A longitudinal examination of the measurement equivalence of mental health assessments in two British birth cohorts

Valid inference from the investigation of mental health relies – among others – on the assumption of no measurement error. However, it is well known that data from self-reported measures are likely to be biased by some process that is driven by the respondent’s personality and/or circumstances. We capitalised on data available in two nationally representative birth cohorts, the National Child Development Study (1958 birth cohort) and the 1970 British Cohort Study to formally test the longitudinal measurement equivalence of the nine-item version of the Malaise Inventory, a measure of psychological distress. The inclusion of identical assessments of mental health in adulthood in both cohorts allowed us to evaluate their measurement properties and investigate whether the passage of time has differentially affected the interpretation of mental health assessments. To do so, we employed methods within the generalised latent variable measurement modelling framework and related extensions for formally testing measurement invariance. We found that the passage of two decades and more in both cohorts have not influenced how participants respond to the short version of the Malaise Inventory. The observed scalar invariance of the short version of the Malaise Inventory implies that potential sources of bias such as age effects, survey design, period effects, or cohort specific effects did not influence the way participants in the two cohorts respond to the symptoms described in the Malaise Inventory. Our results offer some reassurance for the extent to which self-reported mental health survey questions are affected by systematic sources of error

Maternal psychological distress and child decision-making

Background: There is much research to suggest that maternal psychological distress is associated with many adverse outcomes in children. This study examined, for the first time, if it is related to children's affective decision-making. Methods: Using data from 12,080 families of the Millennium Cohort Study, we modelled the effect of trajectories of maternal psychological distress in early-to-middle childhood (3–11 years) on child affective decision-making, measured with a gambling task at age 11. Results: Latent class analysis showed four longitudinal types of maternal psychological distress (chronically high, consistently low, moderate-accelerating and moderate-decelerating). Maternal distress typology predicted decision-making but only in girls. Specifically, compared to girls growing up in families with never-distressed mothers, those exposed to chronically high maternal psychological distress showed more risk-taking, bet more and exhibited poorer risk-adjustment, even after correction for confounding. Most of these effects on girls’ decision-making were not robust to additional controls for concurrent internalising and externalising problems, but chronically high maternal psychological distress was associated positively with risk-taking even after this adjustment. Importantly, this association was similar for those who had reached puberty and those who had not. Limitations: Given the study design, causality cannot be inferred. Therefore, we cannot propose that treating chronic maternal psychological distress will reduce decision-making pathology in young females. Conclusions: Our study suggests that young daughters of chronically distressed mothers tend to be particularly reckless decision-makers

Trends in catastrophic health expenditure in India: 1993 to 2014

OBJECTIVE: To investigate trends in out-of-pocket health-care payments and catastrophic health expenditure in India by household age composition. METHODS: We obtained data from four national consumer expenditure surveys and three health-care utilization surveys conducted between 1993 and 2014. Households were divided into five groups by age composition. We defined catastrophic health expenditure as out-ofpocket payments equalling or exceeding 10% of household expenditure. Factors associated with catastrophic expenditure were identified by multivariable analysis. FINDINGS: Overall, the proportion of catastrophic health expenditure increased 1.47-fold between the 1993–1994 expenditure survey (12.4%) and the 2011–2012 expenditure survey (18.2%) and 2.24-fold between the 1995–1996 utilization survey (11.1%) and the 2014 utilization survey (24.9%). The proportion increased more in the poorest than the richest quintile: 3.00-fold versus 1.74-fold, respectively, across the utilization surveys. Catastrophic expenditure was commonest among households comprising only people aged 60 years or older: the adjusted odds ratio (aOR) was 3.26 (95% confidence interval, CI: 2.76–3.84) compared with households with no older people or children younger than 5 years. The risk was also increased among households with both older people and children (aOR: 2.58; 95% CI: 2.31–2.89), with a female head (aOR: 1.32; 95% CI: 1.19–1.47) and with a rural location (aOR: 1.27; 95% CI: 1.20–1.35). CONCLUSION: The proportion of households experiencing catastrophic health expenditure in India increased over the past two decades. Such expenditure was highest among households with older people. Financial protection mechanisms are needed for population groups at risk for catastrophic health expenditure

Association of nursery and early school attendance with later health behaviours, biomedical risk factors, and mortality: evidence from four decades of follow-up of participants in the 1958 birth cohort study.

BACKGROUND: Although early life education for improved long-term health and the amelioration of socioeconomically generated inequalities in chronic disease is advocated in influential policy statements, the evidence base is very modest. AIMS: To address this dearth of evidence using data from a representative UK national birth cohort study. METHODS: The analytical sample comprised men and women in the 1958 birth cohort study with prospectively gathered data on attendance at nursery or primary school before the age of 5 years who had gone on to participate in social survey at 42 years (n=11 374), or a biomedical survey at 44/5 years of age (n=9210), or had data on vital status from 18 to 55 years (n=17 657). RESULTS: Relative to study members who had not attended nursery, in those who had, there was in fact a higher prevalence of smoking and high alcohol intake in middle age. Conversely, nursery attenders had more favourable levels of lung function and systolic blood pressure in middle age. This apparent association between nursery attendance and lower systolic blood pressure was confined to study members from more deprived social backgrounds of origin (P value for interaction 0.030). There was no apparent link between early school attendance and any behavioural or biological risk factor. Neither nursery nor early school attendance was clearly related to mortality risk. CONCLUSIONS: We found no clear evidence for an association of either attendance at nursery or primary school before the age of 5 years and health outcomes around four decades later

Living longer but not necessarily healthier: The joint progress of health and mortality in the working-age population of England

Despite improvements in life expectancy, there is uncertainty on whether the increase in years of healthy life expectancy has kept pace. In this paper we explore whether there is empirical support for the expansion of morbidity hypothesis in the population aged 25–64 living in England. Nationally representative cohorts born between 1945 and 1980 are constructed from repeated annual cross-sections of the Health Survey for England, 1991–2014. Later-born cohorts at a given age have the same or higher prevalence of self-reported bad general health and long-term illness, self-reported high blood pressure (in men), self-reported and objectively-measured diabetes, circulatory illnesses, clinical hypertension, and overweight BMI. We also find that healthy life expectancies (in the sense of absence of each of these problems) at age 25 have increased at a slower pace than life expectancy between 1993 and 2013. Our findings lend support to the expansion of morbidity hypothesis and point to increased future demand for specific healthcare services at younger ages

Early life mental health and problematic drinking in mid-adulthood: evidence from two British birth cohorts

PURPOSE: Accumulating evidence suggests that externalising problems are consistently associated with alcohol use behaviours, but findings are inconsistent regarding the role of internalising problems. We investigate whether externalising and internalising problems are associated with problematic drinking in mid-adulthood, and whether potential associations are modified by age, sex and cohort. METHODS: The National Child Development Study (NCDS58, n = 17,633) and 1970 British Cohort Study (BCS70, n = 17,568) recruited new-borns in Great Britain in a single week in 1958 and 1970. Mental health was assessed with the Rutter Behaviour Questionnaire at ages 7, 11, and 16 in NCDS58 and ages 5, 10 and 16 in BCS70. Problematic drinking was measured with the CAGE questionnaire at age 33 in NCDS58 and age 34 in BCS70, and the AUDIT scale at age 44/45 in NCDS58 and age 46 in BCS70. Latent scores of externalising and internalising problems were added chronologically into lagged logistic regression models. RESULTS: Externalising and internalising problems were associated in opposite directions with problematic drinking in mid-adulthood. Externalising was a risk factor (OR [95% CI] ranging from 1.06 [1.03, 1.10] to 1.11 [1.07, 1.15] for different ages), and internalising was a protective factor (OR [95% CI] ranging from 0.95 [0.92, 0.99] to 0.90 [0.86, 0.94] for different ages). Associations between early life mental health and mid-adulthood problematic drinking did not differ by developmental timing but were stronger in males. CONCLUSION: Our study provides new insights on links of externalising and internalising difficulties with alcohol use and has implications for public policy in the UK

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

Testing Comparability Between Retrospective Life History Data and Prospective Birth Cohort Study Data

Objectives: To determine whether comparable prospective and retrospective data present the same association between childhood and life course exposures and mid-life wellbeing. Method: Prospective data is taken from the 1958 UK National Child Development Study at age 50 in 2008 and earlier sweeps (n = 8,033). Retrospective data is taken from the English Longitudinal Study of Ageing at ages 50-55 from a life history interview in 2007 (n = 921). Results: There is a high degree of similarity in the direction of association between childhood exposures that have been prospectively collected in National Child Development Study and retrospectively collected in English Longitudinal Study of Ageing and wellbeing outcomes in mid-life. However, the magnitude of these associations is attenuated substantially by the inclusion of measurements, which are difficult or impossible to capture retrospectively, and are only available in prospective data, such as childhood poverty, cognitive ability, and indices of social and emotional adjustment. Discussion: The findings on the one hand provide some reassurance to the growing literature using life history data to determine life course associations with later life wellbeing. On the other hand, the findings show an overestimation in the retrospective data, in part, arising from the absence in life history data of childhood measures that are not well suited to retrospective collection

The relationship between child behaviour problems at school entrance and teenage vocabulary acquisition: A comparison of two generations of British children born 30 years apart

Behaviour problems in early childhood have a lasting impact on cognitive development and education attainment in later adolescence and into adulthood. Here we address the relationship conduct and hyperactivity problems at school entrance, and vocabulary acquisition in adolescence. We compare performance in identical assessments across two generations of British children born 30 years apart in 1970 (n = 15,676) and 2000/2 (n = 16,628) and find that both conduct and hyperactivity problems have a negative association with later vocabulary in both generations. We take advantage of rich longitudinal birth cohort data and establish that these relationships hold once family socioeconomic status and a child’s personal characteristics and earlier vocabulary acquisition are taken into account. We also find that teenagers today achieved substantively lower scores in the vocabulary assessment compared to their counterparts born 30 years earlier, and that this holds across all categories within each of the family and individual characteristics considered in this article. As vocabulary and language skills are key prerequisites for wider learning, we discuss implications the findings have for education policies