Childhood adversity and cardiometabolic biomarkers in mid-adulthood in the 1958 British birth cohort

Studies that have examined associations between adverse childhood experiences (ACEs) and cardiometabolic biomarkers in adulthood are limited as they mainly focus on childhood maltreatment. This study aimed to examine the association between a range of prospectively and retrospectively reported ACEs and cardiometabolic biomarkers in mid-adulthood. Multiply-imputed data on 8511 participants from the National Child Development Study (1958 British birth cohort) were used. ACEs were prospectively reported at ages 7, 11 and 16, and retrospectively reported at age 33/44/45. Cardiometabolic outcomes assessed at age 44/45 included glycated haemoglobin (HbA1c), cholesterol (total, low- and high-density lipoprotein), triglycerides, blood pressure (systolic and diastolic), body mass index, waist circumference and metabolic syndrome. Parental separation/divorce, physical neglect, emotional neglect and psychological abuse were associated with lower HDL cholesterol. Parental offending and physical neglect were associated with higher triglyceride concentrations. Parental offending was also associated with increased HbA1c. Exposure to 2+ (vs. 0) prospective ACEs was associated with lower HDL cholesterol. All these associations were after adjustment for sex and multiple early life factors. To conclude, several individual ACEs are associated with poorer cardiometabolic risk factor profiles in mid-adulthood. Furthermore, exposure to two or more prospective ACEs is associated with lower HDL cholesterol concentrations in mid-adulthood

Age at first birth and cardiovascular risk factors in the 1958 British birth cohort

Background To assess relationships between age at first birth and cardiovascular risk factors in a large longitudinal study of men and women. By assessing associations for both genders, we were able to investigate biological versus social and behavioural explanations from early life through to adulthood. Methods Multiply-imputed data on more than 7600 men and women of a British birth cohort study (National Child Development Study, 1958 British birth cohort) were used. Cardiovascular risk factors at age 44/45 years included body mass index, waist:hip ratio, blood pressure (systolic and diastolic), cholesterol (total, low and highdensity lipoprotein), triglycerides, glycated haemoglobin, C reactive protein, von Willebrand factor and fibrinogen. Age at first birth was categorised as 34 years. Results Being younger than 20 years of age at time of first birth was associated with an adverse cardiovascular profile by mid-life. Conversely, older parents had a lower cardiovascular risk as captured by lower body mass index, waist:hip ratio, blood pressure, high and lowdensity lipoprotein cholesterol, triglycerides, glycated haemoglobin, C reactive protein and fibrinogen. The relationship between age at first birth and cardiovascular risk factors was graded. Few differences between men and women were observed. Associations were largely unchanged after adjustment for early life factors but were partially mediated through adult social and behavioural factors. Conclusions Age at first birth is inversely associated with differences in cardiovascular risk factors in mid-life in a large prospective birth cohort. Our results potentially suggest a social and behavioural rather than a biological explanation

Inequalities in associations between young adult caregiving and social relationships: Evidence from the UK Household Longitudinal Study

Introduction: Young adult caregivers (aged 16–29 years) are an important but underrecognized group of informal caregivers. There is some evidence suggesting that young adult caregivers have fewer social relationships. However, this research has been largely cross-sectional in design or restricted to caregivers, providing no comparison with noncaregivers. Further, there is little evidence on whether and to what extent there are inequalities in associations between young adult caregiving and social relationships by gender, age, caregiving intensity, or household income./ Methods: Using five waves of data on 3-4000 young adults aged 16–29 from the UK Household Longitudinal Study, we investigated associations between becoming a young adult caregiver and subsequent social relationships (number of close friends and participation in organized social activities) in the short-term (1–2 years after caregiving initiation) and longer-term (4–5 years later). We also assessed differences by gender, age, household income, and caregiving intensity./ Results: Overall, those who became young adult caregivers, and particularly those providing 5+ h/week, reported fewer friends in the short- but not longer-term. No associations were observed between young adult caregiving and participation in organized social activities. Also, there was no evidence of differences by gender, age, income, or caregiving hours./ Conclusions: Becoming a young adult caregiver is associated with a reduction in number of close friends, particularly in the short-term. Given the importance of practical and emotional support provided by friends, the early identification of young adult caregivers and greater population awareness of caring in young adulthood may help to mitigate the effects on social relationships

Does providing informal care in young adulthood impact educational attainment and employment? Evidence from the UK Household Longitudinal Study

Most research on the effects of caring has focused on older spouses or working-age carers providing care for older people, but providing care in early adulthood may have longer-term consequences given the importance of this life stage for educational and employment transitions. This study aims to investigate the impact of informal care in early adulthood on educational attainment and employment in the UK, and to test whether these associations differ by gender or socioeconomic circumstances. Data are from young adults (age 16-29 at first interview, n=27,209) in the UK Household Longitudinal Study wave 1 (2009/11) to wave 10 (2018/2020). Carers are those who provide informal care either inside or outside household. We also considered six additional aspects of caring, including weekly hours spent caring, number of people cared for, relationship to care recipient, place of care, age at which caring is first observed, and duration of care. Logistic regression was used to analyse the association with educational qualifications. Cox regression was used to analyse the association with employment transitions, and piecewise models were used to disentangle the short and long-term effects of caring on employment amongst carers. We found that young adult carers were less likely to obtain a university degree and to enter employment, and more likely to enter unemployment and exit from paid employment, compared to young adults who did not provide care. Caring in young adulthood may influence employment both immediately and in the longer term. In terms of care characteristics, weekly hours spent caring is negatively associated with the likelihood of obtaining a degree qualification and being employed. Caring at age 18/19 may have a stronger impact on obtaining a university degree than caring at other ages. Providing care after age 22 negatively impacted employment outcomes. Having a degree qualification and parental educational attainment buffered the negative impact of providing care on employment. Our results highlight the importance of supporting the needs of young adults providing informal care while making key life course transitions

Parental absence in early childhood and onset of smoking and alcohol consumption before adolescence.

BACKGROUND: Parental absence, due to death or separation from a parent, has been associated with smoking and alcohol consumption in adolescence and adulthood. The aim of this study was to investigate whether parental absence in early childhood was associated with smoking and alcohol uptake before adolescence. METHODS: Data on 10 940 children from the UK's Millennium Cohort Study were used. Logistic regression was used to test associations between parental absence (0-7 years) and reports of smoking and alcohol consumption at age 11. RESULTS: Children who experienced parental absence were more likely to have smoked (OR=2.58, 95% CI 1.88 to 3.56) and consumed alcohol (OR=1.46, 95% CI 1.25 to 1.72). No differences were found by child sex or age, or parent absent. Children who experienced parental death were less likely to have drunk alcohol but those who had were more likely to have consumed enough to feel drunk. CONCLUSIONS: Parental absence was associated with early uptake of risky health behaviours in a large, nationally representative UK cohort. Children who experience parental absence should be supported in early life in order to prevent smoking and alcohol initiation.European Research Council [Grant IDs: ERC-2011- StG_20101124, ERC-StG-2012-309337_Alcohol-Lifecourse], Economic and Social Research Council International Centre for Lifecourse Studies in Society and Health (ICLS) [Grant ID: ES/J019119/1], Medical Research Council/Alcohol Research UK [Grant ID: MR/M006638/1]This is the final version of the article. It first appeared from BMJ Publishing Group via http://dx.doi.org/10.1136/archdischild-2016-31044

Mediating mechanisms of the relationship between exposure to deprivation and threat during childhood and adolescent psychopathology: evidence from the Millennium Cohort Study

The key aim of our study was to examine pathways from exposure to childhood adversities (i.e., deprivation and threat) to adolescent psychopathology. The assessed mediating mechanisms included cognitive ability and emotion regulation, as proposed by the Dimensional Model of Adversity and Psychopathology (DMAP). The study comprised participants from the nationally representative Millennium Cohort Study. Latent scores for deprivation and threat were derived using confirmatory factor analysis from indicators collected when participants were at age of 9 months, 3 and 5 years. Cognitive ability was measured using the Verbal Similarities subscale of the British Ability Scales II at age 11, and emotion regulation was measured using emotion dysregulation subscale of the Child Social Behavioural Questionnaire at age 7. Psychopathology, defined as psychological distress, was assessed using the Kessler 6 scale at age 17. We conducted causal mediation analysis adjusting for multiple confounding factors. We did not find total effect of either exposure to deprivation or threat on psychological distress, but we did find significant indirect effects of exposure to deprivation on psychological distress via cognitive ability (− 0.11, 95% CI − 0.20 to − 0.05) and emotion regulation (0.03, 0.02 to 0.12), and exposure to threat on psychological distress via cognitive ability (− 0.04, − 0.07 to − 0.01) and emotion regulation (0.09, 0.03 to 0.15). The lack of associations between deprivation or threat and psychological distress may be due to reporting bias or developmental period of psychopathology. Results of mediation analysis partially support the DMAP but indicate limited benefits to reduce adolescent psychological distress by targeting cognitive ability or emotion regulation to those exposed to childhood adversities

Mental and physical health changes around transitions into unpaid caregiving in the UK: a longitudinal, propensity score analysis

BACKGROUND: The health of unpaid caregivers is poorer, on average, than in non-caregivers. There has been little focus on how health changes when becoming a caregiver and whether this varies by age, gender, and caregiving intensity. We aimed to investigate the mental and physical health changes involved with becoming a caregiver and whether these associations varied by gender, caregiving intensity, or age. METHODS: This study used data from the UK Household Longitudinal Study (2009–20) to examine mental and physical health changes around the transition to becoming a caregiver in adults aged 16 years and older. We included adults with information on care, complete covariates needed for matching, and at least one measure of health before or after becoming a caregiver (or matched non-caregiver). Health was measured via General Health Questionnaire-12 (GHQ-12, psychological distress) and 12-item Short Form Survey (SF-12, physical and mental functioning). We applied piecewise growth curve modelling with propensity score matching to model trajectories of mental and physical health for caregivers and matched non-caregivers. Analyses were stratified by age group, gender, and caregiving intensity. FINDINGS: Sample sizes varied from 3025 (GHQ-12 analyses in early adulthood) to 5785 (SF-12 analyses in early mid-adulthood). Psychological distress increased during transition to caregiving for all ages, particularly in those younger than 64 years, those providing care for 20 h or more per week, and for someone living within the household. Mental health functioning worsened during caregiving transition for those aged 30–64 years, those providing 20 h or more per week, and for those caring for someone within the household. Physical health functioning did not change but there was evidence of lower levels of functioning before caregiving. Changes in mental and physical health upon transition to caregiving did not differ by gender. INTERPRETATION: Our findings highlight the importance of early identification of and support for caregivers, including younger caregivers. This is important to break the cycle of caregiving and future care need. Health services staff, including general practitioners and hospital discharge teams, are well positioned for early identification of caregivers. We also encourage particular support for the mental health of caregivers and particularly those who become caregivers at a younger age. FUNDING: The UK Economic and Social Research Council

Adverse childhood experiences and the development of multimorbidity across adulthood—a national 70-year cohort study

AIM: To examine impact of adverse childhood experiences (ACE) on rates and development of multimorbidity across three decades in adulthood. METHODS: Sample: Participants from the 1946 National Survey of Health and Development, who attended the age 36 assessment in 1982 and follow-up assessments (ages 43, 53, 63, 69; N = 3,264, 51% males). Prospectively collected data on nine ACEs was grouped into (i) psychosocial, (ii) parental health and (iii) childhood health. For each group, we calculated cumulative ACE scores, categorised into 0, 1 and ≥2 ACEs. Multimorbidity was estimated as the total score of 18 health disorders.Serial cross-sectional linear regression was used to estimate associations between grouped ACEs and multimorbidity during follow-up. Longitudinal analysis of ACE-associated changes in multimorbidity trajectories across follow-up was estimated using linear mixed-effects modelling for ACE groups (adjusted for sex and childhood socioeconomic circumstances). FINDINGS: Accumulation of psychosocial and childhood health ACEs were associated with progressively higher multimorbidity scores throughout follow-up. For example, those with ≥2 psychosocial ACEs experienced 0.20(95% CI 0.07, 0.34) more disorders at age 36 than those with none, rising to 0.61(0.18, 1.04) disorders at age 69.All three grouped ACEs were associated with greater rates of accumulation and higher multimorbidity trajectories across adulthood. For example, individuals with ≥2 psychosocial ACEs developed 0.13(-0.09, 0.34) more disorders between ages 36 and 43, 0.29(0.06, 0.52) disorders between ages 53 and 63, and 0.30(0.09, 0.52) disorders between ages 63 and 69 compared with no psychosocial ACEs. INTERPRETATIONS: ACEs are associated with widening inequalities in multimorbidity development in adulthood and early old age. Public health policies should aim to reduce these disparities through individual and population-level interventions

Poverty from fetal life onward and child brain morphology

Poverty is a risk factor for impaired child development, an association possibly mediated by brain morphology. Previous studies lacked prospective poverty assessments during pregnancy and did not stratify by majority/minority status. We investigated the association of household poverty from fetal life forward with brain morphological differences at age 10 years, in 2166 mother–child dyads. Overall, the results showed no associations between any poverty exposure early in life and brain volumes. However, there was the evidence of timing effects: children exposed to poverty in utero had smaller amygdala volumes (B =  − 0.18, 95%CI − 0.30; − 0.07, p(FDR-adjusted) = 0.009). There were also differences in associations by majority/minority status (cerebral white matter: p for interaction = 0.04). Dutch children exposed to childhood poverty showed smaller cerebral white matter volumes than their control (B =  − 0.26, 95%CI − 0.45; − 0.06, p(FDR-adjusted) = 0.035). This association was not observed in the minority population (B =  − 0.05, 95%CI − 0.23; 0.12, p(FDR-adjusted) = 0.542). The smaller cerebral white matter volume mediated the association between childhood poverty and poorer school performance in Dutch children. Our findings point to the importance of poverty exposure in the fetal period and suggest different mechanisms and vulnerabilities across majority/minority groups

Family adversity and health characteristics associated with intimate partner violence in children and parents presenting to health care: a population-based birth cohort study in England

BACKGROUND: Little is known about the clinical characteristics of children and parents affected by intimate partner violence (IPV) presenting in health-care settings. We examined the associations between family adversities, health characteristics, and IPV in children and parents using linked electronic health records (EHRs) from primary and secondary care between 1 year before and 2 years after birth (the first 1000 days). We compared parental health problems in in children and parents with and without recorded IPV. METHODS: We developed a population-based birth cohort of children and parents (aged 14-60 years) in England, comprising linked EHRs from mother-child pairs (with no identified father) and mother-father-child triads. We followed the cohort across general practices (Clinical Practice Research Datalink GOLD), emergency departments, outpatient visits, hospital admissions, and mortality records. Family adversities included 33 clinical indicators of parental mental health problems, parental substance misuse, adverse family environments, and high-risk child maltreatment-related presentations. Parental health problems included 12 common comorbidities, ranging from diabetes and cardiovascular diseases to chronic pain or digestive diseases. We used adjusted and weighted logistic-regression models to estimate the probability of IPV (per 100 children and parents) associated with each adversity, and period prevalences of parental health problems associated with IPV. FINDINGS: We included 129 948 children and parents, comprising 95 290 (73·3%) mother-father-child triads and 34 658 (26·7%) mother-child pairs only between April 1, 2007, and Jan 29, 2020. An estimated 2689 (2·1%) of 129 948 children and parents (95% CI 2·0-2·3) had recorded IPV and 54 758 (41·2%; 41·5-42·2) had any family adversity between 1 year before and 2 years after birth. All family adversities were significantly associated with IPV. Most parents and children with IPV had recorded adversities (1612 [60·0%] of 2689) before their first IPV recording. The probability of IPV was 0·6 per 100 children and parents (95% CI 0·5-0·6) with no adversity, increasing to 4·4 per 100 children per parents (4·2-4·7) with one adversity, and up to 15·1 per 100 parents and children (13·6-16·5) with three of more adversities. Mothers with IPV had a significantly higher prevalence of both physical (73·4% vs 63·1%, odds ratio [OR] 1·6, 95% CI 1·4-1·8) and mental health problems (58·4% vs 22·2%, OR 4·9, 4·4-5·5) than mothers without IPV. Fathers with IPV had a higher prevalence of mental health problems (17·8% vs 7·1%, OR 2·8, 2·4-3·2) and similar prevalences of physical health problems than those without IPV (29·6% vs 32·4%, OR 0·9, 0·8-1·0). INTERPRETATION: Two in five of the children and parents presenting to health care had recorded parental mental health problems, parental substance misuse, adverse family environments, or high-risk presentations of maltreatment in the first 1000 days. One in 22 children and parents with family adversity also had recorded IPV before age 2 years. Primary and secondary care staff should safely ask about IPV when parents or children present with family adversity or health problems associated with IPV, and respond appropriately. FUNDING: NIHR Policy Research Programme