Social isolation in childhood and adult inflammation: evidence from the National Child Development Study

Background Social isolation is known to be associated with poorer health amongst adults, including coronary heart disease. It is hypothesized that this association may be mediated by inflammation. There has been little prospective research on the long-term impact of social isolation in childhood on adult health or the pathways which might be involved. The aim of this study was to investigate whether social isolation in childhood is associated with increased adult inflammation and the mechanisms involved across the life course. Methods This study used multiply-imputed data on 7,462 participants of the National Child Development Study in Great Britain. The association between child social isolation (7-11 yrs) and levels of C-reactive protein (CRP) in middle age (44 yrs) was examined. We additionally investigated the role of adult social isolation, psychological distress, health behaviors and socioeconomic factors as potential mediators using path analysis and concurrent measurements made across the life course. Results Socially isolated children had higher levels of C-reactive protein in mid-life (standardized coefficient= 0.05, p≤0.001). In addition children who were socially isolated tended to have lower subsequent educational attainment, be in a less advantaged social class in adulthood, were more likely to be psychologically distressed across adulthood and were more likely to be obese and to smoke. All of these factors partially explained the association between childhood social isolation and CRP. However this association remained statistically significant after considering all mediators simultaneously. Conclusions Social isolation in childhood is associated with higher levels of C-reactive protein in mid-life. This is explained in part through complex mechanisms acting across the life course. Identification and interventions targeted towards socially isolated children may help reduce long-term adult health risk

Adverse childhood experiences and multiple mental health outcomes through adulthood: A prospective birth cohort study

Objective: Exposure to adverse childhood experiences (ACEs) is associated with a broad range of mental health-related outcomes. Previous studies tended to use retrospectively reported ACEs, measure mental health outcomes at a one time point in adulthood and focus on individual outcomes. Hence, this study aimed to examine the association between prospectively and retrospectively measured ACEs and a wide range of mental health-related outcomes, spanning ages 16 to55, using a prospective birth cohort, representative of those born around 1958 in Great Britain. Methods: The study used the 1958 National Child Development Study (n ​= ​7980). Adverse childhood experiences were measured both prospectively and retrospectively, and combined into ACE scores. The associations between the ACE scores and mental health were quantified with linear regression for continuous and robust Poisson regression for binary outcomes. Results: We found a dose-response association between prospectively and retrospectively reported ACEs and all studied mental health-related outcomes, after accounting for multiple covariates. Among those with 2+ (vs 0) prospective ACEs, the risk of clinically significant psychological distress was up to 2.14 times higher, and of seeing a mental health specialist up to 2.85 times higher. Conclusions: Our findings reiterate the need for early-life interventions to reduce inequalities in mental health

Area-level and family-level socioeconomic position and body composition trajectories: longitudinal analysis of the UK Millennium Cohort Study

Background: Inequalities in the trajectories of body composition in childhood and adolescence have been infrequently studied. Despite the importance of environmental factors in obesity development, little research has looked at area-level socioeconomic position, independent of family socioeconomic position. We aimed to assess how inequalities in body composition develop with age. Methods: The Millennium Cohort Study is a longitudinal study of 19 243 families who had a child born between 2000 and 2002 in the UK. Multilevel growth curve models were applied to examine change in fat mass index (FMI), fat free mass index (FFMI; using the Benn index), and fat mass to fat free mass ratio (FM:FFM), measured using Bioelectrical Impedance Analysis, from ages 7 years to 17 years by the Index of Multiple Deprivation (IMD) and household income at baseline. Findings: Inequalities in FMI and FM:FFM ratio are evident at age 7 years and widen with age. At age 17 years, adolescents in the most disadvantaged IMD group had FMI 0·57 kg/mB (B=Benn parameter; 95% CI 0·43 to 0·70) higher and FM:FFM ratio 0·037 (95% CI 0·026 to 0·047) higher compared with the most advantaged group. Disadvantaged socioeconomic position is associated with higher FFMI but is reversed in adolescence after adjustment for FMI. Inequalities were greater in girls at age 7 years (mean FMI 0·22 kg/mB; 95% CI 0·13 to 0·32) compared with boys of the same age (0·05 kg/mB; –0·04 to 0·15, p=0·3), but widen fastest in boys, especially for FMI, in which there was over an 11 times increase in the inequality from age 7 years of 0·05kg/mB (95% CI –0·04 to 0·15) to 0·62 kg/mB at 17 years (0·42 to 0·82). Inequalities for the IMD were similar to income, and persisted at age 17 years independent of family socioeconomic position. Interpretation: Childhood and adolescence is an important period to address inequalities in body composition, as they emerge and widen. Policies should consider FFM as well as FM, and inequalities in the environment. Funding: Medical Research Council, Economic and Social Research Council

Parental separation in childhood and adult inflammation: the importance of material and psychosocial pathways

Background: Childhood adversities are known to be associated with poorer health outcomes. A potential mechanism may be through changes in inflammatory processes. One such childhood adversity is separation of parents, however relatively little is known about the association between parental separation and inflammation in adulthood. The aims of this study were to (1) investigate whether parental separation is associated with inflammation in mid-life, (2) focus upon the mechanisms that may be involved in translating childhood adversities, such as parental separation, into poorer health outcomes in adulthood. Methods: We examine the association of parental separation in childhood, defined as the breakdown of the parent’s partnership, and levels of C-reactive protein (CRP) in middle age. The role played by material (through material disadvantage and educational attainment), psychosocial (through parent-child relationship quality and psychological distress) and adiposity (through BMI) mechanisms is investigated using path analysis in a multiply-imputed dataset from a British birth cohort with concurrent measurements made throughout the life course (n=7,462). Results: Participants that report parental separation have higher CRP levels at age 44 than those who grew up with both parents (β=0.16, 95% CI: 0.06, 0.27). This association is largely explained by BMI, material and psychosocial factors. Material disadvantage after separation and educational attainment seem to be particularly important in this association. Conclusions: Parental separation increases CRP in adulthood via chains of disadvantage across the life course. This study points towards potential points for intervention and highlights a need to support separating families in order to minimise the long-term impact on adult health

Informal caregiving and markers of adiposity in the UK Household Longitudinal Study

OBJECTIVES:The aim was to investigate associations between caregiving and adiposity using a representative UK longitudinal study. We also investigated whether associations differed by age, gender and caregiving characteristics. METHODS:Data on 9,421 participants aged 16+ from three waves (2009-2012) of the UK Household Longitudinal Study were used. Body mass index, waist circumference and percentage body fat were assessed. Caregiving and caregiving characteristics (hours per week, number of people cared for, co-resident caregiving and combining working and caregiving) was available from the prior wave. Gender-stratified associations between caregiving/caregiving characteristics with adiposity were tested. Covariates included caregiver's health, socioeconomic position, parenthood and partnerships. RESULTS:Caregiving was associated with higher adiposity for women but not men. Younger women caregivers had particularly higher levels of adiposity. Men combining part-time paid work with caregiving had higher levels of adiposity than men working full-time and not caregiving. Women aged 16-44 or 65+ had particularly high levels of adiposity when combining full-time work and caregiving, compared to full-time work alone. CONCLUSION:The health of caregivers should be a public health priority, particularly for younger women and those combining paid work with caregiving responsibilities

Informal caregiving patterns and trajectories of psychological distress in the UK Household Longitudinal Study

BACKGROUND: Approximately seven million people in the UK are engaged in informal caregiving. Informal caregivers are at risk of poorer mental and physical health. However, less is known about how the relationship between the informal caregiving and psychological distress changes over time. The aim of this study was to investigate longitudinal associations between the informal caregiving and psychological distress amongst UK men and women aged 16+. METHODS: Data were analysed from the UK Household Longitudinal Study (UKHLS, n = 9368), a nationally representative study of UK households. Longitudinal linear mixed modelling was used to estimate associations between the longitudinal patterns of informal caregiving (non-caregiver/one episode of 1–2 years/intermittent caregiving/3+ years caregiving) and trajectories of psychological distress across seven waves of UKHLS data. RESULTS: Informal caregiving was not associated with psychological distress for men. Women engaged in long-term (⩾3 years) or intermittent caregiving had higher levels of psychological distress at the point of initiation, compared with women who were not caregivers throughout the study period (3+ years caregiver: regression coefficient 0.48, 95% confidence interval (CI) 0.07–0.89; intermittent caregiver: regression coefficient 0.47, 95% CI 0.02–0.92). Trajectories of psychological distress changed little over time, suggesting a plateau effect for these caregiving women. CONCLUSIONS: Women engaged in long-term or repeated shorter episodes of informal caregiving reported more symptoms of psychological distress than non-caregiving women. Given the increased risk of reporting psychological distress and the increasing importance of the informal care sector, the risk of poorer mental health of informal caregivers should be a priority for public health