Mental health crisis in midlife – a proposed research agenda

There is a growing amount of evidence indicating increased levels of psychological distress, suicide rates and decreased well-being in midlife (age 45-55). We refer to this phenomenon as the ‘midlife mental health crisis’. As there is little empirical evidence or theoretical grounds to explain the midlife mental health crisis, we propose a research agenda. In order to facilitate further research, we consulted members of public, mental health professionals and researchers on potential reasons for the midlife mental health crisis. Subsequently, we translated those into research questions testable with the British birth cohorts. We propose a series of studies using three statistical modelling approaches: descriptive (what is the midlife mental health crisis?), predictive (who is at increased risk of experiencing the midlife mental health crisis?) and explanatory (what are the processes leading to the midlife mental health crisis?)

The role of parental and child physical and mental health on behavioural and emotional adjustment in mid-childhood: a comparison of two generations of British children born 30 years apart

Poor physical health and behavioural and emotional problems in childhood have a lasting impact on well-being in adolescence and adulthood. Here we address the relationship between poor parent and child physical and mental health in early childhood (age 5) and conduct, hyperactivity and emotional problems in mid-childhood (age 10/11). We compare results across two generations of British children born 30 years apart in 1970 (n = 15,856) and 2000/2 (16,628). We take advantage of rich longitudinal birth cohort data and establish that a child’s own poor health was associated with conduct, hyperactivity and emotional problems in mid-childhood in both generations, and that with the exception of conduct problems in the 1970 cohort these relationships remained when family socio-economic status and individual characteristics were accounted for. Poor maternal mental health was similarly associated with conduct, hyperactivity and emotional problems in both generations; poor parental physical health with a child having later hyperactivity and emotional problems in the younger generation. Results also indicated that earlier behaviour problems had more influence on later problems for children in the more recent cohort. Given the increasing proportion of children and adolescents with mental health problems and that socio-economic disadvantage increases physical and mental well-being concerns within families, policy solutions must consider the holistic nature of a child’s family environment to prevent some children experiencing a ‘double whammy’ of disadvantage. The early years provide the best opportunity to promote children’s resilience and well-being and minimise the development of entrenched negative behaviours and their subsequent costs to society

Exploring the role of early-life circumstances, abilities and achievements on well-being at age 50 years: evidence from the 1958 British birth cohort study

Objectives: We aim to examine the relative contributions of pathways from middle childhood/adolescence to mid-life well-being, health and cognition, in the context of family socio-economic status (SES) at birth, educational achievement and early-adulthood SES. Our approach is largely exploratory, suspecting that the strongest mediators between childhood circumstances and mid-life physical and emotional well-being may be cognitive performance during school years, material and behavioural difficulties, and educational achievement. We also explore whether the effects of childhood circumstances on mid-life physical and emotional well-being differ between men and women. / Setting/participants: Data were from the National Child Development Study, a fully-representative British birth cohort sample of 17 415 people born in 1 week in 1958. / Primary/secondary outcome measures: Our four primary mid-life outcome measures are: cognitive performance, physical and emotional well-being and quality of life. Our intermediate adult outcomes are early-adulthood social class and educational/vocational qualifications. Results: Using structural equation modelling, we explore numerous pathways through childhood and early adulthood which are significantly linked to our outcomes. We specifically examine the mediating effects of the following: cognitive ability at ages 7, 11 and 16 years; childhood psychological issues; family material difficulties at age 7 years: housing, unemployment, finance; educational/vocational qualifications and social class position at age 42 years. We find that social class at birth has a strong indirect effect on the age 50 outcomes via its influence on cognitive performance in childhood and adolescence, educational attainment and mid-life social class position, together with small direct effects on qualifications and social class position at age 42 years. Teenage cognitive performance has a strong positive effect on later physical health for women, while educational/vocational qualifications have a stronger positive effect on emotional well-being for men. / Conclusion: Our findings provide an understanding of the legacy of early life on multiple aspects of mid-life health, well-being, cognition and quality of life, showing stronger mediated links for men from childhood social class position to early adult social class position. The observed effect of qualifications supports those arguing that education is positively associated with subsequent cognitive functioning

Factors incorporated into future survival estimation among Europeans

Background: Subjective survival probabilities are affected by individual-specific judgment and vary by factors known to differentiate actual mortality. Objective: The aim of this study is to evaluate whether sociodemographic characteristics, physical and mental health, and lifestyle are incorporated into subjective survival probabilities of Europeans aged 50 or higher. Methods: We use data from Wave 6 of the Survey of Health, Ageing and Retirement in Europe (SHARE) and period life tables from the Human Mortality Database (HMD). For the statistical analysis we employ multinomial logistic regression models. Results: Our results show that common factors drive the self-reported subjective survival probabilities. Certain factors affecting actual mortality are considered when forming subjective survival probabilities: income, education, poor physical and mental health, activities of daily living (ADLs), smoking, physical activity, diet, quality of life, and number of children. Other factors are not considered in a manner consistent with actual mortality patterns: age, gender, marital status, and body weight. The findings regarding cognitive function are inconclusive; whereas some aspects seem to be integrated in subjective survival probabilities (e.g., memory or self-writing skills), others are not (e.g., numeracy or orientation in time). Contribution: The contribution of this study is the grouping of sociodemographic, health, and lifestyle characteristics according to the subjective survival probabilities’ direction and consistency with general population mortality and actual mortality patterns. Hence, we assess which traits are incorporated in the formation of subjective survival probabilities among Europeans aged 50 or higher

Socioeconomic inequalities across life and premature mortality from 1971 to 2016: findings from three British birth cohorts born in 1946, 1958 and 1970

INTRODUCTION: Disadvantaged socioeconomic position (SEP) in early and adult life has been repeatedly associated with premature mortality. However, it is unclear whether these inequalities differ across time, nor if they are consistent across different SEP indicators. METHODS: British birth cohorts born in 1946, 1958 and 1970 were used, and multiple SEP indicators in early and adult life were examined. Deaths were identified via national statistics or notifications. Cox proportional hazard models were used to estimate associations between ridit scored SEP indicators and all-cause mortality risk-from 26 to 43 years (n=40 784), 26 to 58 years (n=35 431) and 26 to 70 years (n=5353). RESULTS: More disadvantaged SEP was associated with higher mortality risk-magnitudes of association were similar across cohort and each SEP indicator. For example, HRs (95% CI) from 26 to 43 years comparing lowest to highest paternal social class were 2.74 (1.02 to 7.32) in 1946c, 1.66 (1.03 to 2.69) in 1958c, and 1.94 (1.20 to 3.15) in 1970c. Paternal social class, adult social class and housing tenure were each independently associated with mortality risk. CONCLUSIONS: Socioeconomic circumstances in early and adult life show persisting associations with premature mortality from 1971 to 2016, reaffirming the need to address socioeconomic factors across life to reduce inequalities in survival to older age

Changes in the adult consequences of adolescent mental ill-health findings from the 1958 and 1970 British birth cohorts

Background: Adolescent mental health difficulties are increasing over time. However, it is not known whether their adulthood health and socio-economic sequelae are changing over time. // Methods: Participants (N = 31 349) are from two prospective national birth cohort studies: 1958 National Child Development Study (n = 16 091) and the 1970 British Cohort Study (n = 15 258). Adolescent mental health was operationalised both as traditional internalising and externalising factors and a hierarchical bi-factor. Associations between adolescent psychopathology and age 42 health and wellbeing (mental health, general health, life satisfaction), social (cohabitation, voting behaviour) and economic (education and employment) outcomes are estimated using linear and logistic multivariable regressions across cohorts, controlling for a wide range of early life potential confounding factors. // Results: The prevalence of adolescent mental health difficulties increased and their associations with midlife health, wellbeing, social and economic outcomes became more severe or remained similar between those born in 1958 and 1970. For instance, a stronger association with adolescent mental health difficulties was found for those born in 1970 for midlife psychological distress [odds ratio (OR) 1970 = 1.82 (1.65–1.99), OR 1958 = 1.60 (1.43–1.79)], cohabitation [OR 1970 = 0.64 (0.59–0.70), OR 1958 = 0.79 (0.72–0.87)], and professional occupations [OR 1970 = 0.75 (0.67–0.84), OR 1958 = 1.05 (0.88–1.24)]. The associations of externalising symptoms with later outcomes were mainly explained by their shared variance with internalising symptoms. // Conclusion: The widening of mental health-based inequalities in midlife outcomes further supports the need to recognise that secular increases in adolescent mental health symptoms is a public health challenge with measurable negative consequences through the life-course. Increased public health efforts to minimise adverse outcomes are needed

Early adolescent outcomes of joint developmental trajectories of problem behavior and IQ in childhood

General cognitive ability (IQ) and problem behavior (externalizing and internalizing problems) are variable and inter-related in children. However, it is unknown how they co-develop in the general child population and how their patterns of co-development may be related to later outcomes. We carried out this study to explore this. Using data from 16,844 Millennium Cohort Study children, we fitted three-parallel-process growth mixture models to identify joint developmental trajectories of internalizing, externalizing and IQ scores at ages 3-11 years. We then examined their associations with age 11 outcomes. We identified a typically developing group (83%) and three atypical groups, all with worse behavior and ability: children with improving behavior and low (but improving in males) ability (6%); children with persistently high levels of problems and low ability (5%); and children with worsening behavior and low ability (6%). Compared to typically developing children, the latter two groups were more likely to show poor decision-making, be bullies or bully victims, engage in antisocial behaviors, skip and dislike school, be unhappy and have low self-esteem. By contrast, children (especially males) in the improver group had outcomes that were similar to, or even better than, those of their typically developing peers. These findings encourage the development of interventions to target children with both cognitive and behavioral difficulties

Variation in antral follicle counts at different times in the menstrual cycle: does it matter?

Antral follicle count (AFC) variation was examined across the menstural cycle and its effect on clinical management assessed. In 79 women, AFC was documented in early (iAFC) and late follicular phase (sAFC). Absolute agreement between iAFC and sAFC and agreement for classification into categories of risk of extremes of ovarian response were examined. Ovarian stimulation protocols designed with iAFC and sAFC, and the predictive value of iAFC and sAFC for extremes of ovarian response, were compared in women undergoing ovarian stimulation. Significant differences were found between iAFC and sAFC (16 [IQR 9-24] versus 13 [IQR 7- 21]; P = 0.001), with moderate agreement for the classification into at risk of extremes of response (k = 0.525). Agreement for protocol selection based on either AFC (k = 0.750) and starting gonadotrophin dose was good (concordance correlation coefficient 0.970 [95% CI 0.951 to 0.982]). Predictive value for iAFC and sAFC was maintained for poor ovarian response and risk of ovarian hyperstimulation syndrome (OR 0.634 [0.427 to 0.920], 0.467 [0.233 to 0.935]) and (OR 1.049 [0.974 to 1.131], 1.140 [1.011 to 1.285]). Across the cycle, AFC varies but does not significantly affect ovarian stimulation protocol design and prediction of extreme ovarian response