Psychosocial stressors in the home environment, obesity and socioemotional difficulties across the first decade of life: Findings from the Millennium Cohort Study

There are a lack of studies which jointly examine psychosocial stressors in the home environment, socioemotional difficulties and obesity during childhood. This study examined two potential pathways of growing up in households characterised by psychosocial stressors on children’s mental wellbeing and obesity across the first decade of life. First, the associations between psychosocial stressors, socioemotional difficulties and obesity were explored. Then, the patterning of socioemotional difficulties and BMI over time was examined. Using the Millennium Cohort Study (MCS), cross-sectional and longitudinal logistic regression analysis was employed to analyse the associations for four family level psychosocial stressors (parental limiting longstanding illness, parental relationship change, parent-child conflict and maternal depression) with socioemotional difficulties and obesity at ages 3, 5, 7, and 11 years. All psychosocial stressors were associated with increased odds of socioemotional difficulties, but associations between psychosocial stressors and obesity were found only for stressors pertaining to parental health (parental limiting longstanding illness; parental relationship change; maternal depression; and parent-child conflict). A significant interaction was found for parent-child conflict by parental relationship status, with children in single-parent families, compared to two-parent families, more likely to have socioemotional difficulties after exposure to parent-child conflict. Finally, cross-lagged structural equation modelling was used to analyse the pathways between socioemotional difficulties and body-mass index (BMI) at ages 3, 5, 7, and 11 years, accounting for maternal and family characteristics and psychosocial stressors. For girls only, socioemotional difficulties and BMI were positively correlated in both directions from ages 7 to 11 years. Preadolescent girls with more socioemotional difficulties were more likely to have higher BMI’s and similarly, girls with higher BMI’s were more likely to have socioemotional difficulties. Policies tackling child health in the UK should take a comprehensive approach to understand the mechanisms which lead to socioemotional difficulties and childhood obesity

Adherence to 5-aminosalicylic acid maintenance treatment in young people with ulcerative colitis: a retrospective cohort study in primary care

BACKGROUND: Maintenance treatment with 5-aminosalicylic acid (5-ASA) is recommended in ulcerative colitis (UC), but accurate estimates of discontinuation and adherence in adolescents transitioning to young adulthood are lacking. AIM: To determine rates and risk factors for discontinuation and adherence to oral 5-ASA in adolescents and young adults 1 year following diagnosis of UC. DESIGN AND SETTING: Observational cohort study using the UK Clinical Practice Research Datalink among adolescents and young adults (aged 10-24 years) diagnosed with UC between 1 January 1998 and 1 May 2016. METHOD: Time to oral 5-ASA discontinuation (days) and adherence rates (proportion of days covered) were calculated during the first year of treatment using Kaplan-Meier survival analysis. Cox regression models were built to estimate the impact of sociodemographic and health-related risk factors. RESULTS: Among 607 adolescents and young adults starting oral 5-ASA maintenance treatment, one-quarter (n = 152) discontinued within 1 month and two- thirds (n = 419) within 1 year. Discontinuation was higher among those aged 18-24 years (74%) than younger age groups (61% and 56% in those aged 10-14 and 15-17 years, respectively). Adherence was lower among young adults than adolescents (69% in those aged 18-24 years versus 80% in those aged 10-14 years). Residents in deprived versus affluent postcodes were more likely to discontinue treatment (adjusted hazard ratio [aHR] 1.46, 95% confidence interval [CI] = 1.10 to 1.92). Early corticosteroid use for an acute flare lowered the likelihood of oral 5-ASA discontinuation (aHR 0.68, 95% CI = 0.51 to 0.90). CONCLUSION: The first year of starting long-term therapies in adolescents and young adults diagnosed with UC is a critical window for active follow-up of maintenance treatment, particularly in those aged 18-24 years and those living in deprived postcodes

Antidepressant medication use in Inflammatory Bowel Disease: a nationally representative population-based study.

BACKGROUND: Despite high rates of depression and anxiety, little is known about the use of antidepressants amongst individuals diagnosed with inflammatory bowel disease (IBD). AIMS: To evaluate temporal trends in the use of antidepressants; rates of antidepressant initiation and adherence of antidepressant use to international guidelines amongst individuals with IBD. METHODS: This is a study of 14,525 incident IBD cases from 2004 to 2016 compared with 58,027 controls matched 1:4 for age and sex from the Clinical Practice Research Datalink. After excluding tricyclic antidepressants, we performed a Cox regression analysis to determine the risk associated with antidepressant use and logistic regression analysis to determine risk associated with antidepressant undertreatment. RESULTS: Antidepressant use amongst individuals with IBD increased by 51% during the 12-year study period, who were 34% more likely to initiate antidepressants in the year after IBD diagnosis compared with controls (aHR:1.34, 95% CI 1.21-1.49). In those with IBD starting antidepressants, 67% received treatment lasting less than the duration recommended in international guidelines, of which 34% were treated for 1 month or less. 18-24 year olds were twice as likely to discontinue treatment within 1 month compared with those aged 40-60 years (aHR:2.03, 95% CI 1.40-2.95). Socioeconomic deprivation was also associated with early treatment discontinuation (aHR:1.40, 95% CI 1.07-1.83). CONCLUSIONS: In the year following IBD diagnosis individuals are significantly more likely to start antidepressants compared with controls, but treatment duration fell short of recommendations in the majority. Better integration of services may benefit individuals with IBD and psychiatric comorbidity

Disadvantage in early-life and persistent asthma in adolescents: a UK cohort study

OBJECTIVE: To determine how early-life risk factors explain socioeconomic inequalities in persistent asthma in adolescence. METHODS: We did a causal mediation analysis using data from 7487 children and young people in the UK Millennium Cohort Study. Persistent asthma was defined as having a diagnosis reported at any two or more time points at 7, 11 or 14 years. The main exposure was maternal education, a measure of early-life socioeconomic circumstances (SECs), used to calculate the relative index of inequality. We assessed how blocks of perinatal (maternal health behaviours, infant characteristics and duration of breastfeeding, measured at 9 months) and environmental risk factors (family housing conditions; potential exposure to infections through childcare type and sibling number, and neighbourhood characteristics, measured at 3 years) mediated the total effect of childhood SECs on persistent asthma risk, calculating the proportion mediated and natural indirect effect (NIE) via blocks of mediators. RESULTS: At age 14 the overall prevalence of persistent asthma was 15%. Children of mothers with lower educational qualifications were more likely to have persistent asthma, with a clear social gradient (degree plus: 12.8% vs no qualifications: 20.3%). The NIE gives the effect of SECs acting only via the mediators and shows a 31% increased odds of persistent asthma when SECs are fixed at the highest level, and mediators at the level which would naturally occur at the lowest SECs versus highest SECs (NIE OR 1.31, 95% CI 1.04 to 1.65). Overall, 58.9% (95% CI 52.9 to 63.7) of the total effect (OR 1.70, 95% CI 1.20 to 2.40) of SECs on risk of persistent asthma in adolescence was mediated by perinatal and environmental characteristics. CONCLUSIONS: Perinatal characteristics and the home environment in early life are more important in explaining socioeconomic inequalities in persistent asthma in British adolescents than more distal environmental exposures outside the home

Associations between prior healthcare use, time to diagnosis, and clinical outcomes in Inflammatory Bowel Disease: a nationally representative population-based cohort study

BACKGROUND: Timely diagnosis and treatment of inflammatory bowel disease (IBD) may improve clinical outcomes. OBJECTIVE: Examine associations between time to diagnosis, patterns of prior healthcare use and, clinical outcomes in IBD. DESIGN: Using the Clinical Practice Research Datalink we identified incident cases of Crohn’s disease (CD) and ulcerative colitis (UC), diagnosed between 01/2003 - 05/2016, with a first primary care gastrointestinal consultation during the 3-year period prior to IBD diagnosis. We used multivariable Cox regression to examine the association of primary care consultation frequency (n=1, 2, >2), annual consultation intensity, hospitalisations for gastrointestinal symptoms, and time to diagnosis with a range of key clinical outcomes following diagnosis. RESULTS: We identified 2,645 incident IBD cases (CD:782; UC:1,863). For CD, >2 consultations were associated with intestinal surgery (adjusted Hazard Ratio (aHR)=2.22, CI:1.45-3.39) and subsequent CD-related hospitalisation (aHR=1.80, CI:1.29-2.50). For UC, >2 consultations was associated with corticosteroid dependency (aHR=1.76, CI:1.28-2.41), immunomodulator use (aHR=1.68, CI:1.24-2.26), UC-related hospitalisation (aHR=1.43, CI:1.05-1.95) and colectomy (aHR=2.01, CI:1.22-3.27). For CD, hospitalisation prior to diagnosis was associated with CD-related hospitalisation (aHR=1.30, CI:1.01-1.68) and intestinal surgery (aHR=1.71, CI:1.13-2.58); for UC, it was associated with immunomodulator use (aHR=1.42, CI:1.11-1.81), UC-related hospitalisation (aHR=1.36, CI:1.06-1.95) and colectomy (aHR=1.54, CI:1.01-2.34). For CD, consultation intensity in the year before diagnosis was associated with CD-related hospitalisation (aHR=1.19, CI:1.12-1.28) and intestinal surgery (aHR=1.13, CI:1.03-1.23); for UC, it was associated with corticosteroid use (aHR=1.08, CI:1.04-1.13), corticosteroid dependency (aHR=1.05, CI:1.00-1.11), and UC-related hospitalisation (aHR=1.12, CI:1.03-1.21). For CD, time to diagnosis was associated with risk of CD-related hospitalisation (aHR=1.03, CI:1.01-1.68); for UC, it was associated with reduced risk of UC-related hospitalisation (aHR=0.83, CI:0.70-0.98) and colectomy (aHR=0.59, CI:0.43-0.80). CONCLUSION: Electronic records contain valuable information about patterns of healthcare use that can be used to expedite timely diagnosis and identify aggressive forms of IBD