Valerie Dunn

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.

Elevated morning cortisol is a stratified population-level biomarker for major depression in boys only with high depressive symptoms

Significance Clinical depression is a severe and common illness, characterized primarily by persistent low mood and lack of pleasure in usually enjoyable activities, that results in significant impairment in everyday living. It also involves alterations in cognitive and hormonal functions. There is substantial variation between depressed individuals in terms of the causes and therapeutic response, making it difficult to identify those most likely to benefit from intervention and treatment. We derived subtypes of adolescents in the population based on different levels of the hormone cortisol and subclinical depressive symptoms. A group (17%) with both high levels of cortisol and depressive symptoms of both sexes had more depressed thinking. Boys in this group were at high risk for clinical depression. Major depressive disorder (MD) is a debilitating public mental health problem with severe societal and personal costs attached. Around one in six people will suffer from this complex disorder at some point in their lives, which has shown considerable etiological and clinical heterogeneity. Overall there remain no validated biomarkers in the youth population at large that can aid the detection of at-risk groups for depression in general and for boys and young men in particular. Using repeated measurements of two well-known correlates of MD (self-reported current depressive symptoms and early-morning cortisol), we undertook a population-based investigation to ascertain subtypes of adolescents that represent separate longitudinal phenotypes. Subsequently, we tested for differential risks for MD and other mental illnesses and cognitive differences between subtypes. Through the use of latent class analysis, we revealed a high-risk subtype (17% of the sample) demarcated by both high depressive symptoms and elevated cortisol levels. Membership of this class of individuals was associated with increased levels of impaired autobiographical memory recall in both sexes and the greatest likelihood of experiencing MD in boys only. These previously unidentified findings demonstrate at the population level a class of adolescents with a common physiological biomarker specifically for MD in boys and for a mnemonic vulnerability in both sexes. We suggest that the biobehavioral combination of high depressive symptoms and elevated morning cortisol is particularly hazardous for adolescent boys.

Cohort Profile: Risk patterns and processes for psychopathology emerging during adolescence: the ROOTS project

Mental illness makes a major contribution to the global burden of disease. The impact of disorders such as depression and anxiety has been heightened by the increasing success of public health measures in controlling physical diseases. Mental health disorders are severely impairing in their own right but may also exacerbate the disability resulting from physical disease. The situation will be worse globally as the pattern of morbidity seen in the developed world sweeps over lowand middle-income countries. Mental illness is commonly understood to result from complex interactions between vulnerability and stress, though such a model is uniquely difficult to study, particularly in longitudinal or life course designs. A considerable proportion of individuals who experience mental illness during their lives report the emergence of symptoms and impairment during the adolescent years. Adolescence is a critical period of accelerated maturation. Individuals differ widely in their rate of physical, social, psychological and sexual development. Physiological changes occurring over the second decade of life include alterations in gonadal hormone levels as well as significant elevations in glucocortioids resulting in physical maturation. There are also changes in psychological functions associated with brain development such as cognitive control of emotions, greater reasoning skills and problem solving ability. These changes occur within the contexts of peer groups, school and family settings, each of which has been shown to have an important impact on individual development. A striking feature of this period is the emergence of major mental illness, such as depressive, anxiety, eating and behaviour disorders and psychoses, some of which have their genesis earlier in childhood. Early onset carries considerable risk for continuity and recurrence into adult life. In particular, rates of depression and suicide rise alarmingly over the adolescent period. The co-occurrence of two or more diagnoses is the rule rather than the exception. Likewise, gender is of considerable importance as there are markedly emerging sex differences in the incidence of emotional disorders (females 4 males) in the adolescent period. In contrast, the known ratio of three males for every female in childhood conduct disorder contrasts with an almost equal sex ratio for cases beginning in the adolescent years.

Breakfast consumption and physical activity in British adolescents

Studies show an inverse relationship between breakfast frequency and weight gain. This may reflect poor eating habits generally and associated low physical activity (PA) or direct impacts of breakfast on mechanisms leading to lethargy and reduced PA. The relationship between breakfast frequency and PA is inconclusive. We aimed to determine whether breakfast frequency is associated with PA levels in British adolescents independent of body composition and socio-economic status (SES). Habitual breakfast frequency (self-report questionnaire) was assessed in 877 adolescents (43% male, age 14·5 (SD 0·5) years old). PA was measured over 5 d (accelerometry, average counts/ min; cpm). Associations between daily PA and breakfast frequency were assessed using linear regression adjusted for body fat percentage and SES. Effect modification by sex and associations with PA during the morning (06.00-12.00 hours) were explored. For boys, there were no significant associations between breakfast frequency and PA. For girls, less frequent breakfast consumption was significantly associated with lower PA (cpm) during the morning (occasional v. frequent b - 6·1 (95% CI - 11·1, -1·1), P = 0·017) when adjusted for body fat percentage and SES. There were no associations between PA and breakfast consumption over the whole day; however, for girls, less frequent breakfast consumption may be associated with lower PA levels during the morning, suggesting that breakfast consumption should perhaps be taken into consideration when aiming to promote PA in adolescent girls.

Physical Activity Awareness of British Adolescents.

OBJECTIVES To assess adolescent physical activity (PA) awareness and to investigate associations with biologic and psychosocial factors. DESIGN Cross-sectional study from November 1, 2005, through July 31, 2007 (the ROOTS study). SETTING Population-based sample recruited from Cambridgeshire and Suffolk schools (United Kingdom). PARTICIPANTS Of 799 participants, 43.6% were male. The mean (SD) age was 14.5 (0.5) years. MAIN EXPOSURES Self-rated PA perception, self-reported psychosocial factors, and measured anthropometry. MAIN OUTCOME MEASURES We measured PA with accelerometry for 5 days. Inactive was defined as less than 60 minutes per day of moderate and vigorous PA (MVPA) measured by accelerometry. Associations between awareness (agreement between self-rated and accelerometry-measured active/inactive) and potential correlates were investigated using multinomial logistic regression. RESULTS Approximately 70.1% of adolescents were inactive (81.2% of girls and 55.8% of boys; odds ratio [OR], 3.41; 95% confidence interval [CI], 2.41-4.82). There were 52.6% of all girls (64.8% of inactive girls) and 33.6% of all boys (60.3% of inactive boys) who inaccurately rated themselves as active (overestimators). Compared with girls accurately describing themselves as inactive (28.6%), girl overestimators had lower fat mass (OR, 0.84; 95% CI, 0.70-0.99), higher socioeconomic status (high vs low OR, 2.38; 95% CI, 1.07-5.32), more parent support (OR, 1.57; 95% CI, 1.12-2.22), and better family relationships (OR, 0.25; 95% CI, 0.09- 0.67). Among boys accurately describing themselves as inactive (22.1%), overestimators had lower fat mass (OR, 0.86; 95% CI, 0.77-0.96) and reported more peer support (OR, 1.75; 95% CI, 1.32-2.30) and less teasing (OR, 0.75; 95% CI, 0.61-0.92). CONCLUSIONS A substantial number of adolescents believe themselves to be more physically active than they really are. They may be unaware of potential health risks and unlikely to participate in PA promotion programs. Increasing information of PA health benefits beyond weight control might encourage behavior change.

Exercise and depressive symptoms in adolescents: a longitudinal cohort study

IMPORTANCE Physical activity (PA) may have a positive effect on depressed mood. However, whether it can act as a protective factor against developing depressive symptoms in adolescence is largely unknown. OBJECTIVE To investigate the association between objectively measured PA and depressive symptoms during 3 years of adolescence. DESIGN, SETTING, AND PARTICIPANTS We performed a longitudinal study between November 1, 2005, and January 31, 2010, of a community-based sample from Cambridgeshire and Suffolk, United Kingdom, that included 736 participants (mean [SD] age, 14.5 years [6 months]). The follow-up period was approximately 3 years after baseline (the ROOTS study). Linear regression models were fitted using physical activity energy expenditure (PAEE) and moderate and vigorous physical activity (MVPA) as the predictors and depressive symptoms as the outcome variable. Binomial logistic regression models were also fitted using PAEE and MVPA as the predictors and clinical depression as the outcome measure. EXPOSURES Exercise. MAIN OUTCOMES AND MEASURES Individually calibrated heart rate and movement sensing were used to measure PA at baseline only. Physical activity summary measures included total PAEE and time spent in MVPA. These measures were divided into weekend and weekday activity. All participants also completed the Mood and Feelings Questionnaire, a self-report measure of current depressive symptoms, and took part in a Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version interview at baseline and 3 years later. RESULTS Depressive symptoms at 3-year follow-up were not significantly predicted by any of the 4 PA measures at baseline: weekend MVPA (unstandardized β = 0.02; 95% CI, -0.15 to 0.20; P = .79), weekday MVPA (β = 0.00; 95% CI, -0.17 to 0.17; P = .99), weekend PAEE (β = 0.03; 95% CI, -0.14 to 0.20; P = .75), and weekday PAEE (β = -0.03; 95% CI, -0.20 to 0.14; P = .71). This was also true for major depressive disorder diagnoses at follow-up: weekend MVPA (odds ratio [OR], 1.37; 95% CI, 0.76-2.48; P = .30), weekday MVPA (OR, 1.33; 95% CI, 0.74-2.37; P = .34), weekend PAEE (OR, 1.19; 95% CI, 0.67-2.10; P = .56), and weekday PAEE (OR, 0.92; 95% CI, 0.52-1.63; P = .78). CONCLUSIONS AND RELEVANCE No longitudinal association between objectively measured PA and the development of depressive symptoms was observed in this large population-based sample. These results do not support the hypothesis that PA protects against developing depressive symptoms in adolescence.

5-HTTLPR and Early Childhood Adversities Moderate Cognitive and Emotional Processing in Adolescence

Background Polymorphisms in the promoter region of the serotonin transporter gene (5-HTTLPR) and exposure to early childhood adversities (CA) are independently associated with individual differences in cognitive and emotional processing. Whether these two factors interact to influence cognitive and emotional processing is not known. Methodology and Principal Findings We used a sample of 238 adolescents from a community study characterised by the presence of the short allele of 5-HTTLPR (LL, LS, SS) and the presence or absence of exposure to CA before 6 years of age. We measured cognitive and emotional processing using a set of neuropsychological tasks selected predominantly from the CANTAB® battery. We found that adolescents homozygous for the short allele (SS) of 5-HTTLPR and exposed to CA were worse at classifying negative and neutral stimuli and made more errors in response to ambiguous negative feedback. In addition, cognitive and emotional processing deficits were associated with diagnoses of anxiety and/or depressions. Conclusion and Significance Cognitive and emotional processing deficits may act as a transdiagnostic intermediate marker for anxiety and depressive disorders in genetically susceptible individuals exposed to CA.

Childhood adversity subtypes and depressive symptoms in early and late adolescence

Within a longitudinal study of 1,005 adolescents, we investigated how exposure to childhood psychosocial adversities was associated with the emergence of depressive symptoms between 14 and 17 years of age. The cohort was classified into four empirically determined adversity subtypes for two age periods in childhood (0–5 and 6–11 years). One subtype reflects normative/optimal family environments (n = 692, 69%), while the other three subtypes reflect differential suboptimal family environments (aberrant parenting: n = 71, 7%; discordant: n = 185, 18%; and hazardous: n = 57, 6%). Parent-rated child temperament at 14 years and adolescent self-reported recent negative life events in early and late adolescence were included in models implementing path analysis. There were gender-differentiated associations between childhood adversity subtypes and adolescent depressive symptoms. The discordant and hazardous subtypes were associated with elevated depressive symptoms in both genders but the aberrant parenting subtype only so in girls. Across adolescence the associations between early childhood adversity and depressive symptoms diminished for boys but remained for girls. Emotional temperament was also associated with depressive symptoms in both genders, while proximal negative life events related to depressive symptoms in girls only. There may be neurodevelopmental factors that emerge in adolescence that reduce depressogenic symptoms in boys but increase such formation in girls.

5-HTTLPR-environment interplay and its effects on neural reactivity in adolescents.

It is not known how 5-HTTLPR genotype × childhood adversity (CA) interactions that are associated with an increased risk for affective disorders in population studies operate at the neural systems level. We hypothesized that healthy adolescents at increased genetic and environmental risk for developing mood disorders (depression and anxiety) would demonstrate increased amygdala reactivity to emotional stimuli compared to those with only one such risk factor or those with none. Participants (n = 67) were classified into one of 4 groups dependent on being homozygous for the long or short alleles within the serotonin-transporter-linked polymorphic region (5-HTTLPR) of the SLC6A4 gene and exposure to CA in the first 11 years of life (present or absent). A functional magnetic resonance imaging investigation was undertaken which involved viewing emotionally-salient face stimuli. In addition, we assessed the role of other variables hypothesized to influence amygdala reactivity, namely recent negative life-events (RNLE) assessed at ages 14 and 17, current anxiety symptoms and psychiatric history. We replicated prior findings demonstrating moderation by gene variants in 5-HTTLPR, but found no support for an effect of CA on amygdala reactivity. We also found a significant effect of RNLE aged 17 with amygdala reactivity demonstrating additive, but not interactive effects with 5-HTTLPR. A whole-brain analysis found a 5-HTTLPR × CA interaction in the lingual gyrus whereby CA appears to differentially modify neural reactivity depending on genotype. These results demonstrate that two different forms of environmental adversities interplay with 5-HTTLPR and thereby differentially impact amygdala and cortical reactivity.

Friendships and Family Support Reduce Subsequent Depressive Symptoms in At-Risk Adolescents

Background Early life stress (ELS) consists of child family adversities (CFA: negative experiences that happened within the family environment) and/or peer bullying. ELS plays an important role in the development of adolescent depressive symptoms and clinical disorders. Identifying factors that may reduce depressive symptoms in adolescents with ELS may have important public mental health implications. Methods We used structural equation modelling and examined the impact of adolescent friendships and/or family support at age 14 on depressive symptoms at age 17 in adolescents exposed to ELS before age 11. To this end, we used structural equation modelling in a community sample of 771 adolescents (322 boys and 477 girls) from a 3 year longitudinal study. Significant paths in the model were followed-up to test whether social support mediated or moderated the association between ELS and depressive symptoms at age 17. Results We found that adolescent social support in adolescence is negatively associated with subsequent depressive symptoms in boys and girls exposed to ELS. Specifically, we found evidence for two mediational pathways: In the first pathway family support mediated the link between CFA and depressive symptoms at age 17. Specifically, CFA was negatively associated with adolescent family support at age 14, which in turn was negatively associated with depressive symptoms at age 17. In the second pathway we found that adolescent friendships mediated the path between peer bullying and depressive symptoms. Specifically, relational bullying was negatively associated with adolescent friendships at age 14, which in turn were negatively associated with depressive symptoms at age 17. In contrast, we did not find a moderating effect of friendships and family support on the association between CFA and depressive symptoms. Conclusions Friendships and/or family support in adolescence mediate the relationship between ELS and late adolescent depressive symptoms in boys and girls. Therefore, enhancing affiliate relationships and positive family environments may benefit the mental health of vulnerable youth that have experienced CFA and/or primary school bullying.