were followed 6 years after randomization (4 1/2 years after completion of CBT) and the longitudinal course assessed. RESULTS Effects in prevention of relapse and recurrence were found to persist, with weakening, and were not fully lost until 3 1/2 years after the end of CBT. Residual symptoms were also lessened. CONCLUSIONS The effect of CBT in reduction of relapse and recurrence persists for several years. The potential value of subsequent additional CBT some time after cessation should be explored.

Long-term outcome of severe puerperal psychiatric illness: a 23 year follow-up study.

BACKGROUND Although there have been many follow-up studies of severe puerperal psychiatric illness, few have been very long-term. METHODS Sixty-four subjects from 85 (75.3%) in an unselected sample of women admitted to a psychiatric hospital within 6 months of childbirth were successfully followed up a mean of 23 years (range 17-28) later. Most subjects were interviewed in detail, with further information obtained from general practice and hospital records. Data included subsequent illnesses and diagnoses, subsequent childbirth, longitudinal social function, current symptoms and social function. RESULTS Seventy-five per cent of subjects had further psychiatric illnesses, most of them unrelated to childbirth, and 37% had at least three subsequent episodes. The risk of puerperal psychiatric illness was 29% in subsequent pregnancies. At outcome interview the majority of subjects were well, with satisfactory social adjustment. Diagnoses in subsequent psychiatric illnesses showed considerable consistency with index diagnoses, with some shift to bipolar disorder. Further illnesses were less likely to occur where the index illness occurred with first child, onset was within 1 month of delivery, and where the index diagnosis was unipolar depression. CONCLUSIONS There is a high risk of subsequent non-puerperal recurrences following severe puerperal psychotic illness, showing considerable diagnostic consistency with the index episode, but with good functional outcome. Puerperal illnesses showed strong continuities with non-puerperal illnesses in these women.

Profiles of family-focused adverse experiences through childhood and early adolescence: The ROOTS project a community investigation of adolescent mental health

BackgroundAdverse family experiences in early life are associated with subsequent psychopathology. This study adds to the growing body of work exploring the nature and associations between adverse experiences over the childhood years.MethodsPrimary carers of 1143 randomly recruited 14-year olds in Cambridgeshire and Suffolk, UK were interviewed using the Cambridge Early Experiences Interview (CAMEEI) to assess family-focused adversities. Adversities were recorded retrospectively in three time periods (early and later childhood and early adolescence). Latent Class Analysis (LCA) grouped individuals into adversity classes for each time period and longitudinally. Adolescents were interviewed to generate lifetime DSM-IV diagnoses using the K-SADS-PL. The associations between adversity class and diagnoses were explored.ResultsLCA generated a 4-class model for each time period and longitudinally. In early childhood 69% were allocated to a low adversity class; a moderate adversity class (19%) showed elevated rates of family loss, mild or moderate family discord, financial difficulties, maternal psychiatric illness and higher risk for paternal atypical parenting; a severe class (6%) experienced higher rates on all indicators and almost exclusively accounted for incidents of child abuse; a fourth class, characterised by atypical parenting from both parents, accounted for the remaining 7%. Class membership was fairly stable (~ 55%) over time with escape from any adversity by 14 years being uncommon. Compared to those in the low class, the odds ratio for reported psychopathology in adolescents in the severe class ranged from 8 for disruptive behaviour disorders through to 4.8 for depressions and 2.0 for anxiety disorders. Only in the low adversity class did significantly more females than males report psychopathology.ConclusionsFamily adversities in the early years occur as multiple rather than single experiences. Although some children escape adversity, for many this negative family environment persists over the first 15 years of life. Different profiles of family risk may be associated with specific mental disorders in young people. Sex differences in psychopathologies may be most pronounced in those exposed to low levels of family adversities.

An evaluation of the precision of measurement of Ryff's Psychological Well-being scales in a population sample

The aim of this study is to assess the effective measurement range of Ryff’s Psychological Well-being scales (PWB). It applies normal ogive item response theory (IRT) methodology using factor analysis procedures for ordinal data based on a limited information estimation approach. The data come from a sample of 1,179 women participating in a midlife follow-up of a national birth cohort study in the UK. The PWB scales incorporate six dimensions: autonomy, positive relations with others, environmental mastery, personal growth, purpose in life and self-acceptance. Scale information functions were calculated to derive standard errors of measurement for estimated scores on each dimension. Construct variance was distinguished from method variance by inclusion of method factors from item wording (positive versus negative). Our IRT analysis revealed that the PWB measures well-being most accurately in the middle range of the score distribution, i.e. for women with average well-being. Score precision diminished at higher levels of well-being, and low well-being was measured more reliably than high well-being. A second-order well-being factor loaded by four of the dimensions achieved higher measurement precision and greater score accuracy across a wider range than any individual dimension. Future development of well-being scales should be designed to include items that are able to discriminate at high levels of well-being.

The relationship between early personality and midlife psychological well-being: evidence from a UK birth cohort study

BackgroundIndividual differences in personality influence the occurrence, reporting and outcome of mental health problems across the life course, but little is known about the effects on adult psychological well-being. The aim of this study was to examine long range associations between Eysenck’s personality dimensions and psychological well-being in midlife.MethodsThe study sample comprised 1,134 women from the 1946 British birth cohort. Extraversion and neuroticism were assessed using the Maudsley Personality Inventory in adolescence (age 16 years) and early adulthood (age 26). Psychological well-being was assessed at age 52 with a 42-item version of Ryff’s Psychological Well-being Scale. Analyses were undertaken within a structural equation modelling framework that allowed for an ordinal treatment of well-being and personality items, and latent variable modelling of longitudinal data on emotional adjustment. The contribution of mental health problems in linking personality variations to later well-being was assessed using a summary measure of mental health (emotional adjustment) created from multiple time-point assessments.ResultsWomen who were more socially outgoing (extravert) reported higher well-being on all dimensions. Neuroticism was associated with lower well-being on all dimensions. The effect of early neuroticism on midlife well-being was almost entirely mediated through emotional adjustment defined in terms of continuities in psychological/ psychiatric distress. The effect of extraversion was not mediated by emotional adjustment, nor attenuated after adjustment for neuroticism.ConclusionsIndividual differences in extraversion and neuroticism in early adult life influence levels of well-being reported in midlife.

Measuring health-related quality of life in bipolar disorder: Relationship of the EuroQol (EQ-5D) to condition-specific measures

Generic utility measures of health-related quality of life provide an independent net valuation of health states. They are increasingly used with condition-specific outcome measures in assessing treatments. In Bipolar Disorder, a few studies indicate poorer quality of life for depressed vs. euthymic patients. A single study suggests mania is less negative than depression. This analysis examines the relationship of one such scale, the EuroQol (EQ-5D), to objective and subjective measures of depression and mania in 221 Bipolar subjects, recently or still in an episode of illness. Results: Depressed patients showed a very poor quality of life (median EQ-5D Index score 0.41). Index and Visual Analogue scores improved significantly as level of depression decreased (Jonckheere–Terpstra test p<0.001). Both scores were significantly negatively related to all depression measures. Patients reported problems across all areas of life covered by the EQ-5D. No such relationships were observed between EQ-5D scores and mania measures, though all mania measures were inter-related. However, the range of mania shown was quite restricted. Conclusions: The EQ-5D is a useful measure of quality of life for Bipolar patients suffering from depression. Conclusions about the role of the EQ-5D in mania are restricted by the limited range of mania observed.