Developmental complexity, structural simplicity: a longitudinal, multi-method investigation of internalising and externalising symptoms in young people

This research involves a series of studies investigating various aspects of the development of mental disorder during late childhood and early adolescence (8-14 years) in a large nationwide longitudinal study in England. The first two studies examine the clinical validity and survey format equivalence of a child self-report measure of mental health, the Me and My School questionnaire, measuring symptoms in the two key domains of child psychopathology: internalising and externalising. The next two studies investigate the complexity of individuals’ symptom development by examining the developmental trajectories of internalising and externalising symptoms using latent class growth analysis, a method that allows the estimation of different person-centred trajectories of symptom development. Subsequently, the studies investigate the socio-demographic correlates (including gender, socio-economic status, ethnicity and age) of individuals with different trajectories. This is followed by examining the impact of these different types of trajectories on another key domain of child functioning: educational attainment. The fifth study focuses on the co-development of symptoms in the internalising and externalising domains in late childhood and early adolescence, trying to uncover patterns in their association and development over time in these two developmental periods. The last study, based on the results of the previous studies, aims to investigate the underlying structure of child psychopathology. Using hierarchical bi-factor analysis, the study explores the possibility of a general propensity for psychopathology that not only is a better predictor of future psychopathology but can lead to better models of specific disorders as well. The thesis contributes to increasing the understanding of complexities in symptom development and proposes a simpler structural model underlying symptoms. The analytic approach used highlights the value of modern data analytic techniques in increasing our understanding of the development of psychopathology

Socioeconomic inequalities in co-morbidity of overweight, obesity and mental ill-health from adolescence to mid-adulthood in two national birth cohort studies

Aim: To examine socioeconomic inequalities in comorbidity risk for overweight (including obesity) and mental ill-health in two national cohorts. We investigated independent effects of childhood and adulthood socioeconomic disadvantage on comorbidity from childhood to mid-adulthood, and differences by sex and cohort. Methods: Data were from 1958 National Child Development Study (NCDS58) and 1970 British Cohort Study (BCS70) [total N=30,868, 51% males] assessed at ages 10, 16, 23/26, 34 and 42 years. Socioeconomic indicators included childhood and adulthood social class and educational level. Risk for i. having healthy BMI and mental ill-health, ii. overweight and good mental health, and iii. overweight and mental ill-health was analysed using multinomial logistic regression. Findings: Socioeconomic disadvantage was consistently associated with greater risk for overweight-mental ill-health comorbidity at all ages (RRR 1.43, 2.04, 2.38, 1.64 and 1.71 at ages 10, 16, 23, 34 and 42 respectively for unskilled/skilled vs. professional/managerial class). The observed inequalities in co-morbidity were greater than those observed for either condition alone (overweight; RRR 1.39 and 1.25, mental ill-health; 1.36 and 1.22 at ages 16 and 42 respectively, for unskilled/skilled vs. professional/managerial class). In adulthood, both childhood and adulthood socioeconomic disadvantage were independently associated with comorbid overweight-mental ill-health, with a clear inverse gradient between educational level and risk for comorbidity. For instance, for the no education group (compared to university education) the RRR is 6.11 (95% CI 4.31-8.65) at age 34 and 4.42 (3.28-5.96) at age 42. There were no differences observed in the extent of inequalities by sex and differences between cohorts were limited. Interpretation: While socioeconomic disadvantage in childhood and adulthood are consistently and independently associated with greater risk for mental ill-health and being overweight separately, these associations are even larger for their comorbidity across the lifecourse. These findings are significant given the increasing global prevalence of obesity and mental ill-health, and their implications for lifelong health and mortality. Funding: This research was supported by grants from the Wellcome Trust (ISSF3/ H17RCO/NG1) and Medical Research Council (MRC) [MC_UU_00019/3]

Development and predictors of mental ill-health and wellbeing from childhood to adolescence

PURPOSE: The aim is to investigate the (1) longitudinal development in mental ill-health and wellbeing from ages 11 to 14, (2) predictors of changes in mental health outcomes, and (3) sex and reporter differences. METHOD: Data are taken from 9553 participants in the Millennium Cohort Study, with both mental ill-health (parent- and self-report) and wellbeing outcomes of the cohort members measured at ages 11 and 14. A range of childhood socio-demographic, human capital, family and wider environment risk and protective factors are investigated. RESULTS: Wellbeing has weak stability and mental ill-health has moderate stability between ages 11 and 14 and large sex differences emerge in all the mental health outcomes investigated, with girls experiencing lower wellbeing and greater symptoms of mental illness at age 14. Raw associations between outcomes, and differences in their predictors, indicate varying patterns emerging for parent- and self-reported mental ill-health, with parent-reported symptoms in childhood a poor predictor of both self-reported wellbeing and depressive symptoms in adolescence. Investigating the emergent sex differences in prevalences highlights childhood risk and protective factors at this age that are more salient in females, including family income, school connectedness, cognitive ability, whereas peer relationships and bullying were equally relevant for mental health development in both males and females. CONCLUSION: Low–moderate stability of mental health outcomes stresses the importance of the transition period for mental health, highlighting an intervention window at these ages for prevention. Socio-economic status is associated with mental health development in females but not in males at this age, highlighting a sex-specific vulnerability of deprivation associated with poorer mental health in adolescent females

Psychological distress, self-harm and attempted suicide in UK 17-year olds: prevalence and sociodemographic inequalities

In a large (n = 10 103), nationally representative sample of 17-year-olds 16.1% had experienced high psychological distress in the past 30 days, 24.1% had self-harmed in the previous 12 months and 7.4% had ever attempted suicide. Females, White adolescents, sexual minorities and those from more socioeconomically disadvantaged families had worse mental health outcomes; with the exceptions of no detected differences in attempted suicide by ethnicity and in self-harm by socioeconomic position. Findings include a narrower gender gap in self-harm at age 17 (males 20.1%, females 28.2%) compared with at age 14 (males 8.5%; females 22.8%) and 2–4 times higher prevalence in sexual minority adolescents (39.3% high distress, 55.8% self-harmed, 21.7% attempted suicide compared with 13.4%, 20.5% and 5.8%, respectively, in heterosexual adolescents)

Educators' perceived mental health literacy and capacity to support students' mental health: associations with school-level characteristics and provision in England

Conceptual frameworks for school-based, preventive interventions recognise that educators' capacity is, in part, dependent on school-level characteristics. This study aimed to (i) examine the factor structure and internal consistency of the Mental Health Literacy and Capacity Survey for Educators (MHLCSE); (ii) assess responses in relation to supporting students' mental health; (iii) describe schools' mental health provision in terms of designated roles, training offered, and perceived barriers; (iv) investigate variance in MHLCSE outcomes explained by schools; and, (v) explore school-level predictors of educators' perceived MHL and capacity after controlling for individual-level characteristics. A multi-level, cross-sectional design involving 710 educators across 248 schools in England was used, and secondary analyses of baseline data collected as part of the Education for Wellbeing Programme were conducted. Mental health provision data was available for 206 schools, of which 95% offered training to some staff, and 71% had a designated mental health lead. Secondary schools offered significantly more training than primary schools. Significant barriers included lack of capacity in Child and Adolescent Mental Health Services (CAMHS) and within school, and communication challenges between agencies. The amount of training offered by schools significantly predicted educators' awareness and knowledge of mental health issues, treatments and services, legislation and processes for supporting students' mental health and comfort providing active support, with increased training predicting higher scores. However, little variance was explained by schools (1.7-12.1%) and school-level variables (0.7-1.2%). Results are discussed in relation to current mental health and education policy in England

Mental health in relation to changes in sleep, exercise, alcohol and diet during the COVID-19 pandemic: examination of four UK cohort studies

BACKGROUND: Responses to the COVID-19 pandemic have included lockdowns and social distancing with considerable disruptions to people's lives. These changes may have particularly impacted on those with mental health problems, leading to a worsening of inequalities in the behaviours which influence health. METHODS: We used data from four national longitudinal British cohort studies (N = 10 666). Respondents reported mental health (psychological distress and anxiety/depression symptoms) and health behaviours (alcohol, diet, physical activity and sleep) before and during the pandemic. Associations between pre-pandemic mental ill-health and pandemic mental ill-health and health behaviours were examined using logistic regression; pooled effects were estimated using meta-analysis. RESULTS: Worse mental health was related to adverse health behaviours; effect sizes were largest for sleep, exercise and diet, and weaker for alcohol. The associations between poor mental health and adverse health behaviours were larger during the May lockdown than pre-pandemic. In September, when restrictions had eased, inequalities had largely reverted to pre-pandemic levels. A notable exception was for sleep, where differences by mental health status remained high. Risk differences for adverse sleep for those with the highest level of prior mental ill-health compared to those with the lowest were 21.2% (95% CI 16.2–26.2) before lockdown, 25.5% (20.0–30.3) in May and 28.2% (21.2–35.2) in September. CONCLUSIONS: Taken together, our findings suggest that mental health is an increasingly important factor in health behaviour inequality in the COVID era. The promotion of mental health may thus be an important component of improving post-COVID population health

Unpacking the associations between heterogeneous externalising symptom development and academic attainment in middle childhood

This study explores children’s externalising symptom development pathways between 8 and 11 years of age (three time points across 2 years) and examines their sociodemographic correlates and associations with change in academic attainment. Externalising symptoms were assessed for 5485 children across three consecutive years (Mage = 8.7 years, SD = 0.30 at time 1). National standardised test scores served as an index of academic attainment. Using latent class growth analysis, six distinct trajectories of externalising symptom development were identified. Children who showed increasing externalising symptomatology across the three time points were more likely to be male or have special educational needs. These derived trajectories differentially predicted children’s subsequent academic attainment (controlling for earlier attainment). Children with increasing externalising symptomatology were significantly more likely to demonstrate negative change in academic achievement compared with children with consistently low externalising problems. The study helps to clarify the longitudinal association between externalising symptom development and academic attainment, and highlights the importance of early intervention for children with increasing externalising symptoms across middle childhoo

The gender gap in adolescent mental health: a cross-national investigation of 566,829 adolescents across 73 countries

Mental ill-health is a leading cause of disease burden worldwide. While women suffer from greater levels of mental health disorders, it remains unclear whether this gender gap differs systematically across regions and/or countries, or across the different dimensions of mental health. We analysed 2018 data from 566,827 adolescents across 73 countries for 4 mental health outcomes: psychological distress, life satisfaction, eudaemonia, and hedonia. We examine average gender differences and distributions for each of these outcomes as well as country-level associations between each outcome and purported determinants at the country level: wealth (GDP per capita), inequality (Gini index), and societal indicators of gender inequality (GII, GGGI, and GSNI). We report four main results: 1) The gender gap in mental health in adolescence is largely ubiquitous cross-culturally, with girls having worse average mental health; 2) There is considerable cross-national heterogeneity in the size of the gender gap, with the direction reversed in a minority of countries; 3) Higher GDP per capita is associated with worse average mental health and a larger gender gap across all mental health outcomes; and 4) more gender equal countries have larger gender gaps across all mental health outcomes. Taken together, our findings suggest that while the gender gap appears largely ubiquitous, its size differs considerably by region, country, and dimension of mental health. Findings point to the hitherto unrealised complex nature of gender disparities in mental health and possible incongruence between expectations and reality in high gender equal countries

Mental health in higher education students and non-students: evidence from a nationally representative panel study

Despite increasing policy focus on mental health provision for higher education students, it is unclear whether they have worse mental health outcomes than their non-student peers. In a nationally-representative UK study spanning 2010-2019 (N = 11,519), 17-24 year olds who attended higher education had lower average psychological distress (GHQ score difference =  - 0.37, 95% CI - 0.60, - 0.08) and lower odds of case-level distress than those who did not (OR = 0.91, 95% CI 0.81, 1.02). Increases in distress between 2010 and 2019 were similar in both groups. Accessible mental health support outside higher education settings is necessary to prevent further widening of socioeconomic inequalities in mental health

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