Stephan Collishaw

Depression in adolescence.

Unipolar depressive disorder in adolescence is common worldwide but often unrecognised. The incidence, notably in girls, rises sharply after puberty and, by the end of adolescence, the 1 year prevalence rate exceeds 4%. The burden is highest in low-income and middle-income countries. Depression is associated with substantial present and future morbidity, and heightens suicide risk. The strongest risk factors for depression in adolescents are a family history of depression and exposure to psychosocial stress. Inherited risks, developmental factors, sex hormones, and psychosocial adversity interact to increase risk through hormonal factors and associated perturbed neural pathways. Although many similarities between depression in adolescence and depression in adulthood exist, in adolescents the use of antidepressants is of concern and opinions about clinical management are divided. Effective treatments are available, but choices are dependent on depression severity and available resources. Prevention strategies targeted at high-risk groups are promising.

Validity of the Malaise Inventory in general population samples

Background: The Malaise Inventory is a commonly used self-completion scale for assessing psychiatric morbidity. There is some evidence that it may represent two separate psychological and somatic sub-scales rather than a single underlying factor of distress. This paper provides further information on the factor structure of the Inventory and on the reliability and validity of the total scale and two sub-scales. Methods: Two general population samples completed the full Inventory: over 11,000 subjects from the National Child Development Study at ages 23 and 33, and 544 mothers of adolescents included in the Isle of Wight epidemiological surveys. Results: The internal consistency of the full 24-item scale and the 15-item psychological sub-scale were found to be acceptable, but the eight-item somatic sub-scale was less reliable. Factor analysis of all 24 items identified a first main general factor and a second more purely psychological factor. Receiver operating characteristic (ROC) analysis indicated that the validity of the scale held for men and women separately and for different socio-economic groups, by reference to external criteria covering current or recent psychiatric morbidity and service use, and that the psychological sub-scale had no greater validity than the full scale. Conclusions: This study did not support the separate scoring of a somatic sub-scale of the Malaise Inventory. Use of the 15-item psychological sub-scale can be justified on the grounds of reduced time and cost for completion, with little loss of reliability or validity, but this approach would not significantly enhance the properties of the Inventory by comparison with the full 24-item scale. Inclusion of somatic items may be more problematic when the full scale is used to compare particular sub-populations with different propensities for physical morbidity, such as different age groups, and in these circumstances it would be a sensible precaution to utilise the 15-item psychological sub-scale.

Trends in adolescent emotional problems in England: a comparison of two national cohorts twenty years apart

BACKGROUND Evidence about trends in adolescent emotional problems (depression and anxiety) is inconclusive, because few studies have used comparable measures and samples at different points in time. We compared rates of adolescent emotional problems in two nationally representative English samples of youth 20 years apart using identical symptom screens in each survey. METHODS Nationally representative community samples of 16-17-year-olds living in England in 1986 and 2006 were compared. In 1986, 4524 adolescents and 7120 parents of young people participated in the age-16-year follow-up of the 1970 British Cohort Study. In 2006, 719 adolescents and 734 parents participated in a follow-up of children sampled from the 2002/2003 Health Surveys for England. Adolescents completed the Malaise Inventory and 12-item General Health Questionnaire. Parents completed the Rutter-A scale. Individual symptoms of depression and anxiety were coded combining across relevant questionnaire items. Young people also reported frequency of feeling anxious or depressed. RESULTS Youth- and parent-reported emotional problems were more prevalent in 2006 for girls, and rates of parent-reported problems increased for boys. Twice as many young people reported frequent feelings of depression or anxiety in 2006 as in 1986. Some symptoms showed marked change in prevalence over time (e.g., worry, irritability, fatigue), whereas others showed no change (e.g., loss of enjoyment, worthlessness). There was no evidence of differential trends in emotional problems for young people from socially advantaged and disadvantaged or intact and non-intact families. Changes in family structure and ethnic composition did not account for trends in youth emotional problems. CONCLUSIONS The study provides evidence for a substantial increase in adolescent emotional problems in England over recent decades, especially among girls.

Mild mental retardation: psychosocial functioning in adulthood

BACKGROUND Evidence on the adult adaptation of individuals with mild mental retardation (MMR) is sparse, and knowledge of the factors associated with more and less successful functioning in MMR samples yet more limited. METHOD Prospective data from the National Child Development Study were used to examine social circumstances and psychosocial functioning in adulthood in individuals with MMR and in a non-retarded comparison group. RESULTS For many individuals with MMR, living circumstances and social conditions in adulthood were poor and potential stressors high. Self-reports of psychological distress in adulthood were markedly elevated, but relative rates of psychiatric service use fell between childhood and adulthood, as reflected in attributable risks. Childhood family and social disadvantage accounted for some 20-30% of variations between MMR and non-retarded samples on a range of adult outcomes. Early social adversity also played a significant role in contributing to variations in functioning within the MMR sample. CONCLUSIONS MMR appears to be associated with substantial continuing impairment for many individuals.

Time trends in child and adolescent mental disorders

Purpose of review 1995 saw the publication of a major review of time trends in psychosocial disorders of youth across the second half of the twentieth century. It found evidence for substantial increases in rates of youth crime, alcohol and drug use, depression and suicide in most industrialized countries in the decades following the Second World War, slowing in some instances in the 1980s. Ten years on, we review findings on more recent trends in rates of these and other indicators of child and adolescent mental health. Recent findings Prevalence estimates for autism spectrum disorders have increased in recent decades, as has public and professional awareness of hyperactivity and attention deficits. Trends in adolescent conduct problems, and in alcohol and drug use, appear to reflect culture-specific influences. Rates of suicide among young males, and self-harm among females have risen in many countries in recent years; trends in emotional disorders are more varied, but there is little evidence for any rise in rates of anorexia nervosa. Although some contributors to these trends have been identified, much remains to be learned about the key risks involved. Summary Monitoring time trends in child and adolescent mental health is essential for service planning; knowledge of changing trends can also provide important pointers to potential risk factors. Current data sources allow relatively reliable tracking of trends in some areas, but remain severely limited in others. Further research is needed to understand the mechanisms underlying recently identified trends in child and adolescent mental health.

Annual Research Review: Secular trends in child and adolescent mental health

BACKGROUND Child and adolescent mental health problems are common, associated with wide-ranging functional impairments, and show substantial continuities into adult life. It is therefore important to understand the extent to which the prevalence of mental health problems has changed over time, and to identify reasons behind any trends in mental health. SCOPE AND METHODOLOGY This review evaluates evidence on whether the population prevalence of child and adolescent mental health problems has changed. The primary focus of the review is on epidemiological cross-cohort comparisons identified by a systematic search of the literature (using the Web of Knowledge database). FINDINGS Clinical diagnosis and treatment of child and adolescent psychiatric disorders increased over recent decades. Epidemiological comparisons of unselected population cohorts using equivalent assessments of mental health have found little evidence of an increased rate of ADHD, but cross-cohort comparisons of rates of ASD are lacking at this time. Findings do suggest substantial secular change in emotional problems and antisocial behaviour in high-income countries, including periods of increase and decrease in symptom prevalence. Evidence from low- and middle-income countries is very limited. Possible explanations for trends in child and adolescent mental health are discussed. The review also addresses how cross-cohort comparisons can provide valuable complementary information on the aetiology of mental illness.

Predictors of suicidality across the life span: the Isle of Wight study.

BACKGROUND Data from a representative community sample were used to explore predictors of lifetime suicidality and to examine associations between distal adolescent and more proximal adult risks. METHOD Data are from a midlife follow-up of the Isle of Wight study, an epidemiological sample of adolescents assessed in 1968. Ratings of psychiatric symptoms and disorder, relationships and family functioning and adversity were made in adolescence; adult assessments included lifetime psychiatric history and suicidality, neuroticism and retrospective reports of childhood sexual abuse and harsh parenting. RESULTS A wide range of measures of childhood psychopathology, adverse experiences and interpersonal difficulties were associated with adult suicidality; associations were particularly strong for adolescent irritability, worry and depression. In multivariate analyses, substantial proportions of these effects could be explained by their association with adult psychopathology and neuroticism, but additional effects remained for adolescent irritability and worry. CONCLUSIONS Factors of importance for long-term suicidality risk are evident in adolescence. These include family and experiential adversities as well as psychopathology. In particular, markers of adolescent worry and irritability appeared both potent risks and ones with additional effects beyond associations with adult disorder and adult neuroticism.

School achievement and adult qualifications among adoptees: a longitudinal study

Data from the National Child Development study (NCDS) were used to examine predictors of attainment among adoptees, nonadopted children from similar birth circumstances, and other members of this national birth cohort. Adoptees performed more positively than nonadopted children from similar birth circumstances on childhood tests of reading, mathematics, and general ability, and retained this advantage in school-leaving and later adult qualifications. In addition to family SES and material circumstances, measures of the educational environment of the home and of parental interest in education emerged as central predictors of these variations. Further analyses suggested possible differences in the mode of operation of these variables between boys and girls, and at different stages of young peoples educational careers.

Infant adoption: psychosocial outcomes in adulthood

Abstract Adoption studies are able to provide important insights into the impact of changed rearing environments for childrens development. A number of studies reporting on the childhood adjustment of adoptees have found an increased risk for disruptive behaviour problems when compared with children brought up in intact families. The long-term implications of adoption for psychosocial adjustment in adult life are less clear. We have used data from the National Child Development Study (NCDS) to examine the psychosocial functioning over a number of life-domains of an unselected sample of adoptees, non-adopted children from similar birth circumstances, and other members of the cohort. Adopted women showed very positive adult adjustment across all the domains examined in this study, whilst our findings suggest some difficulty in two specific domains (employment and social support) for adopted men. Implications of the findings are discussed.

Do parents know best? Parent-reported vs. child-reported depression symptoms as predictors of future child mood disorder in a high-risk sample

BACKGROUND Parents with depression are thought to be unreliable reporters of childrens depression symptoms, but findings are contradictory and primarily focus on discrepancies between parent and child reports rather than on the predictive validity of informants. Using a sample of parents with recurrent depression, our analyses utilised data from a prospective high-risk longitudinal study (the Early Prediction of Adolescent Depression study) to investigate whether baseline parental reports of child depression symptoms predicted new onset mood disorder (NOMD) in children. METHODS The sample included 287 parents with a history of recurrent depression and their adolescent offspring (aged 9-17 at baseline). Families were assessed at three time points. The Child and Adolescent Psychiatric assessment (parent and child versions) was used to assess the number of child depression symptoms (computed separately by informant at baseline) and NOMD at follow-up. All DSM-IV diagnoses were confirmed by two child psychiatrists. RESULTS Parent reports of child depression symptoms at baseline significantly predicted NOMD in children. Secondary analyses stratifying the sample according to child age showed that, for younger children, parent reports were significantly better at predicting NOMD compared to child reports. For children aged 12 or older, there were no significant differences between parent and child reports in predicting NOMD. The pattern of association remained the same once we controlled for baseline levels of parental depression. LIMITATIONS Not all parents were currently experiencing an episode of depression at the baseline assessments; the sample consisted predominantly of mothers, thus findings may not be applicable to fathers or families without a history of parental depression. CONCLUSIONS In this high risk sample, child and parent ratings of depression predict new onset child mood disorder to a similar degree. Clinicians and researchers should give due consideration to parent ratings of their childrens depression symptoms, regardless of whether the parent suffers with depression.